Both Africa and India continue to have the highest percentage of under-five children who are undernourished.
Africa and India share a rich history that dates back to the 17th century. Over the past few decades, the population of Africa and India has grown exponentially and currently accounts for 43 percent of the global population. Both Africa and India have shown a decline in infant and under-five mortality. However, they continue to have the highest percentage of under-five children who are undernourished. Indeed, India and Africa account for the largest number of people in the world facing poor health and nutrition, low education, and an overall poor standard of living.
What are the reasons for this continued prevalence of malnutrition? Will India and the countries in Africa be able to meet the goal of Zero Hunger by 2030?
Global malnutrition is still prevalent
According to the Global Nutrition Report 2018, “malnutrition is unacceptably high and affects every country in the world, but there is also an unprecedented opportunity to end it.”
Globally, malnutrition rates are high: 150.8 million under-five children are stunted, 50.5 million children are “wasted”, and an estimated 20 million babies are born with low birth weight. Paradoxically, 38.3 million children globally are overweight.
The malnutrition burden costs the global economy a GDP loss ranging from three to 16 percent; about US$ 3.5 trillion a year. This loss is up to 2.5 percent for Africa and India respectively.
How serious is the problem in Africa and India?
Africa has the highest number of stunted children (46.6 million), followed by India with 58.7 million. Both Africa and India face the challenge of a double burden of malnutrition: At 9.7 million, Africa accounts for 25 percent of the world’s overweight children and India alone accounts for almost half of the world’s total at 25.5 million.
Hunger is a problem as well. A recent report, “The State of Food Security and Nutrition in the World,” states that 821 million — or one in every nine people — are hungry. Of that number, 94 percent live in Africa and India. Africa has more than 231 million undernourished people and 33.5 percent of the African population lives in extreme poverty.
The map at this link illustrates the extent of undernutrition and stunting in these countries.
In terms of wasting, as indicated in the figure below, almost one-third of African countries have an acceptable prevalence of wasting (<5%) as compared to India, which has only six states falling in the acceptable category but a very high prevalence (15%+) in the rest of the country.
Factors adding to the malnutrition malaise
1. Climate change and conflict
Climate change, conflict, and protracted crises have contributed to an increase in hunger and child malnutrition in Africa. Approximately 27.4 percent of the population in Africa was classified as severely food insecure in 2016, which is almost four times as high as any other region.
Inadequate access to food increases the risk of low birth weight and stunting, which in turn is associated with a higher risk of being overweight as an adult. Food insecurity can also have a negative effect on infant nutrition as explained in the diagram at this link.
With the high prevalence of malnutrition, high food insecurity and increase in the number of poor in Africa, it is unlikely that either Africa or India will achieve the SDG targets set out for 2030 or Agenda 2063.
2. Unbalanced diet and inadequate access to food
The World Health Organization (WHO) has long linked an unbalanced diet and lack of food (other than the mother’s milk) to high rates of stunting, overweight and death in children under five. It is important to break this intergenerational cycle of malnutrition and scale up access to nutrition. How can that be achieved?
The 1000 days between conception to two years of age provides a critical window of opportunity to prevent childhood stunting and obesity problems later in life. Exclusive breastfeeding, long considered the best form of nutrition for new-born babies, averages 42 percent globally with a wide variation among regions; the lowest is 29 percent in Western and Central Africa.
India also lags behind in terms of exclusive breastfeeding at 54.9 percent and complementary feeding rates is 42.7%, with only 9.6% children receiving adequate diet.
What can policymakers do?
To end malnutrition, Africa needs a comprehensive policy on nutrition and programmatic action in order to achieve the goals laid down in the Malabo declaration, a commitment that aims to halve poverty and end hunger on the African continent by 2025. Estimates for Africa indicate that every dollar invested for combating undernutrition in children can yield a return of US$16.
The Rwanda model of multisector public-private partnership to tackle malnutrition is a good example of an effective policy in the African continent. Rwanda provides malnourished children and pregnant and lactating mothers with high-quality, fortified, locally-sourced food. Also, the government encourages kitchen gardens to increase dietary diversity and meal frequency; a policy initiative that has improved the nutritional status of children and families alike.
Some case studies from India have found tremendous potential in the ability of nutrition gardens to reduce the cases of malnutrition amongst children and families, while empowering women and improving means of livelihood. India can also learn from Ethiopia on sustainable undernutrition reduction through community based nutrition programmes and improving food security. It is evident from the low rate of prevalence of anemia in women and low birth weight children in Ethiopia.
Thus, investing in both nutrition-specific and nutrition-sensitive interventions could help combat malnutrition and build nutrition resilience. Addressing all forms of malnutrition should be the top priority of the government and policy makers. It is important to invest in interventions across sectors like agriculture, sanitation, health, and education to complement the nutrition interventions in combating malnutrition.
In conclusion, the solutions are available and need to be put into action by scaling-up nutrition programmes. There is a need to adopt a multisectoral approach on nutrition to improve nutrition outcomes. This can ensure a secure future of children, reap the benefits of the demographic dividend and maintain strong and sustainable economic growth.
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