MALNUTRITION AMONG CHILDREN WITH DISABILITIES: CHALLENGES AND OPPORTUNITIES FOR ZAMBIA JULY 2020 PREPARED BY: RESEARCH: Esther Nyemba Besa (Researcher) with the support of Bernadette Deka Zulu (Executive Director) TECHNICAL REVIEW: Salim Kaunda (Head of Research and Analysis) EDITORIAL TEAM: Chiti Jacob Nkunde (Communication Specialist) Layout and Design Melody Simukali (Head of Communications & Grants) Editorial This document and trademark(s) contained herein are protected by the laws of The Republic of Zambia. This electronic representation of PMRC intellectual property is provided for non- commercial use only. Unauthorized posting of PMRC electronic documents to a non-PMRC website is prohibited. PMRC electronic documents are protected under copyright law. Permission is required from PMRC to reproduce, or reuse in another form, any of our research documents for commercial use. For information on reprint and linking permissions, please see PMRC Permissions . 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TABLE OF CONTENTS Overview 6 Definitions 9 Link between Nutrition and Disability 10 Profile of disability among children in Zambia 13 Profile of malnutrition among children in Zambia 16 Relationship between child disability and undernutrition in Zambia presented in figures 19 Obstacles in providing good nutrtion to children with disabilites 20 Opportunities for improved nutrition among children with disabilities 22 Recommendations 24 References 26 LIST OF FIGURES Figure 1 - Inter-relationship between malnutrition and disability throughout the life cycle Figure 2 - Prevalence of disability among children 2-17 years by sex Figure 3 - Prevalence of disability among children 2-17 years by rural/urban Figure 4 - Prevalence of disability among children 2-17 years by Province Figure 5 - Nutritional status of children under age five (5) Figure 6 - Relationship between child disability and under-nutrition in Zambia presented in figures LIST OF TABLE Table 1- Stunting, Wasting and Underweight: cut-off values for public health significance ABBREVIATIONS AND ACRONYMS CTs Cash Transfers CRPD Convention on the Rights of Persons with Disabilities CSO Central Statistics Office IDD Iodine Deficiency Disorder MCDP Most Critical Days Project SSA Sub-Saharan Africa UN United Nations UNICEF United Nations International Children’s Fund WHO World Health Organization ZDHA Zambia Demographic Health Survey i MALNUTRITION AMONG CHILDREN WITH DISABILITIES: CHALLENGES AND OPPORTUNITIES FOR ZAMBIA. OverviewOverview Conventional and traditional medicine, therapy, treatments and surgery are the common methods used to alleviate the physical and mental symptoms of illness, disease and disabilities (Jackie Booth, 2019). However, nutrition as an important remedy for improved wellbeing especially for persons with disabilities has not fully been utilized in many cases. There is a dual link between disability and lack of nutrition; both can be a cause of the other. According to Kuper et al. (2014), undernutrition and disability are inherently linked with the former both a cause and consequence of the latter and people with disabilities are at increased risk of being malnourished. However, nutrition as an important remedy for improved wellbeing especially for persons with disabilities has not fully been utilized in many cases. According to the World Health Organization (WHO) and World Bank Report (2011) on disability, an estimated one billion people are living with different forms of disabilities globally of whom 93 million are children under the age of 14 years (UNICEF, 2013). These statistics represent approximately 15.6% of the world’s population with 15 years and older living with moderate or severe disability, while children 14 years and below standing at 5.1% living with disabilities. In relation to nutrition, there are 6 | Malnutrition among Children with Disabilities: Challenges and Opportunities for Zambia DISABILITY 93 MILLION Children under the age of 14 living with disabilities 1 Billion worldwide living with disabilities Worldwide These statistics represent approximately 15.6% of the world’s population 15 years and older living with moderate or severe disability, while children 14 years and below standing at 5.1% living with disabilities. almost one billion people who are malnourished and malnutrition has continued to be one of the major causes of child mortality. The latest statistics indicate that under nutrition causes about 1.3 million deaths annually, of which 45% of all deaths in children (Black RE, Victora CG, Walker SP, et al. 2013). MALNUTRITION 1.3 MILLION Number of deaths caused by under-nutrition annually 1 Billion People who are malnourished ...malnutrition has continued to be one of the major causes of child mortality. The latest statistics indicate that undernutrition causes about 1.3 million deaths annually, of which 45% of all deaths in children... Globally, disability and malnutrition are not only considered to be health problems; they are also characterized as human rights problems. Article 25 of the Universal Declaration of Human Rights and the General Comments No. 12 on the right to food specifically mentions rights of people with disabilities to have physical access to adequate food (UN (1948) Universal Declaration of Human Rights). The rights to health care, education and social participation are articulated in the 2006 UN Convention on the Rights of Persons with Disabilities. It reinforces the rights of persons with disabilities to enjoy the highest standard of health without discrimination on the basis of disability and it highlights the duty of state parties to prevent discriminatory denial of health services or food on the basis of disability. Moreover, the Convention on the Right of the Child emphasises that all children, including children with disabilities, have a right to adequate nutrition. Malnutrition among Children with Disabilities: Challenges and Opportunities for Zambia | 7 WHO recognizes disability as a global public health issue, a human rights issue and a development priority. Disability is a global public health issue because people with such challenges face widespread barriers in accessing health and related services such as rehabilitation and have worse health outcomes than people without disabilities. Disability is also a human rights issue as people with disabilities more often than notexperience stigmatization, discrimination and inequalities; they are subject to multiple violations of their rights including their dignity, for instance through acts of violence, abuse, prejudice and disrespect because of their disability, and they are denied autonomy (Quinn and Degener, 2002). Disability is a development issue, because of its bi-directional link to poverty: disability may increase the risk of poverty, and poverty may increase the risk of disability (Sen, 2009). POVERTY BI-DIRECTIONAL DISABILITY Poverty increases the likelihood of impairments through malnutrition, poor health care, and dangerous living, working and travelling conditions. Disability may lead to a lower standard of living and poverty through lack of access to education and employment, and through increased expenditure related to disability. It is against this background that this paper analyses the challenges and opportunities for proper nutrition of children with disabilities with particular focus on undernutrition in Zambia. 8 | Malnutrition among Children with Disabilities: Challenges and Opportunities for Zambia DEFINITIONSOverview DISABILITY: United Nations Convention on the Rights of Persons with Disabilities (CRPD) in promoting a human rights approach to disability defines persons/people with disabilities as: ‘people with long- term physical, mental, intellectual or sensory impairments which in interaction with various barriers may hinder their full and effective participation in society on an equal basis with others.’ (Article 1, UN 2006). The concept, according to the Convention, moves away from the traditional, medical based perspective of disability characterized by a focus on physical defects, to one that encompasses the attitude, environment and institutional barriers that limit or exclude persons with impairments from participation. The Zambia National Policy on Disability defines disability as “any restriction resulting from impairment or inability to perform any activity in the manner or within the range considered normal for a human being and would or would not entail supportive or therapeutic devices and auxiliary aids, interpreter, white canes, reading assistants, hearing aids, guide dogs or any other animal trained for that purpose” (National Policy on Disability, 2013). A similar definition by World Health Organization (WHO) states that disability is an umbrella term covering impairments, activity limitations and participation restrictions (WHO, 2018). Impairment in both definitions is defined as a problem in the body structure; an activity limitation or difficulties encountered by an individual in executing tasks or actions; while participation restriction is a problem experienced by an individual in involvement in life situations. MALNUTRITION: The term malnutrition covers both undernutrition and overnutrition. The term undernutrition includes stunting (low height for age), wasting (low weight