A ticking time-bomb

Malnutrition is a silent killer and causes the death of some 300 children every hour, warns a new report by Save the Children, a leading international NGO on children's rights.  Chee Yoke Heong highlights its stark findings.

ABOUT 300 children die from malnutrition every hour while one in four children is stunted, and in developing countries that figure rises to one in three. If the trend continues, more than 450 million children globally will be affected by stunting in the next 15 years.

These stark statistics are revealed by a new report by the charity Save the Children - A Life Free from Hunger: Tackling Child Malnutrition - which laments the extremely slow progress made in reducing malnutrition over the past 20years as compared to other global health issues. It calls for urgent actions to be stepped up.

'This is a hidden hunger crisis that could destroy the lives of nearly half a billion children unless world leaders act to stop it,' Justin Forsyth, chief executive of Save the Children, told the Guardian newspaper.

The organisation wants leaders of the G8 and G20 major economies to take up the issue in their summits in the next two years.

It points out that 2012 is a crucial year to prevent the crisis from worsening as by 2013 it would be too late to prevent stunting in this last generation of children who will reach their second birthday - a crucial nutrition milestone - by 2015, the deadline for achieving the UN's Millennium Development Goals.

Malnutrition is the underlying cause of death of more than 2.6 million children each year, a third of under-five deaths, and a third of total child deaths. Unlike headline-grabbing emergencies, the unseen crisis of long-term chronic malnutrition is more devastating in terms of scale but has failed to attract global attention.

According to the World Health Organisation, poor nutrition is the most important single threat to the world's health. But because death resulting from malnutrition is not officially recorded in the statistics, efforts at addressing the problem have largely been neglected.

'Malnutrition is a silent killer - under-reported, under-addressed and consequently under-prioritised,' according to the report.

It is estimated that 80% of the world's stunted children are in just 20 countries, with malnutrition as the cause of 51% of diarrhoea deaths, 57% of malaria deaths, 52% of pneumonia deaths and 45% of measles deaths.

Global progress in combating stunting - a consequence of chronic malnutrition - is not fast enough given the seriousness of the crisis, according to the report. Between 1990 and 2010, the percentage of stunted children fell from 39.7% to 26.7% or 82 million children.

Progress is even slower in Africa, which saw a reduction of only 2% in 20 years, while in West Africa stunting rates have stagnated at 38%. But due to population growth, the numbers of stunted children actually increased by 15 million between 1990 and 2010 and this figure is expected to grow in the future. Nigeria is predicted to have 2.4 million more stunted children by 2020 and in Tanzania another 450,000 children will be stunted.

In Asia, while East and parts of South-East Asia have recorded a commendable reduction in the number of malnourished children, this is not the case in South and much of South-East Asia (i.e., Cambodia and Laos). It is predicted that the prevalence of stunting will fall by just a quarter (or 26%) in South-Central Asia in the next 10 years compared with half in Eastern Asia.

In comparison, the malnutrition rate in Asia in 2020 is predicted to be half of that in Africa and the top eight countries with the fastest declines in stunting will be from Asia, according to Save the Children.

Many children in the developing world suffer from malnutrition because their diets consist mainly of starchy foods like rice, maize or millet with few vegetables and little protein, hence depriving them of a balanced diet.

The lack of proper nutrition means their brains and bodies will not develop properly, leading to severe consequences. A child suffering prolonged malnutrition will grow up physically shorter, usually with lower IQs, and have a high likelihood of doing less well at school and also earning less as an adult, says the report.

Economic growth is also negatively affected by malnutrition, leading to as much as a 2-3% loss in GDP yearly in poor countries, while globally it is estimated that the direct cost of child malnutrition is between $20 billion and $30 billion per year.

Besides benefiting a country's GDP, ensuring good nutrition for young children will also in the long term cut costs by preventing illnesses. It has been estimated that 11% of the global disease burden relates back to malnutrition; thus, improving childhood nutrition would eventually reduce national health bills.

The report's analysis suggests that while better nutrition can be positive for economic growth and development, a growing economy does not necessarily translate into an improvement in nutrition.

'Although economic growth no doubt played a role in the reduction of stunting in some countries, a growing GDP in itself is not sufficient to guarantee a positive impact on nutrition,' the report states. For example, between 1990 and 2009, the GDP of Vietnam grew at an average of 6% per year while the number of stunted children fell by about 4% each year, halving the number since 1990. However, in neighbouring Myanmar, GDP grew faster during the same period at 8% a year but stunting fell by only 1.5% each year, or a drop from 46% in 1990 to 41% based on the latest figures available.

Underlying causes

The underlying causes of increased risk of malnutrition and stunting among children arevaried. Among them are climate change, high food prices, poverty, socio-economic factors, and conflicts and political upheavals.

Adverse changes in climate such as extreme weather events, including high temperatures, droughts and floods, are already more frequent and severe and are threatening food security. Future cereal yields are expected to be affected and it is predicted that there will be 11-24 million more malnourished children or an increase of 10-12% in 2050 as a result of adverse climate change impacts on agricultural production.

Poverty is another major contributory factor to why children are not receiving proper nutrition. The situation is not likely to improve, as World Bank findings suggest that poverty is set to increase as families face falling incomes, rising costs and shrinking public expenditure such as aid.

And soaring food prices have made the situation worse. The report estimates that food price spikes since June 2010 might have pushed another 44 million people into poverty. 'When food prices skyrocket, children feel the effects in their daily diets, and their nutrition suffers,' the report says.

Growing land acquisitions by governments, corporations and others  (sometimes called 'land grabs') are also said to have worsened food and nutrition security of poorer countries. Such takeovers of large tracts of land often displace small farmers and convert land away from growing food, thus putting many poor people at risk of malnutrition. The report quotes the United Nations as saying that 'large-scale investment is damaging the food security, incomes, livelihoods and environment for local people'.

Conflicts and political upheavals have been shown to be devastating to progress against malnutrition and stunting, as in the case of Cote d'Ivoire and Burundi. In the latter, where 50% of the population was displaced between 1994 and 2001, it was found that children in areas affected by conflict were more likely to be stunted than others as crops were destroyed or stolen.

In Cote d'Ivoire, one of the worst countries in terms of progress against stunting, a breakdown in public healthcare during the civil war that began in 2002 resulted in a drastic drop in intervention efforts including immunisation and vitamin A supplementation, as well as breastfeeding.

The Save the Children report does highlight some progress made in saving children's lives - for example, the number of children not making it to their fifth birthday fell by 4.4 million between 1990 and 2011 - but stresses the need to keep up the momentum and to 'accelerate efforts to improve nutrition, which holds the key to further progress'.

The solutions to malnutrition are already well known, proven effective and relatively cheap.  According to the World Bank, it could cost as little as $10.3 to $11.8 billion a year to successfully tackle malnutrition in 36 countries that are home to 90% of the world's stunted children.

What is needed in most cases is political commitment and leadership in implementing nutrition programmes, said the report. These include direct interventions such as providing food supplements and fortification.

Preventing families from falling into poverty by providing cash and food to vulnerable families and introducing social protection schemes as safety nets have also shown to be successful.

The report also points out that the current global food system is failing to meet the hunger and nutritional needs of many people in the world. The challenge is not just to increase production but to improve nutrition through agriculture.

It calls, among others, for more support for small-scale farmers and women farmers, a greater focus on agricultural projects that will improve children's diets and making nutritious food available and affordable.      

Chee Yoke Heong is a researcher with the Third World Network.

*Third World Resurgence No. 257/258, January/February 2012, pp 9-10