[Editorial] Child malnutrition: hungry for action

In 2020, the size and severity of the world's food crises reached a new peak in a global hunger surge that started 5 years ago. The Global Report on Food Crises, released on May 5, found that 155 million people were acutely food insecure and in need of urgent assistance in 2020, representing an increase of 20 million since 2019. Children facing these food crises are especially vulnerable to wasting and stunting. The 2021 child malnutrition estimates from UNICEF, WHO, and the World Bank Group corroborate these warnings, and also highlight the increasing prevalence of a third form of malnutrition: overweight.

Despite the dangers of malnutrition to the health and future potential of children worldwide, only about a quarter of countries are on track to meet the 2030 Sustainable Development Goals (SDGs) for stunting, wasting, and overweight. In the 55 countries or territories affected by food crises, 15·8 million children younger than 5 years were affected by wasting and 75·2 million were affected by stunting. Globally, these values climb higher still, reaching 45·4 million and 149·2 million, respectively. Most people in food crises and most children with malnutrition live in Africa or Asia, with northern Nigeria, Ethiopia, the DR Congo, and Sudan accounting for more than a third of all children affected by wasting in food crisis countries. The overlap of undernutrition and overnutrition—the double burden of malnutrition—faced by some countries (eg, Yemen and Egypt) further compounds these pressing and complex issues.

The causes of malnutrition are often intertwined and mutually reinforcing. Protracted conflicts, extreme weather events associated with climate change, and the economic fallout from the COVID-19 pandemic have worsened food insecurity. Conflict has impeded food access channels, severely impacting children's rights to a nutritious and diverse diet essential for their growth and development. For the third consecutive year, three conflict-affected countries—the DR Congo, Yemen, and Afghanistan—had the largest food-insecure populations; of the ten countries or territories with the highest prevalence of wasting, eight were afflicted by protracted conflicts. Extremely heavy rains and floods in parts of Africa, the Middle East, and south Asia in 2020 also contributed to rising acute food insecurity. Job and income losses caused by the COVID-19 pandemic have pushed many more families into poverty. Projected levels of malnutrition will set back progress made in the past three decades in reducing child mortality and threaten the human capital of millions of children and adolescents. The forecast for 2021 is dire—unless we act now.

Evidence on interventions to prevent and manage malnutrition has increased in the past decade. Given the common drivers behind undernutrition and overweight, double-duty interventions across the life course are crucial—eg, micronutrient supplementation, promotion of exclusive breastfeeding, complementary and therapeutic foods, and regulation of marketing of unhealthy foods and breast milk substitutes. Schools are essential in providing nutritious meals, malnutrition screening, and lifestyle modification interventions to promote nutritious diets and physical activity. None of these ideas are new, but there is an urgent need to scale up these programmes, strengthen their implementation, and adapt them to local contexts and cultures. Implementation research, pragmatic guidance, and agile programmes should be prioritised to improve the efficiency of delivering these life-saving interventions.This requires a renewed commitment from donors. Large-scale humanitarian access and assistance are urgently needed to avert famine in at least 20 countries, and an estimated US$2·3 billion in cash transfers is required this year to meet the immediate needs of the additional people at risk of hunger in fragile contexts. The G7 famine prevention and humanitarian crises compact, launched on May 5, is therefore welcome and necessary. But given its G7 presidency this year, the UK must show its commitment by reversing its drastic cuts of up to 80% (compared with 2019) in aid spending on vital nutrition services.

Tackling hunger and malnutrition will be necessary to achieve multiple SDGs, and there must be urgent and concerted action across the health, social protection, and agriculture sectors. The various international summits in 2021—eg, the G7, COP26, and the Nutrition for Growth Summit—are opportunities to accelerate efforts to alleviate hunger, improve maternal and child nutrition, and enhance the resilience of food systems to future disasters. With less than 10 years until the SDG deadline, there is no time to lose.

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DOI: https://doi.org/10.1016/S2352-4642(21)00170-X

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© 2021 Elsevier Ltd. All rights reserved.

ScienceDirectAccess this article on ScienceDirect Linked ArticlesDouble burden of malnutrition in children and adolescents in the Arab region

Amid the social and political challenges faced by the Arab region in recent decades, a rapid nutrition transition has also been evolving. With accelerated urbanisation and food system transitions, the region has consistently witnessed increases in the numbers of people who are overweight and obese, including among children and adolescents. At the same time, child stunting and acute malnutrition burdens linger inequitably across the region and remain particularly high in populations affected by conflict.

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