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Zero Hunger

Living Edition
| Editors: Walter Leal Filho, Anabela Marisa Azul, Luciana Brandli, Pinar Gökcin Özuyar, Tony Wall

Child Nutrition: Benchmarking Progress since Implementation of UN Sustainable Development Goals

  • Margaret LombeEmail author
  • Smitha Rao
  • Yoosun Chu
Living reference work entry
DOI: https://doi.org/10.1007/978-3-319-69626-3_85-1
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Synonyms

Definitions

The SDGs are seen as a globally agreed upon agenda providing nations with requisite standards for assessing performance on targets to promote welfare, improve health, and advance equity and environmental sustainability. Within this framework, child nutrition is conceptualized as a continuum reflecting the dietary needs of healthy children under the age of 5. Since child growth is accepted as a useful measure of child as well as overall health status worldwide, the World Health Organization (WHO) guidelines highlight four essential anthropometric indicators to estimate nutritional imbalances among children under the age of 5: stunting, wasting, overweight, and underweight. These indicators are articulated in SDG #2, providing guidelines for assessing the prevalence of stunting and malnutrition (defined as wasting and overweight) among children under the age of 5.

Child Nutrition: Introduction and Overview of Issue

This entry highlights the latest thinking, research, and evidence on child nutrition within the framework of the United Nations Sustainable Development Goals (UN-SDGs). Two targets relevant to child nutrition and health as articulated in SDG #2, achieving Zero Hunger (see Table 1), are spotlighted. The highlighted targets underscore the world’s commitment to addressing the continued prevalence of undernourishment, stunting, and malnutrition among children under age of 5 defined by wasting and overweight (UN General Assembly 2015).
Table 1

SDG #2 and child nutrition

Goal 2: Zero Hunger

2.1. By 2030, end hunger and ensure access by all people, in particular the poor and people in vulnerable situations, including infants, to safe, nutritious and sufficient food all year round.

365体育网站2.1.1. Prevalence of undernourishment

2.1.2. Prevalence of moderate or severe food insecurity in the population, based on the Food Insecurity Experience Scale (FIES)

2.2. By 2030, end all forms of malnutrition, including achieving, by 2025, the internationally agreed targets on stunting and wasting in children under 5 years of age, and address the nutritional needs of adolescent girls, pregnant and lactating women and older persons.

2.2.1. Prevalence of stunting (height for age < −2 standard deviation from the median of the World Health Organization (WHO) child growth standards) among children under 5 years of age.

2.2.2. Prevalence of malnutrition (weight for height > +2 or < −2 standard deviation from the median of the WHO child growth standards) among children under 5 years of age, by type (wasting and overweight)

Source: United Nations SDG Tracker (Ritchie and Mispy 2018; UNSTATS 2019)

This entry focuses on infants and children under the age of 5 and provides data across regions on the magnitude of child malnutrition. Beginning with the definitions of key concepts within child nutrition, the entry provides an overview of the issue across regions. Sub-Saharan Africa and South Asia are highlighted as areas in need of special attention. Key challenges in child undernutrition are underscored with a focus on correlates and measurement. Major global-, regional-, and national-level policies aimed at curbing child nutrition are presented. The entry closes with a reflection of key points and suggestions of ways forward in the areas of policy, practice, and scholarship.

The key indicators for measuring child nutritional imbalances as per the WHO guidelines are:
  • Wasting: Low weight for height. Wasting is defined as weight for height falling below 2 standard deviations of the WHO Child Growth Standards median (WHO 2010365体育网站) and is seen as a sign of extreme malnutrition. It is usually compounded by undernutrition and the presence of infectious diseases that are connected to compromised immunity and ability to withstand diseases into adulthood.

  • Underweight: Low weight for child’s age. Underweight is defined as weight for age falling below 2 standard deviations of the WHO Child Growth Standards median (Darrouzet-Nardi et al. 2016; WHO-UNICEF 2017; WHO 2010). Child underweight is one of the most common measures of child nutritional status for children under the age of 5. Severe child underweight is generally associated with high risk of child mortality.

  • Stunting: Low height for child’s age. Stunting is defined as impaired growth and development. It is assessed by height for age, i.e., a child under the age of 5 is considered stunted if her height is more than 2 standard deviations below the World Health Organization (WHO) Child Growth Standards median (WHO-UNICEF 2017; WHO 2010). Stunting is linked to poor or inadequate nutrition among children under the age of 5. This, in turn, is associated with higher morbidity and mortality. Other factors linked to stunting include delayed developmental milestones, inadequate psychosocial stimulation, poor school performance over the years, and a compromised life-course potential (WHO-UNICEF 2017; WHO 2010).

  • Obesity/overweight: High weight for child’s height. This is defined as weight for height over 2 standard deviations of the WHO Child Growth Standards median (WHO 2010). Childhood obesity increases the propensity of obesity as adults elevating the risk of both short- and long-term adverse health effects (Bhutta et al. 2013; WHO 2010).

Child Undernutrition: Magnitude of the Problem

Significant gains have been recorded toward eliminating hunger in the last half century; however, worldwide an estimated 820 million people are hungry and undernourished (FAO et al. 2019). This figure is expected to increase to about two billion people by the year 2050. Children are among some of the most vulnerable groups when it comes to addressing food security, facing compounded burdens of stunting, wasting, overweight, and low birthweight (FAO 2018; United Nations 2018). The data in place suggests that availability of adequate safe and nutritious food, particularly among infants and children, remains a challenge worldwide (FAO et al. 2019; FAO 2018; Smith et al. 2017). The internationally agreed upon targets on child undernutrition (for children under the age of 5) continue to be elusive, particularly in resource-poor countries (FAO 2018). According to the latest estimates, maternal and child malnutrition is responsible for 45% of mortality among children under the age of 5 (FAO et al. 2019).

Although the prevalence of stunting has declined since the year 2000, the challenge still remains urgent with nearly one in four children under 5 classified as stunted. Additionally, about 49 million children suffer from wasting, and roughly 41 million are said to be overweight (FAO et al. 2019; WHO 2017). The problem is particularly critical in low-resource regions of the world, particularly, sub-Saharan Africa and South Asia, regions reported to be most vulnerable to food insecurity. According to the latest statistics from the Food and Agricultural Organization (FAO), almost 239.1 million people in sub-Saharan Africa and 278.5 million in South Asia experienced undernourishment in 2018. The regions also reported higher rates of stunting at 33.6% and 34.4% and wasting 7.5% and 15.2% compared to the global average of 21.9% and 7.3%, respectively (UNICEF et al. 2019). The data also indicates that approximately half of all overweight children under the age of 5 lived in Asia, while a quarter lived in Africa (WHO-UNICEF 2017).

Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery. In fact, adult health risks, including obesity, hypertension, and diabetes, are greatly influenced by nutritional status during this critical period in childhood (Gupta and Thakur 2018; Speirs et al. 2016). Moreover, globally, child undernutrition accounts for about half of all mortality among children under the age of 5 (FAO et al. 2019). Failure to address child undernutrition during the first 1000 days of life compromises healthy development of children and their future productivity; it is detrimental to school performance, general welfare, economic growth, and national-building efforts and adversely impacts their life chances (Blesh et al. 2019; Ke and Ford-Jones 2015; Millimet and Roy 2015; Richter et al. 2017). Promoting child nutrition is, therefore, a moral and ethical imperative, a basic human right, and a key determinant of public health which is reflected in the global agenda articulated under Sustainable Development Goal #2 (UN General Assembly 2015).

Child Nutrition: The Main Challenges

Child undernutrition does not occur in a vacuum; it is influenced by food insecurity and poverty, which are propelled by multiple factors, often intertwined with one another (FSIN 2018). Current thinking suggests child undernutrition is influenced by three broad pathways: household, environment, and scholarship challenges. An overview of these is presented below.

Household-Level Factors

Poverty and economic vulnerabilities. Poverty has been highlighted as the principal cause of chronic food deprivation (FAO et al. 2019). Individuals and households living in poverty often cannot afford sufficient and nutritious food to enable them to live a healthy life. The landscape of poverty is often split into two levels: contextual (region and/or country) and household. The data point to South Asia and sub-Saharan Africa as the two regions with the highest poverty rates. Within these regions, India and Bangladesh and Ethiopia and the Democratic Republic of the Congo report higher rates of extreme poverty (FAO et al. 2019). Although the relationship between region/country level and child undernutrition is complex, economically vulnerable contexts tend to report high prevalence of child undernutrition (Dureab et al. 2019; FAO 2018; Howell et al. 2019; Smith et al. 2017). A similar picture emerges at the household level; children in low-resource and poor households tend to suffer from higher rates of malnutrition. The evidence also points to gendered differences in certain forms of undernutrition; being female emerges as a risk factor for malnutrition. Worldwide, a third of women in the reproductive age group are anemic (Bhutta et al. 2013; Development Initiatives 2018).

Maternal characteristics: caregiver’s level of education. A positive correlation between maternal education and child nutrition status is generally assumed; however the evidence does not present consensus on the effect of maternal education on child nutritional status (Abuya et al. 2012365体育网站). Maternal education could simply be a proxy for the socioeconomic conditions among many other things, necessitating the need to investigate this correlation using context-specific measures.

Maternal health. Undernutrition in children under the age of 5 is usually a result of poor maternal health along with poor access to health services, including reproductive health services and family planning (Bhutta et al. 2013; Development Initiatives 2018) and optimal feeding practices (Gupta and Thakur 2018). Investing in maternal health therefore continues to be an effective strategy to remedy the challenge of undernutrition and improve nutrition outcomes in children under the age of 5.

For global targets on maternal and infant nutrition, see World Health Assembly (WHA) and (Development Initiatives 2018; FSIN 2018, 2019).

Environmental Factors

Climate change and environmental degradation. Anthropogenic climate change is one of the biggest threats to achieving child nutrition (Blesh et al. 2019; IPCC 2018, 2019). The world’s poorest are most likely to depend on agriculture for subsistence (Castañeda et al. 2018), and erratic weather, droughts, and extreme weather events like floods are predicted to result in crop losses, adding to pressures on natural resources, lowering nutritional content of key cereals, and exacerbating food insecurity in already volatile regions of the world (Lloyd et al. 2011; Lobell and Gourdji 2012). Fluctuations in the market owing to climate change further impact those living in poverty (UN 2019). In 2017, two-thirds of the countries that experienced food crises due to climate and weather conditions countries were in Africa with the nutritional status of approximately 32 million people critically impacted (Blesh et al. 2019; IPCC 2018, 2019).

Conflict and civil unrest. Conflict and civil unrest continue to be dominant drivers of food insecurity and undernutrition affecting 21 countries worldwide in 2018 (FSIN 2019), with about 489 million of the 815 million hungry people living in countries affected by conflict (FSIN 2018). In fact, the highest levels of food insecurity and undernourishment are evident in countries which had recently undergone or were currently experiencing civil unrest/conflict (UNOCHA 2018, 2019). Myanmar and Afghanistan in Asia and Nigeria, South Sudan, and Democratic Republic of the Congo in sub-Saharan Africa have all experienced food insecurity. Civil unrest/conflict does not only destroy lives and livelihoods, it disrupts food production and agricultural development, exacerbating undernutrition particularly for women and children (See UNOCHA 2019365体育网站 for examples of conflict-induced food-insecure countries).

Governance. Poor governance along with absence of a comprehensive policy response and distribution obstacles are connected to hunger, malnutrition, and child undernutrition. Government action is the key mechanism through which SDG #2 and its targets can be achieved. Good governance accompanied by sound strategic goals of tackling the multidimensional challenges of child nutrition is a key element for promoting child nutrition.

Scholarship Challenges

Measurement is typically used to determine and monitor nutritional status at the individual and national levels. The data generated are essential in guiding care and treatment decisions; the design, implementation, monitoring, and evaluation of nutrition interventions; as well as policy decisions and resource allocation (Tuffrey and Hall 2016; Shim et al. 2014).

Generally, three primary measures are utilized to assess child undernutrition: self-report, biochemical, and anthropometric measures. Each represents its own unique merits and challenges. Self-report measures, although context specific, tend to be subjective and rely heavily on recall, limiting their accuracy and reliability (Shim et al. 2014). Biochemical measures often have limited utility in the assessment of child nutritional status in that they can change on a daily basis and may be affected by disease and appropriate facilities are not available in different regions. They are also very expensive to administer (Inelmen and Sergi 2006). Overall, anthropometric measures tend to have high utility in determining and monitoring child nutritional status. Their main challenges relate to interpretation and validity. For example, a child’s weight and height can be difficult to obtain, leading to problems of measurement validity.

Underutilization of theory. Despite broad consensus that child undernutrition is one of the most challenging global health issues of our time (WHO [NEWSROOM] 2018), scholarship on the subject has been largely atheoretical, limiting comprehensive understanding of the issue along with capacities to implement theory-driven interventions. For the most part, determinants of child undernutrition tend to be confined to a “black box” and remain unspecified (Benson 2008; Bronfenbrenner and Morris 1998). The current global momentum and commitment to address the problem of child undernutrition demand context-specific theory-informed responses to curb child undernutrition. This is only possible with theory-driven research. Utilizing Bronfenbrenner’s social ecological model for child development and child nutrition is helpful to locate the nested nature of organized social structures that affect child nutrition, at the household, environmental, as well as institutional levels (Bronfenbrenner and Morris 1998; Bruckauf and Cook 2017).

Sustainable Development Goal #2 and Child Nutrition: Regional and Global Performance

The SDG on Zero Hunger presents us with a global commitment to curb child undernutrition and specific yardstick to measure progress. The United Nations Children’s Fund (UNICEF), WHO, and World Bank jointly estimate the data on child malnutrition; these data are published annually. The latest estimation available is based on 2018 data (UNICEF et al. 2019). While there has been considerable effort in collecting data on child undernutrition, the challenge of lack of comparable, robust data confounded by the inconsistency in reporting at the country level still remains. Country-level data, on many indicators and targets, are not collected annually in many countries. For instance, only two countries reported the 2018 estimation on stunting. Furthermore, incidence data, reflecting the number of new cases across the year, is not available at the moment (UNICEF et al. 2019). Below, we present data on the three primary indicators of child undernutrition at the regional and global levels. Please note that Tables 2, 3, and 4 present statistics on performance on the targets based on data from UNICEF, WHO, and the World Bank. The UNDP, FAO, WFP, and WHO also put out other regional and global statistics and estimates of progress on child undernutrition.
Table 2

365体育网站Progress on wasting

 

2016

2017

2018

365体育网站% of wasted children under 5

365体育网站Number of wasted children under 5 (million)

365体育网站% of wasted children under 5

Number of wasted children under 5 (million)

% of wasted children under 5

365体育网站Number of wasted children under 5 (million)

365体育网站Global level

7.3

49.5

365体育网站Sub-Saharan Africa

7.6

13.3

South Asia

15.2

25.9

East Asia and the Pacific

2.9

4.5

Eastern Europe and Central Asia

2.0

0.6

365体育网站Western Europe

Latin America and the Caribbean

1.3

0.7

Middle East and North Africa

7.7

3.7

365体育网站North America

0.4

0.1

Note: The regional classification is based on UNICEF; means that no estimates are reported

365体育网站Source: UNICEF/WHO/World Bank joint child malnutrition estimates (global and regional), March 2019 edition

Table 3

365体育网站Progress on stunting

 

2016

2017

2018

% of stunted children under 5

365体育网站Number of stunted children under 5 (million)

365体育网站% of stunted children under 5

365体育网站Number of stunted children under 5 (million)

% of stunted children under 5

365体育网站Number of stunted children under 5 (million)

Global level

22.8

154.4

22.4

151.7

21.9

149

365体育网站Sub-Saharan Africa

34.3

57.7

33.8

57.9

33.3

57.9

South Asia

36.2

61.5

35.3

60.0

34.4

58.7

East Asia and the Pacific

9.6

15.0

9.0

14.0

8.4

13.0

365体育网站Eastern Europe and Central Asia

9.9

2.1

9.5

2.0

9.0

2.8

365体育网站Western Europe

Latin America and the Caribbean

9.7

5.2

9.3

5.0

9.0

4.8

Middle East and North Africa

15.5

7.6

15.1

7.4

14.7

7.1

North America

2.7

0.6

2.6

0.6

2.6

0.6

Note: The regional classification is based on UNICEF; means that no estimates are reported

365体育网站Source: UNICEF/WHO/World Bank joint child malnutrition estimates (global and regional), March 2019 edition

Table 4

Progress on overweight

 

2016

2017

2018

365体育网站% of overweight children under 5

365体育网站Number of overweight children under 5 (million)

365体育网站% of overweight children under 5

Number of overweight children under 5 (million)

% of overweight children under 5

Number of overweight children under 5 (million)

365体育网站Global level

5.8

39.2

5.8

39.6

5.9

40.1

365体育网站Sub-Saharan Africa

3.6

6.1

3.6

6.1

3.5

6.1

South Asia

3.0

5.1

3.0

5.1

3.1

5.2

East Asia and the Pacific

6.1

9.6

6.2

9.7

6.3

9.7

365体育网站Eastern Europe and Central Asia

14.0

3.0

14.4

3.1

14.9

4.5

Western Europe

365体育网站Estimates not reported

Estimates not reported

Estimates not reported

365体育网站Estimates not reported

Estimates not reported

Estimates not reported

365体育网站Latin America and the Caribbean

7.4

4.0

7.4

4.0

7.5

4.0

365体育网站Middle East and North Africa

10.9

5.4

11.0

5.4

11.2

5.4

North America

8.5

1.8

8.7

1.9

8.8

1.9

365体育网站Note: The regional classification is based on UNICEF

365体育网站Source: UNICEF/WHO/World Bank joint child malnutrition estimates (global and regional), March 2019 edition

Updated and comprehensive global and country-level statistics can be obtained at .

Responding to the Challenge: An Overview of Policies on Child Undernutrition

Efforts Prior to 2015

Efforts to tackle hunger and undernutrition around the world have been a mainstay in global policy instruments even before the SDGs were adopted in 2015. For instance, the Malabo Declaration on Accelerated Agricultural Growth and Transformation for Shared Prosperity and Improved Livelihoods was ratified in 2014 with the expressed view of centering agriculture in Africa’s development story (Olomola and Nwafor 2018). Policies such as Women, Infants, and Children (WIC) and Head Start in the USA, Sure Start in the UK, Integrated Child Development Scheme (ICDS) in India, Grade R (South Africa), and the Health, Population and Nutrition Sector Development Programme within Shishu Bikash Kendra (SBK) or child development centers in Bangladesh are examples of programs at the country level that have addressed early childhood development including nutritional and multi-sectoral services (Richter et al. 2017). At the global level, the World Health Organization’s Global Strategy on Diet, Physical Activity and Health of 2004 and the World Health Assembly’s comprehensive plan on maternal, infant, and young child nutrition of 2014 were instrumental in providing frameworks to help governments strengthen their food and nutrition policies (WHO 2014).

Effort during and Post 2016

A number of policy initiatives have been put in place to run concurrently with the SDGs. Prominent among these are policy measures to end hunger by 2030 which were implemented by the Global Parliamentary Summit against Hunger and Malnutrition in October 2018. These underscored the need to focus on vulnerable groups such as women, children, indigenous groups, and other marginalized communities with limited or no access to social services (FAO et al. 2019; FAO 2018; Global Parliamentary Summit 2018). Alongside these, high-income countries have enacted policies leading to the implementation of large-scale programs for early childhood development. The enhanced WIC and Head Start programs in the USA and Sure Start in the UK continue as initiatives to treat critically undernourished and malnourished children. Low- and middle-income countries have followed suit with active government interventions that often include prioritizing child development and building a component into existing health- and nutrition-oriented cash transfers to make maternal and child nutrition affordable. Under the National Cash Transfer Program (NCTP) in Nigeria, households with pregnant women and schoolgoing children receive N10,000 each month to help boost maternal and child nutrition and health status (Otekunrin et al. 2019). Other notable examples of enhanced policies include India’s (ICDS) that has shifted its focus to children under the age of 3, Bangladesh’s National Nutrition Policy and Health, Nutrition, and Population Strategic Investment Plan (HNPSIN) Sector Development Program within the SBK, and Africa Regional Nutrition Strategy (ARNS) and African Renewed Initiative for Stunting Elimination (ARISE) initiatives (Glover and Poole 2019; Ministry of Health and Family Welfare 2016; Richter et al. 2017; UNDESA 2015365体育网站). It is worth noting that while there a number of national-and regional-level initiatives that have been put in place, SDG #2 and the first two targets highlighted provide the most comprehensive global policy framework on child nutrition and its key correlates.

The Way Ahead

Health and nutrition are important starting points for interventions that can be scaled up and are crucial to attaining other SDGs (Richter et al. 2017). Millions of children are at risk of falling behind and not achieving their full human potential as a result of inadequate nutrition and living in extreme poverty. Some implications for scholarship, policy, and practice are presented below.

Scholarship

Availability of skewed data is a recurrent feature in child nutrition such that more is known about countries that have the resources to collect and analyze data, while a knowledge gap about the phenomenon in resource- and infrastructure-poor countries continues to exist. Regions reporting poor performance in child nutrition tend to be the regions with inadequate estimates and data inconsistencies. The observed data gaps are critical. Lack of data often means limited scholarship, translating into policy decisions and interventions that are not guided by evidence. Moreover, community-informed measures, oftentimes, tend to be left out of the conversation on child nutrition scholarship. Context-relevant measures informed by community actors need to be part of child nutrition scholarship. The social ecological framework offers scholars a model that takes into account the nested social structures at the micro, mezzo, and macro levels that influence child development and nutrition (Bronfenbrenner and Morris 1998; Bruckauf and Cook 2017).

Practice

Child nutrition is critical for health child development starting at conception. Therefore, both maternal antenatal health and the early years of a child’s life are crucial for child development and nutrition. Improving nutrition among women of childbearing age can go a long way in addressing the issue of child nutrition. Government and nongovernment interventions need to strengthen their focus on education, awareness, and increased access to nutritious foods especially among marginalized communities to meet the challenge of child nutrition at the regional and global levels.

Policy

Low- and middle-income countries, in particular, face critical policy-level challenges including poor or inadequate funding and inefficient monitoring along with policy implementation. Additionally, inefficient use of agricultural production and inputs has hindered the mandate of improving child nutrition (Olomola and Nwafor 2018; Otekunrin et al. 2019). There is need for political prioritization to address environmental and familial challenges for the creation of an enabling environment for children to thrive (Richter et al. 2017). Further, to improve the reach and impact of these policies, efficient delivery systems will be needed. International and multilateral collaborations are critical for boosting governmental effort to employ structural interventions, especially in regions where child undernutrition remains a challenge.

Cross-References

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Boston College School of Social WorkBostonUSA
  2. 2.Korea Institute for Health and Social AffairsYeongi-gunSouth Korea

Section editors and affiliations

  • Datu Buyung Agusdinata
    • 1
  1. 1.School of SustainabilityArizona State UniversityTempeUSA