2. WHY do we have to address Malnutrition?

Malnutrition affects all countries regardless of the nature of the malnutrition problem and income levels. WHO estimates that globally 1 out of 3 people is affected by one form of malnutrition and almost half of all child deaths among children under 5 years of age are linked to undernutrition, making it a global public health problem. Many developing countries are currently affected by the double burden of malnutrition (undernutrition and overnutrition) hence it is important to address all forms through a comprehensive approach. However, during emergencies the focus is often on preventing and treating undernutrition (wasting, stunting, micronutrient deficiencies and underweight) due to its impact on child morbidity and mortality. Children with severe acute malnutrition are nearly 12 times more likely to die than healthy children[1] Hence, saving lives and preventing deaths are the primary objectives of all emergency nutrition programs. In emergency situations, protecting optimal infant and young child feeding (IYCF) practices is also critical as mortality rates of artificially fed infants are elevated in comparison to breastfed babies[2]. This is because the risk of mortality due to diarrhea and other infectious diseases are 20 times higher in infants who are not exclusively breastfed compared to those who are exclusively breast fed[3]; due to prevalent unhygienic conditions coupled with lack of safe water and facilities to sterilize feeding bottles and prepare formula safely. Children who have been breast fed for longer periods of time tend to also exhibit lower odds of infectious morbidity and mortality[4],as infants who are not breast fed have sixfold greater risk of infections related in the first 2 months of life when compared with infants that have been adequately breast fed[5]. Therefore, supporting optimal breast feeding, re-lactation, and timely introduction of complementary foods, and continuation of breastfeeding up to 2 years should always be part of any emergency nutrition response.

Reducing malnutrition, its causes, and effects is important for achieving the Sustainable Development Goals (SDGs). Several scientific publications have indicated the importance of addressing and preventing malnutrition during the first 1000 days of a child’s life: from conception to the second birthday. If during this period the foundations for good nutrition are not properly established, irreversible damage will result such as stunting, and the child will not be able to grow to her or his full potential. It is estimated that scaling up of evidence-based nutrition specific intervention could reduce stunting by 20% and the prevalence of severe acute malnutrition by 50%[6].  Building on the 1000 days cycle, specific attention needs to be placed on supporting adolescent girls and women of reproductive age. Evidence exists of the positive effects of several specific nutrition interventions during that time period (e.g., exclusive breastfeeding during the first six months; introduction of complementary foods after 6 months, proper hygiene practices, deworming, fortification of salt with iodine). [7] even if they are scaled up to 90% coverage. Therefore, it’s important to make sectors such as food, agriculture, WASH, and health, nutrition sensitive and take a life cycle approach to prevent malnutrition at each stage of life and break the cross-generational cycle of malnutrition.

[1] UNICEF . The state of the worla’s children, 2019. Children, food, and nutrition. 2019.

[2] Davanzo R. Newborns in adverse conditions: issues, challenges, and interventions. J Midwifery Womens Health 2004;49:29–35.

[3] Maclaine A. Infant feeding in emergencies: experiences from Lebanon, 2007.

[4] Victora CG, Bahl R, Barros AJD, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet 2016;387:475–90

[5] Davanzo R. Newborns in adverse conditions: issues, challenges, and interventions. J Midwifery Womens Health 2004;49:29–35.

[6] Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider BA, Kirkwood B, Morris SS, Sachdev H. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;371(9610):417–40.

[7] Bhutta et al (2013) Evidence-based interventions for the improvement of maternal and child nutrition. What can be done and at what cost?. Lancet. 2013.