Childhood Nutrition Vital to Achieving Mdg 1, 2, 4, 5

Childhood nutrition vital to achieving MDG 1, 2, 4, 5

Childhood malnutrition being the biggest contributor to child mortality and morbidity, continues to be one of the greatest social injustices affecting achievement of Millennium Development Goals (MDGs) especially MDG 1 (eradication of extreme poverty and hunger). Failure to achieve MDG 1 jeopardizes achievement of MDG 2 (achievement of universal primary education), MDG 4 (reducing child mortality) and MDG 5 (improvement in maternal health). Childhood malnutrition is one of the most common causes of morbidity and mortality among children under 5yrs worldwide with nearly 20 million children in sub-Saharan Africa and Asia suffering from it. Current estimates suggest about 1 million of these children die yearly. Childhood malnutrition is however preventable and treatable with cost-effective interventions. 

Causes of Childhood Malnutrition and Child Death

       Causes of childhood malnutrition and child death are two of the manifestations of a multi-sectoral development challenge which are as a result of three levels of complex and interlinked causes. These causes are categorized into immediate (which acts on individuals), underlying (acting on households and communities) and basic causes (acting on entire societies). The immediate causes are inadequate dietary intake and infectious disease whiles the underlying causes include household food insecurity, inadequate maternal and childcare practices and inadequate health services and health environment (poor water/ sanitation). In addition, the basic causes include formal and non-formal institutions, political and ideological (including religion, culture and tradition) superstructure, economic structure and potential resources. These underlying and basic factors are known as “the social determinants of health” which are conditions in which individuals are born, grow, live, work and age.

       The Social Determinants of Health are shaped by the distribution of money, power and resources at global, national and local levels, which are themselves influenced by policy choices. Thus Social Determinants of Health of childhood malnutrition include gender inequality, inequitable conditions of daily living (poor social protection policy), inadequate maternal and child care practices, unfair and lack of employment, poor governance, lack of political commitment, poverty, poor access to clean water and sanitation. According to World Health Organisation, access to and utilisation of maternal, child and nutrition is vital to reducing childhood malnutrition since the health-care system is itself a Social Determinants of Health of childhood malnutrition, influenced by and influencing the effect of other Social Determinants of Health. Education, occupation, income, ethnicity, and place of residence are closely linked to mothers and children’s access to, experiences of, and benefits derived from Maternal, Newborn, Child and Women’s Health and Nutrition Interventions.

Intervention Strategies to Addressing Childhood Malnutrition

       Efforts to address underlying causes of childhood malnutrition in Ghana should ensure that under-served districts and sub-districts are prioritized in efforts to scale-up and improve quality of priority Maternal, Newborn, Child and Women’s Health and Nutrition Interventions. The intervention should incorporate home-based post-natal care by Community Health Workers providing full package of community-based interventions. This should include support in caring for and breastfeeding their babies. Also, provision should be made for strengthening community-based child preventive services which includes immunization, growth monitoring and promotion, vitamin A supplementation and other micronutrients, regular deworming, measles elimination and polio eradication. Child health days or weeks must provide support, preventive and promotive services on infant and young child feeding to Early Childhood Development centres. These strategies will go a long way in reducing the challenge of long distance and cost in travelling to health facilities. Strategies should be implemented to address underlying poor childcare practices includes promotion of early and exclusive breastfeeding for infants for six months and thereafter giving appropriate complementary foods. Moreover, the Integrated School Health Programme should be strengthened through close collaboration between the Ministry of health, Ghana Health Service and Ministry of Education.

       Another underlying cause of childhood malnutrition is inadequate access to health services. In addressing lack of access to health services, efforts should be directed at prioritizing under-served districts and sub-districts in efforts to scale-up and improve the quality of priority Maternal, Newborn, Child and Women’s Health and Nutrition Interventions. In addition, there is the need to strengthen capacity of the health system to support its provision through ensuring appropriate resources (equipment, essential supplies and drugs, etc) are available at sub-district, district, regional and national levels.

       Focus should also be directed at strengthening human resource capacity, defining roles of different cadres of health workers, updating curricula of health professionals to ensure adequate strengthening of in-service training in Maternal, Newborn, Child and Women’s Health and Nutrition Interventions. Childhood malnutrition can also be prevented through the execution of environmental programmes such as improving access to sufficient safe and clean drinking water, sanitation and improvement in personal and domestic hygiene. This can only be achieved through the strengthening of multi-sectoral action to reduce poverty and inequity through improved access to basic services, especially improved water and adequate sanitation.

       Political action is vital in addressing basic causes or root causes including poor availability and control of resources, political, social, ideological and economic, poor agriculture, urbanisation, trade agreements, religious and cultural factors of childhood malnutrition. Since stakeholders have a key role to play in promoting improved health and nutrition which should involve the strengthening of inter-sectoral collaboration amongst government departments (example, Ministry of Rural Development, Ministry of Education, Ministry of Agriculture, Ministry of Women and Children Affairs, etc), local government, academic and research institutions, professional councils and associations, civil society, private health providers and development partners, including United Nations and other international and aid agencies. Strengthening partnerships with community structures to address gender issues through empowering women, children and men to participate in efforts to improve their health would contribute in addressing the challenge of childhood malnutrition. Furthermore, there should be strengthening of systems for monitoring and evaluation through institutionalise reviews of maternal, perinatal, neonatal and child deaths and strengthening routine health information systems for monitoring of nutrition services.