Prior to the outbreak of COVID-19, the world was already behind in meeting the Sustainable Development Goal 2: the elimination of hunger and malnutrition by 2030. However, the global pandemic has now pushed progress on this front back even further, particularly for maternal and child nutrition. Economic recessions and interrupted food supply chains have caused delays to global nutrition targets for stunting, wasting, maternal anemia, and breastfeeding by 2025 -- threatening to exacerbate maternal and child malnutrition in low and middle-income countries.
Indeed, current global estimates of food insecurity are bleak. Evidence suggests that 95 million people fell into severe poverty in 2020, while telephone surveys in Asia and Africa indicate steep increases in poverty as well as food insecurity throughout the year. One reason for this is that local lockdowns have led to disruptions of supplies of fresh foods, such as animal products, fruits and vegetables. The ensuing price increases cause poor families to shift to cheap, nutrient-poor foods such as cereals and processed goods, which increase families’ risk of malnutrition. Interruptions in the early months of the pandemic to social assistance programs providing cash and food transfers have also left their mark. Governments have struggled to reinstitute such programs, leaving many vulnerable.
A study published in December 2020 by a group of researchers from the World Bank, International Food Policy Research Institute, and the John Hopkins School of Public Health, uses modelling tools to estimate the potential impact of the pandemic on undernutrition. The authors estimate that an additional 9.3 million children under five will experience wasting from 2020 to 2022, two-thirds of them hailing from South Asia. The evidence also suggests that an additional 2.6 million children will be stunted in 2022 (relative to 2019) due to interruptions in food supply services and increases in household poverty. Nearly 1.2 million of these children would be in Sub-Saharan Africa.
As for maternal nutrition, rates of anemia among pregnant women are similarly predicted to rise in 2020-2022 relative to 2019. What the researchers dub the “moderate scenario” estimates an additional 2.1 million pregnant women with anemia in the 118 countries studied (4.8 million being the pessimistic estimate). The financial cost of mitigating this impact is stark: to combat these increases in wasting, stunting, and maternal anemia, they argue that an additional $1.2 billion will be needed per year. Nutritional interventions will also have to be rolled out on a massive scale.
An effective solution to this problem could be efficiently targeted interventions and nutritional supplements. The researchers note that shifting financing from provision of complementary foods towards a more targeted and balanced mix of interventions could lead to as many as 8.2 million (4.9%) fewer stunted children under five in 2022 and 339,000 (2.2%) under-five deaths averted in 2020-2022. This could include expanding infant and young child feeding (IYCF) counselling for children 6-23 months of age in food-secure populations, as well as breastfeeding promotion (which reduces mortality). Moreover, evidence suggests that small-quantity lipid nutrient supplements may improve growth, particularly when timed appropriately. ‘Women First’, a 3-arm individualized randomized controlled trial (RCT) in which women in the Democratic Republic of the Congo (DRC), Guatemala, India, and Pakistan, were randomly assigned a lipid-based micronutrient supplement that contained micronutrients, polyunsaturated fats, and modest quantities of protein, found that commencing the nutritional supplements either before delivery or late in the first trimester had positive fetal-growth outcomes. In any case, creative solutions, as well substantial investment, will be necessary to combat the the pandemic's impact on global maternal nutrition.
By Laila Rodenbeck
K Michael Hambidge, Jamie E Westcott, Ana Garcés, Lester Figueroa, Shivaprasad S Goudar, Sangappa M Dhaded, Omrana Pasha, Sumera A Ali, Antoinette Tshefu, Adrien Lokangaka, Richard J Derman, Robert L Goldenberg, Carl L Bose, Melissa Bauserman, Marion Koso-Thomas, Vanessa R Thorsten, Amaanti Sridhar, Kristen Stolka, Abhik Das, Elizabeth M McClure, Nancy F Krebs, Women First Preconception Trial Study Group, A multicountry randomized controlled trial of comprehensive maternal nutrition supplementation initiated before conception: the Women First trial, The American Journal of Clinical Nutrition, Volume 109, Issue 2, February 2019, Pages 457–469, https://doi.org/10.1093/ajcn/nqy228
Saskia Osendarp, Jonathan Akuoku, Robert Black et al. The potential impacts of the COVID-19 crisis on maternal and child undernutrition in low and middle income countries, 11 December 2020, PREPRINT (Version 1) available at Research Square [https://doi.org/10.21203/rs.3.rs-123716/v1]
Dr. Daniel Kimani is a trained and licensed medical officer in Kenya, holding a Bachelor of Medicine & Surgery, and a post-graduate certificate on basic oncology training. Dr. Kimani is the founder of the Global Cancer Care and Research Institute, and is an expert in clinical colposcopy — a procedure to examine the cervix, vagina, and vulva.