NUTRITION AND SOCIAL PROTECTION: THE CASE FOR SCHOOL FEEDING S. D. Maruapula, PhD Department of Family & Consumer Sciences University of Botswana

BACKGROUND Child malnutrition is a big problem in Africa According to S. Maxwell, a previous Director of Overseas Development Institute (ODI), probably a third of African children are brain damaged as a result of malnutrition. One third of child deaths in this age group attributed to under-nutrition

BACKGROUND 54% of deaths in the developing world is due to under-nutrition (United Nations Children’s Fund (UNICEF, 2000) Rapid economic gains in developing countries has not abated the malnutrition problem Many developing countries now confronting the double burden of malnutrition, which includes both under-nutrition (underweight, stunting & wasting) & over-nutrition (overweight & obesity)

MALNUTRITION FACTS Malnutrition Compromises children’s survival, health, growth and development, Slows national progress towards development goals. (UNICEF, 2009)

MALNUTRITION FACTS Malnutrition Compromises children’s survival, health, growth and development, Slows national progress towards development goals. (UNICEF, 2009)

EFFECTS OF MALNUTRITION Childhood Morbidity Although there are debates about whether malnutrition leads to a higher incidence of diarrhoea, there is little doubt that malnourished children tend to have –more severe diarrhoeal episodes in terms of duration, risk of dehydration or hospital admission –associated growth faltering increased risk of pneumonia (Tomkins & Watson, 1989; Briend, 1990; Victora et al., 1994). –

EFFECTS OF MALNUTRITION Childhood Mortality Studies have demonstrated the association between increased mortality and increasing severity of anthropometric deficits. –Out of the 11.6 million deaths among children under-five in 1995 in developing countries, it has been estimated that 6.3 million—or 54% of young child mortality—were associated with malnutrition, the majority of which is due to the potentiating effect of mild-to-moderate malnutrition as opposed to severe malnutrition (Figure 1).

EFFECTS OF MALNUTRITION Childhood Mortality Figure 1: Distribution of deaths among children

EFFECTS OF MALNUTRITION Childhood Mortality

EFFECTS OF MALNUTRITION Child Development & School Performance There is strong evidence that poor growth or smaller size is associated with impaired development (Pollitt et al., 1993) Several studies have demonstrated a relationship between growth status and school performance and intellectual achievement (McGuire & Austin, 1987). But, this should not be regarded as a simple causal relationship because of the complex environmental or socioeconomic factors that affect both growth and development.

EFFECTS OF MALNUTRITION Child Development & School Performance An intervention study in Jamaica indicates that the developmental status of underweight children can be partly improved by food supplementation or by intellectual stimulation, but greatest improvements are achieved through a combination of both (Martorell et al, 1992).

Effects of Malnutrition Adult-Life Consequences Childhood stunting leads to a significant reduction in adult size as demonstrated by a follow-up of Guatemalan infants who, earlier, had been enrolled in a supplementation programme The main consequences of small adult size resulting from childhood stunting is reduced work capacity which in turn has an impact on economic productivity.

Effects of Malnutrition Adult-Life Consequences Maternal size is associated with specific reproductive outcomes: Short women, are at greater risk for obstetric complications because of smaller pelvic size There is also a strong association between maternal height and birth weight which is independent of maternal body mass. There is thus an intergenerational effect since low-birth- weight babies are themselves likely to have anthropometric deficits at later age s

Effects of Malnutrition Adult-Life Consequences

The Importance of adequate nutrition Wellnourished children: Perform better in school Grow into healthy adults and, in turn, Give their own children a better start in life.

Prevalence of Malnutrition in 2000 & 2007

Prevalence of Stunting by place of residence

Prevalence of Stunting by age category

Prevalence of Stunting by gender

Prevalence of Stunting by district

Prevalence of Stunting by Wealth Score Stunting 2000Stunting 2007 Total Stunt % S/ Stunt (Z< - 3) % M/ Stunt (-3  Z <-2) % Mean Total Stunt % S/ Stunting (Z< -3) % M/ Stunt (-3  Z <-2) % Mean t-test (p-v) Wealth Score Poorest Second Third Fourth Richest a 17.3 ab 15.3 abc 11.9 bc 10.5 c 16.9 ab 19.2 a 16.6 ab 12.3 b 11.5 bc a a ab b bc

Prevalence of underweight by age

Prevalence of underweight by residence

Prevalence of underweight by district

Prevalence of Wasting by district

Low birth weight by district

Risk for overweight by district

Conclusions The prevalence of stunting and wasting in children increased from 2000 to 2007, signifying a deteriorating nutritional status. Botswana still needs to do a lot to combat the problems of poor nutritional status of children despite the many interventions in place to mitigate problems of poor nutrition.

Conclusions Children in the age category of months seem to have poor nutrition indicators than the other groups. –But indicators like stunting show events that happened in the past. In undertaking efforts improve nutritional status in children, the younger age group should be targeted so that by the time children reach this age group their nutritional status is protected.

Conclusions Female children, and those from female headed households had poor nutritional status. In targeting children these two issues should be considered. Low education achievement was linked with poor nutritional indicators for children. In targeting, it is important to pay special attention to those with low education attainment so that their children are not left behind.

Conclusions Rural children had poor nutritional status compared to those in towns. This might be linked to poor economic performance of rural areas. Undernutrition still has a rural face and efforts to combat malnutrition should target rural areas The district of Ghanzi had poor nutritional indicators for children. There is need to find out as to why Ghanzi’s children have poor nutritional outcomes so that appropriate programs should be instituted to combat the problems in the district.

Conclusions Overweight and obesity are increasing in Botswana, especially in urban areas, hence the country is experiencing the double burden of both over and undernutrition. Programs should just not focus on undernutrition but also ensure the prevention of overnutrition which in the long run is detrimental to individual and country well being