80% of acutely malnourished children untreated - Humanitarian leaders call for action
by UNICEF, Action Against Hunger, agencies
Alarmingly high number of children malnourished worldwide
Across the globe, at least one in three children under-five are malnourished and not developing properly, UNICEF revealed in its most comprehensive report on children, food and nutrition in 20 years.
“An alarmingly high number of children are suffering the consequences of poor diets and a food system that is failing them,” the UN children’s agency (UNICEF) warned.
Around 200 million children under-five are either undernourished or overweight, while one-in-three globally - and almost two-thirds of children between the fragile ages of six months to two years - are not fed food that nurtures proper development, The State of the World’s Children 2019: Children, food and nutrition, found.
The lack of adequate nutrition increases youngsters’ vulnerability to health problems, namely poor brain development, weak learning, low immunity, increased susceptibility to infections and in many cases, premature death.
Despite growing technological advances to address health and nutrition, the world has lost sight of “the most basic fact: If children eat poorly, they live poorly”, the agency’s Executive Director, Henrietta Fore said, explaining that millions of children are not living on healthy diets “because they simply do not have a better choice.”
“It is not just about getting children enough to eat; it is above all about getting them the right food to eat. That is our common challenge today”, she urged.
The problem of ‘hidden hunger’
The flagship report describes the “triple burden” of malnutrition: Undernutrition, overweight, and deficiencies in essential nutrients. While 149 million youngsters under-five have stunted growth, 50 million are too thin for their height - common signs of undernutrition.
Another 40 million in the same age bracket are overweight or obese, and at the same time, half of all children under five worldwide are not getting essential vitamins and nutrients, an issue UNICEF has dubbed “hidden hunger”.
Poor diets are being introduced at the onset of life, which prove particularly detrimental in the crucial first 1,000 days. Though breastfeeding is shown to be lifesaving, only 42 per cent of children under-six months of age are exclusively breastfed, with a growing reliance on infant formula, the report warns.
Milk substitute sales rose by 72 per cent between 2008 and 2013 in upper middle-income countries including Brazil, China and Turkey.
Breastfeeding has demonstrated it can supply a range of benefits, including lowering the likelihood of infant mortality, being overweight and obesity; and improving school performance.
As children reach school age, they are routinely exposed to unhealthy, ultra-processed foods, with some 42 per cent of adolescents in low- and middle-income countries consuming a sugary soft drink at least once daily, and 46 per cent eating fast food at least once a week. In high-income countries, the figures jump to 62 and 49 per cent, respectively.
The result in a young population globally which is chronically overweight, which has increased across every continent. From 2000–2016, the proportion of overweight children aged five to 19 years, rose from one-in-10, to almost one-in-five.
Children living in poverty, bear the greatest burden of all forms of malnutrition, with poorer families more inclined to purchase lower-quality, less costly food options.
The lack of healthy food perpetuates families’ poverty status across generations, with the challenges posed by environmental changes worsening the problem.
More families have abandoned the countryside to become city dwellers, more women have joined the workforce, while also balancing motherhood, and with the crisis of climate change, biodiversity, water, air quality and soil have all been degraded.
UNICEF offers recommendations for nutritious, safe and affordable diets for children across the world:
Empower families to reduce demand for unhealthy food. Incentivize food suppliers to provide healthy, affordable food. Create accurate, easy-to-understand labelling. Scale up nutrition by protecting water and sanitation systems. Collect and analyzing quality date to track progress.
The agency’s “systems approach” highlights the role of food, health, water and sanitation, social protection and education, in better feeding the world’s youngsters.
The placement of nutritional information can play a vital role as well, with evidence building that well-designed nutritional labels can positively affect consumer choice, regardless of being rich or poor; an incentive for manufacturers to create healthier products.
Overall, the effort to address faults in the food system must involve all sectors of society.
Child nutrition: the need for courageous action, by Richard Horton. (The Lancet)
Sally Davies has stepped down as Chief Medical Officer for England, using her final report to make strong and ambitious recommendations for the UK to stem childhood obesity. Her proposals include a cap on the calories per serving for food sold in restaurants and takeout outlets, a ban on eating and drinking on public transport, and the possibility of introducing plain packaging for unhealthy foods, similar to that used with success for tobacco.
Nearly a third of young people aged 5–19 years in the UK are overweight or obese. “Children”, Davies warns, “are drowning in a flood of unhealthy food and drink options”.
These suggestions have been criticised as too radical by some critics. Whether they make it into legislation remains to be seen. But in a Comment published by The Lancet last week, Davies and colleagues make the case that governments have a legal duty, not to mention any moral or practical reasons to prioritise children''''s wellbeing over commercial concerns. The UN Convention on the Rights of the Child, adopted 30 years ago next month, obliges signatories to act.
Contrast these proposals with those of UNICEF, which on Oct 15 published its 2019 report on the state of the world''s children — Children, food and nutrition—which covers undernutrition and overweight and obesity.
The report clearly quantifies the huge burden, but its suggestions to address malnutrition are largely a combination of the old (improve education on nutrition, provide food vouchers), the vague (“understand and leverage family and community dynamics”), and the weak (“…food producers should be discouraged from marketing nutrient-poor, sugar-rich, and highly processed food…”).
UNICEF''s leaders have defended the organisation''s record on health in a letter published online in The Lancet, identifying inadequate domestic spending on health and lack of donor support for multilateral agencies as barriers to “achieving much more” for children.
If UNICEF had put these criticisms of governments at the heart of its work on malnutrition, its call to action would have been more forceful. As it stands, the report is unlikely to gain traction.
We are in the midst of the UN Decade of Action on Nutrition and these reports are just two of many published recently that shed light on nutrition in children.
In considering them, several broad points emerge. First, global data mask the disproportionate burden in Africa and Asia. Undernutrition has seen some improvements globally—stunting has decreased from 26% of children in 2010, to 22% in 2018. But the number of stunted children in sub-Saharan Africa has grown, not fallen, since 2000.
India''s new Comprehensive National Nutrition Survey, 2016–18, shows that only 6·4% of children aged 2 years and younger get a minimum acceptable diet, and too few infants are exclusively breastfed up to 6 months of age. As a result, more than one in three Indian children younger than 5 years are stunted, and huge proportions of preschoolers are anaemic, lack vitamin A, or have zinc deficiency. The burden varies substantially by state and much of it falls on the children in the lowest socioeconomic groups.
The situation is no better for childhood overweight and obesity. The burden is increasing everywhere and, by 2030, an estimated 254 million people 5–19 years of age will be obese. Although rises in childhood overweight and obesity are at least starting to plateau in many high-income countries, they are accelerating in Asia and Africa as marketing of unhealthy food expands, diets shift, physical activity falls, and urbanisation occurs.
In 2018, roughly three-quarters of overweight children younger than 5 years lived in Asia and Africa. Since 2000, the number in Africa has increased by 44%.
Second, the harms of childhood malnutrition are pervasive. Health (both short term and long term), life expectancy, education, and employment prospects all suffer as a result of poor diet. Obesity can produce lasting stigma. Cycles of illness and poverty are perpetuated across generations.
And there are economic costs too: malnutrition exerts a sizeable toll on gross domestic product, so there is a financial pay-off to reducing it. For Organisation for Economic Co-operation and Development member countries, every US$1 invested in obesity prevention results in a return of $5·60.
Finally, there is an enduring need for fresh thinking and ambitious global leadership. Industry, governments, and other stakeholders need to be held to account.
Davies report gives an example of what is possible (as do the EAT-Lancet Commission and the Global Syndemic Commission). Childhood malnutrition is a burgeoning public health disaster. It is only with courageous new ideas, and clear lines of independent accountability, that there is any chance of meaningful progress. http://bit.ly/36dXoWK
Oct. 17, 2019
A child''s right to health, by Stefan Peterson, Luwei Pearson, Robin Nandy, Debra Jackson, David Hipgrave. (Unicef)
Richard Horton took issue with what he characterised as “the false narrative of ‘tremendous progress’” on maternal and child survival and health.
While the immense progress achieved on reducing child mortality by more than half since 1990 is unquestionably worth celebrating, Horton is correct in asserting that this progress remains inadequate and in reflecting on the remaining gross inequities. Certain population groups and regions lag well behind the majority, and 53 countries are unlikely to achieve the Sustainable Development Goal (SDG) 3 targets for maternal and child mortality unless progress is accelerated.
However, Horton also asserted that “health is no longer prioritised by UNICEF''s leadership”. This is incorrect. UNICEF continues to prioritise inequities and to reach the most vulnerable children with the health services they need to survive and thrive, but it is clear that multilateral agencies, including UNICEF, national governments, and the donor community, must do more to deliver better health outcomes for children.
Health is badly under-resourced globally, with many national health budgets well below recommended levels. In the ten countries with the highest median rates of child mortality in 2018 (where 1·55 million under-fives are estimated to have died), average government expenditure on health in 2016 was a mere 1·4% of gross domestic product, much less than the recommended 5%.
To implement primary health care in low-income and middle-income countries (LMICs) requires an additional US$200 billion to $300 billion annually.
While the overwhelming majority of health expenditure in LMICs is domestic, UNICEF (and multilateral agencies more broadly) are unquestionably important in plugging funding gaps and complementing national efforts to improve outcomes, particularly in poorly performing or fragile contexts with major technical and operational constraints. With adequate domestic and donor allocation and efficient use of resources, we could be achieving much more.
As Horton notes, the remaining mortality burden is concentrated in a handful of countries; these need a continued Millennium Development Goal-like response, with coordinated donor support focused on survival.
At the same time, in most countries, the broader focus on health and wellbeing for all through the SDGs is also appropriate. Health challenges are growing in complexity and diversity; we need contextualised responses in which global health partners collaborate to encourage and support governments to prioritise and oversee effective, quality health services.
Partners should contribute more broadly to the establishment of robust health systems that deliver quality primary health care near to where people live and work. Universal health coverage through primary health care should be assessed not only through service coverage and financial protection, but for reductions in mortality, including from neglected diseases like pneumonia (still the primary cause of death in children), and through measures of child and adolescent wellbeing.
UNICEF is strongly committed to supporting this broader agenda of helping children to not only survive but to also thrive, throughout childhood and adolescence, and to leveraging its multisectoral engagement to do so.
This is reflected in the agency''s Strategic Plan 2018–21, developed under the leadership of the executive director and the senior management team. It is also reflected in our budget: more than two-fifths of UNICEF''s budget is spent on maternal and child health in both development and humanitarian settings.
This year marks the 30th anniversary of the Convention on the Rights of the Child, and the right to health must be upheld and enforced in every country. The multilateral system and country governments should be held accountable for this right.
Progress is always worth celebrating, but renewed efforts are indeed urgently required to rapidly reduce the millions of easily preventable child and maternal deaths that still occur every year and to ensure that all children reach their full potential. http://bit.ly/2Wa9jAf
Mapping 123 million neonatal, infant and child deaths between 2000 and 2017. (Nature)
Here we quantified, for the period 2000–2017, the subnational variation in mortality rates and number of deaths of neonates, infants and children under 5 years of age within 99 low- and middle-income countries using a geostatistical survival model.
We estimated that 32% of children under 5 in these countries lived in districts that had attained rates of 25 or fewer child deaths per 1,000 live births by 2017, and that 58% of child deaths between 2000 and 2017 in these countries could have been averted in the absence of geographical inequality.
This study enables the identification of high-mortality clusters, patterns of progress and geographical inequalities to inform appropriate investments and implementations that will help to improve the health of all populations.
To pursue the ambitious Sustainable Development Goal (SDG) of the United Nations9 to “end preventable deaths of newborns and children under 5” by 2030, it is vital for decision-makers at all levels to better understand where, and at what ages, child survival remains most tenuous.
Gains in child survival varied substantially within the vast majority of countries from 2000 to 2017 we studied. Countries such as Vietnam, for example, showed more than fivefold variation in mortality rates across second administrative-level units. The inconsistency of successes, even at subnational levels, indicates how differences in health policy, financial resources, access to and use of health services, infrastructure, and economic development ultimately contribute to millions of lives cut short.
(Joint statement by: Action Against Hunger; ALIMA; Amref Health Africa ; Children''s Investment Fund Foundation; Concern Worldwide; Eleanor Crook Foundation ; International Rescue Comittee; Save the Children; World Vision).
Acute malnutrition is a major global public health threat. At least 50 million children under five suffer from acute malnutrition (an extreme loss of weight that impairs health), and nearly 50% of under five deaths are driven by malnutrition.
Acute malnutrition has been – and remains – highly treatable and preventable. Yet, despite the existence of life-saving treatment and two decades of work to reach those in need, current strategies reach less than 20% of affected children with care.
We are at a critical crossroads. We can choose to stay the course, leaving an estimated 80% of acutely malnourished children untreated. Or we can transform the system and save millions of lives. What’s holding us back?
The problem is four-fold:
The current approach to treating acute malnutrition is fragmented and unnecessarily complicated with moderate and severe acute malnutrition treated separately in systems overseen by two different UN agencies.
Diagnosis and treatment for acute malnutrition is complicated and confined to health facilities meaning the burden is on the parents and their children to travel long distances to access life-saving care.
Funding for acute malnutrition treatment does not match the scale of the crisis.
There is a lack of national ownership with ministries’ of health and finance often failing to adequately prioritize nutrition related policies and budget lines.
We see these challenges every day in the countries and communities where we work. Political will and financial investment is urgently needed to address each of these barriers.
We, a group of leading humanitarian and development organizations working in some of the hardest to reach places, are calling on world leaders – from UN officials to Ministries of Health – to accelerate action toward a more effective, efficient and accessible treatment system that leaves no child behind.
The time is ripe for action and accountability.
This past July, leaders from across the United Nations system announced they would develop a Global Action Plan on Wasting by the end of 2019 with a roadmap to address acute malnutrition.
This represents a critical first step toward the reform needed – we are eager to see this commitment translated into tangible action with treatment adequately addressed. With less than two months until the UN shares the most comprehensive plan on wasting in recent history, here are our recommendations for what the Global Action Plan (GAP) must include:
A commitment to simplifying the current treatment approach so that all children with acute malnutrition – regardless of the severity – are treated in a single program.
A time-bound blueprint for how the United Nations will change to a single treatment system, adopted by all UN agencies, with unified leadership in place to ensure strong oversight and accountability for the global system.
A clearly articulated vision and implementation plan for how the UN leadership will drive this systems-level change across UN entities at global and national levels.
A commitment to update the WHO treatment guidelines by mid-2021 through coordinated efforts to generate the operational evidence needed and to provide interim guidance where context-specific evidence already exists.
A commitment to promoting more continuum of care approaches linking treatment to prevention.
A roadmap for how the World Health Assembly (WHA) and Sustainable Development Goal (SDG) targets on wasting will be achieved with an emphasis on building national ownership.
A commitment to resource mobilization to secure the financing required to achieve the WHA wasting target by 2025 and SDG wasting targets by 2030, with Nutrition for Growth 2020 serving as a critical opportunity for donor and member state commitments.
A commitment to, and plan for, civil society engagement, in the GAP development and implementation.
And because we all have a responsibility, we stand ready to work together to ensure the Global Action Plan is ambitious, time bound, and offers concrete steps for addressing the realities of the crisis; to hold leadership accountable to the commitments made; to continue strengthening our programs, strategies, and partnerships that put a premium on expanding access to both curative and preventative services; and to advocate with Ministries of Health and Finance to see these solutions adopted into national health and nutrition action plans and budgets.
Now is the time to turn good will into action and to give this neglected health issue the attention and resources it deserves and requires.
Some global crises seem insurmountable. But this isn’t one of them. As we stand at this crossroads, we know we cannot stay the course. We must seize the opportunity presented by the Global Action Plan to positively disrupt the status quo. Now is the time to act.
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Minimum Standards for Child Protection in Humanitarian Action 2019
by Hani Mansourian
Alliance for Child Protection in Humanitarian Action
Today, one in four children lives in a country affected by conflict or disaster. Girls and boys face daily risks to their lives and threats to their future physical and mental health.
Evidence shows that illness, developmental challenges and even early death are connected to childhood hardship and exposure to violence. Children’s survival, well-being and healthy development are seriously jeopardised in humanitarian settings.
Given these immediate and long-term risks, it is an urgent priority for all those working in humanitarian settings to protect children from violence, abuse, exploitation and neglect.
While child protection actors play a central role, all sectors need to be involved in preventing and responding holistically to the risks and vulnerabilities that affect girls and boys in crises.
Humanitarian efforts must be predictable, swift, well-planned and responsive to children’s and families’own priorities. Actions need to be grounded in rights, informed by evidence and measurable in their results. It is also essential to strengthen the formal and informal systems that will continue to protect children after the emergency response is over.
Taken together, all these requirements comprise the inter-agency Minimum Standards for Child Protection in Humanitarian Action. Since their launch in 2012, the standards have contributed significantly to the professionalisation of the sector.
Widely known and used by child protection and other experts in humanitarian settings, they have markedly improved the quality of work. As part of the Humanitarian Standards Partnership, they have strengthened accountability to those served.
This second edition of Minimum Standards for Child Protection in Humanitarian Action has been realised through the hard work of over 1,900 individuals from 85 agencies and 82 countries. It is a true example of collaboration. This edition strengthens the standards’ emphasis on principles, evidence and prevention and increases their applicability to internal displacement and refugee contexts.
We believe these changes will further professionalise the sector and add to the rigour and quality of programmes at the field level. We urge all those involved in humanitarian action to take this opportunity to implement and promote these standards.
# Child protection is the prevention of and response to abuse, neglect, exploitation and violence against children. Effective child protection builds on existing capacities and strengthens preparedness before a crisis occurs. During humanitarian crises, timely interventions support the physical and emotional health, dignity and well-being of children, families and communities. Child protection saves lives.
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