The race to eliminate malnutrition, one bowl of food at a time

 The health of millions of African children hangs in the balance as hunger and malnutrition continues to rob them of their futures.

According to the United Nations Children’s Fund (Unicef), millions of children under the age of five across the continent are not getting enough nutrients to grow and thrive. 

 “Malnutrition or nutrition is not about how much one eats, but what one eats,” explains Dr Souymya Swaminathan, chairperson of Swaminathan Research Foundation, a non-profit research organisation based in India.
 
“It all starts with what you eat. The problem is that we have a diverse nutritious diet that is not always affordable or available. If you look at the dinner plate of an average lower-income family in Africa, you will find mostly carbohydrates with little other nutrients. They are not eating like this because they want to but it is all they can afford,” she says. 

 She adds that most malnourished people may not be able to produce, or afford micronutrient-rich foods like meat, leafy green vegetables and fruit. 

“They are more concerned about what is cheap and fulfilling.”
 
In a rapidly warming world where climate change increasingly impacts food security, health and livelihoods, countries are being forced to rethink how they keep their populations, including children and expectant women, healthy and nourished. 
 
According to the 2024 Goalkeepers Report by the Bill & Melinda Gates Foundation, between 2024 and 2050, climate change will mean 40 million additional children will be stunted and 28 million additional children will be wasted.

Experts note that countries might not be able to escape this if they do not tackle malnutrition - if children are not getting the nutrients they need to grow and thrive. 
 
But all is not doom and gloom.

Some African nations are now implementing innovative solutions to reduce malnutrition in children under five, with impressive results recorded in improving child health and well-being. 
 
Healthy Nation has put together innovations from different countries that are transforming the fight against malnutrition. Experts say these scalable and cost-effective interventions can improve millions of lives, helping children thrive and reach their full potential.

 Biofortification of staple crops

 
Countries: Nigeria, Rwanda Zambia, India, Ethiopia, Uganda and Tanzania.
 
This involves breeding staple crops like maize, cassava, rice, and sweet potatoes to enhance their nutrient content, especially iron, zinc and vitamin A.

This innovation addresses micronutrient deficiencies known as “hidden hunger.”

When diets lack sufficient nutrients, millions of people in developing countries suffer from micronutrient malnutrition. This leads to health problems and loss of life on a massive scale. For example, vitamin A deficiencies are the leading cause of childhood blindness, while folate deficiencies are the leading cause of neural tube defects.
 
In Nigeria, it is being practised in cassava to provide high pro-vitamin A, in Zambia, corn to increase vitamin A, in Rwanda and the Democratic Republic of Congo, beans to increase iron, in India, pearl millet to increase high iron and zinc and in Ethiopia, salt to increase iodine. 

Nigeria is also doing large-scale fortification of bouillon cubes, a staple of local cuisine. According to data from the country’s Ministry of Health, it is estimated that fortified bouillon cubes could halve deaths and stillbirths from neural tube defects up to 11,000 per year and avert up to 16.6 million cases of anemia each year in Nigeria.
 
Malnutrition is still an underlying cause of nearly half of the deaths of children under five years old in Nigeria, according to the 2018 Nigeria Demographic Health Survey. 
 
Nigeria has the second-highest burden of stunted children in the world, with 37 per cent or six million children stunted annually, and seven per cent of children diagnosed with wasting each year; with the prevalence of folate deficiency remaining high; hence contributing to serious health outcomes such as stillbirths due to neural tube defects and anemia.
 
“Leaning heavily on what has made iodized salt programmes successful, we believe that these bouillon cubes would support ongoing strategies to combat micronutrient deficiencies “hidden hunger” here. While we all value a more nutritious diet filled with fresh fruits and vegetables, and rich in protein animal products, fortified bouillon can contribute to meeting the micronutrient needs of families as we continue to strengthen our overall food system for the future,” said Dr Muhammed Pate, coordinating minister of Health and Social Welfare. 
 
In Nigeria, vitamin A-enriched cassava has reached over 1.8 million households, significantly reducing vitamin A deficiency, which is critical for child vision and immune function. In Zambia, biofortified maize has improved the iron and zinc intake of thousands of households, addressing anaemia and stunted growth
. 
In Ethiopia, the production of iodized salt has eliminated iodine deficiency and the percentage of households using iodized salt has increased from less than 20 per cent to nearly 90 per cent, according to the data from World Health Organization. 
 
Ethiopia is now exploring adding another critical nutrient, folic acid, to iodized salt. They are testing a way to produce this “double fortified” salt nearly as cheaply as iodized salt without having to build new factories. 
 
“This approach has the potential to reduce devastating birth outcomes, including nearly eliminating three-quarters of all deaths and stillbirths due to neural tube defects, up to 5,000 per year in Ethiopia,” says data from the Ethiopian ministry of Health. 
 
In Tanzania, maize flour fortified with iron has reduced iron-deficiency anemia in children by 19 per cent, helping improve school performance and physical health, according to the data by the country’s Ministry of Health while in Uganda, fortified cooking oil and wheat have contributed to reduced cases of vitamin A deficiency, which impacts eye health and immune systems.
 
“Countries can adopt biofortification to improve the nutritional value of locally consumed crops, particularly in areas where diets lack variety. Governments can work with agricultural and food research institutions to introduce biofortified crops adapted to local growing conditions,” Dr Pate said. 

Micronutrient powders (MNPs)

 
Countries: Kenya, Rwanda, Pakistan
 
MNPs are single-dose sachets of vitamins and minerals that can be added to children's food. This low-cost solution tackles iron deficiency anemia and other micronutrient deficiencies.
 
In Kenya, the most common MNDs include iron, vitamin A and zinc. Among children aged six-59 months old, according to the data from the Ministry of Health.
 
One out of every four (26 per cent) children suffers from anaemia. Vitamin A Deficiency (VAD) affects one out of every 10 (9 per cent) children, with one out of every 2 (53per cent) children at risk of VAD (Marginal). Zinc deficiency affects eight out of every 10 (82 per cent) children.
 
“Zinc is an essential nutrient for growth and recovery from childhood illness such as diarrhoea; therefore, its deficiency can lead to stunted growth,” Dr Patrick Amoth, Health Director General said. 
 
Kenya targets children aged six–23 months, starting at the time when complementary foods are introduced and are likely to be given in limited varieties and quantities. An eligible child consumes 10 sachets of MNPs per month, receiving a minimum of 60 sachets within six months.
 
“The Ministry of Health is committed to addressing the triple burden of malnutrition as outlined in the Kenya Health Policy (2014-2030). One of the objectives of the Kenya Health Policy is to minimise exposure to health risk factors and promotion of control of micronutrient deficiencies is one of the interventions,” Dr Amoth said. 
 
In Kenya, MNPs distribution has reduced anemia among young children by up to 30 per cent. In Pakistan, the government’s large-scale MNP distribution programme has benefited over six million children, improving their growth and cognitive development.
 
Rwanda’s Ministry of Health in partnership with Unicef is giving expectant mothers micronutrient supplementation (MMS) with 15 essential micronutrients proven to reduce low birthweight, anemia, infant mortality, and stillbirths,  in seven districts with the highest rates of stunted growth are 
 
“Healthcare workers are providing women with the one pill that can help them stay healthy during pregnancy and give their children a better start in life. Since we started distributing MMS in January this year, we have reached over 50,000 women,” says Dr Sabin Nsanzimana, the Minister of Health in Rwanda.
 
“The supplements promote foetal growth and have the potential to accelerate our progress even further. When we set a child on a trajectory for healthy growth, we do the same for our whole country. Prenatal vitamins save lives. That’s why you can find them on grocery store shelves in wealthy nations. But for women in low- and middle-income countries, they are more essential and harder to find,” Dr Nsanzimana said. 
 
Dr Nsanzimana recommended that countries incorporate MNPs into national nutrition programmes through maternal and child health clinics, with governments ensuring that children in nutritionally vulnerable areas receive the essential micronutrients they need for proper development. 

School feeding programmes

 
Countries: Kenya, Ghana, Brazil
 
Access to quality nutrition is threatened by the rising cost of living. School feeding programmes provide nutritious meals to children during school hours, improving their nutritional intake and incentivising school attendance.
 
Kenya has a long history of school feeding from the late 70s when President Daniel Arap Moi introduced a small packet of milk, ‘Maziwa ya Nyayo” to public schools to increase attendance and enrollment.
 
The World Food Programme then began implementing a programme, along with the Ministry of Education, to feed primary schools in the arid and semi-arid lands of Kenya and in urban informal settlements. This shifted from development partner-led back to government-led.
 
In Kenya, the programme helped improve cognitive abilities, school attendance, and retention in underprivileged areas. In Ghana, a study titled “Nutritional quality and diversity in Ghana’s school feeding programme, revealed that nutritional status improved and stunting reduced by 10 per cent among primary school children, according to data of study findings published in the BMC Nutrition journal. In Brazil, the programme is part of a larger food security effort that has drastically reduced hunger and malnutrition rates in the last decade. 
 
 
Ready-to-use therapeutic foods (RUTF)Countries: Malawi, South Sudan, Somalia
 
RUTF is a high-energy, nutrient-dense paste used to treat children suffering from severe acute malnutrition. It requires no water for preparation and can be given at home. It can quickly help in the recovery of children.
 
A report by Unicef stated that 1.4 million children in South Sudan suffered from acute malnutrition in 2021 and 300,000 more will suffer from severe acute malnutrition, with some even at risk of dying.
 
In 2022, with funding from Unicef, a total of 2,094 children aged six-59 months in Juba with severe acute malnutrition were enrolled to World Vision’s Out-Patient Therapeutic Program. The children were provided with RUTF and out of those admitted and treated, 85 per cent were cured and discharged. 
 
In Malawi, the use of RUTF has reduced child mortality rates among severely malnourished children by 55 per cent. In Somalia, humanitarian efforts using RUTF have saved thousands of children’s lives in conflict and famine-hit regions, demonstrating the critical role of RUTF in emergency nutrition, according to the country’s Health ministry.
  

Mobile health solutions (mHealth)

 
Countries: Rwanda, Uganda and India
 
mHealth initiatives use mobile technology to provide nutritional advice, track child growth and deliver health reminders to mothers and caregivers. SMS services guide mothers on breastfeeding practices, feeding schedules and vaccination alerts.
 
A study on the evaluation of a mHealth tool to improve nutritional assessment among infants under six months in paediatric development clinics in rural Rwanda published in Maternal and Child Nutrition Journal in May 2021 revealed that there was great nutritional improvement to 90 per cent.
 
Findings suggest that integrating mHealth in providing nutrition interventions is feasible and may help in improving child nutrition outcomes. 

In Rwanda,  stunting declined from 59 per cent to 44 per cent. Underweight decreased from 47 per cent to 33 per cent. The proportion of infants with inadequate interval growth fell from 59 per cent to 26 per cent. The prevalence of wasting declined from 19 per cent to 10 per cent. 
 
India’s mHealth initiatives reach millions of mothers in rural areas, providing them with real-time data on their children's growth and vaccination schedules, leading to a 20 per cent increase in timely interventions for malnutrition.
 
A study published in the East Africa Science Journal on Mobile Health in Uganda revealed that mobile phone-based health innovations provide an affordable and flexible way to overcome the chronic challenges to healthcare delivery in the country, including the low doctor-to-patient ratio, long waiting times at health facilities and poor or non-existent patient follow-up systems. 
 
“Such mHealth services allow for large numbers of beneficiaries to be served at minimal expenditure of time and resources relative to traditional models of healthcare delivery, which require physical interactions in most circumstances. Mobile technologies are particularly useful for preventive interventions such as behavioural change communication for HIV/AIDS prevention and nutrition. 
 

Integrated nutrition and agriculture programmes

 
Countries: Ethiopia, Senegal
 
These programmes combine agriculture and nutrition interventions, promoting the cultivation of nutrient-rich crops and providing nutrition education to families. 
 
The Senegal government in partnership with Feed the Future increase food security and agriculture-led growth while boosting nutrition and reducing poverty.
 
The programme integrates agriculture and nutrition investments to enhance cognitive and physical development, increase economic productivity, strengthen resilience and advance global development.

From the project, 1.6 million children under five have been reached with nutrition help.
 
In Ethiopia, similar efforts to integrate agricultural productivity with nutrition education have significantly reduced child malnutrition rates, enhancing both food security and health outcomes. In Nepal, the integrated programmes have led to a 12 per cent reduction in stunting among under-five children by encouraging the consumption of diverse, nutrient-dense foods.
 
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