Field Note

Strategies for Improving Nutrition of Children

Jean Baker
Vice President, Center for Family Health
Academy for Educational Development

For the last 30 years, nutritionists have noted that many child deaths are due to the indirect effects of malnutrition on immunity and susceptibility to infection.¹ A 1995 study² confirmed this link, attributing more than 50 percent of deaths in children younger than five years old to malnutrition, either directly or indirectly. Undernutrition is an underlying cause in the main killers of children - diarrhea, pneumonia, malaria, measles and AIDS. Today we increasingly recognize the devastating effects of malnutrition and the importance of improved nutrition to achieving gains in child health and survival and the Millennium Development Goals.³

Malnutrition, including vitamin and mineral deficiencies in children younger than five years of age is often the result of a complex set of factors. But most simply put, it stems from poor maternal nutrion, poor feeding practices, too little food, and too much disease. Worldwide, the profile of malnutrition suggests the magnitude of the problem:

• 150 million children are underweight, the vast majority of these in South Asia and Africa. Based on projected trends and population growth rates, by 2015, approximately 60 out of 100 underweight children will live in Asia and 38 out of 100 in Africa.⁴


• According to a 2001 analysis,⁵ growth stunting affects 182 million children younger than five years old, with the highest stunting rates found in South Asia. Stunting leaves a legacy of delayed motor development, impaired cognitive function, poor school performance, and overall reduced productivity.


• Micronutrient deficiencies are also common. We have known for more than a decade that providing vitamin A supplements reduces child mortality by about 23 percent in areas with high deficiency.⁶ Despite the existence of this affordable effective remedy, UNICEF estimates that at least 100 million children younger than five years old continue to suffer from vitamin A deficiency.


• Anemia is the most prevalent nutritional disorder worldwide and iron deficiency is its most common cause. In Africa 60 percent of children under five are anemic. In South Asia two-thirds in this age group are anemic. The consequences of anemia include reduced cognitive and physical development.

• More than half of the developing world's children are iron deficient in the critical stages of brain development between the ages of six months and 24 months.⁹ After the age of six months, iron stores and breastmilk are inadequate and additional iron is needed but the usual complementary foods for children in this age range are often deficient to bridge this iron gap. The balance must come from iron rich foods, fortified complementary foods, or supplementation of gruels and mashes given to children. Progress in reducing iron deficiency has lagged behind that of efforts to address deficiencies of vitamin A and iodine.


• Vitamin A deficiency increases the severity and case fatality of common childhood illnesses such as measles and diarrhea. It is estimated that 700,000 child deaths can be averted with vitamin A supplementation and another 394,000 deaths can be averted through zinc treatment for diarrhea.¹⁰ There has been good progress worldwide in vitamin A delivery through supplementation programs, particularly through vitamin A capsule distribution. Fortification and agricultural strategies promoting dietary diversity are potentially effective but not applied as widely as they might be.¹¹


• While considerable progress has been made in the past decade or so to address iodine deficiency, it is still the primary cause of preventable mental retardation and brain damage. UNICEF estimates that the 30 per cent of households in the developing world not consuming iodized salt include 41 million infants and newborns that are not protected.