From Africa Recovery, Vol.11#3 (February 1998), page 3

Malnutrition: the 'silent emergency'

UNICEF urges massive action to stem millions of preventable deaths

By Frehiwot Bekele

Malnutrition constitutes a global "silent emergency," killing millions every year and sapping the long-term economic vitality of nations, says the UN Children's Fund (UNICEF). In The State of the World's Children 1998, UNICEF urges intensive efforts by governments to counter the scourge, which it also regards as a violation of children's rights.

The statistics on malnutrition are grim. Nearly 12 million children under the age of five (over 4 million of them in sub-Saharan Africa alone) die annually; malnutrition is a culprit in 55 per cent of these deaths. Iron deficiency anaemia is a contributing factor in over 20 per cent of post-birth maternal deaths in Africa and Asia.

About 43 million people worldwide are suffering from varying degrees of brain damage due to iodine deficiency. Some 226 million children are stunted (shorter than they should be for their age); nearly 67 million are estimated to be wasted (weigh less than they should for their height); and about 183 million weigh less than they should for their age. In sub-Saharan Africa every third child is underweight, while two out of five are stunted.

Malnutrition is a tangle of two mutually reinforcing factors: insufficient nutrient intake and illness, according to the report. Its root cause, therefore, is poverty -- at the household, community and national levels -- which results in lack of access to such basic necessities as food, health care, safe drinking water and sanitation. A second cause is an insidious combination of simple ignorance and prejudice against women, which deprives them of the rest and care they require during pregnancy and lactation, as well as access to education and economic resources.

The report observes that, while caused by poverty, malnutrition also perpetuates a generational cycle of poverty, as a malnourished girl tends to grow up and bear underweight, malnourished children; and malnourished children are likely to be intellectually impaired, with diminished productive and creative capacities. In addition, malnutrition may pose heavy future economic burdens to societies. Recent studies suggest that full-term low-birthweight babies are likely as adults to develop chronic illnesses such as heart disease, diabetes and hypertension.

Since the roots of malnutrition have long been well known, so are its solutions, says the report. Pregnant and lactating women need to work less, rest and eat well. Babies need to be breastfed -- exclusively until the age of six months, and with appropriate supplements until the age of two. Families need to have access to adequate preventive and curative health care. They also need access to safe water and sanitation to prevent infection and disease.

Supplements of nutrients such as vitamin A and iron can easily be made available, at minimal cost. In addition, the simple act of iodizing salt can save millions from brain damage. And new techniques have been developed for easy detection of vitamin and mineral deficiencies.

Cost-effective, easy-to-implement programmes, with educational and practical follow-up components, can be put in place at the grassroots level, allowing communities to take the matter of nutrition into their own hands, monitor their children's growth and organize to secure what they require to meet their children's needs. The report cites numerous such community programmes implemented throughout the world with impressively successful results, at minimal financial cost. In Tanzania, for example, such programmes have improved the nutrition of half the country's children.

Tackling the problem requires the active involvement of families and communities, as well as political will at the national and international levels. Governments have to build widespread awareness of the roots and consequences of malnutrition, along with the ways of reducing it; they have to spend more on clinics, clean water supply and sanitation. Women must also have greater access to education and economic resources.

At the international level, donors and recipient countries need to earmark funds for essential social services. In addition, UNICEF calls for deeper debt reduction to enable poor countries to channel their meagre resources to meeting the basic needs of their people. Sub-Saharan Africa, for example -- the only world region where malnutrition rates have worsened during the last two decades -- paid $13.6 bn in debt service in 1995, almost twice the amount it spent on health, the report says.

UNICEF presents the policy options in stark terms. "Governments ... may choose to allow children to be intellectually disabled, physically stunted and vulnerable to illness in childhood and later in life," it says, or they could "resolve to consolidate lessons already learned about reducing malnutrition ... and mount massive actions that can clearly succeed."

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