Why Malnutrition Matters
For individuals: Children weakened by all forms of malnutrition often die from diseases that are both preventable and easy to treat, such as diarrhoea and pneumonia. Those who survive typically face frequent illnesses as well as reduced opportunities for education and income earning. Young women with a history of malnutrition tend to have more difficulty in childbirth and give birth to smaller babies, thus perpetuating a cycle of malnutrition.
For communities and nations: In a global context, malnutrition continues to be the world’s most serious health problem. Malnutrition is the single-biggest contributor to child mortality (deaths of children under five years of age per 1,000 live births) and to the global burden of disease. Approximately 45 per cent of all child mortality, 3.1 million deaths per year, is linked to malnutrition. Malnutrition also reduces human capital through compromised cognitive development and physical health. This leads to lost productivity, which in turn reduces economic growth and development.
Most malnutrition is chronic and can be prevented through targeted interventions in the first 1,000 days of life.
Chronic malnutrition results in stunting, or reduced growth in height, and means that a child has persistently not received adequate nutrition. Stunting affects one-third of all children in developing countries. The girls pictured below are the same age.
Acute malnutrition results in wasting, or rapid weight loss, and means that a child has experienced a relatively sudden drop in food intake. This is usually due to a severe food shortage or period of illness. Ten to 13 per cent of children under five suffer from acute malnutrition.
World Vision focuses nutrition programming on mothers and children who are experiencing or at risk for undernutrition. Undernutrition occurs when individuals do not eat enough food of sufficient quality to meet all their nutritional requirements for healthy life and growth. However, because ‘malnutrition’ is a more familiar term, it is used throughout this website instead of ‘undernutrition’. Technically, malnutrition includes both over- and undernutrition. Overnutrition, or obesity, is not a focus of World Vision’s nutrition programming or advocacy work, although it is a significant health issue around the world.
First 1,000 Days
Most stunting begins in early childhood. Both stunting and its effects are very difficult to reverse. In fact, once a child is stunted, the damage to the body and brain is already done. Optimising nutrition during the first 1,000 days, the period from conception to a child’s second birthday, can prevent this from happening. World Vision joins the global community in targeting the first 1,000 days through the interventions in our 7-11 Approach.
Watch a clever twist of the Peter Pan story, to illustrate the ultimate importance of nutrition during the first 1,000 days.
Micronutrients are vitamins and minerals. These are essential nutrients needed in tiny amounts. Micronutrient malnutrition occurs when individuals do not receive adequate intakes of specific vitamins and minerals. Often people who are deficient in one micronutrient will be deficient in many others, reflecting the fact that overall diet quality is poor. Priority micronutrients include iron, vitamin A, iodine and zinc. Micronutrient malnutrition is often called ‘hidden hunger’ because the effects of deficiency are not visibly obvious, yet have a devastating impact.
Iron is an essential component of haemoglobin, the molecule in red blood cells that transports oxygen to the body’s tissues. Iron deficiency is the most common nutritional disorder, and the major cause of anaemia, which affects two billion people worldwide. Anaemia is a condition in which haemoglobin is malformed and is therefore unable to deliver sufficient oxygen to the tissues of the body and brain. Consequences of anaemia include fatigue, reduced cognitive capacity and decreased immune function. Key strategies to meet iron needs of mothers and children include supplementation, home-based fortification, small-scale fortification and improved diet diversity.
Vitamin A is an essential factor for both eyesight and immune function. Vitamin A deficiency disorders are the leading cause of preventable childhood blindness. Children with even mild or moderate vitamin A deficiency have weakened immune systems and suffer more from common infectious diseases, contributing to an increased risk of death.
Globally, 190 million preschool children and 19 million pregnant women are affected by vitamin A deficiency, with the highest numbers in Africa and Southeast Asia. Key strategies to meet the vitamin A needs of mothers and children include supplementation and improved diet diversity.
Iodine is used by the thyroid gland to produce hormones. Iodine deficiency disorders are the leading causes of preventable brain damage and result in poor growth, poor childbirth outcomes, decreased cognitive ability and goitre (enlargement of the thyroid). The impacts are greatest during the first 1,000 days of life, when the brain is developing rapidly. Fortification of salt with iodine is the primary global strategy to eliminate iodine deficiency disorders, but more than 30 per cent of households around the world still do not have access to sufficiently iodised salt.
Zinc plays a significant role in growth and immune function. Zinc deficiency leads to impaired growth and increased risk of illness and death, particularly related to diarrhoeal diseases. Global estimates are that 30 per cent of preschool children are affected by zinc deficiency, with the greatest burden in Africa, Eastern Mediterranean and Southeast Asia. Key strategies to meet the zinc needs of mothers and children include home-based fortification, small-scale fortification, improved diet diversity (particularly the consumption of animal source foods) and providing zinc supplements with oral rehydration therapy for the treatment of diarrhoea.
Reducing malnutrition is an urgent global challenge. It is essential to the achievement of the Millennium Development Goals (MDGs), a set of internationally agreed upon development targets for 2000–2015. Nutrition is directly addressed in MDG 1 and must be improved in order to achieve MDGs 4 and 5.
MDG 1: Eradicate extreme poverty and hunger.
MDG 4: Reduce child mortality rates.
MDG 5: Improve maternal health.
Scaling up a handful of proven nutrition-related interventions for both mothers and children will save and improve millions of lives. This has already happened in high-income countries. At World Vision, we believe that all children deserve the best start in life, regardless of where they live. We believe that by focusing on the most effective interventions, working with communities and families to develop context-sensitive solutions, and engaging with partners and stakeholders at all levels, the next generation of children can enjoy a life free from malnutrition.
Nutrition Interventions Targeting Just 20 Countries Can Impact 80 Per Cent of the World's Undernourished Children.
Malnutrition is the world’s number one health problem, yet 80 per cent of the world’s chronically undernourished children live in just 20 countries.
(Bryce J, Coitinho D, Darnton-Hill I, et al., for the Maternal and Child Undernutrition StudyGroup. Maternal and child undernutrition: effective action at national level. The Lancet 2008, published online Jan 17. DOI:10.1016/S0140-6736(07)61694-8.)
A concerted effort to intensify nutrition programming in these countries will greatly reduce the global burden of undernutrition. It will also help achieve MDG 1 and greatly increase the chances of reaching MDGs 4 and 5. Evidence from countries such as Costa Rica, Cuba, Sri Lanka, Thailand and China shows that the nutrition of mothers and children can be improved fairly quickly with focused political will.
World Vision’s 7-11 Approach defines our core package of priority preventive interventions. Strategies to achieve the nutrition-focused components of 7-11 include the following:
Optimal Breastfeeding – Breastfeeding is the first-line intervention for healthy growth and the prevention of malnutrition. It is also a life-saving intervention, because the combination of nutrition plus immune factors from the mother builds the infant’s defences against disease. Optimal breastfeeding means that infants are breastfed within one hour of birth, and are then exclusively breastfed (that is, no other food or liquids, except essential medicines) for the first six months. After six months, breastfeeding is continued, along with appropriate complementary feeding, until at least two years of age. In places where HIV is highly prevalent, the World Health Organization's Guidelines for Infant Feeding in HIV Contexts guide breastfeeding recommendations.
Appropriate Complementary Feeding – In addition to breastmilk, infants over six months of age receive increasing amounts of family foods, with age-appropriate composition, quantity, frequency and texture. Appropriate complementary feeding is an essential component of stunting prevention, yet it is time-intensive and challenging to achieve in many contexts. Positive Deviance/Hearth is a proven methodology that applies local wisdom to improve child feeding and care practices.
Vitamin A Supplementation – Many countries have national strategies to provide high-dose vitamin A capsules to children between the ages of six and 59 months and to post-partum women. A semi-annual dose is sufficient to meet children’s needs, given vitamin A is stored in the liver and gradually released as needed.
Iron Supplementation – Provision of daily iron/folate supplements to pregnant mothers is a standard component of antenatal care around the world. Supplementation of non-pregnant women and preschool children has also been shown to be beneficial, but is not routine for most ministries of health. In contexts where malaria is endemic, iron supplementation must be targeted, not universal. World Vision follows international guidelines related to iron supplementation.
Fortification – Fortification is the process of adding vitamins and minerals to foods during processing or preparation. This is typically done during commercial food production, but in developing countries, additional approaches are necessary. Home-based fortification refers to adding a small sachet of micronutrients during food preparation in the home. Small-scale fortification refers to adding micronutrients to staple grains during processing at a community mill.
Increased Diet Diversity – The basis of good nutrition is a balanced diet providing a variety of nourishing foods in sufficient quantity to meet nutrient requirements for health and growth. Many families in developing countries consume primarily starchy foods with small amounts of foods rich in protein, fats, vitamins and minerals. This type of diet cannot meet the nutritional requirements of growing children, but can be diversified through home gardening, small-animal raising, fruit tree cultivation and improved preservation techniques.