Urgency To Address Malnutrition

Good nutrition is the key to overall growth for children and healthy life. The effects of any form of malnutrition are enormous and long-lasting. The Sustainable Development Goals (SDGs) of zero hunger by 2030 seem difficult unless more collaborative efforts are made urgently through national as well as international stakeholders. The resultant effects due to malnutrition, malnourishment, and starvation are hindrances to the overall development of countries around the globe. The progress made to reduce problems of malnutrition is slow and millions of people are at higher risk of dying prematurely every year.

Facts

In 2020, around a tenth of the global population i.e. between 720 million and 811 million persons were suffering from hunger which was about 161 million more than in 2019. In the same year, a staggering 2.4 billion people, or above 30 per cent of the world’s population, were moderately or severely food-insecure, lacking regular access to adequate food (SDG Report, 2022). Globally, 149 million children under five were estimated to be stunted, and 45.4 million, or 6.7 per cent of children under five were estimated to be wasted in 2020 (WHO, 2021). Undernutrition was linked to the deaths of around 45 per cent of children under five. Those deaths mostly occur in low- and middle-income countries (WHO, 2021). 

There are different causes of malnutrition that include unsuitable dietary choices, having a low income, difficulty obtaining food, and various physical and mental health conditions. Undernutrition is one type of the various forms of malnutrition. It occurs when the body does not get enough food and enough necessary nutrients which lead to delayed growth, low weight, stunting, or wasting.

The government had set a target for the prevalence of stunting among children under five to be at or below 29 per cent by 2022, and at or below 15 per cent by 2030. Similarly, the prevalence of wasting among children under five is 7 per cent by 2022 and 4 per cent by 2030 (National Planning Commission, 2020). The prevalence of stunting has declined from 57 per cent in 1996 to 25 per cent in 2022. During the same period, the prevalence of wasting declined from 15 per cent to 8 per cent (NDHS, 2022).

Exclusive breastfeeding which is vital for children, has fluctuated considerably. Among children aged 0–5 exclusive breastfeeding declined from 75 per cent in 1996 to 53 per cent in 2006, then rose to 70 per cent in 2011, and again declined to 56 per cent in 2022 (NDHS, 2022). Nepali children are also suffering from micronutrient (vitamins, minerals, and trace elements) deficiency along with protein-energy malnutrition and low birth weights. These three interrelated factors are responsible for aggravating the problems of malnutrition in Nepal.

It has been reported that Nepali children are deprived of enough food both in terms of quantity and quality which results in protein-energy malnutrition and low birth weights which makes them susceptible to various diseases and leads to a deficiency of micronutrients. Consecutively, diseases and micronutrient deficiencies contribute to malnutrition and therefore are responsible for stunting and wasting. It is a vicious cycle that takes its toll in terms of premature deaths of children under five. 

The deaths due to malnutrition remain unrecorded. The ultimate cause of death for children due to malnutrition does not appear in records. Therefore, proper attention has not been placed upon solving the root cause of deaths. Moreover, the consequences of malnutrition are devastating even if children survive. The long-term consequences can be late enrollment and poor performance in school. Malnutrition coupled with a deficiency in other micronutrients and illnesses results in a less developed body and mind. It is an obvious fact that children who are stunted and have poor performance in school will contribute less to the national economy when they grow as an adult.  The deficiency of micronutrients such as iron, iodine, vitamin A, and Zinc in children has long-term consequences. It has been estimated that half of the anemia cases are due to iron deficiency.  

Food fortification

Environmental degradation, drought, and loss of biodiversity coupled with conflict and poverty make countries struggle to provide sufficient nutrition for its population. In turn, a less nourished adult who was undernourished during childhood contributes less to the economic development of the country. This vicious cycle has to be stopped. It has been estimated that in the long term, the investment of one dollar in nutrition results in many-fold benefits in return. 

Foods fortified with essential micronutrients should be made available to the affected areas and vulnerable groups will help reduce the problem of malnutrition in the country. All the stakeholders from governmental to non-governmental organisations should come forward to reduce the burden of diseases due to preventable nutrition-related issues. 

Zinc supplementation is vital for the growth of stunted children and can be included in wheat flour, maize flour, or rice. Nepal has numerous plans, policies, strategies, and programmes for food and nutrition security. It is therefore called upon to scale up a plan of fortification of foods with micronutrients, Vitamin A supplementation, and provision of deworming medicines, iron, and folic acid tablets during pregnancy.  Similarly, community-based management of severe acute malnutrition is urgently needed throughout the affected areas of the country.  

(Dr. Lohani is the clinical director at the Nepal Drug and Poison Information Centre. lohanis@gmail.com)