Nearly half the children in drought-stricken South Madagascar are malnourished. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
AMBOVOMBE, Madagascar, Jul 8 2016 (IPS)

Voahevetse Fotetse can easily pass for a three-year-old even though he is six and a pupil at Ankilimafaitsy Primary School in Ambovombe district, Androy region, one of the most severely affected by the ongoing drought in the South of Madagascar.

“Fotetse is just like many of the pupils here who, due to chronic malnutrition, are much too small for their age, they are too short and too thin,” explains Seraphine Sasara, the school’s director.

The school has a total population of 348 – 72 boys and 276 girls – and they range from three to 15 years. Fewer boys stay in school as they spend most of their time helping on the farm or grazing the family livestock.

The tide, however, turns when the girls reach 15 years, at which point most are withdrawn from school and married off.

But in school or out of school, nearly half of the children in Southern Madagascar have not escaped malnutrition. The United Nations World Food Programme (WFP) says that stunting –  where children are too short for their age – affects at least 47 percent of children under five.“I feed my eight children on rice for breakfast and supper but for lunch, they have to eat cactus fruits." -- Mamy Perline

Compared to acute malnutrition, which can develop over a short period and is reversible, stunting has more far-reaching consequences.

“Stunting is a gradual and cumulative process during the 1,000 days from conception through the first two years of a child’s life,” Sasara told IPS.

It develops as a result of sustained poor dietary intake or repeated infections, or a combination of both.

“It is not just about a child being too short for their age, it has severe and irreversible consequences including risk of death, limited physical and cognitive capacities,” Sasara said.

Statistics show that two million children in this Southern African country are stunted, placing Madagascar fourth in the “Global Chronic Malnutrition” table.

In February this year, though the global acute malnutrition level reached an average of eight percent, it is much higher in many regions in Southern Madagascar where most districts have surpassed the critical threshold of 10 percent.

Rainfall deficit and recurrent drought in Southern Madagascar has led to the deterioration of household food security, which has had a significant impact on the nutritional status of children under five.

Sasara says that the situation has been worsened by the rice eating culture across Madagascar “where children eat rice for breakfast, lunch and supper.”

But Mamy Perline told IPS that even rice is not always available. “I feed my eight children on rice for breakfast and supper but for lunch, they have to eat cactus fruits,” she said.

According to the WFP, which runs a school feeding programme in affected districts, Tsihombe district in Androy region is the most affected, with an average of 14 percent of children under five presenting signs of acute malnutrition.

WFP estimates show that nearly 50 percent of the Malagasy children under five suffer from iron deficiency which causes anemia.

Consequently, of every 1,000 live births, 62 result in children dying before they reach five years.

The lack of clean water and proper sanitation has compounded the situation facing the South.

The education sector continues to bear the brunt of the severe drought, with statistics by various humanitarian agencies including WFP showing that the net primary education enrolment rate in Madagascar is on a downward spiral.

Though an estimated 96.2 percent of children were enrolled in 2006, the number had dwindled to 69.4 percent in 2012, with Sasara saying that the current enrolment is likely to be much lower as children are too hungry to stay in school.

This is the case in Tanandava village, Amboasary district, Anosy region, where hundreds of out of school children gather each day to receive a meal from the village canteen offered by Catholic Relief Services, a humanitarian agency working in the area.

WFP statistics further show that the number of out of school children between six and 12 years is estimated at 1.5 million, with regions such as Anosy, Androy and Atsimo Andrefana in the South of Madagascar which have high rates of food insecurity posting alarmingly low levels of school performance.

Since 2005 WFP has implemented a school feeding programme, providing daily fortified meals to nearly 300,000 children in 1,300 primary schools in the south of the country but also in the urban slums of Antananarivo, Tulear and Tamatave.

“The meals are fortified with micronutrients and are crucial in breaking the malnutrition cycle in this country,” Sasara said.

The school feeding programme is a joint community effort where parents are involved in the preparation of the food, therefore providing a platform for the implementation of other interventions geared towards improving the health and nutrition of vulnerable children.

These interventions access to water and sanitation, which are twin problems in this region.

“When it rains and water collects in potholes on the road, this is the water we collect in containers for drinking, cooking and washing. It does not matter how many cars or people have stepped into the water, it is the only source we have,” says Perline.

Given the increase in acute malnutrition, a contributing factor to child mortality, WFP supports the National Office for Nutrition through its Regional Office for Nutrition, which continues to provide supplementary feeding programs for the treatment of moderate acute malnutrition across villages in the South.

“Treating children affected by moderate acute malnutrition can reduce drastically the number of those affected by severe acute malnutrition and to restore an adequate nutritional status,” says Yves Christian, Head of Regional Office for Nutrition.

WFP is further providing technical assistance to the government at various levels that is expected to result in a nationally owned school feeding programme.

New modalities of school feeding will also be piloted at the start of the next school year later in September 2016.

Nepal has one of the highest rates of malnutrition in the world. Over 41 percent of the country’s children suffer from chronic malnutrition, predominantly in rural areas. Credit: Naresh Newar/IPS

By Jomo Kwame Sundaram
ROME, Mar 9 2015 (IPS)

In 2014, an estimated 805 million people – one in nine people worldwide – were estimated to be chronically hungry. All but 14 million of the world’s hungry live in developing countries, i.e., 791 million are in developing countries, where the share of the hungry has declined by less than half – from 23.4 per cent (1990-1992) to 13.5 per cent (2012-2014).

Progress uneven

Overall progress has been highly uneven. Some countries and regions have seen only slow progress in reducing hunger, while the absolute number of hungry has even increased in several cases. Marked differences in reducing undernourishment have persisted across regions.Nutrition failures are due not only to insufficient food access, but also to poor health conditions and the high incidence of diseases such as diarrhoea, malaria, HIV/AIDS and tuberculosis.

There have been significant reductions in both the estimated share and number of undernourished in most countries in South-East Asia, East Asia, Central Asia, Latin America and the Caribbean – where the target of halving the proportion of the hungry has been reached, or nearly reached.

Progress in sub-Saharan Africa has been more limited, and the region now has the highest prevalence of undernourishment. West Asia has seen a rise in the share of the hungry compared to 1990-1992, while progress in South Asia and Oceania has not been sufficient to meet the MDG hunger target by 2015.

In several countries, underweight (low weight-for-age) and stunting (inadequate length or height for age) persist among children, even when undernourishment is low and most people have access to sufficient food. Nutrition failures are due not only to insufficient food access, but also to poor health conditions and the high incidence of diseases such as diarrhoea, malaria, HIV/AIDS and tuberculosis.

One in seven children under five are underweight

An estimated 99 million children under five years of age were underweight in 2012. This represents a fall of 38 per cent from an estimated 160 million underweight children in 1990. Yet, 15 per cent, or about one in seven, of all children under five worldwide are underweight.

East Asia has led all regions with the largest decrease of underweight children between 1990 and 2012, followed by the Caucasus and Central Asia, Latin America and the Caribbean, and West Asia. While the proportion of underweight children was highest in South Asia, the region has also experienced the largest absolute decrease since 1990, contributing significantly to the global decrease over the period.

Despite a modest reduction in the proportion of underweight children, Sub-Saharan Africa was the only region where the number of undernourished children increased, rising from 27 million in 1990 to 32 million in 2012.

In 2013, about 17 per cent, or 98 million children under five years of age in developing countries were underweight. Underweight is most widespread in South Asia (30 per cent), followed by West Africa (21 per cent), Oceania and East Africa (both 19 per cent) and South-East Asia and Central Africa (both 16 per cent) and Southern Africa (12 per cent).

Underweight prevalence was below 10 per cent in 2013 in East, Central and West Asia, North Africa and Latin America and the Caribbean.

Globally, the proportion of underweight children under five years of age declined from 25 per cent to 15 per cent between 1990 and 2013. Africa experienced the smallest decrease, with underweight prevalence declining from 23 per cent in 1990 to 17 per cent in 2013, while in Asia, it fell from 32 per cent to 18 per cent, and in Latin America and the Caribbean, from 8 per cent to 3 per cent.

This means Asia and Latin America and the Caribbean are likely to meet the MDG target for underweight, while Africa is likely to fall short, achieving only about half of the reduction target. And although Asia as a whole is likely to meet the MDG target, underweight rates remain very high in South Asia (30 per cent). With its large, growing population, South Asia will be home to 53 million underweight children in 2013.

One in four children under five are stunted

Stunting is a better indicator than underweight for capturing the cumulative effects of child undernutrition and infection during the critical thousand day period from conception through the first two years of a child’s life. Stunting is also more common than underweight, with one in four children globally affected in 2012.

Stunting is caused by long-term inadequate dietary intake and continuing bouts of infection and disease, often beginning with maternal malnutrition, which leads to poor fetal growth, low birth weight and poor growth. Stunting causes permanent impairment to cognitive and physical development that can lower educational attainment and reduce adult incomes.

Although the prevalence of stunting in children under five fell from about 40 per cent in 1990 to 25 per cent in 2012, an estimated 161 million children under five in 2014 remained at risk of diminished cognitive and physical development due to chronic undernutrition.

Nearly all regions in the world have seen declines in the number of children affected by stunting. The exception is sub-Saharan Africa, where the number of stunted children increased by a third, from 44 million to 58 million between 1990 and 2012.

Lessons

In countries where low undernourishment coexists with high malnutrition, specially-designed nutrition-enhancing interventions may be crucial to address early childhood stunting. Improvements in nutrition generally require complementary policies, including improving health conditions, hygiene, water, sanitation and education. More sophisticated and creative approaches to coordination as well as adequate resources are needed.

The Second International Conference of Nutrition in Rome in November 2014 articulated coherent bases for accelerated progress to overcome all types of malnutrition (undernourishment, micronutrient deficiencies, obesity) and defined pathways to international cooperation and support for integrated national nutrition efforts.

The international community, including those in the U.N. system, must come together to improve coordination for a sustained effort against malnutrition over the next decade.

But with high levels of deprivation, unemployment and underemployment continuing and likely to prevail in the world for the foreseeable future, poverty and hunger are unlikely to be overcome without the extension of universal social protection to all in need.

Edited by Kitty Stapp

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By Jomo Kwame Sundaram
ROME, Sep 19 2014 (IPS)

At the 1996 World Food Summit (WFS), heads of government and the international community committed themselves to reducing the number of hungry people in the world by half. Five years later, the Millennium Development Goals (MDGs) lowered this level of ambition by only seeking to halve the proportion of the hungry.

Jomo Kwame Sundaram

The latest State of World Food Insecurity (SOFI) report for 2014 by the Rome-based Food and Agriculture Organization, World Food Programme and International Fund for Agricultural Development estimates that 805 million people – one in nine people worldwide – remain chronically hungry: 789 million are in developing countries where this share has declined from 23.4 to 13.5 percent.

By 2012-14, 63 developing countries had reached the MDG target – to either reduce the share of hungry people by half, or keep the share of the hungry under five percent – with several more on track to do so by 2015.

Some 25 countries have made more impressive progress, achieving the more ambitious WFS target of halving the number of hungry. However, the number of hungry people in the world has only declined by one-fifth from the billion estimated for 1990-92.

Major effort needed

The proportion of undernourished people – those regularly not able to consume enough food for an active and healthy life – has decreased from 23.4 percent in 1990–1992 to 13.5 percent in 2012–2014. This is significant because a large and growing number of countries show that achieving and sustaining rapid progress in reducing hunger is feasible.

However, the MDG target of halving the chronically undernourished people’s share of the world’s population by the end of 2015 cannot be met at the current rate of progress. Meeting the target is still possible, however, with a sufficient, immediate additional effort to accelerate progress, especially in countries which have showed little progress so far.

Progress uneven

“By 2012-14, 63 developing countries had reached the MDG target – to either reduce the share of hungry people by half, or keep the share of the hungry under five percent – with several more on track to do so by 2015”
Overall progress has been highly uneven. All but 14 million of the world’s hungry live in developing countries. Some countries and regions have seen only slow progress in reducing hunger, while the absolute number of hungry has even increased in several cases. While sub-Saharan Africa has the highest share of the chronically hungry, almost one in four, South Asia has the highest number, with over half a billion undernourished.

Marked differences in reducing undernourishment have persisted across regions. There have been significant reductions in both the estimated share and number of undernourished in most countries in Southeast Asia, East Asia, Central Asia, Latin America and the Caribbean – where the MDG target of halving the hunger rate has been reached, or nearly reached.

West Asia has seen a rise in the share of the hungry compared with 1990–1992, while progress in sub-Saharan Africa, South Asia and Oceania has not been sufficient to meet the MDG hunger target by 2015.

In several countries, underweight and stunting persist in children, even when undernourishment is low and most people have access to sufficient food. Such nutrition failures are due not only to insufficient food access, but also to poor health conditions and the high incidence of diseases such as diarrhoea, malaria, HIV/AIDS and tuberculosis.

Food security and nutrition

Hunger is conventionally measured in terms of the prevalence of undernourishment, the FAO estimate of chronic inadequacy of dietary energy. While such a measure is useful for estimating hunger, it needs to be complemented by more measures to capture other dimensions of food security.

SOFI’s suite of indicators measures different dimensions of food security. Information thus generated can guide priority policy actions. For example, in countries where low undernourishment coexists with high malnutrition, specially-designed nutrition-enhancing interventions may be crucial to address early childhood stunting.

With the post-2015 Sustainable Development Goals likely to seek to overcome hunger, food insecurity and malnutrition, FAO has recently developed and tested a new Food Insecurity Experience Scale (FIES) in over 150 countries to measure the severity of reported food insecurity.

Lessons

Improvements in nutrition generally require complementary policies, including improving health conditions, hygiene, water supply and education. More sophisticated and creative approaches to coordination and governance are needed, with more, and more effective, resources to end hunger and malnutrition in our lifetimes.

With high levels of deprivation, unemployment and underemployment continuing and likely to prevail in the world in the foreseeable future, poverty and hunger are unlikely to be overcome without universalising social protection to all in need, but also to provide the means for future livelihoods and resilience.

The forthcoming Second International Conference of Nutrition in Rome on November 19-21 is expected to articulate coherent bases for accelerated progress to overcome undernutrition as well as for greater international cooperation and support for enhanced and more integrated national nutrition efforts.

(Edited by Phil Harris)

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