THINKING ALOUD: Why malnutrition keeps mauling peaceful Tanzania

Malnutrition includes both under nutrition and over nutrition. Under nutrition can result in stunting, wasting, underweight or micronutrient deficiencies.

Malnutrition is estimated to contribute to more than one third of all child deaths, although it is rarely listed as the direct cause. Poverty remains the major contributor to this ill.

The vicious cycle of poverty, disease and illness aggravates this situation. Grooming undernourished children causes children to start life at mentally sub optimal levels. This becomes a serious developmental threat.

Adverse climatic conditions have also played significant roles like droughts, poor soils and deforestation. Sociocultural barriers are major hindrances in some communities, with female children usually being the most affected. Corruption and lack of government interest and investment are key players that must be addressed to solve this problem.

A multi-sectorial approach is vital in tackling this problem. Improvement in government policy, fight against corruption, adopting a horizontal approach in implementing programs at community level must be recognized.

Genetically modified foods to increase food production and socio-cultural peculiarities of each community are an essential baseline consideration for the implementation of any nutrition health promotion programs.

It is estimated that in Tanzania in children under five, stunting is about 40 per cent, wasting is about 10 per cent, underweight is about 15 per cent and anemia is about 50 per cent, these data vary by regions.

There has been least progress toward reducing hunger in the sub-Saharan region, where more than one in four people remain undernourished the highest prevalence of any region in the world. In 2012, 47 per cent of the population of sub-Saharan Africa lived on $1.90 a day or less, a principal factor in causing widespread hunger.

In general, the principal causes of malnutrition include poverty, conflict, and environmental factors such as drought and climate change, low agricultural productivity, cultural taboos, diseases and uncontrolled population growth.

It is important to realise that children depend on others for their feeding. I vividly remember as a young doctor in the early 1980s a concept was well built in our mind: mother is the prime responsible of feeding and she will change/improve the feeding only when she will be convinced that her child is malnourished.

Thus growth monitoring was ingrained in us, we checked the child’s weight in front of the mother and she would immediately understand the status of her child and instructed on what to do. Mothers were anxiously and eagerly waiting for growth checking to know the growth of their children, unfortunately I am told this is not done anymore with the same zeal.

This was the primary preventive measure. Nowadays growth monitoring has lost momentum because there is a ‘wonderful’ paste called Plumpynut, do we need another ‘dawa’ like the ORS fiasco.

I get the feeling that communities now ignore that there is malnutrition among them. They see children die due to pneumonia but they do not see that that child was malnourished. A well and normally nourished child has very few chances to die, even in a dirty environment.

Malnutrition is a silent epidemic since nobody protests, certainly not the children and where death is not perceived as the final outcome.

Malnutrition is not a disease, it is a community problem, and therefore intervention should be local involving local leadership.

Is the regional commissioner of the number one region aware that his area of jurisdiction has the highest stunting rates (almost 57 per cent) and what is he doing about it? The approach should be political and should strongly be in the hands of local system of health and not of Unicef or NGOs or good Samaritans.

On a serious note, I have a feeling of shame and disgrace to show the world that we are not able to feed our children. Tanzania is not in the midst of a catastrophe or war or famine. It is not the responsibility of the government, Unicef or NGOs to feed our children. These children are in the midst of villages and communities and it is the onus of local authorities to intervene.

Doctors have drugs but not food but it is their responsibility to inform the local authorities about the magnitude of the problem and provide guidance and leadership. Its time MoH should reinforce the growth-monitoring chart.

Tanzania’s future economic success lies in increasing human capital, schooling, knowledge and skills that will allow Tanzanians to compete and thrive in a global economy.

Human capital is an important determinant of labour productivity; raising labour productivity lies at the heart of raising incomes across the country.

It has long been assumed that increasing human capital comes about through investments in the formal education system but this is only partially true.

Investments in nutrition particularly in the nutrition of very young children are equally important.

Malnutrition costs African economies between 3 and 16 percent of GDP annually. Interventions that prevent malnutrition are excellent investments; for a typical African country, every dollar invested in reducing chronic under nutrition in children yields a $16 return.