summary briefing A LIFE FREE FROM HUNGER TACKLING CHILD MALNUTRITION As world leaders have been occupied with one economic crisis after another, a hunger and malnutrition crisis affecting millions of children has gone unchecked. While the world has been experiencing years of financial turmoil, pervasive long-term malnutrition is slowly eroding the foundations of the global economy by destroying the potential of millions of children. This crisis is not new. Progress on reducing Action must be taken now to prevent the malnutrition has been pitifully slow for 20 crisis deteriorating and more children suffering years. But a combination of global trends – the life-long consequences. By mid-2013, it climate change, volatile food prices, economic will already be too late to make a difference uncertainty and demographic shifts – is putting to the last generation of children who will future progress on tackling malnutrition at risk. reach their second birthday – a crucial nutrition milestone – by 2015. That’s the deadline for the eight Millennium Development Goals, six of which are dependent in part on tackling malnutrition. Every hour of every day, 300 children die because of malnutrition. It’s an underlying cause of more than a third of children’s deaths – 2.6 million every year.1 But it’s not recorded on death certificates and, as a result, it’s not effectively addressed. Even for those children who survive, long-term malnutrition causes devastating and irreversible damage. Lack of nutritious food, coupled with infection and illness, means their bodies and brains don’t develop properly. At least 170 million children are affected by stunting.2 This means that not only are they too short for their age, they’re also likely to enrol at school later and to do less well academically. For example, iodine deficiency, a type of malnutrition caused by a lack of specific nutrients, affects one- third of schoolchildren in developing countries and is associated with a loss of 10–15 IQ points.3 Childhood malnutrition can lessen productivity – stunted children are predicted to earn an average of 20% less when they become adults.4 If current trends continue, the lives of 450 million children globally will be affected by stunting in 5 CLARKE the next 15 years. J C 1 VITAL STATISTICS 1 IN 4 2.6 MILLION TWICE AS LIKELY One in four of the Malnutrition is an underlying 6 world’s children are stunted. cause of the death of 2.6 In the poorest countries, the In developing countries this million children each year – poorest children are two figure is as high as one in one-third of the global total times as likely to be chronically 7 10 three. That means their of children’s deaths. malnourished than their body and brain has failed to richest counterparts.13 develop properly because of malnutrition. 450 MILLION 80% 48% 450 million children will be affected by stunting in 80% of stunted children live 14 48% of children in in India the next 15 years if current in just 20 countries. are stunted.8 trends continue.11 1.6 MILLION 20% LESS 0.6 PERCENTAGE POINTS MORE Adults who were malnourished Global progress on stunting Seven countries are projected as children earn at least has been extremely slow. to see an increase in numbers 20% less on average than The proportion of children of stunted children by 2015. those who weren’t.9 who are stunted fell from Nigeria is projected to have 40% in 1990 to 27% in 1.6 million additional stunted 2010 – an average of just children. By 2020 Tanzania is 0.6 percentage points projected to have 450,000 per year. 12 more stunted children.15 “There isn’t enought to eat” “Today I had a small piece of injera (flatbread served with a basic sauce) for breakfast – one injera shared between four people – and I had the same for lunch. We don’t eat anything else – I might get egg or meat once a year for special occasions. There isn’t enough, but my parents give me whatever is available. HILDREN C Sometimes I feel hungry at school. I walk to school as it’s just HE T over the hill.” FOR SAVE FOR SAVE S Maritu, 9, Ethiopia, left, with her friend Adna /PANO T E B OUR C REDERIC F 2 3 MALNUTRITION: THE TRUE STORY Improving nutrition is key to stronger communities with a healthier, smarter child survival. It will save many lives and more productive population. and give all children the chance of a good start The world has enough food in life so they can grow up to fulfil their potential. for everyone, so putting an end to the MALNUTRITION IS UNDERMINING hunger and malnutrition crisis is the right thing ECONOMIC GROWTH and reducing the to do. Every child has the right to a life free from productivity of people trying to work their way hunger. No child should be born to die from a out of poverty in the world’s poorest countries. cycle of malnutrition and disease because they It’s estimated that 2–3% of the national income are not able to eat enough nutritious food. 16 of a country can be lost to malnutrition. Improving child nutrition and reducing levels of Improving nutrition is a good child mortality can lead to smaller families and investment. The solutions that are outlined more sustainable societies. When children are in this report are cost-effective and relatively healthier and more likely to survive, and when simple to implement. Many of them will pay for parents have access to voluntary family planning themselves in terms of the boost they give the methods, many parents will choose to have economy of a country and by lowering the cost fewer children, further apart, and to invest in of healthcare – well-nourished children are less the children who now survive. An added benefit prone to disease and illness. Investing in nutrition is the reduction in population growth over the is investing in the future of a country – it creates long term. WORKING ON THE FRONTLINE OF THE HUNGER AND MALNUTRITION CRISIS From the Horn of Africa to the slums of La Paz, Bolivia, Save the Children staff work every day with some of the world’s poorest children, helping tackle malnutrition. And our experts in nutrition interventions and policy have in-depth knowledge ALMER P of both the underlying causes of malnutrition, such as poverty and poor agricultural practices, and the RACHEL RACHEL Dr Mourou Arouna examining 8-month-old Nazifa solutions that work and how they can be applied at a Save the Children-supported stabilisation centre in different countries and contexts. for malnourished children in Niger 2 3 WE ALREADY KNOW THE solutions THAT WORK Direct interventions: Simple Fortification, or the process of adding vitamins solutions delivered to children who are at risk and minerals to food, is one of the most of malnutrition and their families are already cost-effective direct interventions. Fortification well known and well supported by nutrition of staple foods during production – for example, experts. In 2008 The Lancet medical journal adding iron to flour in mills or through breeding identified a package of 13 direct interventions – crops that are more nutritious, such as a such as vitamin A and zinc supplements, iodised sweet potato rich in vitamin A that has been salt, and the promotion of healthy behaviour, introduced in Mozambique – can benefit an including handwashing, exclusive breastfeeding entire population. To reach children with fortified and complementary feeding practices – that foods during the critical periods of growth and were proven to have an impact on the nutrition development requires a more targeted approach. and health of children and mothers. This cost- Commercial fortification of products for 6–24- effective and affordable package could prevent month-old children by food companies and the the deaths of almost 2 million children under addition of micronutrient powders to traditional five and a substantial amount of illness if it was foods both show promise. delivered to children in the 36 countries that At a cost of just over US$1 per person per year, are home to 90% of the world’s malnourished 17 the World Bank has estimated that more than 4 children. The reason these proven interventions billion18 people would be able to benefit from have not been scaled up is due to public policy access to fortified wheat, iron, complementary decisions and chronic under-investment in the food and micronutrient powders.19 health services needed to deliver them. “Then Save the Children’s community health volunteer came” “At 14 months Yameen started to develop scars and wounds around the mouth and he had a severe case of diarrhoea. I was helpless and did many things to try and make him better. Then Save the Children’s community health volunteer, Ruksana, came visiting. She asked me to take him to the growth monitoring centre. After 12 days, I brought him home on my own. I fed him special medicinal food [nutritious peanut paste] on my index M finger and rubbed it in his gums. The diarrhoea stopped. ENACA Ruksana came and checked up on him every day. Gradually his C AL condition improved.” Y ANERA Jostna, who lives with her son Yameen (opposite) in Bhola, Bangladesh, where T NE Save the Children’s community health volunteers provide ante- and postnatal care to improve the health and nutrition of mothers and children under five. The volunteers are trained to identify cases of malnutrition and to manage cases where children have diarrhoea or pneumonia. 4 5 Protecting families from protection has real potential to reduce global poverty: Poverty is one of the main malnutrition.