4 ways to reduce malnutrition

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Tackling undernutrition is, as the full extent of malnutrition and micronutrient deficiencies becomes apparent, critical for human wellbeing and development. In the past we have tended to focus, with limited success, on ensuring people have enough to eat, on making the world “food secure” and on fighting hunger but now we are beginning to understand that if we are to lead healthy, productive lives, it is also about having enough to eat of the right mix of nutrients. And unlike hunger, often viewed as a more common problem in developing countries, poor nutrition, whether through famine or feasting, can be universal.

In 2008, when The Lancet published their Series on Maternal and Child Undernutrition, global policymakers began to take notice and the Scaling-Up Nutrition movement was born. Today this momentum is continuing and the new Sustainable Development Goals focus more on nutrition and non-communicable diseases than the Millennium Development Goals did. We are also learning more and more about what can be done to lessen the burden of malnutrition. Here we discuss four approaches, all of which will be needed for malnutrition to significantly decline: the scaling up of successful and cost-effective direct interventions; prioritisation of the first 1,000 day window in a child’s existence; the development of food systems that deliver enough healthy food and prioritise human health; and coordination and collaboration across government sectors to put nutrition at the heart of relevant policies and programmes.

Scale-up direct interventions where they work

Nutrition, while impacted by agricultural productivity, poverty and income, is unlikely to be improved through more general programmes aimed at bringing about economic and social development. Income growth alone will not reduce rates of malnutrition, and so we need direct interventions to tackle malnutrition. Things such as vitamin, mineral and micronutrient supplementation; delayed cord clamping after birth, kangaroo mother care, early initiation of breastfeeding, promotion of dietary diversity, fortifying staple foods, cash transfer programmes, community-based nutrition education, and school feeding programmes.

The 2013 Lancet Series on Maternal and Child Nutrition

In 2008, The Lancet published a series of papers on maternal and child nutrition. In particular the journal highlighted the significant burden of undernutrition in early life on an individual’s development and survival but also on their future education, labour productivity and earning potential and, as a result, on a country’s GDP.

The series was followed by high-level international action, specifically the 1000 Days Initiative and the UN’s Scaling Up Nutrition movement.

Today The Lancet has released a second series of papers on maternal and child nutrition. The series examines progress that has been made in tackling undernutrition as well as the emerging issue of the double burden of malnutrition in low-income countries: populations exhibiting both obesity as well as micronutrient deficiencies.

Changes, from the last series, in numbers of children stunted, a commonly used measure for malnutrition in children, are largely positive. In 2011, the prevalence of stunting in children under 5 years in developing countries was 26%, compared to 32% in 2005. The number of stunted children has also decreased globally, from 178 million in 2005, to 165 million in 2011.

Obesity however is on the rise. The number of overweight mothers has risen steadily since 1980, and leads to increased maternal morbidity and infant mortality. In children under five, obesity is increasing, particularly in developing countries and is becoming a more significant contributory factor to adult obesity, diabetes, and non-communicable diseases.

Home grown nutrition

The 1,000 day Initiative and Scaling Up Nutrition movement, detailed in Chapter 2, brought to the political fore the serious impacts of child malnutrition, which affects 40% of children under the age of five in sub-Saharan Africa. Malnutrition early in life not only impacts learning, levels of schooling attained, future earning potential and national economic growth but is a condition which is often passed from mothers to children, persisting across generations.

In a new UK Parliamentary report, Home Grown Nutrition, produced by the All-Party Parliamentary Group on Agriculture and Food for Development, agricultural and other pathways to improving nutrition are discussed.

Agriculture and nutrition

Agriculture is a key industry for sub-Saharan Africa and investments in agricultural development are one of the most effective tools to ensure economic, social and political well-being. Smallholder farmers in Africa represent the largest economically productive business sector in the developing world, but they produce only a sixth of the output of farmers in Europe or North America. The potential to increase their productivity is enormous.

Investing in smallholder agriculture can address malnutrition directly through increased incomes and the diversification of food for household consumption. In the Democratic Republic of Congo, research has shown that the biggest limiting factor on food and nutrition security is income. And a diet that meets children’s energy, protein and micronutrient needs for optimal growth and development is four times more expensive than a diet with only adequate calories. Greater income, generated through agriculture, a sector that employs the majority of people in sub-Saharan Africa, can be spent on healthcare, education and, crucially, food.