Malnutrition: where the world stands now and how we in PIN tackle itPublished: Sep 26, 2023 Reading time: 9 minutes
According to WHO, in 2020, every second child in the world that died before the age of 5 died of undernutrition. These deaths mostly occured in low- and middle-income countries. However, rates of childhood obesity and overweight are constantly rising within the same countries. How is that possible? Let us have a closer look at malnutrition, its painful and paradoxical consequences, and our specific responses and initiatives here in People in Need.
What is malnutrition, exactly?
Malnutrition is a condition in which someone’s body does not receive the right amount of necessary nutrients – it can be too little (undernutrition, resulting in stunting, wasting, and underweight), or too much (overnutrition, resulting in overweight and obesity), or it can be right, but imbalanced (micronutrient-related malnutrition, ie. diet missing of important vitamins and minerals).
However, when we talk about malnutrition, we often talk about the insufficient intake of proper nutrients specifically.
Malnutrition can take forms of undernutrition, overweight and obesity, and micronutrient-related malnutrition.
In undernutrition, someone’s body receives too little necessary nutrients which results in three related conditions:
- stunting: stunting is an impaired growth and development which shows as low height-for-age. Stunting is caused by undernutrition in early age and even before birth if the mother is malnourished during the fetal development of the child.
Stunting has been declining slowly over the last decade: in 2022, 148.1 million (22.3 %) children under the age of 5 worldwide were affected by stunting. Nearly all of the affected children lived in Asia (52 % of the global share) and Africa (43 %).
- wasting: wasting is a muscle atrophy accompanied by a severe loss of weight. Wasting is marked by low weight-for-height. It is a life-threatening condition, often exacerbated by infectious diseases or diarrhoea.
Children suffering from wasting have weakened immunity, are susceptible to long-term developmental delays and face an increased risk of death, particularly when wasting is severe. However, the treatment is possible: children suffering from severe wasting require early detection and timely treatment and care to survive.
In 2022, an estimated 45 million children (6.8 %) under 5 were affected by wasting, of which 13.6 million (2.1 %) were suffering from severe wasting. More than three quarters of all children with severe wasting live in Asia and another 22 % live in Africa.
- underweight: underweight is measured as low weight-for-age. The metrics used for determining healthy weight are body mass index (BMI) and/or body fat percentage (BFP). Children who are underweight can be stunted, wasted, or both; however, due to malnutrition, adults can experience underweight, too: as of 2021, 462 millions adults were underweight worldwide.
Overweight and obesity
If someone’s body receives too many nutrients, it can result in two related and overlapping conditions:
- overweight: both children and adults can become overweight when their caloric intake is higher than their energy requirement. This could be a short-termed temporary deviation in body weight; however, it can evolve into a regular obesity.
- obesity: obesity is a long-term medical condition in which a person’s excessive body fat negatively affects their health in the long term.
In micronutrient-related malnutrition, a person does not receive enough important micronutrients in their diet. Micronutrients are vital vitamins and minerals which enable the body to produce enzymes, hormones, and other substances essential for its proper growth and development. Iodine, vitamin A, and iron are the most important in global public health terms; their deficiency represents a major threat to the health and development of populations worldwide.
Micronutrient deficiencies can lead to poor health and development, particularly in children and pregnant women.
Recent situation and trends
The recent account of global efforts tackling malnutrition does not bode well. Since the last year’s invasion of Ukraine by Russia and the ongoing climate crises, the hunger is threatening millions of more people around the world. The gains made in building resilience in communities and tackling short- and long-term undernutrition are in severe jeopardy.
Much of the world is not on track to achieve international nutrition targets set for the next decade, including the World Health Assembly (WHA) targets for 2025 and SDG 2 targets for progressively eradicating all forms of malnutrition by 2030. Worldwide, 149 million children under 5 are stunted, while 45 million are wasted, and close to 400 million children are deficient in micronutrients.
This global food and nutrition crisis has been impacting whole families, communities, and countries. Added to this, ongoing conflict and instability around the world, including the invasion in Ukraine, is undermining the supply and availability of food and agricultural inputs and driving up global food prices. This further undermines people’s ability to afford a healthy diet and improve their nutritional status.
Our approach in tackling malnutrition
Here in People in Need, we focus our work on two main types of malnutrition:
- stunting, i.e. chronic malnutrition, measured by low height-for-age
- wasting, i.e. acute malnutrition measured by low weight-for-height
Our primary aim is to improve the diets and nutritional status (to reduce acute and chronic malnutrition) of young children and women of reproductive age by the integrated multisectoral approach.
What is the integrated multisectoral approach?
Malnutrition is not just about food or health care. It is an issue that warrants a locally adapted, sustained, multi-sectoral and rights-based approach, creating synergies and partnerships to address the multiple causes in a coherent way. This means that we directly address the causes of malnutrition arising from different aspects of life, or sectors, namely:
- Water, sanitation, and hygiene (WASH)
- Food security and livelihoods
- Climate resilient food systems
In order to maximize the impact of our work:
- we work with partners to prevent malnutrition for women, adolescents, and children, particularly during the first 1,000 days (this refers to a child’s life from the moment they are conceived until they reach 2 years of age).
- focus on inclusive and participatory approaches, underpinned by our work in Civil Society and Inclusive Governance (CSIG). We work through existing structures to strengthen social mobilisation and capacity of local systems to deliver nutrition services
- we use formative behavioural research to directly address the barriers to improve dietary and nutrition practices. Engaging stakeholders in the design, delivery and analysis of the formative research enables local ownership of results. Our website focusing on behaviour change demonstrates its resources, which address the true cultural, gender and social barriers faced by our target groups.
- we apply social and behaviour change communication (SBCC) techniques. This involves tailoring approaches to local strengths and resources, fostering positive social norms, and strengthening community capacity to have agency to improve nutrition practices.
- we recognise that gender equality and empowerment of women are critical to achieve nutrition objectives, and hence, we apply a gender-transformative lens on all programmes. We address the role men and women have in the household and how intrahousehold dynamics shape the food family members eat.
Case studies: Our current nutrition programmes
DRC and Zambia
Community and/or integrated management of acute malnutrition (CMAM, IMAM) is a key part of our work in emergency, recovery and development settings although the approach taken varies according to the context. Where feasible, we integrate into the existing health system and we embed preventative activities such as maternal and infant and young child feeding (IYCF) counselling and engagement of fathers, and other community members to support the adoption of positive nutrition practices. We also promote early detection and referral to prevent a child who is moderately malnourished from becoming severely malnourished.
In emergency contexts, we aim to not only ensure that the immediate food needs are met, but also consider how best to support communities to access their own food.
For example, in the Bwegera health centre in Lemera in DRC, we engage mothers with small children how to prepare nutritious porridge from locally available ingredients. Step by step, the members of our team explain and demonstrate how to cook it. The porridge contains flour from maize and cassava, dry fish powder, sugar, salt, oil and water from cooked amaranth leaves. The porridge is served with a piece of fruit like orange or tomato. We call it "four-star porridge" because it contains all the nutrients needed for the child's growth – vegetables, meat, fruit, and cereals.
Afghanistan and Syria
In emergency contexts, we aim to not only ensure that the immediate food needs are met, but also considers how best to support communities to access their own food. Programmes are designed using an analysis of how different modalities can be used to achieve food and nutrition security in the short-term and then transitioned towards recovery programming (e.g. cash and voucher assistance, agricultural or livelihood support). In North-East Syria and in Afghanistan, for example, we support households (with pregnant and lactating women (PLW) and children) with cash assistance and participatory nutrition sessions (SBCC). Cash assistance allows households to purchase nutritious foods and access services that can have a positive impact on maternal and child nutrition.
Angola and Ethiopia
In Ethiopia and Angola, our programmes integrate nutrition into agriculture and WASH sectors. We engage households to learn about diet diversity, production, and consumption of nutritious dense, locally available crops. Building on many years of experience in using approaches such as the community and school Healthy Living Clubs, we promote better hygiene and nutrition. We strive to improve coordination among relevant ministries (of nutrition, health, agriculture).