Africa hardest hit by overlapping forms of malnutrition- 2018 global report

Tracy Ncube is the deputy sister in charge of the maternity wing at Maphisa District Hospital in Zimbabwe’s Matabeleland South Province.

With the help of her team, she has been ensuring that the mothers and their premature and underweight babies admitted in the Kangaroo Mother Care ward (KMC) receive the best of care and reach a discharge weight of 2500 grammes.

In the KMC ward are babies born prematurely to mothers who experience various complications during pregnancy. Some of the babies weigh as little as 700 grammes at birth. Other babies are born full term but have low birth weight.

Her team also teaches the mothers how to breastfeed and express milk where cup feeding is required especially those with babies under 1500 grams.

According to Sister Ncube, one of the reasons women have premature births and low birth weight babies is malnutrition during pregnancy.

“When pregnant, some women do not eat a balanced diet yet maternal nutrition during pregnancy plays an important role in providing the necessary nutrients for fetal growth. An imbalance in maternal nutrition may be a key factor associated with preterm birth which is one of the leading causes of neonatal mortality and morbidity, and has long-term adverse consequences such as poor physical growth,” she said.

Before a child is born, a balanced diet should already be in place. Mothers need to access good nutrition when they are pregnant, should breastfeed exclusively for at least six months and offer a varied diet including breast-milk for the first two years. This window period – the ‘first 1000 days’ will benefit a child for a lifetime, enabling optimal brain and physical development, a solid foundation for future learning, strength and the ability to recover from childhood illnesses.

Failure to access these nutritional requirements increases the risk of childhood stunting – damage that will last a lifetime and for which there is no cure.

Malnutrition is a huge headache in many developing countries.

In Zimbabwe, over a quarter of children under-five suffer from stunting– 27.6 per cent, according to Unicef Zimbabwe. Under-nutrition is the single largest factor affecting child mortality, and stunting is likely to contribute to more than 12,000 child deaths each year.

According to Unicef Zimbabwe, the prevalence of stunting in the country rose in the period between 1995 and 2008, reaching a peak of 36 per cent in 2005. Since then it has begun to decrease, due to a concerted effort by UNICEF, donors and implementing partners. While it is still lower than in other subSaharan African countries, it remains too high.

In Zimbabwe, there are huge variations in rates of malnutrition between districts, affecting more rural than urban areas. It is also more common in boys than girls and children born into poor families are more likely to be susceptible to stunting.

The global picture is worrying too.

The findings of the world’s most comprehensive report on nutrition, the 2018 Global Nutrition Report, released on November 29 in Bangkok, Thailand, during the global event “Accelerating the end of hunger and malnutrition”, highlights the worrying prevalence and universality of malnutrition in all its forms.

The gathering brought together decision makers, researchers and practitioners from key organisations such as the Food and Agriculture of the United Nations, UNICEF, the World Health Organisation and the European Union.

In its fifth edition, the report provides a concrete overview of progress made and calls on all stakeholders to act now to address malnutrition.

While the report provides new and expansive data highlighting the changing face of malnutrition in Africa, it also sheds light on new initiatives from across the continent designed to respond to this greater and more diverse challenge.

The burden of malnutrition is unacceptably high.

Africa is the region by far the hardest hit by overlapping forms of malnutrition. Of 41 countries that struggle with three forms of malnutrition – childhood stunting, anaemia in women of reproductive age and overweight among women – 30 are in Africa, or 73 percent.

Corinna Hawkes, Co-Chair of the Report and Director of the Centre for Food Policy, said: “The figures call for immediate action. Malnutrition is responsible for more ill-health than any other cause. The health consequences of overweight and obesity contribute to an estimated four million deaths globally. The uncomfortable question is not so much “why are things so bad?” but “why are things not better when we know so much more than before?”

Progress to date is simply not good enough.

Significant steps are being made to address malnutrition. Globally, stunting among children under five years has fallen from 32.6 percent in 2000 to 22.2 percent in 2017. Yet, while stunting in children under five years of age is declining at a global level, the numbers in Africa are increasing. Driven by population growth, despite the decrease in stunting prevalence in Africa, the number of stunted children has steadily increased from 50.6 million in 2000 to 58.7 million in 2017.

Data shows an overall increase in both overweight and obesity in Africa. At the same time, the region is undergoing significant growth in consumption of packaged foods.

At the global level, none of the countries with sufficient data are on course to meet all nine targets on malnutrition. Africa is no exception and below is why.

Of the nine global nutrition targets assessed in 2018, there are five targets for which none of the 54 African countries are on track.

Africa was the only region not to experience an overall increase in the rate of under-5 overweight, experiencing stagnation in overweight prevalence since 2000.

However, in children aged 5-19 levels of overweight and obesity in both girls and boys have increased, with girls registering a faster increase than boys.

Spending around nutrition at the national levels is inconsistent, with governments just as likely to increase future spending as to decrease it.

Overall, total nutrition-related official development assistance allocated to Africa has increased over the last five years.

New data also highlights that national statistics are not enough to understand the extent of the challenge. A geospatial analysis of undernutrition in 51 African countries, conducted by the Institute for Health Metrics and Evaluation, reveals a striking heterogeneity in levels and trends of undernutrition at national and subnational levels. Even where countries appear to be on track to achieve global targets, the picture is different at the subnational level.

We are better equipped to end malnutrition

Across Africa there have been steps taken to reduce malnutrition, which can act as models and catalysts of change.

The 2018 Global Nutrition Report highlights that solutions already exist but finds effective ideas are not being adopted at scale.

There are examples of countries building multisectoral plans to deliver on their targets.

One such country is Tanzania where a wide range of targets has been adopted – seven in all, including for stunting, anaemia and low birth weight. These targets form part of the National Multisectoral Nutrition Action Plan 2016–2021, an ambitious five-year action plan to reduce multiple burdens of malnutrition. The plan was set up under the direct leadership of the Prime Minister’s office to reduce all forms of malnutrition associated with both deficiency and excess/imbalances. Its broad goal is to scale up high-impact interventions among the most vulnerable people, including children under five years of age, adolescent girls and pregnant and lactating women. It does this by calling for action across sectors, from social protection to education and food.

New data a game changer

New data is a game changer and can drive more effective action. In 2018 the journal Nature published the results of a comprehensive geospatial analysis of child growth failure, which covers stunting, wasting and underweight, in 51 African countries from 2000 to 2015. It draws from more than 200 geo-referenced household surveys representing more than 1.2 million children, drilling down to unprecedented levels of detail. It shows that many localities are off track, and that no country in Africa is likely to achieve all the WHO global nutrition targets in all of its territory if current trends continue.

Governments are showing commitment and stepping up to lead action. The Ethiopian government’s commitment to end child undernutrition by 2030 has taken a significant step forward with the recently developed National Food and Nutrition Policy. This accountable, legal framework emphasises the right of children to adequate nutrition and normal growth and strengthens actions outlined in the National Nutrition Programme. Between 2000 and 2016 the rate of stunting in children dropped by a third. However, there is more to do as the prevalence of stunting, wasting and anaemia remain high.

The world is off track but the opportunity to end malnutrition has never been greater, nor has the duty to act.

To translate solutions into action, the report’s authors urge critical steps in the following areas:

• Breaking down existing silos to tackle malnutrition in all its forms;

• Prioritising and investing in data to identify key areas of action;

• Scaling up and diversifying funding for nutrition programmes;

• Immediately taking action on healthy diets by making healthy foods affordable across the globe;

• Implementing more ambitious commitments that are designed for impact through SMART targets.

Jessica Fanzo, PhD, Co-Chair of the Report and Bloomberg Distinguished Associate Professor at Johns Hopkins University, said: “While malnutrition is holding back human development everywhere, costing billions of dollars a year, we are now in a position to fight it. From policies such as sugar taxes, to new data that enables us to understand what people are eating and how we can best target interventions, the global community now has the recipes that work.”

According to David Beasley, the Executive Director, World Food Programme, the information in the Global Nutrition Report goes far beyond facts and figures.

“What is really behind these tables and graphs are stories of potential: the potential of more babies seeing their first birthdays, of children achieving their potential in school and of adults leading healthy and productive lives – all on the foundation of good nutrition. The information collected, analysed and shared in the Global Nutrition Report is never an end in itself, but a means that allows us to save lives, change lives and ensure that nobody is left behind,” he said.

UNICEF Executive Director, Henrietta H Fore said the 2018 Global Nutrition Report offers forward-looking steps to strengthen the ability of global and national food systems to deliver nutritious, safe, affordable and sustainable diets for children.

“This paradigm shift – food systems that contribute to prevent malnutrition in all its forms – will be critical for children’s growth and development, the growth of national economies, and the development of nations,” Fore said.

In Zimbabwe, UNICEF and partners have been directly supporting Sustainable Development Goals 2 and 6, including targets 2.2 on ending all forms of malnutrition, achieving targets on stunting and wasting in children under five years of age, as well as achieving access to safe and affordable drinking water and adequate sanitation and hygiene for all.

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