Improving maternal nutrition in South Asia: Implications for child wasting prevention efforts

Field Exchange issue 63, October 2020, www.ennonline. net/fex Introduction The South Asia region has made remarkable gains in child survival over the past two decades. Child deaths are now concentrated in the neonatal period because of the success in preventing and treating childhood illnesses (UN IGME, 2019; Hug et al., 2019). In comparison, the rate of decline in child malnutrition has been slow. High prevalence rates and burdens persist and the region remains home to over half of the world’s wasted children (25.1 million) and nearly 40% of the global stunting burden (56.1 million) ((UNICEF, WHO and World Bank, 2020). The prevalence of child wasting in the region (14.8%) is just below the World Health Organization (WHO)’s ‘very high’ threshold of 15%. Wasting increases the vulnerability of children to infectious diseases and death and raises the risk of stunting and its associated long-term consequences on development. These risks accumulate with the frequency, duration and severity of wasting episodes (Richard et al., 2014; Schoenbuchner et al., 2019). They are also greater for children who are wasted at birth or in early infancy (Mwangome et al., 2019), a period of life that has received relatively less attention in wasting prevention and treatment efforts. The South Asia region also has the highest prevalence of low birth weight (LBW) in the world. More than one in four children (27%) have a birth weight of less than 2.5 kg and start their first days small and vulnerable (UNICEF & WHO, 2019). This unacceptably LBW prevalence may explain why child wasting is so widespread in South Asia. Compared to sub-Saharan Africa (the region with the second highest prevalence of LBW and wasting), South Asia has double the prevalence of LBW (14% vs. 27%) and double the prevalence of child wasting (6.9% vs. 14.8%). While such comparisons are simplistic, we believe they help to understand the epidemiology of and solutions to resolving child wasting in South Asia. LBW can be traced to the poor nutrition and health status of women before and during pregnancy. In this views article, firstly we share evidence as to why maternal nutrition matters in wasting prevention efforts in South Asia and, secondly, we review the response to maternal nutrition in the region and identify the gaps and challenges in ongoing efforts. Lastly, we discuss and conclude the implications of our findings for child wasting prevention efforts in South Asia. Why maternal nutrition matters in child wasting prevention in South Asia Children are born small either because they are small for gestational age and/or because they are preterm. In South Asia, the proportion of small for gestational age newborns is about three times that of preterm newborns (Lee et al., 2013). Small for gestational age is often the result of intrauterine growth restriction and these newborns are particularly vulnerable to infections, poor linear growth and delayed neurodevelopment (Lee et al., 2017). Early growth failure also predisposes infants to persistent growth failure and increased mortality risks in early childhood (Mertens et al., 2020). Preterm delivery can be caused by poor maternal nutrition including calcium deficiency, iron deficiency and anaemia (Kumar & Kaur, 2017; Rahman et al., 2016). Women’s nutritional status before and during pregnancy has a profound effect on fetal growth and development as well as the mother's own health and wellbeing. Over the last two decades, the proportion of women affected by thinness (body mass index <18.5 kg/m2) and short stature Zivai Murira is Nutrition Specialist at United Nations Children’s Fund (UNICEF) Regional Office for South Asia (ROSA), Kathmandu, Nepal. Improving Maternal Nutrition in South Asia: Implications for Child Wasting Prevention Efforts