Childhood nutrition vital to achieving MDG 1, 2, 4, 5

Childhood malnutrition being the biggest contributor to child mortality and morbidity, continues
to be one of the greatest social injustices affecting achievement of Millennium Development
Goals (MDGs) especially MDG 1 (eradication of extreme poverty and hunger). Failure to
achieve MDG 1 jeopardizes achievement of MDG 2 (achievement of universal primary
education), MDG 4 (reducing child mortality) and MDG 5 (improvement in maternal health).
Childhood malnutrition is one of the most common causes of morbidity and mortality among
children under 5yrs worldwide with nearly 20 million children in sub-Saharan Africa and Asia
suffering from it. Current estimates suggest about 1 million of these children die yearly.
Childhood malnutrition is however preventable and treatable with cost-effective interventions.

Causes of Childhood Malnutrition and Child Death

Causes of childhood malnutrition and child death are two of the manifestations of a multisectoral development challenge which are as a result of three levels of complex and interlinked
causes. These causes are categorized into immediate (which acts on individuals), underlying
(acting on households and communities) and basic causes (acting on entire societies). The
immediate causes are inadequate dietary intake and infectious disease whiles the underlying
causes include household food insecurity, inadequate maternal and childcare practices and
inadequate health services and health environment (poor water/ sanitation). In addition, the basic
causes include formal and non-formal institutions, political and ideological (including religion,
culture and tradition) superstructure, economic structure and potential resources. These
underlying and basic factors are known as the social determinants of health which are
conditions in which individuals are born, grow, live, work and age.
The Social Determinants of Health are shaped by the distribution of money, power and
resources at global, national and local levels, which are themselves influenced by policy choices.
Thus Social Determinants of Health of childhood malnutrition include gender inequality,
inequitable conditions of daily living (poor social protection policy), inadequate maternal and
child care practices, unfair and lack of employment, poor governance, lack of political
commitment, poverty, poor access to clean water and sanitation. According to World Health
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Organisation, access to and utilisation of maternal, child and nutrition is vital to reducing
childhood malnutrition since the health-care system is itself a Social Determinants of Health of
childhood malnutrition, influenced by and influencing the effect of other Social Determinants of
Health. Education, occupation, income, ethnicity, and place of residence are closely linked to
mothers and childrens access to, experiences of, and benefits derived from Maternal, Newborn,
Child and Womens Health and Nutrition Interventions.

Intervention Strategies to Addressing Childhood Malnutrition

Efforts to address underlying causes of childhood malnutrition in Ghana should ensure that
under-served districts and sub-districts are prioritized in efforts to scale-up and improve quality
of priority Maternal, Newborn, Child and Womens Health and Nutrition Interventions. The
intervention should incorporate home-based post-natal care by Community Health Workers
providing full package of community-based interventions. This should include support in caring
for and breastfeeding their babies. Also, provision should be made for strengthening communitybased child preventive services which includes immunization, growth monitoring and promotion,
vitamin A supplementation and other micronutrients, regular deworming, measles elimination
and polio eradication. Child health days or weeks must provide support, preventive and
promotive services on infant and young child feeding to Early Childhood Development centres.
These strategies will go a long way in reducing the challenge of long distance and cost in
travelling to health facilities. Strategies should be implemented to address underlying poor
childcare practices includes promotion of early and exclusive breastfeeding for infants for six
months and thereafter giving appropriate complementary foods. Moreover, the Integrated School
Health Programme should be strengthened through close collaboration between the Ministry of
health, Ghana Health Service and Ministry of Education.
Another underlying cause of childhood malnutrition is inadequate access to health services.
In addressing lack of access to health services, efforts should be directed at prioritizing underserved districts and sub-districts in efforts to scale-up and improve the quality of priority
Maternal, Newborn, Child and Womens Health and Nutrition Interventions. In addition, there is
the need to strengthen capacity of the health system to support its provision through ensuring
appropriate resources (equipment, essential supplies and drugs, etc) are available at sub-district,
district, regional and national levels.
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Focus should also be directed at strengthening human resource capacity, defining roles of
different cadres of health workers, updating curricula of health professionals to ensure adequate
strengthening of in-service training in Maternal, Newborn, Child and Womens Health and
Nutrition Interventions. Childhood malnutrition can also be prevented through the execution of
environmental programmes such as improving access to sufficient safe and clean drinking water,
sanitation and improvement in personal and domestic hygiene. This can only be achieved
through the strengthening of multi-sectoral action to reduce poverty and inequity through
improved access to basic services, especially improved water and adequate sanitation.
Political action is vital in addressing basic causes or root causes including poor availability
and control of resources, political, social, ideological and economic, poor agriculture,
urbanisation, trade agreements, religious and cultural factors of childhood malnutrition. Since
stakeholders have a key role to play in promoting improved health and nutrition which should
involve the strengthening of inter-sectoral collaboration amongst government departments
(example, Ministry of Rural Development, Ministry of Education, Ministry of Agriculture,
Ministry of Women and Children Affairs, etc), local government, academic and research
institutions, professional councils and associations, civil society, private health providers and
development partners, including United Nations and other international and aid agencies.
Strengthening partnerships with community structures to address gender issues through
empowering women, children and men to participate in efforts to improve their health would
contribute in addressing the challenge of childhood malnutrition. Furthermore, there should be
strengthening of systems for monitoring and evaluation through institutionalise reviews of
maternal, perinatal, neonatal and child deaths and strengthening routine health information
systems for monitoring of nutrition services.
In developing and implementing nutrition programmes, efforts should be made to
incorporate the communities own assessment of their nutritional challenges and addressing
household food security challenges such as improvement in agriculture, diversification and
introduction

of

crops

to

increase

the

variety

of

foods,

home

gardens,

dietary

diversification/modification etc. The government needs to address economic decline and scale-up
access to social protection (example, child support grant) which is vital to combating childhood
malnutrition.

Adoption of Comprehensive Primary Health Care Approach

To achieve MDG 1, 2, 4, 5, there should be a paradigm shift from the Selective Primary
Health Care approach which involves only activities in the health sector by focusing on only
preventive, curative and rehabilitative interventions to disease reduction and prevention and
adopt the Comprehensive Primary Health Care (CPHC) approach. The CPHC approach entails
Primary Health Care services involving five principles namely universal accessibility and
coverage on the basis of need (equity), comprehensive care with emphasis on disease prevention
and health promotion, community and individual involvement and self-reliance, inter-sectoral
action for health and cost-effective interventions. CPHC encompasses an additional intervention
being promotive intervention in addition to preventive, curative and rehabilitative interventions.
CPHC therefore addresses social injustices such as underlying social, economic and political
causes of poor health. CPHC also combines clinical, Public Health and health promotion
undertaken in conjunction with other sectors (Education, Works and Housing, Sanitation etc)
apart from the health sector. CPHC increases inter-sectoral collaborations at households/
communities, at international and national level through advocacy and lobbying of government
and policymakers.
CPHC seeks to increase equity in access to health care and other services essential to health
for the whole population at risk. CPHC results in improved community participation,
opportunities and political capabilities of marginalized population groups thereby reducing
vulnerabilities through improvement in community empowerment. Elements of Comprehensive
Primary Health Care approach to address child malnutrition includes the promotion of proper
nutrition and adequate supply of safe water, basic sanitation, maternal and childcare,
immunisation, prevention and control of locally endemic disease, health education, and methods
of prevention and treatment for common diseases. Ghana needs to adopt a holistic approach by
using CPHC since it addresses presents curative, preventive, rehabilitative and promotive
intervention for addressing child malnutrition. Curative interventions are health care approach
emphasising treatment of biological and psychological causes and symptoms of disease through
medicine and other therapies. Curative interventions should espouse the correct management of
common childhood through provision of protocols, training of healthcare workers and
strengthening of supportive supervision. Moreover, availability of supplies and drugs must be
ensured.
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Preventive interventions emphasises preventing sickness in individuals and populations.

Preventive interventions entails promotion of post-natal visit within six days which includes
newborn care, supporting mothers to practice exclusive breastfeeding for six months and
thereafter give appropriate complementary foods, and continue breastfeeding up to two years and
beyond. Also, preventive interventions include provision of services through community-based
campaigns such as immunization, growth monitoring and promotion, Vitamin A, mass
deworming campaigns. These should be strengthening of Maternal, Newborn, Child and
Womens Health and Nutrition communication strategy to improve practices promoting child
nutrition especially amongst mothers and caregivers and to enhance community involvement and
participation in child survival activities. Rehabilitative interventions emphasises on restoring
people to a state of improved health and functioning. Rehabilitative interventions include care for
Low Birth Weight infants and the management of malnourished children in health facilities using
WHOs recommended strategy for management of severe malnutrition.
Promotive intervention addresses basic social, economic and political causes of ill-health
that is Social Determinants of Health. Promotive interventions should include mobilizing and
empowering women, children and men to participate in efforts to improve their health at
individual, household and community levels. Also, there should be strengthening of school
health services through provision of comprehensive and integrated school health programme.
Promotive interventions should fosters partnerships with other role-players through establishing
stakeholder forums for coordination of nutrition interventions, strengthening multi-sectoral
collaboration to reduce poverty and inequity - in particular programmes and interventions that
improve access to clean water, sanitation and promotes comprehensive health education and
promotion in schools.
Improvement in nutritional status of children can only be achieved through improvements in
Social Determinants of Health. Thus poverty alleviation is an important intervention essential in
the fight against childhood malnutrition which can only be achieved through collaboration
amongst government, civil society and local communities, business, and international agencies.
In addition, long-term investments through female education, economic, social, and political
empowerment will result in sustainable reduction of childhood malnutrition. Also, investment in
physical infrastructure, creating healthy environments (sanitation, water supply), job creation,
quality health services, etc are key to addressing childhood malnutrition.
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