Childhood Undernutrition in Sub-Saharan Africa
By K. Coco Zhang
Childhood undernutrition has been a major public health problem in low- and middle-income countries. It is a major cause of child mortality, contributing to nearly half of all deaths reported for children under five years of age. Suboptimal nutrition, especially in the first 1000 days of life, may stunt cognitive and socio-emotional development, reduce educational performance, and increase the risk of adult health problems. In addition, childhood undernutrition can decrease human capital and economic productivity in adulthood, resulting in decreased socioeconomic attainment. It also lowers immunity, thereby predisposing a child to a greater risk of infections. Infections can, in turn, contribute to undernutrition, which subsequently creates a vicious cycle of worsening illness and deteriorating nutritional status. The World Health Organization (WHO) classifies undernutrition as wasting, stunting, being underweight, and deficiencies in vitamins and minerals—also known as “hidden hunger.” Undernutrition is commonly assessed through a child’s anthropometric measurements, including height and weight, as well as through screenings for biochemical and clinical markers.
African countries have reported the highest prevalence of undernutrition globally, with a stunting prevalence of 30.7% in children under five in 2022, which is significantly higher than the global average of 22.3%. According to the Millennium Development Goal Report (2015), sub-Saharan Africa (SSA) accounts for a third of all undernourished children worldwide, thus buttressing the pressing need for nutrition-related intervention. Studies investigating the sub-regional prevalence of undernutrition in children under five revealed that stunting was the most prevalent in East African countries in the SSA region while wasting and being underweight were the most prevalent in West African countries.
The predictors of childhood undernutrition operate at different levels. Proximate factors, such as age, sex, birth size, birth order, and infections, affect the nutritional status of children at the individual level. Distal factors include those within the socio-cultural, economic, environmental, climatic, and political context. They influence food security, sanitation practices, access to healthcare services, and access to education at the community level.
An important factor contributing to childhood undernutrition in the SSA region is unfavourable climatic conditions, such as droughts and floods, which have negatively affected food production. The frequency of droughts and floods has increased over the past few decades and is likely to continue increasing due to climate change. This can further reduce agricultural productivity and worsen food insecurity in Africa. Therefore, policies and programs aimed at improving agricultural productivity, particularly in light of climate change, are crucial to improving food security in the SSA region. Climate-smart agriculture has been practiced in African countries to increase food security and resilience. In Rwanda, for example, the Land Husbandry, Water Harvesting, and Hillside Irrigation Project (LWH) has helped control erosion, increase the productivity of existing land, and provide greater protection from droughts. Under this program, maize yields increased nearly threefold between 2009 and 2018. In Senegal, the West Africa Agricultural Productivity Program (WAAPP) has developed new high-yielding, early-maturing, drought-resistant varieties of crops such as sorghum, millet, peanut, and cowpeas, which have raised yields by an average of 30%.
Moreover, poverty remains the principal cause of childhood undernutrition in SSA, with nearly half of the population living on less than $1.25 per day. The rapidly rising food prices across the world have further exacerbated food and nutrition crises for underprivileged households, particularly those residing in rural areas with limited access to basic health services. Addressing poverty, therefore, is critical in improving food security and childhood nutrition. The Poverty-Environment Initiative (PEI) Africa currently supports nine African countries, including Botswana, Burkina Faso, Kenya, Malawi, Mali, Mauritania, Mozambique, Rwanda, and Tanzania. PEI Africa has significantly contributed to the development of national-level and sectorial policies, sub-national development plans, and budget processes, with the objective of improving livelihoods, reducing poverty, and promoting sustainable growth.
Another well-established predictor of child health in SSA is maternal education. The existing literature highlights mothers’ educational attainment as a key to reducing child mortality, as educated mothers tend to be more receptive to new health-related information, more aware of appropriate healthcare practices, and more financially capable. Nutrition education programs carried out on African mothers have shown a positive effect on the mother’s knowledge and eating practices, as well as on the child’s nutritional intake and growth. However, given that food shortages are a latent problem in Africa, these programs need to be accompanied by other strategies, such as domestic agriculture or nutritional supplementation. In doing so, African households will be able to adhere to the recommendations and guidelines of a healthy diet to combat child malnutrition.
Overall, a multi-sectoral approach is vital in improving agricultural capacity, reducing poverty, achieving food security, and ultimately improving the nutritional status of children in SSA. Policies supporting cost-effective interventions around nutrition education, which take into consideration the socio-cultural and environmental peculiarities of various sub-regions, are urgently needed to tackle childhood undernutrition in SSA.