Save Our Children From Malnutrition

By A H Monjurul Kabir

"TO look into some aspects of the future, we do not need projections by supercomputers. Much of the next millennium can be seen in how we care for our children today. Tomorrow's world may be influenced by science and technology; but more than anything, it is already taking shape in the bodies and minds of our children." - Kofi A Annan, Secretary-General of the United Nations

UNICEF, the United Nations Children's Fund, was created by the United Nations General Assembly on 11 December, 1946 as the "United Nations International Children's Emergency Fund" to help the starving children in Europe. Now UNICEF is the only United Nations agency dedicated exclusively to children. And 'The State of the World Children" is the prime annual report of UNICEF about the state of the children of this earth. Each year this report reveals ordinary but some of the most pressing truths based on a particular discipline or a specific point of view. In The State of the World's Children-1998 the prime focus is on nutrition. Sound nutrition can change children's lives, improve their physical and mental development, protect their health and lay a firm foundation for future productivity. And children have the right, recognised in international law, to good nutrition. The world has the obligation to protect that right, building on both the great experience gained and the scientific knowledge achieved.


Malnutrition is rarely regarded as an emergency, the children are not facing famine and betray few or no obvious signs. Yet the largely invisible crisis of malnutrition is implicated in more than half of all child death worldwide, and violates children's rights in profound ways, compromising their physical and mental development and helping perpetuate poverty. More widespread than many suspect - with one out of every three children affected - malnutrition lowers the productivity and abilities of entire societies.

Over 200 million children in developing countries under the age of five are malnourished. Malnutrition contributes to more than half of the nearly 12 million under five deaths in developing countries each year. Often they also suffer the loss of precious mental capacities.

The State of the World's Children 1998 report details the scale of the loss and the steps being taken to stem it. Sentinels of progress are lighting the way: Nearly 60 per cent of the world's salt is now iodised, and millions of children every year are spared mental retardation as a result. Vitamin A supplementation is helping bolster disease resistance in children and may soon become an important measure in helping reduce maternal deaths, around the world.

Malnutrition is not, as many think, a simple matter of whether a child can satisfy her appetite. A child who eats enough to satisfy immediate hunger can still be malnourished.

Malnutrition is usually the result of a combination of inadequate dietary intake and infection. In children, malnutrition is synonymous with growth failure - malnourished children are shorter and lighter than they should be for their age. To get a measure of malnutrition in a population, young children can be weighed and measured and the results compared to those of a 'reference population' known to have grown well. Measuring weight and height is the most common way of assessing malnutrition in populations.

Although many people still refer to growth failure as 'protein-energy malnutrition' or PEM, it is now recognised that poor growth in children results not only from a deficiency of protein and energy but also from an inadequate intake of vital minerals (such as iron, zinc and iodine) and vitamins (such as vitamin A) and often essential fatty acids as well.

The 1990 World Summit for children singled out deficiencies of three micronutrients - iron, iodine and vitamin A - as being particularly common and of special concern for children and women in developing countries. Recently, knowledge of the prevalence and importance of Zinc for child growth and development has placed it in that league as well. Vitamin D deficiency is now recognised as a major problem of children in countries such as Mongolia, the northern parts of China and some of the countries of the Commonwealth of Independent states that have long winters.


Highlighting the Causes
An understanding of the complex and subtle causes of malnutrition is important to appreciate the scale and depth of the problem, the progress achieved to date and the possibilities for further progress that exist.


Immediate causes: The interplay between the two most significant causes of - inadequate dietary intake and illness - tends to create a vicious circle: A malnourished child, whose resistance to illness is compromised, falls ill, and malnourishment worsens. Children who enter their malnutrition-infection cycle can quickly fall into a potentially fatal spiral as one condition feeds off the other. Malnutrition lowers the body's ability to resist infection by undermining the functioning of the main immune-response mechanism. This leads to longer, more severe and more frequent episodes of illness.


Underlying Causes: Three clusters of underlying causes lead to inadequate dietary intake access to food in a household; insufficient health services and an unhealthful environment and inadequate care for children and women. Malnutrition, clearly, is not a simple problem with a single simple solution. Multiple and interrelated determinants are involved in why malnutrition develops and a similarly intricate series of approaches, multifaceted and multisectoral are needed to deal with it.


Spotting Useful Lessons
There is no single prescription. In 'The State of the World's Children-1998', some useful lessons are spotted for consideration:

** Solutions must involve those most directly affected. Problems must be assessed with the full and active participation of the families most threatened by nutritional problems and must familiar with their impact and causes.

** A balance of approaches is necessary. Processes involving assessment, analysis and action - the 'triple A' approach - are essential for formulating appropriate 'bottom-up' solutions, particularly with respect to the ways in which programmes are organised, managed and monitored. A combination of top down and bottom-up actions may be best, as demonstrated by Baby-Friendly Hospital Initiative (BFHI) in promoting breastfeeding, experience with vitamin A supplementation efforts and progress in salt iodization.

** Nutrition components work better in combination. Combining improved infant feeding with better household access to food and more accessible health services and sanitation is clearly more effective in reducing malnutrition than any one of these interventions alone.

** Progress hinges on continuing research. Gains against malnutrition have depended on relevant research, but more is needed. Research institutions, both industry-based and academic, need to include the poor and their day-to-day nutrition problems on the research agenda.

** Food production is important but not enough. Nutrition can be improved even in poor communities without increasing overall food availability. Increasing food production, while often necessary, is never enough to ensure nutrition improvement.

** Everyone has an obligation to child rights. Children have a valid claim to good nutrition and government agencies and members of society including parents, have duties to realise this right. Advocacy, information, education and training are important strategies to create or increase this awareness.

** Community and family based involvement is vital. If they are to care properly for their children, the poor must be recognised as key actors rather than as passive beneficiaries of commodities and services.

** Government policies must reflect the right to nutrition. Some national policies affect nutrition directly, such as salt iodization or immunisation programmes. Others like income and price policies, affect nutrition indirectly. With the ratification of the Convention on the Rights of the Child, governments have the obligation to respect, protect facilitate and fulfil the rights enshrined in the convention. All policies should therefore be analysed in terms of their real and potential impact on the right to good nutrition.


Save Our Children from Malnutrition
Some 56 per cent of Bangladeshi children under five suffer from moderate and severe malnutrition, 21 per cent of whom are severely underweight and studies show that more than 70 per cent of pregnant and breastfeeding women are also malnourished. Protein-energy malnutrition is the main problem but, as often, happens, it occurs together with such conditions as iron deficiency anemia and vitamin A deficiency. In Bangladesh, lack of food is not the main cause of malnutrition, the lack of proper caring practices for children and pregnant women is an important contributing factor.
Malnutrition plays a role in more than half of the nearly 12 million deaths each year of children under five in developing countries, a proportion unmatched since the Black Death ravaged Europe in the 14th century. It blunts intellect and saps the productivity and potential of entire societies. Poverty, one of the causes of malnutrition, is also a consequence, a tragic bequest by malnourished parents to the next generation.

We must remember that however far-reaching the benefits of nutrition may be, ensuring good nutrition is a matter of international law, articulated in variously specific language in international declarations and human rights instruments dating back to the adoption of the Declaration of the Rights of the Child in 1924.

Under the 1979 Convention on the Elimination of All Forms of Discrimination against Women, for example, states parties must ensure that women receive full and equal access to health care, including adequate nutrition during pregnancy and lactation. And the 1990 World Summit for Children, with a Plan of Action that recognised the devastating effects of malnutrition on women and their children, set specific nutritional goals for children and women, including access to adequate food during pregnancy and lactation; the promotion, protection and support of breastfeeding and complementary feeding practices; growth monitoring with appropriate follow-up actions; and nutritional surveillance.

But the right to nutrition receives its fullest and most ringing expression in the 1989 Convention on the Rights of the Child, whose 191 ratifications as of late 1997 make it the most universally embraced human rights instrument in history.

Under the Convention, which commits states parties to realise the full spectrum of children's political, civil, social, economic and cultural rights, virtually every government in the world recognises the right of all children to the highest attainable standard of health, to facilities for the treatment of illness and for the rehabilitation of health - specifically including the right to good nutrition and its three vital components: food, health and care.

Under the Convention's pre-eminent guiding principle, good child nutrition is a right because it is in the "best interests of the child."Article 24 of the Convention specifies that states parties must take "appropriate measures" to reduce infant and child mortality, and to combat disease and malnutrition through the use of readily available technology and through the provision of adequate, nutritious foods and safe drinking water.

The world is obligated to ease child malnutrition on the basis of international law, scientific knowledge, practical experience and basic morality.

In fewer than three years we enter a new millennium. And it is in our power to create the future we want and to decide how it should be achieved. The ravages caused by malnutrition on individuals, families and societies are preventable. We must-steer a path that will bring closer to us a safe heaven for the children in future. To quote Kofi A Annan again,"The world knows what is needed to end malnutrition. With a strong foundation of cooperation between local communities, non-governmental organisations, governments and international agencies, the future - and the lives of our children - can take the shape we want and they deserve, of healthy growth and development, greater productivity, social equity and peace."

Source: The Daily Star, January 4, 1998