The many faces of mal­nu­tri­tion

Financial Mirror (Cyprus) - - FRONT PAGE -

If you hap­pen to be sit­ting with two other peo­ple right now, chances are one of you is mal­nour­ished. And you might not even know it. Yes, that’s right: one in three peo­ple world­wide suf­fer from mal­nu­tri­tion, and it does not al­ways look the way one might ex­pect.

From the two bil­lion adults who carry too much weight to the 159 mil­lion chil­dren with stunted growth, mal­nu­tri­tion takes many forms. As a doc­tor, I see women who ap­pear healthy, but who suf­fer from anaemia, ow­ing partly to low iron in­take. And I see rel­a­tively able-bod­ied men with big bel­lies, which el­e­vate their risk for heart disease.

West Africa is home to some of the world’s high­est rates of mal­nu­tri­tion. That in­cludes the most ob­vi­ous “face” of the con­di­tion: roughly 9% of West African chil­dren un­der five are wasted, or too thin for their height. At its most se­vere, wast­ing is fa­tal.

But West Africa also suf­fers from many other forms of mal­nu­tri­tion. One-third of chil­dren un­der five in the re­gion are stunted (too short for their age), a con­di­tion with ir­re­versible ef­fects on cog­ni­tive de­vel­op­ment. Ac­cord­ing to the Cost of Hunger in Africa stud­ies, stunted chil­dren across the con­ti­nent re­ceive up to 3.6 fewer years of school­ing than well-nour­ished chil­dren.

The prob­lem does not af­fect only chil­dren. Half of all women of re­pro­duc­tive age in West Africa are anaemic. Not only does anaemia con­trib­ute to al­most one-fifth of global ma­ter­nal deaths; ba­bies born to anaemic women are also more likely to be un­der­weight. The re­sult is a vi­cious cy­cle of poor health. Per­haps the least ob­vi­ous face of mal­nu­tri­tion is not un­der­nu­tri­tion, but ex­ces­sive weight and obe­sity. To­day, 31% of adults in West Africa are over­weight or obese. In Nige­ria, my home coun­try, the share is 33%. Be­yond heart disease, that ex­tra weight raises the risk of di­a­betes, high blood pres­sure, stroke, and more.

Mal­nu­tri­tion also has se­ri­ous eco­nomic con­se­quences. The 2016 Global Nu­tri­tion Re­port es­ti­mates that, across Africa, mal­nu­tri­tion re­sults in a loss of 11% of GDP – more than the an­nual losses brought about by the 2008-2010 global fi­nan­cial cri­sis.

On an in­di­vid­ual level, adults who were stunted in their child­hood – a con­di­tion that has af­fected nearly 70% of the work­ing pop­u­la­tion in some ar­eas – of­ten face a di­min­ished ca­pac­ity to work and earn a liv­ing, ow­ing to the de­vel­op­men­tal chal­lenges they faced. The ef­fects of wast­ing on hu­man de­vel­op­ment and eco­nomic progress are al­most as pro­found.

The im­per­a­tive to tackle mal­nu­tri­tion could not be clearer. Yet progress has been mixed, par­tic­u­larly in West Africa.

To be sure, some coun­tries have had im­pres­sive suc­cess, thanks to de­ci­sive govern­ment ac­tion. In just a decade, Ghana cut stunt­ing by nearly half, partly through in­vest­ment in ar­eas that af­fect nu­tri­tion, such as agri­cul­ture and so­cial pro­tec­tion. Niger’s govern­ment halved the num­ber of deaths of chil­dren un­der the age of five over a sim­i­lar pe­riod, by mak­ing spe­cific bud­get and op­er­a­tional de­ci­sions to tackle se­vere wast­ing.

But other coun­tries have hardly made a dent in the mal­nu­tri­tion prob­lem. In Togo, stunt­ing rates have barely moved in the last decade. In Mali and Guinea, wast­ing is on the rise. And these coun­tries are not alone.

Many other African coun­tries may be



start writ­ing their own suc­cess sto­ries. Cote D’Ivoire has po­si­tioned it­self to re­duce stunt­ing, while Sene­gal is close to be­ing on track to ad­dress wast­ing. In both coun­tries, ex­tra in­vest­ment – both po­lit­i­cal and fi­nan­cial – could have an out­size im­pact.

Yet donors and gov­ern­ments re­main re­luc­tant to pro­vide the needed fund­ing. Ac­cord­ing to the 2016 Global Nu­tri­tion Re­port, donor funds for nu­tri­tion-fo­cused in­ter­ven­tions are stag­nat­ing at $1 bil­lion. Nine West African gov­ern­ments spend, on av­er­age, just over 1% of their bud­gets on nu­tri­tion.

And yet nu­tri­tion is one of the best in­vest­ments we can make, with ev­ery $1 in­vested in nu­tri­tion yield­ing $16 in re­turns. In many coun­tries, such as In­dia, obe­sity-re­lated ill­nesses like heart disease are con­sum­ing up to 30% of fam­i­lies’ an­nual in­comes. Un­less African gov­ern­ments start mak­ing smart choices and smart in­vest­ments, the con­ti­nent may face a sim­i­lar fate. Many African gov­ern­ments have set out am­bi­tious goals re­lat­ing to se­cu­rity, sta­bil­ity, and longterm eco­nomic pros­per­ity. Nu­tri­tion is crit­i­cal to achiev­ing any of them. It is cen­tral to our con­ti­nent’s de­vel­op­ment, and should thus be a high pri­or­ity for our pol­i­cy­mak­ers. Mil­lions of lives de­pend on it.

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