Combating malnutrition

Investment in health, education, sanitation and other social sectors is an important policy tool for overcoming malnutrition, which, UNICEF says, is growing at an alarming rate.

MALNUTRITION, the focus and theme of the State of the World's Children report released by the United Nations Children's Fund recently, has been described as the "silent and invisible emergency" of today.

Malnutrition, described very basically, is a result of inadequate dietary intake and illness. According to World Health Organisation estimates, malnutrition was associated with over half of all child deaths in developing countries in 1995. Of the 12 million children under five who die each year in developing countries - mainly from preventable causes - the deaths of over 6 million or 55 per cent of the total number of child deaths are either directly or indirectly attributable to malnutrition. Illness is frequently a consequence of malnutrition and malnutrition is also commonly the result of illness. In Africa, the UNICEF report says, one-third of child malnutrition is caused by malaria.

Half of South Asia's children are deemed to be malnourished. Although dramatic gains have been made in reducing child malnutrition in some parts of Latin America and East Asia, an alarming feature of the present situation is that the absolute number of malnourished children worldwide has grown.

The UNICEF report says that malnourished children are much more likely to die as a result of common childhood disease than those who are adequately nourished. The most critically vulnerable groups are developing foetuses, children up to the age of three and women before and during pregnancy and while they are breastfeeding. Some 2.2 million children die from diarrhoeal dehydration as a result of persistent diarrhoea, which is often aggravated by malnutrition. Anaemia, which has been identified as the cause of at least 20 to 23 per cent of the post-partum maternal deaths in Asia and Africa, also ensues from malnourishment.

To a survivor, the consequences of malnourishment are equally serious: malnourished children have lifetime disabilities and weakened immune systems and their learning ability is also seriously affected. Foetal malnourishment has been shown to be related to conditions that occur later in life, such as coronary heart disease, high blood pressure and even diabetes.

An adequate diet, protection from illness and care are seen as deterrents to malnutrition; it follows that access to basic health services, household access to food, child and maternal care, safe water and sanitation are some of the crucial services that a state can provide to combat malnutrition.

UNICEF figures for the 1990s show that the reduction of social benefits has adversely affected the health of mothers as well as children. Increasing malnutrition in countries where it was hitherto an unknown entity indicates that poverty has risen worldwide. In a developed and industrially advanced country like the United States, it is estimated that over 13 million children - more than one in every four under the age of 12 - have a difficult time getting all the food they need. The problem is worst for these families in the last week of the month, when money that comes from wages or social benefits runs out. Over 20 per cent of children in the U.S. live in poverty, which is more than double the rate of most other industrialised countries. In the United Kingdom, children and adults in poor families face health risks linked to diet. According to one study, high rates of anaemia among children and adults and premature and low-weight births are increasingly being reported.

THE STATE OF THE WORLD'S CHILDREN, 1998

Elsewhere too, economic vulnerability and malnutrition go hand in hand. In Sub-Saharan Africa, as government budgets shrank in the late 1980s, basic social services and health services were hit particularly hard. Per capita incomes also declined, affecting people's ability to purchase food. In Eastern and Central Europe, the transition to market economies coupled with slashes in state-run social programmes have taken their toll on the very poor. In the Russian Federation, the prevalence of stunting among children under two years of age increased from 9 per cent in 1992 to 15 per cent in 1994. Similarly, in the post-Soviet Union era, the situation of women and children in the Central Asian republics and Kazakhstan has worsened. Nearly 60 per cent of pregnant women and young children in the region were anaemic.

International assistance and loans to developing countries have also not been very encouraging. For instance, in 1996, middle-income countries were the major recipients of the $232-billion aggregate resource flows to the developing world. The two regions of the world with the highest rate of childhood malnutrition - Sub-Saharan Africa and South Asia - received only $1.6 billion and $5.2 billion respectively. In 1995, Sub-Saharan Africa paid out $13.6 billion towards debt servicing, almost double the sum it spent on health services.

With increasing evidence that good nutrition helps the body counter infection, it is being recognised that initiatives to improve nutrition may be as powerful and important as immunisation programmes. Rising social incomes, especially among the poor, can be used to put programmes in place to fight malnutrition; it is also clear that a range of policy measures are needed to put an end to this worldwide scourge.

In Indonesia, for example, between 1976 and 1986, a 50 per cent rise in the income of the poorest 40 per cent of the people saw significant improvements in their nutrition levels.

THE STATE OF THE WORLD'S CHILDREN, 1998

In Latin America and the Caribbean, where rates of poverty changed only marginally between 1970 and 1997, the drop in malnutrition levels was associated with good healthcare practices, access to basic health services, family planning, water and sanitation services and the empowerment of women.

In Sri Lanka, increases in spending on public health services have been shown to be more strongly associated with reduced infant mortality and better nutrition than have overall increases in income.

The importance of social sector spending cannot be understated.