Stunted growth: Prioritise investment in nutrition, or risk robbing Africa of its future

21 Sep 2021

Sub-Saharan Africa is the only region in the world with a rising number of stunted children. Among many of the continent’s low- and middle-income countries, a healthy diet is neither easily affordable nor accessible, leading to poor diets deficient in key vitamins and minerals.

Goutham Kandru is Nutrition Lead, Exemplars in Global Health at Gates Ventures. Desta Lakew is Global Director of Partnerships and External Affairs, Amref Health Africa.

As the Covid-19 pandemic continues to severely affect the global economy, and alter the social and cultural fabric of humanity, another threat is on the horizon. According to the UN World Food Programme, more than 950 million people across 93 countries do not have enough to eat.

In May, as the world marked World Nutrition Day, looming or present famine was reported in parts of Ethiopia, Madagascar, South Sudan, Yemen, Nigeria and Burkina Faso. The food shortage puts millions of people – most of them women and children – at risk of malnutrition and stunting, which is associated with poor cognitive development, lost human capital and decreased economic productivity. All of these have long-term effects on health and development.

Globally, the rate of stunting has been declining gradually since 2000, with global prevalence falling from 32.6% in 2000 to 22.2% in 2017. Despite this progress, malnutrition remains one of the greatest challenges facing human development in Africa – and is the largest killer of children under five on the continent. The situation could get worse as climate change, rapid population growth, poverty, Covid-19, conflict and other risk factors further weaken shaky food systems and deepen food insecurity.

According to the State of Food Security and Nutrition in the World Report, sub-Saharan Africa is the only region in the world with a rising number of stunted children. Among many of the continent’s low- and middle-income countries, a healthy diet is neither easily affordable nor accessible, leading to poor diets deficient in key vitamins and minerals.

This is especially evident in countries such as Madagascar and Kenya, where the proportion of children aged below 23 months receiving the minimum acceptable diet stands at 3% and 39%, respectively, placing them among the 10 countries that account for more than 80% of stunting in the region.

In South Africa, where about one in three children is stunted, an estimated 50% of childhood deaths can be attributed to chronic malnutrition.

Investment in nutrition – particularly during the first 1,000 days of life – can prevent the irreversible lifelong consequences of chronic malnutrition and stunting. Beyond health, there are great economic benefits to such investment. Research has shown that every $1 invested in reducing stunting early in a child’s life can yield returns of up to $85 in some African countries, laying a foundation for the achievement of food security and nutrition goals by 2030. However, to reap these benefits and meet the continent’s health and development targets, multistakeholder collaboration will be required to address the drivers of stunting and ensure that children in the region are not left behind as the rest of the world makes progress towards achieving Zero Hunger.

Action towards addressing the continent’s nutrition barriers is especially urgent in the wake of the Covid-19 pandemic, which has weakened food security in what is already one of the most food insecure regions in the world.

In the Democratic Republic of Congo, for example, an estimated 50% of households in areas hit hardest by Covid-19 do not have enough food to eat. In northeastern Nigeria, the number of severe malnutrition cases grew by 10%, according to a survey conducted by the International Committee of the Red Cross between June and August 2020.

We know that the inability of poorer households to provide adequate nutrition results in higher stunting rates among children from low-income families, compared with those from wealthier backgrounds. Addressing the socioeconomic disparities that lead to inequities in access to basic services such as healthcare and water, sanitation and hygiene, is a key step towards reducing the prevalence of stunting in the region.

Also required is greater political will to strengthen food systems, stabilise food pricing and improve interventions in maternal nutrition and child feeding practices.

Where strong political will is matched by action, results are evident.

Senegal, for example, is making significant progress in reducing the prevalence of stunting and malnutrition through improvements in health services; parental education, which has been linked to increased uptake of maternal supplements and deworming medication; access to water and sanitation; poverty reduction and improved food security.

These interventions have led to a reduction in child stunting prevalence by 17.9% between 1992 and 2017, earning Senegal recognition as an exemplar country based on research by Exemplars in Global Health, which is incubated at Gates Ventures and seeks to identify positive global health outliers (“exemplars”), analyse their success and help decision-makers use the findings.

This success offers key lessons that can be leveraged to strengthen multisectoral collaboration to address the stunting burden in Africa. Since March this year, Amref Health Africa has been working with Exemplars in Global Health to establish a collaboration focused on South-South learning, knowledge exchange and engagement of key stakeholders to deploy interventions in countries with high incidences of child malnutrition and stunting, beginning with a pilot in Nigeria and Malawi and borrowing lessons from model countries Ethiopia and Senegal, which have seen reduced child stunting prevalence.

More than 50% of African countries are currently off course to meet targets set by the African Regional Nutrition Strategy (2015-2025). This is a race against time. Much more needs to be done to implement both immediate and long-term solutions for sustained reduction in child stunting. We need investments and interventions to strengthen capacity for health and food systems to withstand climate variability; effective conflict resolution to prevent displacement and interruptions to agricultural production and food supply; mitigation of economic shocks to protect people from the rising cost of food and ensure access to nutritious foods; delivery of quality healthcare and basic water and sanitation services, particularly to low-income populations; and implementation of policies designed to improve living conditions to enable children to lead healthy and prosperous lives.

Now is the time to scale up multisectoral collaboration, interventions and investments to protect the survival, growth and development of children under five. Failure to tackle this problem is denying millions of children in sub-Saharan Africa the opportunity to reach their full potential, robbing Africa of its future. DM

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