Global: $8.8 billion the magic malnutrition number?
In its report, Hungry for change, Save the Children focuses on eight countries where it says half of the world's malnourished children live: Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, India, Kenya, Sudan and Vietnam.
Political leaders have focused on agriculture and food security at the expense of nutrition in their response to global high food prices, Alex Rees, head of Save the Children's hunger reduction team, told IRIN.
"The nutrition MDG [Millennium Development Goal] has not had high-level political attention," he said. "Malnutrition has no champions....Malnutrition is typically everyone's business but no one's responsibility".
Five percent of the 19 million children suffering severe acute malnutrition reportedly receive treatment annually, while donor funding for nutrition interventions in 2008 amounted to just $2 per child under two in the 20 worst-affected countries, according to the Lancet.
Save the Children's Rees said: "Malnutrition should go right to the top and all the ministries involved in it report directly to the President's office."
The Ethiopian government is among a handful to have adopted this approach, which Rees said has made its response to malnutrition more effective.
The $8.8-billion price tag on Save the Children's plan is equivalent to the annual budget of the UK Department of International Development (DFID).
Save the Children says donors and governments must address the underlying economic causes of malnutrition through cash transfers or social protection schemes such as education and health subsidies.
"Economic barriers to a nutritious diet have not been adequately considered in donors' or governments' nutrition strategies," Rees told IRIN.
High food prices have pushed between four million and 10 million more children into malnutrition, according to World Bank and Save the Children statistics. While an average UK-based family will spend 9 percent of its income on food, rural families in parts of Ethiopia and Kenya spend as much as 80 percent.
Preliminary studies of the few existing nutrition-related cash transfer programmes show they can reduce the risk of children becoming malnourished, according to Save's report.
In one programme cash transfers to combat malnutrition in urban families in Colombia resulted in average birth weight increases of 578 grams.
The Save the Children package also pushes recommendations made by nutrition experts in a series of 2008 Lancet articles, including exclusive breastfeeding, micro-nutrient and fortified food supplements, nutrition and hygiene education and enhanced treatment for severe acute malnutrition.
The critical period for malnutrition is from conception to a child's second birthday, during which most developmental defects can occur.
Rees said while donors to date have been slow to make malnutrition prevention a priority, attitudes appear to be changing. DFID is launching a nutrition strategy soon and the European Commission has held high-level meetings on nutrition over the past year.
DFID will address the causes of under-nutrition in high-risk countries, including food insecurity, ill health, lack of social protection and gender inequality, according to its October nutrition report which forms the basis of its forthcoming strategy.
The World Food Programme launched a nutrition strategy last month and the World Bank is channeling more money to nutrition, recently hiring seven nutrition advisers, according to Rees.
National governments, donors and UN agencies working on nutrition need to coordinate their efforts so they are all working towards the same goal, Rees told IRIN.
UNICEF West Africa spokesperson Martin Dawes said UN agencies, NGOs, donors and the World Bank are starting to collaborate more closely on nutrition interventions.
The UN Standing Committee on Nutriton and European Commission are currently meeting to discuss stronger coordination and governance on nutrition.
"Certainly we could do better," said Dawes. "We need to advocate for a common agenda - one that includes not only the UN and NGO community, but donors as well - to accelerate the scale-up of proven interventions."
Value for money
Well-timed and -targeted early warning mechanisms can save governments millions of dollars in nutrition interventions, Rees said. In Niger, hit by a malnutrition crisis in 2005, it would have cost $1 a day per child to prevent acute malnutrition, but by July 2006 the cost of treatment had reached $480 per child, estimates the UN Office for the Coordination of Humanitarian Affairs.
In developing countries one child in three is chronically malnourished, while malnutrition accounts for 35 percent of child deaths annually, according to the UN.
Malnutrition reduces gross domestic product by 3 percent to 6 percent and costs billions of dollars in lost productivity and healthcare expenses, the UN says.
"Preventing malnutrition should appeal as much to ministries of finance as to ministries of health and social welfare," Rees said.