Associate Lecturer in Global Health, UNSW
Children – and countries – need proper nutrition to grow and develop. Good food does more than keep children alive and well. It also allows them to learn, play, participate and contribute to their world.
But undernutrition, when children don’t get enough nutrient-dense food, remains a major public health problem. This is especially true in many low- and middle-income countries.
Childhood stunting is a situation where undernutrition has left a child too short for his or her age. Stunting in children younger than five can have a long-term effect on physical development, cognitive development, educational performance and economic productivity in adulthood. It affects women’s ability to give birth to normal weight children. Stunting also holds back the productivity of nations and creates economic and social challenges among vulnerable groups.
This waste of potential in individuals and countries can be prevented, as long as the causes are properly understood and addressed. The United Nations’ goal is to end malnutrition by 2030. Before that, by 2025, it aims to achieve “internationally agreed targets on stunting and wasting in children under five years of age”.
My research on child undernutrition examined factors associated with stunting and severe stunting among children under five in Nigeria. The percentage of Nigeria’s children with stunting has remained unchanged since 2013: it is a shocking 37%.
Globally, stunting has declined from 32.5% to 21.9% between 2000 and 2018. But this decline is not equal across regions and countries. One-third of all undernourished children live in sub-Saharan Africa. Nigeria has one of the highest prevalences of undernutrition in the region.
The situation in Nigeria
According to the 2018 Nigeria Demographic and Health Survey report, 37% of Nigerian children aged between 6 and 59 months are stunted (short for their age); 7% are wasted (thin for their height); 22% are underweight (thin for their age); and 2% are overweight (heavy for their height).
Within Nigeria, there have been wide variations by geopolitical zone in the prevalence of stunting. The 2018 survey reports that stunting is most prevalent in the North West (57% of children under five in the region are stunted) and least prevalent in the South East (18% are stunted). These findings could be attributed to the overall status of women in each region. In the north, rates of teenage pregnancies are very high and women’s education levels are very low.
Though the nationwide estimate of wasting and underweight has declined in Nigeria, stunting persists. It shows that the National Strategic Plan of Action for Nutrition (2014-2019) has not achieved much in this regard.
The plan focused on the treatment of severe childhood wasting through community-based management of acute malnutrition. This approach involved timely detection of severe acute malnutrition in communities and provided homes with nutrient-dense food for children who do not have medical complications. As a result of these, childhood wasting declined from 18% in 2013 to 7% in 2018.
Progress with stunting would have been achieved if the plan had addressed the underlying causes. It is possible to reduce stunting through socioeconomic changes, infection control and dietary interventions.
My research suggests that interventions addressing childhood stunting should focus on improving women’s nutrition to reduce low birth size, improving household hygiene to reduce infections such as diarrhoea, and promoting exclusive breastfeeding as well as appropriate complementary and child feeding practices. At the community level, cash transfer programmes are needed, especially among uneducated mothers of low socioeconomic status. These should focus on the northern geopolitical zones of Nigeria.
Socioeconomic factors are the strongest contenders in addressing childhood stunting. Research conducted in Ghana,Nigeria and Tanzania has shown that improving maternal education and household income are two key strategies.
For instance, mothers with a lower level of education are less likely to have the information they need about child stunting. And mothers with low income may struggle to provide a nutritious and diversified diet.
Brazil experienced a significant decline in stunting from 1996 to 2007 by reducing socioeconomic inequalities. Two thirds of the decline was attributed to improvements in educating girls and mothers, household income, maternal and child health care, and water supply and sanitation services. Cash transfer programmes for low-income families were expanded.
For Nigeria to achieve a significant drop in childhood stunting, it urgently needs more community-based interventions which take into consideration socioeconomic inequalities. This will set the country on the path to achieving the global nutrition targets for 2025.
More government commitment to improve stunting in Nigeria is needed, most notably the education of girls and women. The education sector must work together with the health sector to incorporate valuable nutrition components into the school curriculum. Currently, the school curriculum does not provide much information about maternal and child nutrition, despite the high expectation that girls will shortly become caregivers.
Other commitments aimed at improving access to health care, water and sanitation, food security and appropriate childcare will also reduce stunting in Nigeria. Improvement in employment rates and the official minimum wage will increase household income resulting in more money being spent on appropriate food – and research has shown that cash transfer programmes could also be effective.