Addressing malnutrition to improve national health

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Malnutrition is on the rise in every country in the world and is a leading global driver of disease. Malnutrition represents one of the biggest challenges facing the global community and directly affects one in three people in multiple forms, including undernourishment, overweight, mineral deficiencies and excess sugar, salt, fat or cholesterol levels.

The 2016 Global Nutrition Report (GNR), which was released on June 14 in seven cities around the globe – Beijing, Johannesburg, Nairobi, New Delhi, New York, Stockholm and Washington DC – provides an independent and annual review of the state of the world’s nutrition.

The report shows that 44 percent of countries with data available (57 out of 129 countries), now experience very serious levels of both undernutrition and adult overweight and obesity and that despite good progress in some countries, the world is off track to reduce and reverse the trend.

The report highlights the staggering economic costs of malnutrition, estimated at – 11 percent of GDP per year in Africa and Asia, as well as the critical gaps in investments and commitments. Malnutrition thus provides a serious challenge for every country and all members of society.

Over the last nine years, major international commitments have been made to reduce undernutrition. These were articulated at the World Summit for Children in 1990, the International Conference for Nutrition in 1992, and the World Food Summit in 1996. These Conferences emphasized the reduction of undernutrition as part of a broader strategy to eliminate poverty.

The establishment of the Sustainable Development Goals (SDGs) in 2015 and the UN’s labelling of the coming decade as the ‘Decade of Action on Nutrition’ shows that there is renewed awareness and commitment to tackling the varied challenges of malnutrition. At least 12 of the 17 SDGs goals are directly related to nutrition and contain nutrition related indicators, this reflects nutrition’s central role in achieving sustainable development, as well as its interrelationships with the majority of developments sectors.

Kenya has solid evidence of interventions that work to reduce undernutrition in children. Much of this is based on the declining rates of stunting, wasting and underweight reported in the latest Kenya Demographic Health Survey (KDHS) 2014. The Survey indicates that more than a quarter (26pc) of the children below five years are stunted down from 35pc in the 2008-09 KDHS, 11pc are underweight down from 16pc, and 4pc are wasted down from 7pc.

Yet, more needs to be done to address regional disparities and escalating nutrition rates. In addition, the challenges of other forms of malnutrition are significant, 28pc of Kenyans are either overweight or obese and 45pc experience high blood pressure, reported in the first Kenya STEPwise Survey (2015). These place a significant burden on our country’s health and economy.

Kenya has demonstrated significant commitment to meeting nutrition targets. Article 43 (1) (c) of the constitution recognizes nutrition as a human right. It states that every person has the right to be free from hunger and to access adequate food of acceptable quality. The very inclusion of this article demonstrates the collective will of the people to overcoming the burdens of malnutrition-but we know that the fight doesn’t stop there.

The Ministry of Health is keen to ensure that there is appropriate legislation to raise the profile of nutrition coordination. However, legislation and commitment alone are not enough. We need to transform the political commitments for action into on-the-ground actions. This will require significantly increasing the number and capacity of frontline workers. It will also require sustained support for strategies that promote good maternal nutrition, optimal breastfeeding, appropriate complementary feeding, early detection and management of illness and acute malnutrition; and improved water, sanitation and hygiene behaviours and conditions.

With collective efforts at international, national and county levels, ending malnutrition is both a credible and achievable goal. However, tackling malnutrition in all forms will require multi-faced actions across multiple sectors.

The global nutrition targets aim to; achieve a 40 percent reduction in the number of children under 5 who are stunted; reduce and maintain wasting in children under 5 at less than 5 percent; see no increase in overweight children under 5 years of age; achieve a 50 percent reduction of anaemia in women of reproductive age; achieve a 30 percent reduction in low birth weight; increase the rate of exclusive breastfeeding in the first 6 months to at least 50 percent; halt the rise in prevalence of adult overweight, adult obesity and adult type 2 diabetes; achieve a 30 percent reduction in salt intake (in adults).

To ensure that we reach these global goals, commitment must be associated with multi-sector investments in areas that affect nutrition, both directly and indirectly. Action Against malnutrition addresses nutrition on several fronts: identification and diagnosis, treatment and nutritional care, prevention and risk reduction, strengthening capacity and sustainability, research and innovation and political impact.

This means that civil society organizations, donors and businesses -as well as government–need to step up their efforts to direct more of the resources already invested in agriculture, education, food systems, health systems, social protection, and water, sanitation and hygiene (WASH) towards nutrition. These investments must also address data gaps, which present a significant roadblock to nutrition progress globally and in Kenya.

Recognizing and addressing the world’s malnutrition problem as one of the major underlying impediments to eradicating global poverty and economic growth will not only save lives, but also unleash the potential of our people to speed up Kenya’s development agenda.

(Dr Mailu is the Cabinet Secretary for Health)

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