Interventions to Protect the Heart of the World

By: Thandiwe Kubere

The World Health Organization (WHO) is currently working towards advancing the global fight against acute malnutrition in children under five years with the launch of its new guideline on the prevention and management of wasting and nutritional oedema (acute malnutrition). This milestone is a crucial response to the persistent global issue of acute malnutrition, which affects millions of children worldwide.

In Lesotho, food insecurity remains a chronic challenge, hindering the country’s development and progress towards zero hunger. According to the World Food Program (WFP), despite some economic growth, Lesotho has been unable to address rural poverty and promote inclusive social development. Due to this reason, over a quarter of the population faces high levels of acute food insecurity and requires humanitarian action to reduce food gaps, protect and restore livelihoods, and prevent acute malnutrition.

Acute malnutrition is a condition that results from lack of sufficient nutrients in the body. It is characterized by a combination of varying degrees of under-nutrition with or without inflammatory activity that have led to a change in body composition and diminished function. Severe acute malnutrition (SAM) results from insufficient energy (kilocalories), fat, protein and/or other nutrients (vitamins and minerals, etc.) to cover individual needs, (Jensen, 2010).

Lesotho struggles with chronic malnutrition, particularly among children aged 2-3, with stunting (impaired growth due to malnutrition) rates at 34.5 percent. Micronutrient deficiencies (mainly iron and vitamin A) also remain a challenge, affecting more than half of children under 5. Almost half of children between 6 and 59 months suffer from iron deficiency anaemia. This can result in stunted development, which may become irreversible without iron supplements.

According WHO data published in 2020, Malnutrition Deaths in Lesotho reached 357 or 1.07% of total deaths, which ranked Lesotho number 13 in the world. Moreover, United Nations International Children Emergency Fund (UNICEF) revealed that nearly half of all deaths in children under 5 are attributed to under-nutrition; under-nutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery.

When a child is undernourished, the negative consequences follow that child for his/her entire life. These negative consequences also have grave effects on the economies where s/he lives, learns and works, stated Stephen Wong from WFP.

In 2015, the world committed to achieving the Sustainable Development Goals (SDGs), including the ambitious target of eliminating malnutrition in all of its forms by 2030. However, despite these commitments, the proportion of children with acute malnutrition has persisted at a worrying level, affecting an estimated 45 million children under five worldwide in 2022, (WHO, 2023).

As an intervention measure, the UNICEF-WHO-World Bank JME Working Group was established in 2011 to address the call for harmonized child malnutrition estimates that would be instrumental in benchmarking progress on child malnutrition. The first edition of the JME was released in 2012 and provided estimates for stunting, wasting, severe wasting, underweight and overweight, as well as a detailed description of the methodology (UNICEF & WHO, 2012).

World Vision’s Health and Nutrition Chief, Dan Irvine, argues that, when it comes to ending child malnutrition, an ounce of prevention is worth a pound of cure. “Some of us have now witnessed multiple famines in our lifetime, and will never be able to erase the tragic images of starving children from our minds, or conscience. Famines are a scourge on humanity, a scorching rebuke to our failed stewardship of God’s creation and our most precious responsibility– our children. There is no question that these crises demand urgent and comprehensive response, and that every child should be cared for. Over time, however, I have realized that the urgent is simply a symptom of a far greater tragedy: our collective failure to prevent all forms of malnutrition affecting children, and to invest in human and social resilience to the shocks that are inevitable.”

According to World Vision, half of the children under the ages of five globally, suffer from what is referred to as “hidden hunger” – their diets are insufficient to meet their nutritional needs. Subsequently, their physical health is undermined, as is their cognitive development, leading to poor lifetime health and livelihood outcomes. “These children will never know life in all its fullness. This chronic malnutrition is a starting point of vulnerability that often leads to more severe forms of malnutrition like stunting, wasting, or obesity. The marginalization of their human potential becomes intergenerational, as malnourished children become malnourished parents who struggle to prevent malnutrition in their own children.”

WHO report stated that in 2022, approximately 7.3 million children received treatment for severe acute malnutrition (SAM). Although treatment coverage has increased, children with SAM in many of the worst affected countries are still unable to access the full necessary care for them to recover.

The Global Action Plan (GAP) on child wasting recognized the need for updated normative guidance to support governments in the prevention and management of acute malnutrition. WHO answered this call to action and developed a comprehensive guideline that provides evidence-based recommendations and good practice statements and will be followed by guidance and tools for implementation.

WHO Director-General Dr Tedros Adhanom Ghebreyesus said, “This guideline helps to support countries to prevent and manage acute malnutrition with a specific emphasis on the continuum of care to deliver the best services possible for children and their families.”

“We are calling for more integration of nutrition services into health systems and the strengthening of those health systems.  This is a more comprehensive approach to address the complex issue of acute malnutrition in children than ever before.”

This is the first WHO guideline focusing on both prevention and management of acute malnutrition and highlights the vital importance of investing in both these aspects to have real impact on reducing the prevalence and negative impacts of acute malnutrition on children and their families around the world.

According to the report, Key recommendations of the guideline focus on:

Child-centred approach and of caring for mothers and their infants as an interdependent pair;

Breastfeeding and access to nutrient-dense home diets are a critical component of both prevention and management; and

Community health workers can play an important role in providing evidence-based care for children with acute malnutrition.

WHO is working closely with UNICEF and the other UN agencies collaborating on GAP to develop pragmatic operational guidance that will help policy-makers, programme managers and health workers implement the guideline. This will be done in collaboration with experienced practitioners and programmers through the convening of an official UNICEF-WHO Technical Advisory Group which will also bring in academics and other key stakeholders to develop and prioritise a research agenda.

In addition, regional and country workshops are ongoing and other activities planned for wide stakeholder involvement in how WHO can support Member States and implementing partners in adapting this global guidance to their specific context for meaningful implementation and impact.

This intervention efforts go in line with World Vision’s statement: ‘Our vision for every child, life in all its fullness, our prayer for every heart and the will to make it so.’