The congregation of health leaders at the 2018 World Health Assembly (WHA) in Geneva, Switzerland, this week, is an opportune time to shine a light on the problem of stunting in Africa and for African governments to do more to reverse the negative trends on the continent.
The World Health Organization (WHO) describes stunting as low height for age or height more than two standard deviations below its median Child Growth Standards, one of the most significant impediments to human development. Globally, in 2016, 22.9 percent children under five years of age, or 154.8 million, suffered from stunting. Of those, 59 million are in Africa. In 2012, the WHA Resolution 65.6 endorsed a comprehensive implementation plan on maternal, infant, and young child nutrition, which specified six global nutrition targets to achieve by 2025. The first seeks to realize a 40 percent reduction in the number of children under five who are stunted.
Good nutrition is present when a child consumes enough and well-balanced food that is age appropriate and contains all the nutrients necessary for healthy growth. In the reverse, malnutrition occurs when a child does not get enough good food for their daily body requirements.
Stunting is an indication of malnutrition or nutrition-related disorders that may arise following many factors, including poor maternal health and nutrition before, during, and after pregnancy; inadequate infant feeding practices, especially during the first 1,000 days of a child’s life; infections; or general lack of food.
A young student at the Early Childcare and Development Centre leads her class in reciting the alphabet. Photo credit: RESULTS Canada
Stunting is not only a physical issue; it is associated with underdeveloped brain with long-lasting harmful consequences, including diminished mental capacity, poor school performance, and increased risks of nutrition-related chronic diseases such as diabetes, hypertension, and obesity in adulthood. It worsens when infants’ diets are poor and sanitation and hygiene are inadequate. It is irreversible by the age of two.
While Africa’s land is fertile and productive, children here experience the highest rates of stunting. The contradiction can be explained by the fact that good nutrition is dependent on good agricultural practices, such as clearing of the land at the right time, planting, harvesting, and proper food storage. Inadequate food storage is a major problem for families in rural Africa; food goes bad after short periods of harvesting, leading to waste and seasons of lack.
Additionally, most rural families in any given region will consume similar, limited kinds food throughout their life. These are typically stable foods, but over-consumption and the narrow range of nutrients may lead to malnutrition. African governments must invest in infrastructure and local, regional markets where families can sell their excess crops and buy food from other regions to diversify their nutrient intake. Governments must also invest in the technology to promote proper storage. Inadequate water supply and unemployment are other conditions of poverty that impact families and lead to malnutrition in children. These kinds of investments combined with health and nutrition education are key to preventing malnutrition in Africa.
Governments’ primary role is to ensure that citizens attain the highest attainable standards of health. Therefore, governments must ensure scaling up evidence-based interventions such as iron, folic acid, and iron-folic acid supplementation; multiple micronutrient supplementation; calcium supplementation; iodine fortification through the iodization of salt; maternal supplementation with balanced energy and protein; neonatal vitamin K administration; vitamin A supplementation; promotion of exclusive breastfeeding; and care of preterm infants.
Civil society and communities, meanwhile, must keep on strengthening governance and accountability roles for governments, donors, and the private sector for quality and effective implementation of investments in nutrition as well as call for additional resources to fill the nutrition funding gaps in their countries.
Joyce Nganga is policy advisor at WACI Health, an African regional advocacy organization that champion the end of life-threatening epidemics and health for all in Africa.