A UNICEF worker uses a MUAC (Mid-Upper Arm Circumference) band to measure the state of wasting afflicting a young girl. Photo credit: UNICEF
Geoffrey P. Johnston
Surging COVID-19 case counts around the globe and the emergence of the Omicron variant of concern are capturing news headlines and crowding out coverage of an unfolding humanitarian crisis—the rise of malnutrition.
In 2015, the community of nations came together at the United Nations to endorse the Sustainable Development Goals (SDGs). Under SDG 2, the world committed to ending malnutrition in all its forms by 2030.
However, the world isn’t on track to achieving zero hunger by the end of the decade. Of particular concern is the persistence of wasting. The proportion of the world’s children suffering from wasting remains almost the same as it was in 2015.
The World Health Organization’s website defines wasting as “low weight-for-height” and “often indicates recent and severe weight loss.” However, wasting “can also persist for a long time.”
In addition, the WHO notes that wasting “usually occurs when a person has not had food of adequate quality and quantity and/or they have had frequent or prolonged illnesses.” And it is linked to “a higher risk of death if not treated properly.”
According to the Ottawa-based Nutrition International, severe acute malnutrition (SAM) is a form of wasting that requires specific medical treatment. While wasting can sometimes be addressed through long-term nutrition programming, people suffering from SAM receive treatment consisting of specially designed high-energy and nutrient-dense foods or supplements, which are referred to as ready-to-use therapeutic foods (RUTF).
Five United Nations agencies have come together to address wasting in children. The ‘Global Action Plan on Child Wasting’ puts forth a strategy to coordinate efforts to deliver desperately needed nutritional assistance to children and expectant mothers.
“Today, an estimated 7.3% (50 million) of all children under five suffer from wasting at any given time,” the action plan reveals. The framework is a joint project of the United Nations Children’s Fund (UNICEF),
UN Food and Agriculture Organization (FAO), United Nations High Commissioner for Refugees (UNHCR), World Food Programme (WFP), and the World Health Organization (WHO).
Policy shift
While gains have been made in recent decades in reaching and treating children suffering from wasting, the Global Action Plan acknowledges that “the proportion of wasted children who can access treatment remains unacceptably low with just one in three severely wasted children receiving treatment.”
To meet the SDG targets on wasting and undernutrition, the action plan calls for a policy shift that will “scale up radically improved solutions addressing the fundamental drivers of malnutrition.”
The wasting crisis is driven by complex and varied risk factors, including “environmental conditions, inadequate or lack of hygiene and sanitation, household food insecurity and lack of age-appropriate caregiver and child interactions,” reads the action plan. In addition, “emergencies, outbreaks of communicable diseases and disasters may trigger or aggravate the incidence of child wasting.”
According to the Global Action Plan, an effective and sustainable campaign to address the root causes of wasting requires more resilient food systems, universal health coverage with a special focus on nutrition, and social protection programs to address inequality.
The document recognizes that the first 1,000 days from when a child is conceived through early childhood are a crucial time in human development. “Preventing and reducing wasting generally requires that children are born to healthy, well-nourished mothers who receive appropriate antenatal care, and live in households with access to adequate food and care practices as well as to functional quality primary health care services, potable water, safe sanitation and good hygiene.”
The Global Action Plan sets four strategic outcomes in order to “reduce wasting prevalence to less than 5% by the year 2025 and further reduce wasting prevalence to less than 3% by the year 2030.”
The first outcome is reduced low birthweight through improved maternal nutrition. The second outcome aims for improved child health by enhancing access to primary healthcare and to water, sanitation and hygiene (WASH), and by improved food safety. The third outcome focuses on improved infant and child feeding through better breastfeeding practices and enhanced diet in the first year of life. The fourth outcome is enhanced treatment of child wasting by bolstering health systems and integrating treatment into primary healthcare services.
Interview
Why are UNICEF and its partner agencies so concerned about the state of wasting in 2021?
“What we are seeing in 2021 is a bit of a perfect storm,” replied Annie Bodmer-Roy, director of international policy and programs for UNICEF Canada. The COVID-19 pandemic, ongoing conflicts in a number of countries, and climate related disasters have combined over the past year “to drive hunger and malnutrition worldwide,” she said.
“UNICEF estimates that due to COVID-19, an additional 6.7 million children under the age of five could suffer from wasting this year,” she continued. “And without urgent action, the number of children around the world suffering from wasting could reach almost 54 million in the coming year. And when you work that out, that actually predicts about 250 additional child deaths everyday over the next three years due to malnutrition and an additional 13.6 million wasted children who have a high risk of death.”
Where in the world is wasting a major problem?
“We’re seeing wasting come up all over the world,” Bodmer-Roy told the Whig-Standard in a telephone interview. UNICEF is especially concerned about those populations experiencing crises. For example, conflicts and climate shocks that displace people result in lost family livelihoods and the destruction of crops, driving hunger and malnutrition. Sub-Saharan Africa is particularly vulnerable, but UNICEF is also seeing the rise of wasting in Asia.
No energy to even cry
If you look at a child suffering from wasting, what do you see?
“That’s a great question. And it’s a really powerful one, because it’s actually very visible,” the UNICEF staffer responded. From “very, very thin arms” to a very visible rib cage to a swollen abdomen—and sometimes even swollen feet--are the visible signs of wasting, she said.
“It is really heartbreaking to see wasting in young children. I have seen this myself on a number of different deployments I have taken over the course of my career. And to see very young children, in some cases infants, who don’t have the physical energy to even to cry, to even lift themselves, is really heartbreaking--particularly because it’s preventable.”
UNICEF and its partners have programs in place to detect, treat and prevent wasting, she stated. “And this is where we are really working with the Government of Canada to try and ensure that they are spending across those different areas, so we don’t have even more children suffering from this condition.”
How will investing in the nutrition of young girls and adolescents reduce the incidence of low birthweight babies?
When women and girls are malnourished and eventually get pregnant, “their children are more likely to be born undernourished, malnourished,” she answered. “And so when we’re looking at preventing wasting, one of those key areas is reducing low birthweight. We really need to be looking at the nutrition of women and adolescent girls before, during and after pregnancy.”
For example, adolescent girls “really need to have access to adequate nutrition, including micro-nutrient supplements. Because undernourished girls do have a higher likelihood of becoming mothers who are undernourished.” That puts them at greater risk of giving birth to low birthweight babies. “And what we start to see there is an intergenerational cycle of malnutrition.”
UNICEF attempts to interrupt that cycle by supporting women and girls’ nutrition, which in turn supports the nutrition of the babies that they may eventually give birth to in the fullness of time.
In addition, UNICEF works to detect malnutrition and wasting at the community level. For instance, a band, known as the MUAC (Mid-Upper Arm Circumference), is wrapped around the circumference of the upper arm of a child to measure wasting.
WASH
What is the connection between WASH (Water, Sanitation and Hygiene) and wasting?
“That really gets to looking at our second priority area, which is improved child health. So, if we want children to have improved health outcomes, recognizing that malnutrition has a direct impact on children’s immune systems, then we need to be also improving their access to primary healthcare, as well as water, sanitation and hygiene,” she replied.
“When children are malnourished, they are not as capable of fighting off disease,” Bodmer-Roy continued. “The lack of access to WASH services exposes children to disease, increasing the risk of diarrhea, malaria and acute respiratory infections.
“We need to have integrated responses where we’re looking not just at what would be considered pure nutrition interventions, which are absolutely needed, but we need to go beyond that and go wider, so that other risk factors that children have are also addressed at the same time.”
Cooperation
The action plan addresses the lack of coordination between agencies as a barrier to reducing the incidence of wasting. What needs to change?
“The United Nations has actually come together on the Global Action Plan on Child Wasting,” Bodmer-Roy said of the new coordinated strategy, which she described as “a shared vision” on addressing the problem, especially targeting children under the age of five. And she said that over the last 18 months, there has been great improvement in coordination between agencies as well as working with national governments on their own roadmaps.
The community of nations, including Canada, will have a prime opportunity to address the global malnutrition crisis when representatives of national governments, civil society, and other organizations attend a virtual nutrition summit hosted by the Government of Japan.
“The Tokyo Nutrition for Growth (N4G) Summit December 7-8, 2021 provides a historic opportunity to transform the way the world tackles the global challenge of malnutrition,” states the N4G Summit’s website.
According to the United Nations website, the N4G Summit represents “an important opportunity to set the world on a path to achieving the SDG (Sustainable Development Goals) targets – in particular, to end malnutrition in all its forms by 2030 and to strengthen the link between diet, food systems and health.” And the stated goal of the summit “is to galvanize commitments from governments, civil society, the private sector, donor agencies and the UN to end malnutrition in all of its forms.”
What do you hope Canada will commit to at the upcoming virtual Nutrition for Growth Summit to be hosted by the Government of Japan?
“What we would really to see is for Canada to come to the table with a bold pledge that really fights the global malnutrition crisis at the scale at which we’re seeing it. And that has to include funding to tackle wasting across the prevention, early detection and response side of things.
“Canada has actually been a leader tackling malnutrition for many years. They are one of the top global donors to malnutrition. And what we’re seeing right now with the global crisis is the fact nutrition programs have been disrupted or suspended through COVID, but also because people have had limited access to nutritious food. There has been an increase in prices and there’s been a decrease in availability of affordable food.”
Bodmer-Roy describes the current level of need as acute. “We do need the Canadian government to come to the table with a package that is bold and ambitious, in terms of funding amount,” she said. “But also really looking at the key areas of intervention, which have to include wasting.”
In addition, she said that the specific needs of women and girls and adolescent girls should be met within the context of Canada’s feminist international development assistance policy.
Government of Canada
Will Canada commit funding to child survival and malnutrition prevention at the Nutrition for Growth Summit?
“In August 2021, Canada announced US$155 million for emergency humanitarian and development assistance to avert famine in crisis-affected countries and contribute to the prevention of child wasting ,or acute malnutrition, and promotion of maternal and child health and nutrition,” replied Geneviève Tremblay, spokesperson for International Development at Global Affairs Canada.
“As reported in the 2020 Global Nutrition Report, in 2018, Canada provided US$1.2 billion in nutrition programming overall,” Tremblay stated in an email. “Of this amount, US$93 million was for nutrition-specific programs, which address the immediate causes of malnutrition (food/nutrient intake and disease), and US$1.1 billion for nutrition-sensitive interventions, which address the underlying causes of malnutrition--food insecurity, inadequate health services, safe water and sanitation.”
Are early detection and treatment of malnutrition and wasting priorities for Canada?
“Canada takes a twin-track approach to nutrition: we support cost-effective and evidence-based interventions that address immediate nutrition needs for the most vulnerable, while simultaneously addressing the root causes of malnutrition through long-term sustainability approaches,” Tremblay replied. “Canada’s efforts to address child wasting, or acute malnutrition, are largely focused on prevention interventions.”
According to the Global Affairs spokesperson, “ending child wasting starts with prevention, ensuring mothers and children benefit from targeted interventions that strengthen systems and improve access to nutritious and safe diets and life-saving services.”
To prevent malnutrition, especially in women, teenagers and young children, Canada supports “high-impact cost-effective nutrition interventions” by helping to fund programs delivered by nongovernmental partner organizations, including Nutrition International, UNICEF, World Food Programme and others. Those programs range from antenatal care to micronutrient supplementation and fortification to support for breastfeeding.
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Note: This article was updated and corrected on Dec. 6, 2021. The original version incorrectly identified SDG 5 as pertaining to malnutrition. In fact it is SDG 2 that aims to "end hunger, achieve food security and improved nutrition and promote sustainable agriculture."