Holistic approach needed to tackle childhood stunting

The Consumers Association of Penang (CAP) welcomes the move made by the health minister, Khairy Jamaluddin, to set up a special committee to combat multiple nutrition problems in children, especially regarding the problem of stunted growth.

Childhood stunting due to chronic undernutrition is a worrisome piece of news in our country, which claims to enjoy rapid economic growth, development and improvements in socio-economic status and the healthcare system.

According to the 2016 National Health and Morbidity Survey (NHMS), Malaysia’s stunting rate was about 21%. This was three times higher than the overall 7% prevalence that year in upper middle-income countries, of which Malaysia is one. According to the study, the number of stunted children under five years old increased from 17.7% in 2015 to 21.8% in 2019. 

The present situation could be worse as low-income families affected by the Covid-19 crisis do not have enough money to buy food, what more nutritious food, for their children.

According to a report from the Families on the Edge Project, jointly conducted by Unicef and UNFPA, there has been a deterioration of dietary quality among low-income families. 

Stunting, a common growth failure in young children, is mainly caused by poor nutrition and infections rather than genetic factors.

This growth failure is closely associated with poverty which restricts access to adequate quantity and quality food, clean water and sanitation, and quality primary healthcare.

Both poverty and stunting are well-known risk factors for poor child development, including in cognitive functions.

Malaysia has ratified the Convention on the Rights of the Child (CRC), so food security and children's health are the state's responsibility.

The government has to develop a holistic approach to nutrition, looking beyond just the health sector.

School feeding programmes may help undernourished children recover from stunting – in India, for example, the national school feeding programme helped children recover from a decline in growth.

In Peru, national feeding programmes such as Qali Warma and Vaso de Leche ("Glass of Milk") has helped children who became stunted as a result of the food crisis to recover.

Conditional cash transfer programmes that provide financial incentives for poor households to invest in children’s health could also help the fight against child undernutrition.

An example of such a programme in Peru is Juntos ("Together"), which requires that children below the age of five in families that receive the support attend health facilities for comprehensive healthcare and nutrition.

Where Malaysia is concerned, the government should also put policies in place to increase families' access to nutritious but affordable food sources.

The "invisibility" of stunting in Malaysia coupled with Malaysians’ poor health literacy highlights the need for a nationwide mass communication campaign on stunting and nutrition.

Currently, numerous public campaigns exist such as the Malaysian Healthy Plate initiative and the Healthy Eating through Healthy Shopping programme.

Nutrition education for pregnant and lactating mothers is carried out at clinics and hospitals, while education on feeding practices for infants and young children are integrated into public health programmes at clinics. The latter includes the dissemination of written material, postnatal talks, seminars and even cooking demonstrations.

Despite the existence of these programmes, there is limited reach and low public participation. The current nutrition campaign does not explain stunting, its impact on children's health and development, or the critical 1,000-day window. Instead, there is a heavy focus on obesity and non-communicable diseases.

Even though there is a documentary on stunting in children which is being broadcast by a national television channel, it does not explain in length the detrimental effects of stunting on the future of Malaysians. Many do not understand the message of the programme.

In view of the present situation, CAP calls on the authorities to:

· Make nutritious food affordable;
· Carry out research to make every child visible;
· Advocate and support child-friendly policy change;
· Provide quality services for every child;
· Conduct campaigns to change mindsets and perceptions about stunting; and
· Empower young people to be agents of change by equipping them with the needed knowledge  and skills.
 
Mohideen Abdul Kader is president of the Consumers Association of Penang.

The views expressed in this article are those of the author(s) and do not necessarily reflect the position of MalaysiaNow.