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No Time to Waste – the growing problem of child wasting

These are sachets of Ready-to-Use Therapeutic Food that contain a nutrient-rich paste made mainly of peanuts which helps the body recover from malnutrition.

“Wasting is the most lethal form of undernutrition, affecting an estimated 50 million children around the world: the youngest, the poorest, and the ones left behind by development efforts. Wasting makes a child eleven times more likely to die from other illnesses, making it a major contributing factor to child mortality,” said Kerrie Barker, Global Forum Youth Advisory Board member, as she introduced the session No Time to Waste at the Global Forum for Children and Youth 2021.  

Most of the children that suffer from wasting live in Africa or Asia with South Asia being the region with the highest prevalence, according to the UN report The State of Food Security and Nutrition in the World (SOFI 2021). The report projects that the situation will worsen in the coming years, as the immediate effects of the Covid-19 pandemic are manifested first with this acute condition in children.

Based on the session No Time to Waste, this article aims to describe the condition of child wasting and its drivers and causes. The article also aims to highlight important areas that need to be considered moving forward to ensure that affected children get the treatment they need. Ultimately, child wasting may be prevented altogether.   

What is child wasting?

“Wasting is basically when a child becomes too thin,” explains Dr. Marco Kerac, Associate Professor in Public Health Nutrition at London School of Hygiene and Tropical Medicine. He explains how the condition results from poor nutrient intake and/or illness. A growing child, he says, needs a variety of nutrients to ensure normal developmental growth and general health. When the balance between the child’s nutritional requirements and the nutrition available to the child becomes unbalanced, the child’s body will start using the fat-and protein reserve and become dangerously thin. Dr. Helen Young, Research Director and Professor at Tufts University, continues by highlighting the vicious cycle between poor diet and illness that exacerbates wasting in a child. She emphasises how illness can lead to poor nutrient uptake, which, in turn, leaves the child more vulnerable to illness, stressing that “this relationship between diet and disease is really critical and both important principal reasons for a child becoming wasted.” Dr. Young also explains that wasting is worse at certain times of the year and highlights the need to better understand the seasonality of wasting. 

Dr. Kerac brings up the effects of wasting on children’s life across the life cycle. He explains that child wasting may lead to children not developing their full developmental- or educational potential. He continues by saying that evidence also suggests that early child wasting can lead to non-communicable diseases in adults, such as heart disease and diabetes.

Child wasting also has intergenerational effects, as highlighted in the Global Action Plan on Child Wasting (the GAP Framework) – an action plan to tackle child wasting developed by several UN agencies. While recognising that preventing malnutrition is crucial for women’s  health and well-being, the GAP Framework brings to the fore the potential for undernourishment to be perpetuated across generations:

“Undernourished girls have a greater likelihood of becoming undernourished mothers, who in turn have a greater chance of giving birth to low birthweight babies, perpetuating an intergenerational cycle of malnutrition”.

“There are two basic ways that we measure wasting,” continues Dr. Kerac. He describes how the child’s weight is measured against their height or, in the case of small children, to how long they are. These measures are then compared to the weight and height of a healthy child in the relevant age bracket. The second way child wasting is measured, he explains, is by measuring the child’s mid-upper arm circumference. Whereas it in a well-nourished child is about 16cm, a malnourished child’s mid-upper arm circumference is, by contrast, approximately 11.5cm or, as Dr. Kerac says, “just a bit bigger than a British two-pound coin.” Both measurements have proven useful, but the latter method is a straightforward and quick way to identify wasting in children.     

International Rescue Committee staff measure the upper arm circumference of a 7-year-old boy as part of a malnutrition screening programme, at a health clinic in Turkana County, northwest Kenya, 29 March 2017.

What are the drivers of wasting? How can they be addressed?

Drivers of child wasting

Dr. Kerac and Dr. Young identify two main reasons for wasting in children: poor diet, illness, or a combination of the two. However, this acute condition in children can be traced to drivers and structural causes operating far from the individual, family-and community level. The SOFI 2021 report states that conflict, climate variability and extremes, and economic slowdowns and downturns “can negatively affect food security and nutrition through their impacts on our food systems.” Poverty and inequality further exacerbate the impact of these drivers.

Corroborating the connections made in the SOFI 2021 report, Dr. Young says that wasting has become an increasing problem in areas affected by conflict or humanitarian crises. Illustrating the complex relationship between different drivers and wasting, she explains that events like famine often are “linked to political crisis – civil war, conflict – that force people to flee and become displaced or even to cross borders and become refugees.”

When asked about the link between climate change and wasting, Dr. Kerac explains that climate change and higher temperatures will drive infections, but will also impact food production and food security, stressing the importance of recognising “climate change as a huge threat, a huge driving force behind wasting.” Underlining Dr. Kerac’s message, Dr. Young links climate change to an expected increase in climate variability and extremes, making events such as droughts and floods more common and potentially more extreme and persistent. In turn, this will impact food production, drive up market prices and contribute to an increase in child wasting. She says:

“I think we are beginning to see this. And in fact, there is now a lot of evidence linking high temperatures with a high risk of wasting.”

Combat child wasting with food, health, and care

Individuals, families, and communities may experience child wasting, but it is caused and driven by factors operating on the national, regional, and global level. Given this, the work to combat child wasting needs to take place at all levels simultaneously.

Dr. Kerac explains that early detection and treatment are critical for child wasting. In theory, children can recover by getting back on family foods, but in reality many children need additional medical treatment. “For the ones that are very ill, we use specially formulated milk,” he explains, “but we also want to identify as many as early as possible and treat them with ready to use therapeutic foods, which are very nutrient-dense.”

When asked how child wasting can be prevented, Dr. Young lists food, health, and care areas that are “critically important for ensuring a child has a nutritious diet and is free of disease.” She continues by explaining that food refers to household food security, health to health services and the health environment and, care refers to care for children, parents and the wider community. She illustrates that  complex systems support these areas that include governments, the private sector, organisations, and institutions responsible for providing basic services and protection. Their functioning and involvement, she says, are crucial for the prevention of child wasting. She stresses, in particular, the importance of supporting and protecting people’s livelihoods. She adds:

“People’s livelihoods – how they earn a living, their daily work – is essential in terms of providing for the family and ensuring the necessary food, health, and care for their young children to prevent child wasting.” 

No Time to Waste

Child wasting is a lethal form of undernourishment in children. It is an acute condition driven and further exacerbated by factors far removed from the families and communities most affected. Consequently, the responsibility to alleviate and prevent it from happening to any child lies with us. In the words of Dr. Young:

“So, with this big, complex problem, I really want to stress that preventing child wasting is everybody’s business. Starting with you and me, and from the top – governments, international organisations – and right down to the local level – communities, families, and individuals.”

Wasting in children is projected to increase in the wake of the Covid-19 pandemic. In the SOFI 2021 report, it is estimated that between 11 to 16 million additional children will suffer from wasting between 2020 and 2022. It is projected that 6.1 to 6.5 percent of children under five will be wasted in 2030. This leaves the number of children that will suffer from wasting ranging from 37.3 to 39.6 million. It is a level of wasting twice as high as the global target of 3 percent by 2030. Given the relationship between wasting and child mortality, the report emphasises that if nothing is done to prevent child wasting and if treatment of these children is disrupted, child mortality can be expected to increase in the coming years. In short, there is no time to waste to facilitate treatment of child wasting and take action to prevent it from occurring altogether.   

Suggested Further Resources

Global Action Plan on Child Wasting – a framework for action to accelerate progress in preventing and managing child wasting and the achievement of the Sustainable Development Goals published by FAO, UNHCR, UNICEF, WFP and WHO. 2021.

No Time to Waste organised by Global Forum for Children and Youth. 2021.   

The State of Food Security and Nutrition in the World published by FAO, IFAD, UNICEF, WFP and WHO. 2021.

Written by Josefine Jacobsson, intern at SIANI.