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Arrested development: Why Africa’s under-fives are hungry and stunted

Saturday September 20 2014
stunted growth

A child who has grown to normal height is more likely to live in a household where they wash their hands and have a toilet; eat fruits and vegetables, go to school, get a good job; and is less likely to die from disease. ILLUSTRATION | JOHN NYAGAH |

Eric Turyasingura chases after a ball made from polythene bags outside his mud-brick home in the mountainous southern Uganda.

Yelling in his mother tongue, Nkore, “Arsenal with the ball! Arsenal with the ball!” he jostles with his younger brothers for possession. The fame of the English football club has reached even his little ears.

Pretending to be a sports star offers a moment of escape from his daily struggles. At five years, Eric’s tiny body already tells a story of poverty and lost opportunity.

He is six inches shorter than he should be for his age. His arms and legs are pencil-thin and his head is out of proportion to his body. Because he is stunted, experts say his chances of growing up healthy, learning at full potential, and getting a job, let alone playing professional soccer, have greatly diminished.

In 2013, a UN report said across the world, one in four children under five years — a total of 165 million — were stunted. Last year, The Lancet estimated that under-nutrition contributed 45 per cent of all under-five deaths.

Beginning in the womb as poverty-stricken mothers live hand-to-mouth, stunting can be a lifelong affliction. Studies show it is linked to poor cognition and educational performance, low adult wages and lost productivity.

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A stunted child is nearly five times more likely to die from diarrhoea than a healthy one because of the physiological changes in a stunted body.

Development agencies say significant progress has been made in ensuring children are properly nourished, and as a result, the incidence of stunting is declining.

However, huge challenges remain and, in sub-Saharan Africa, the proportion of stunted under-fives is two in five. With crises in South Sudan, the Central African Republic, Syria and Iraq displacing millions of people, combating hunger and ensuring stunting rates do not creep back up has become a top priority.

“We will not eliminate extreme poverty or achieve sustainable development without adequate food and nutrition for all,” said UN Secretary-General Ban Ki-moon at a meeting of global hunger agencies in Rome. “We cannot know peace or security if one in eight people are hungry.”

As such, the first “pillar” of Mr Ban’s Zero Hunger Challenge is to eliminate stunting in children under two years.

Unicef is also a partner in the Scaling Up Nutrition (SUN) movement, another major global push bringing together more than 50 countries in an effort put national policies in place and implement programmes with shared nutrition goals.

One innovative programme , the Africa Nutrition Security Partnership, being implemented by Unicef and funded by the European Union since 2011, is combating stunting at community and institution levels.

Acutely malnourished children at risk of death are taken to health clinics, and health institutions and partners are given the tools they need to improve infant and young child feeding practices and hygiene, and better fight hunger and disease.

The four-year programme focuses on Ethiopia (with a stunting rate of 44 per cent), Uganda (33 per cent), Mali (38 per cent) and Burkina Faso (35 per cent). The aim is to change behaviour among households, set up systems for effective multi-sectoral approaches and increase government capacity, helping these countries battle against the effects of hunger.

In Uganda, community workers have been provided with smartphones programmed with information about hygiene, postnatal care and proper infant and maternal diet. The workers share the information with households and then log their location on the smartphone’s GPS to prove they were there.

In Mali’s capital Bamako, funding has been provided to broaden a master’s degree to provide advanced training to health care professionals on how to best design and implement nutrition programmes.

In Ethiopia, schoolgirls are being encouraged to delay marriage and pregnancy until they are at least 18, as a way of preventing inter-generational under-nutrition. Older women are better able to carry and rear children with stronger bodies and minds.

The increased focus on stunting by the humanitarian community is telling: Its prevalence has become a kind of litmus test for the wellbeing of children. A child who has grown to normal height is more likely to live in a household where they wash their hands and have a toilet; eat fruits and vegetables, go to school, get a good job; and is less likely to die from disease.

But tipping the balance in favour of a child’s future is not as hard as some may think. The simple act of reinforcing the importance of exclusively breastfeeding a baby for the first six months of his or her life, for example, increases an infant’s chances of survival by six times.

Most of the regions where the partnership is being run have ample food to go around. It is other factors such as failing to properly wash and dry utensils after meals, selling nutritious homegrown foods rather than eating them, and cultural sensitivities to things like vegetables and eggs that are causing problems. As such, simply education programmes can make a real difference and save countless lives.

The other challenge is ensuring enough political will to keep those programmes running. If the international community remains focused, the downward trend in stunting will continue.

It could only be a few short years before children from modest African communities like the mountains of southern Uganda get to really play for teams like Arsenal. Children just need to be allowed to grow to their full potential and good things will follow.

Dr Noel Marie ZAGRE is Unicef’s regional nutrition adviser for Eastern and Southern Africa and Gary Quince is Head of the European Union Delegation to the African Union.

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