Understanding Malnutrition and Responding Effectively

Children under the age of 5 are most at risk of death from malnutrition. As Figure 4.2 shows the odds of death from diarrhea, pneumonia, malaria, and measles are higher for children under 5 who are malnourished compared to those who are properly nourished.⁴

Children who lack adequate energy and protein suffer from what is known as “protein-energy malnutrition.” Children suffering from chronic protein-energy malnutrition become “stunted”—shorter than they should be for their age.  “Wasting” occurs when children suffer from acute food shortage (such as famine).  Wasting is what we see in photographs of emaciated children, such as the shocking images from Somalia in 2011.

Severe malnutrition poses an immediate threat to a child’s life, but more children die every year because of mild or moderate malnutrition.⁵

Humans also need micronutrients (vitamins and minerals) to lead a healthy and productive life. Micronutrient malnutrition may not always have obvious signs, but left untreated the consequences are serious. Zinc and Vitamin A deficiencies, for example, put children at increased risk of dying from diarrhea and malaria.⁶

Childhood death is not the only potential danger from malnutrition; multiple extended studies have shown that early childhood malnutrition also shapes lifelong development. Guatemalan adults who had been given a protein-enhanced nutrition supplement through age 2 were found to have better intellectual functioning than adults who had been given a sugar-sweetened nutrition supplement.⁷ Improvements in nutritional status through age 2 have lifelong impacts: studies in Brazil, Guatemala, India, the Philippines, and South Africa found that healthy weight gain until age 2 was associated with more years of schooling and lower risk of failing a grade—yet improvements made in a child’s nutritional status between ages 2 and 4 had little relationship to schooling outcomes.⁸

Maternal malnutrition also affects a child’s nutrition and health. Women who are underweight before pregnancy and who gain little weight during pregnancy are particularly at risk of giving birth to babies of low birth weight. Even excluding those born prematurely, babies who are born at low birth weight are more likely to die as newborns than babies born at a healthy weight. Babies born between 4 pounds, 6 ounces and 5 pounds, 8 ounces are 2.8 times as likely to die as newborns than heavier babies. This figure rises to 8.1 times as likely for full-term babies born between 3 pounds, 5 ounces and 4 pounds, 6 ounces.⁹

Inadequate levels of maternal iodine during pregnancy can cause brain damage in the child.¹⁰ Populations with high rates of chronic iodine deficiency have dramatically lower IQ scores—an average of 14 points lower.¹¹

A malnourished mother can produce breast milk containing all of the fat, protein, and carbohydrates (macronutrients) a baby needs. Only under famine or near-famine conditions would the macronutrient content of the milk be affected.¹² Babies given partial or no breastfeeding in the first few months of life are nearly 2.5 times as likely to die as babies who are breastfed exclusively.¹³ However, if a mother experiences certain micronutrient deficiencies, she requires micronutrient supplements in order to pass these micronutrients on to her baby.

Nutrition is critical throughout life, but nutrition from pregnancy to age 2 has dramatic potential to shape the trajectory of a child’s life. To reduce child mortality, interventions must cover all malnourished children, not simply those experiencing severe forms of malnutrition. Simple, cost-effective nutrition interventions would not only save millions of children from illness or death, it would also improve their health, intelligence, and productivity for the rest of their lives.

Because investing in the nutrition of children under age 2 has such a multiplier effect, agricultural development and food aid should focus particularly on targeting benefits to young children and pregnant mothers. Well-nourished young children become productive adults who have the potential to improve the outlook of entire nations.

Rebecca J. Vander Meulen is the director of community development for the Anglican Diocese of Niassa (Mozambique). From June 2011 to September 2011, she was a fellow in Bread for the World Institute.