A key target under Sustainable Development Goal (SDG) 2 is ending all forms of malnutrition, including achieving by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age.

 

This article focuses on reviewing the global progress towards reducing the prevalence of stunting in young children. It also highlights the interventions necessary for eliminating malnutrition in children, including but not limited to, stunting.

 

Globally, approximately 149 million children under the age of 5 years are affected by stunting. While the numbers have undoubtedly declined, from 32.5% children under 5 years stunted in 2000 to 21.9% in 2018, the pace of reduction in stunting has been slow. Asia and Africa are the worst affected. Nearly 50% of all stunted children under 5 live in Asia and more than 1/3rd live in Africa. South Asia is home to 40% of stunted children. In India, 38.4% of children under 5 are stunted.

 

There are several underlying determinants of malnutrition including lack of access to health services, safe drinking water, sanitation and household food security as well as unhealthy behavioural practices. As a result, both direct and indirect interventions in areas like agriculture, education, drinking water, sanitation and gender equity, impact outcomes in nutrition. For instance, several studies have highlighted the link between inadequate sanitation, diarrhoea and stunting in children. Similarly, a greater influence of women in household decisions plays a major role in the nutritional choices made by households. Studies show that that direct nutrition interventions (adequately scaled up) can account for a reduction in stunting by only 20% with the balance resulting from indirect interventions such as access to water, sanitation or health services.

 

This implies that implementing programs in a fragmented manner can contribute significantly to the persistence of malnutrition. A comprehensive and coordinated approach is therefore necessary for addressing the multiple and inter-related determinants of malnutrition across the life cycle of an individual.

 

For instance, the Indian Government has launched the Prime Minister’s Overarching Scheme for Holistic Nourishment or POSHAN Abhiyan, a multi-ministerial convergence mission for holistically improving nutritional outcomes among children, adolescents, pregnant women and lactating mothers with the overall vision of ensuring a malnutrition free India by 2022. By adopting a life-cycle approach for tackling malnutrition, the POSHAN Abhiyaan aims to improve service delivery through the use of technology, inter-sectoral convergence, focusing on the first 1,000 days of a child’s life which are critical for development and converting nutrition into a mass movement.

 

Such a coordinated approach to tackling malnutrition has proven to be successful in various countries. In Brazil, for example, childhood stunting reduced from 37% in 1974 to 7% in 2006-07 due to improvements in maternal schooling, family purchasing power, maternal and child health care, coverage of water supply and sanitation, prevalence of breastfeeding, birth spacing, minimum wages of unskilled workers as well as the introduction of cash transfer programmes for low-income families.

 

It is also important that evidence-based interventions with a proven track record of reducing malnutrition are scaled-up. For instance, improved access to sanitation played an important role in the decline of stunting among children under 2 years of age in Bangladesh. Similar successes were observed in Ethiopia following greater emphasis on water, sanitation and hygiene (WASH) programs. India has given tremendous importance to sanitation over the last few years. Under Indian Government’s flagship Swachh Bharat Mission, sanitation coverage in rural India has increased from 38% in 2014 to over 99% as of April, 2019. Numerous surveys have indicated that more than 90% of toilets constructed under the Mission are being used by household members thereby reflecting that behaviour change has also started becoming discernible. A significant scaling-up of access to toilet facilities coupled with regular usage is starting to impact health and nutrition outcomes positively, by reducing diarrheal episodes among children, for instance.

 

 

Another effective strategy for combating malnutrition is food fortification. In Indonesia, it was found that children aged 6–59 months who consumed fortified milk or noodles had a lower risk of stunting, and those who consumed both food items had the lowest risk of stunting. Similarly, Senegal’s food fortification program which aims to reduce micronutrient deficiencies (Vitamin A, Folic Acid, Iron) among children under 5 years of age and women of childbearing age is playing an important role in addressing malnutrition in the country. The program was launched in 2010 following the adoption of a mandatory law for fortification of refined oils with Vitamin A and wheat flour with Iron and Folic Acid. In Peru, the promotion of iodized salt was a key contributor to the reduction in stunting among children from 30% in 2004 to 20% in 2011.

 

 

Achieving the World Health Assembly’s Global Nutrition Target of a 40% decline in the number of stunted children under 5 years by 2025 is challenging indeed. However, the adoption of a systematic and multi-sectoral approach, with a particular focus on scaling-up evidence-based interventions for tackling malnutrition in Asia and Africa, can make the accomplishment of this target a reality. Government action alone will not suffice. With the future of children around the globe at stake, is imperative that all stakeholders, including the private sector and citizens, make nutrition a top priority.

 

 

Disclaimer: The views expressed are personal.