Undoubtedly, Madagascar is a country located on an island off Africa’s south-eastern coast and is the fourth-largest island in the world. 1.8 million or 47% of the children below 5 years are stunt. This data obtained from Madagascar related to child stunting is the highest among all the countries in the world. As stated by the World Health Organisation (WHO), Globally around 155 million children below the age of 5 years suffered from Stunting in 2016. Poverty and weaker healthcare system have obstructed attempts for the implementations of interventions. So, some important determinants of malnutrition include Intergenerational transmission of growth failing as well as exposure to early life.

Undoubtedly, in the determination of health in the later stages of childhood, the most important aspect during the first 1000 days. The Linear growth or Height – for – Age among the children can change rapidly until 2 years of age. In Weight – for – Height, variability exhibits more. It shifts to 1 year of age, and since then it tends to recover. Malnutrition predicts low socio-economic position in the first year of life of adulthood. So, chronic malnutrition is the greatest barrier to the potential of a child’s development. One out of two children is a stunt in Madagascar. So, its annual Malnourishment costs are 7 – 12 % of the Gross Domestic Product (GDP).

WHAT IS MALNUTRITION?

Malnutrition is a term used for referring deficiencies and imbalances in the intake of nutrients by a person. Moreover, malnutrition is mainly classified into two groups based on their characteristics which are as follows:

  • Undernutrition
  • Overnutrition

Undernutrition

It includes stunting, wasting, underweight and micronutrient deficiencies. Undernutrition makes children vulnerable to illness and death. Wasting is the term used for the low weight for height. Moreover, there is a severe drop in a person’s weight.

Stunting is the term used for low height for age. It occurs due to chronic undernutrition caused due to poor socio-economic conditions, faulty maternal and nutritional health. Additionally, recurrent illness as well as early-life improper feeding and the care of infants as well as younger children. Achieving physical and cognitive capacity is prevented in children due to stunting. Low weight for age is referred to as underweight which makes children vulnerable to disease, illness or death.

Overnutrition

Overnutrition is used to refer to deficiencies and imbalances in the intake of nutrients by a person. It includes overweight, obesity and Non-communicable diseases (NCD) related to diet. Micronutrients deficiency is the inadequacies during the intake of vitamins and minerals. Vitamin A, Iodine and iron are important micronutrients for global public health. An insufficiency in these micronutrients is a major threat to the world’s health and development.

Overweight as well as obesity is when a person’s weight is too high. To differentiate between Overweight and Obesity it uses The Body mass index (BMI). It represents in meters by the square of the height divide by the weight of a person in kilograms. Overweight as well as obesity results due to a disparity in the consumed energy (input) and expended energy (output). Non – Communicable Diseases (NCD) are linked to a diet. It includes Cardiovascular disorders like Hypertension, Angina Pectoris, Congestive Cardiac Failure, Cardiac Arrhythmias. Moreover, Type – II Diabetes Mellitus. Globally, unhealthy diets which include a large number of junk foods and insufficient nutrition are the main risk factors.

Malnutrition is further classified into the following subtypes:

  • Acute Malnutrition
  • Chronic Malnutrition

Acute Malnutrition

Martin Vogl described Acute Malnutrition as a condition where a child suffers when there is a severe lack of food. Sometimes, children suffering from acute malnutrition are very thin, and they can have a swollen abdomen and limbs at times.

Chronic Malnutrition

Martin Vogl described Chronic Malnutrition as a condition where there is a lack of essential nutrients in a person. The external symptoms of chronic malnutrition are not as easy to find. Children with chronic malnutrition are smaller and thinner than other children of the same age, otherwise they may look fairly healthy. The tragic thing about chronic malnutrition is that it’s having long-term effects on the brain development of children.

STEPS TAKEN TO PREVENT OR REDUCE CHILD STUNTING IN MADAGASCAR

In Madagascar, poverty and a weaker healthcare system have slowed down the attempts for the implementation of various interventions related to malnutrition for saving their lives during the critical phases of faltering growth. Some important determinants of malnutrition include Intergenerational transmission of growth failing as well as exposure to early life. So, Malnutrition is the greatest hindrance to the ability of a child and the long – term production of human resources and economic growth of Madagascar. One child in two is a stunt in Madagascar. Furthermore, the annual cost of the national measures at 7 to 12% of the Gross Domestic Product (GDP).

STUNTING

Stunting is a red flag indicator. It associates with a variety of issues such as low dietary awareness, poor approach to healthcare facilities, water, sanitation as well as dietary behaviours. Madagascar’s government is planning and implementing various methods to reduce stunting by the year 2021 from 47 % of the total affected child population to 38 %. As of 2013, the national overweight prevalence of children below five years of age is 1.1 %, which fell from 6.2 % in 2004.

The national stunting prevalence of children below five years of age is 48.9 %, which is significantly higher than the 25 % average of the world’s developed countries. Conversely, the age group of under 5 years, the waste prevalence of 7.9 % in Madagascar is lower than the 8.9 % average in the developed countries of this world. In Madagascar, 41.9 % of infants under the age of 6 months are exclusively breastfed, the 59.7 % average is observed in Eastern Africa. The low birth weight prevalence of 17.1 % in Madagascar in the year 2015 has been slightly decreased from 19.8 % in the year 2000.

Stunting causes devastating effects because it would be difficult for the children to manage with the underdevelopment of the brain. Stunt children learn slowly and are less likely in reaching full potential till adulthood as a result of a possible irreversible cognitive damage. The prevalence of stunting in children below the age of 5 years has declined from 32 per cent in 2000 to 22 per cent by 2017 globally. Senegal triumphed in decreasing the prevalence of stunting from 30 per cent in the year 2000 to 19 per cent as of today, meanwhile, Peru has seen a decline in more than half of its rates of stunting in a time period less than a decade, from 28 per cent in the year 2008 to 13 per cent in the year 2016.

HOW COULD STUNTING CRISIS BE RESOLVED?

The World Bank’s team in Madagascar acknowledged that the stunting crisis in Madagascar could be benefitted by the Multiphase Programmatic Approach (MPA) which is a systematic but versatile and adaptive process. The Bank and Government’s support resulted in the approval of the MPA operation which provides 200 million USD over a period of 10 years. Its programmatic structure ensures that work on chronic malnutrition across the country.

A close to 75 % of children under 5 targets with the help of this programme. In the first phase, the highest stunt rates include after which the programme expands to 15 regions by its end. There are few priorities that promote proper nutrition for the initial 1,000 days from a child’s birth until the age of 2 years. This seeks to decrease the number of children stunted in the selected regions by 30 per cent by the year 2028 and also to offer a brighter future to about Six hundred thousand children in Madagascar.

HOW CAN MALNUTRITION BE PREVENTED?

Malnutrition is one of the most common conditions which occurs when there is a deficiency during the intake of micronutrients. In addition to this, it is one of the main causes of death in children belonging to the age group below five years. It is also a common cause of a decline in the health & the lives of children, resulting in reduced learning ability, skill-acquisition and inefficiency. In the continents of Asia and Africa, nearly half of the children below the age of five years died due to malnutrition. Insufficient nutrition raises the possibilities of death. Additionally, the only way malnutrition could be avoided is by eating a safe and nutritious diet. To conclude, here are some recommended foods:

  • A variety of fruits and vegetables
  • A variety of starch-based foods such as bread, rice, potatoes and pasta
  • Milk and milk products, or non-milk alternatives
  • Moreover, protein sources like beef, fish, eggs and beans