STOP STUNTING Good nutrition vital for children’s health.

  It is time the SUN must rise; rays of sunshine should touch lives of millions of children and women suffering from malnutrition who  deserve equal dignity, health and economic opportunity. Every year, stunting is the cause of one million child deaths around the world. For the children who survive, stunting in infancy and early childhood causes lasting damage, including poor cognition and education performance, reduced lean body mass, lower productivity, reduced adult wages and pregnancy complications. ¨While childhood stunting was estimated to drop globally from 40% in 1990 to 25% in 2013, Asia as a whole showed a dramatic decrease over the same period, nearly halving the number of stunted children from 190 million  to 100 million.This shows a heavy trend in stunting reduction over time, a global and regional feature. This trend is expected to reach 21.8%, or 142 million, in 2020, globally, and Asia to drop below the symbolic threshold of 20% by 2020.

Risk factors for childhood Stunting

The most pervasive and dominant factor underlying maternal and  child undernutrition is widespread poverty and food insecurity. These are also compounded by poor and unhygienic living conditions, little access to safe water and adequate sanitation that exposes children to high rates of intestinal infections and diarrhea. Beside these, lowest rates for the early  initiation of breastfeeding, exclusive  breastfeeding rates and timely  initiation of complementary feeding, and the highest rate  for bottle-feeding are also the contributing factors.

Role of UNICEF

Child stunting has become a global development priority. UNICEF will continue to focus efforts in the first 1000 days of a child’s life, starting from conception. Programs also emphasize actions that improve the nutritional status of mothers and pregnant/lactating women. Further, the focus is shifting from curative only approaches to both curative and preventive approaches.

IMPORTANT ACTIONS

  Integrating nutrition into government strategies.

UNICEF has been working tirelessly to ensure children and women’s nutrition is included in the national agenda.

UNICEF is currently supporting the development of a National Infant and Young Child Feeding (IYCF) Practices Strategy and guidelines to promote IYCF care practices.

The Pakistan Integrated Nutrition Strategy (PINS), supported by UNICEF, was also formulated and used as a strategic framework to guide provinces to define nutrition in their provincial post devolution development agendas. As a result, inter-sectoral nutrition policy guidance notes and strategies were developed by four provinces in Pakistan.

UNICEF’s Programs

It has been recognized that a reduction in the prevalence of child stunting calls for a multi-sectoral response.

UNICEF’s programs are both nutrition specific and nutrition sensitive.

     NUTRITION SPECIFIC

1.Improving breastfeeding practices.

2.Improve the quality of complementary foods for children aged 6-23 months.

3.Improving women’s nutritional status.

4. Preventing micronutrient deficiencies among pregnant and lactating mothers.

5.Improving early detection and treatment of severe wasting in young children.

6. Improving women’s nutrition, especially for adolescent girls and mothers.

¨It has been recognized that a reduction in the prevalence of child stunting calls for a multi-sectoral response.

¨UNICEF’s programs are both nutrition specific and nutrition sensitive

     UNICEF and Partners

  UNICEF will work with partners towards:

1.High-level country political commitment to improve nutrition governance and programs.

2.Nutrition- specific and nutrition-sensitive interventions and programs  implemented countrywide.

3.Strengthening of institutional and human capacity to manage nutrition programs

4.Improved knowledge-management systems and evidence generation..

5.  Renewed focus on food fortification.

6. Developing a multiyear, multi-sectoral strategy for stunting reduction,  collaborating with all relevant UNICEF sections and external  partners.

7.Developing an evidence-based and multi-sectoral communication strategy in  coordination with Pakistan’s Planning Commission and the Ministry of National Health Services, Regulation and Coordination.

Promoting inter-sectoral programs

   NUTRITION SENSITIVE

1.Integrating nutrition and WASH behavior messages to improve  family and  community hygiene practices.

2.   Ensuring UNICEF multi-sector programs are aligned to leverage the effects  on stunting prevention.

The World Bank

On May 26, 2017, the World Bank approved a fund of $61.6 million to reduce stunting in Pakistan over the next 25 years through the Sindh Enhancing Response to Reduce Stunting Project.The stunting problem is an education issue as well as a health issue. In the long-term, stunted children may have a hard time getting an education due to arrested mental development. According to Illango Patchamuthu, the World Bank Country Director for Pakistan, stunting “puts them at a permanent disadvantage in the age of the knowledge economy.” ¨The World Bank recognizes the different consequences of stunting, and according to the Sindh Enhancing Response to Reduce Stunting Project, its strategy to reduce stunting will be two-fold.

1.Address stunting directly by expanding a “package of services” that focus   on nutrition practices.

2.The  project will attempt to establish a cash transfer program. Cash transfers are a form of direct monetary aid that can allow poor families affected by stunting easier access to nutritious food.

Urban versus Rural: It is evident that the percentage of stunting is much higher among children whose mothers are illiterate versus those whose mothers have completed at least 10 years of education.

How to reduce stunting

It is imperative to focus on factors including improving maternal nutrition and antenatal care; especially the nutrition of adolescent girls and young mothers. Low literacy rates especially among women, their lack of empowerment and involvement in decision-making, early marriages, high fertility rates with a lack of birth spacing, and poor access to healthcare facilities are all important determinants of child and maternal malnutrition.Low levels of education, especially awareness of maternal care are also important drivers of under-nutrition largely through improper feeding or dietary practices.Major contributor to childhood malnutrition is the overall poor state of infant and young child feeding.

LOOKING FORWARD

1.Child feeding: Improving the quality of  complementary foods for children aged 6-23 months.

2. Improving breastfeeding rates and decreasing the high use of infant formulas.

3. Women’s nutrition: Improving women’s food intake (quantity and quality) along the lifecycle.

4. Household sanitation: Improving family and community hygiene practices,    with a particular emphasis on washing hands with soap after defecation and   before child feeding.

Recommendations

Regular monitoring and accountability is critical. There is need for integrating various different sectors and programs to achieve the desired results effectively and efficiently as many of the determinants and influencing factors are outside the health sector.

Policymakers need to recognize the importance of improved child health and nutrition for national development.

Bringing health and nutrition services closer to women and children and addressing social determinants, such as poverty and lack of women’s empowerment would make the difference.

Pakistan has an extensive existing lady health workers program, that, with improvements, can pave the way to reduce these inequalities.

An enhanced focus on promoting exclusive breastfeeding and appropriate complementary feeding through mass media campaigns and existing programs should be prioritized.

Religious leaders, school teachers and social mobilisers can play an important role in promoting exclusive breastfeeding and appropriate complementary feeding.

Healthcare providers must be trained in practices that promote nutrition adequacy for mothers and children, including those that advocate healthy lifestyles, nutrition and physical activity.

Acknowledgement:

¨PROGRESS REPORT 2013-2015/ STOP STUNTING, UNICEF.

¨Losing a generation: the impact of malnutrition, By Zulfiqar A Bhutta