1. Stunting and Programmatic Responses - A Regional Overview
Grow Great Seminar on Stunting 18th October 2019
Presentation by
Dr Richard Pendame
Regional Director, Nutrition International, Africa

2. Outline Introduction What is Stunting? What are Impacts of Stunting?
What is the Burden of Stunting?
What is Africa Doing About Stunting?

3. Nutrition International
A global nutrition organization headquartered in Canada
27 years history
Operate in 10 core countries
Over 600 staff worldwide
Regional Offices in Kenya and India
Reach > 500m people/year
Thank you XXX.
Before I unpack that – I should explain who we are, because many of you might not have heard of us.
Nutrition International was originally created as a small secretariat by Canada following the World Summit for Children in 1990.
Throughout our history, we have focused on delivering low-cost, high-impact, nutrition interventions to people in need.
Our primary approach is to stand shoulder to shoulder with governments around the world and across Africa over the long-term to reinforce their own efforts to end malnutrition.
Over the past 25+ years we have grown into one of the world’s leading global nutrition organizations.
Today, we have over 600 staff and consultants worldwide, reaching over 500 million people every year.
We concentrate our core work in 10 countries in Asia and Africa:
Ethiopia, Kenya, Nigeria, Senegal, Tanzania, Bangladesh, India, Indonesia, Pakistan and the Philippines.
With two regional offices, one in India and one in Kenya.
This was a deliberate focus on East Africa as we recently moved our regional office from Senegal.

4. Nutrition International
Technical assistance in > 20 Sun Countries
Vitamin A programing in 55 countries
Reaching M children a year.
We are also one of the largest provider of technical assistance to the Scaling Up Nutrition Network
Working in 20 SUN countries, over half in Africa.
As well as the world leader in Vitamin A,
Procuring up to 75% of the world supply.
Support governments in 55 countries reaching between million children under 5 annually. 
That includes the national supply of Vitamin A for Ethiopia.

5. Nutrition International
NI’s global programming has averted:
5 million child deaths
10 million cases of stunting
1.6 million permanent mental impairments
Half a million cases of anemia among women
In the last 25 years, I am really proud to say NI has averted:
5 million child deaths
1.6 million permanent mental impairments
Half a million cases of anemia among women, and
10 million cases of stunting

6. What is Stunting?
Stunting refers to a child who is too short for his or her age.
Stunted children can suffer severe irreversible physical and cognitive damage.
The devastating effects of stunting can last a lifetime and even affect the next generation.

7. Faces of Stunting Photo credit: Tom Maguire/RESULT
Here is a real world example:
Miranto is 5 years old.
He proudly wears his school uniform, a blue smock, along with Mickey Mouse sneakers and a tilted baseball cap.
He’s been in school for two years, where he’s on track and has made dozens of friends.
Sitraka is a head shorter than Miranto and looks about half his age.
He’s not wearing any shoes, and his tiny T-shirt reads “Special Baby Boy.”
He’s still learning to speak and has trouble sitting or standing still for any length of time.
This means he can’t go to school and has trouble making new friends.
They were born on the very same day in the village of Ambohimidasy Itaosy, about an hour by car outside Madagascar’s capital city of Antananarivo.
They are both 5 years old, yet Miranto has been in school for two years, Sitraka is still learning to speak and struggles to sit still.
Like 47 per cent of children in the country, Sitraka suffers from stunting,
Photo credit: Tom Maguire/RESULT

8. Effects of stunting on a child’s brain
Here is another stark example. The images illustrates the effects of stunting on a child’s brain. 
On the right, a single stunted infant at 2-3 months of age.
You can see the variety of white matter fibres are significantly fewer than the image on the left.
Which shows a single non-stunted infant
It is important to keep in mind that this is but a single (albeit representative) infant; thus, until these findings are replicated at the group level, such findings should be considered preliminary.
These data were collected as part of an ambitious program of research taking place in Dhaka, Bangladesh (Charles A. Nelson, Ph.D., Principle Investigator), supported by the Bill and Melinda Gates Foundation. The goal of this work is to examine the effects of biological and psychosocial adversity on early brain development.  Nadine Gaab, Ph.D. and her colleagues are overseeing the MRI portion of this project, including the tractography data.
Stunted growth
Never Stunted growth

9. What are the Impacts of Stunting?
So let’s get underway…

10. Impact Stunting Health
Stunted children are sick more often and 4X more likely to die.
Poor immunity
Reduces effectiveness of vaccines
NCDs

11. Impact of Stunting Education
Reduced cognitive development combined with poor health impacts education outcomes.

12. Impact of Stunting Earnings
Reduced education outcomes combined with poor health impacts earning potential.
This perpetuates the cycle of poverty and malnutrition.
In women, this also impacts economic independence and choice.

13. Impact of Stunting Economic Growth
Reduced education outcomes and earning potential impacts the future of entire countries.
Reduced tax revenue limits countries abilities to provide social services such as education and health care.

14. Impact of Stunting Health System Costs
DMS = increased burden to health care system.

15. What is the Burden of Stunting?
So let’s get underway…

16. Stunting: Global Burden
UNICEF, WHO, World Bank Group Joint Child Malnutrition Estimates
Key findings of edition
Nearly 151 million children are stunted worldwide – and a significant amount of the burden in in Africa.

17. Percentage of stunted children under 5
Global prevalence of stunting is 21.9%.
In 7 sub regions at least one in every four children under 5 is stunted
In Africa it is one in every X on average.
Prevalence of stunting in South Africa is 27.4%.
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019

18. Stunting numbers by region
However, despite this progress the absolute numbers of stunted children in African has increased.
Africa is the only region where the number of stunted children has risen.
We are going in the wrong direction.
So what do we do about it?
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019

19. Trends in % of stunted children <5 in Africa (2000 - 2018)
Large disparity in stunting reduction exist between sub regions.
The highest prevalence of stunting is in eastern Africa and the lowest prevalence is in Northern Africa.
In all sub- regions in Africa, the % of stunted children has reduced between 2000 and 2018.
Source: UNICEF/WHO/WBG Joint Child Malnutrition estimates, 2019

20. Global Nutrition Targets for 2025
No increase in childhood overweight
TARGET 1:
40% reduction in the number of children under 5 who are stunted
TARGET 5:
Increase the rate of exclusive breastfeeding in the first 6 months to at least 50%
TARGET 2:
50% reduction of anaemia in women of reproductive age
TARGET 6:
Reduce and maintain childhood wasting to less than 5%
TARGET 3:
30% reduction in low birth weight
Stunting and wasting are recognized globally as critical indicators of malnutrition
Global nutrition target 1 and 6 focus on stunting and wasting respectively. Both Stunting and Wasting are important because they are associated with increased mortality
2018 Global Nutrition Report

21. WHA Nutrition Targets - Progress
Countries on course:
Burkina Faso
Egypt
Ghana
Kenya
Eswatini
Liberia
Cote d’Ivoire
Source: Global Nutrition Report 2018

22. Ranking of solutions Copenhagen consensus
Challenge 1
Micronutrient supplements for children (A & zinc)
Malnutrition 2
The Doha development agenda
Trade 3
Micronutrient fortification (iron and salt iodization) 4
Expanded immunization coverage for children
Diseases 5
Biofortification 6
Deworming, other nutrition programs in school 7
Lowering the price of schooling
Education 8
Increase and improve girl’s schooling
Women 9
Community-based nutrition programs
2008 Copenhagen consensus - Over two years, more than 50 economists worked to find the best solutions to ten of the world’s biggest challenges. During the last week, an expert panel of 8 top-economists, including 5 Nobel Laureates, sat down to assess the research. They came up with a priority list highlighting the potential of specific solutions to combat some of the biggest challenges facing the world.

23. Critical steps to speed up progress
Planning: Propose African learning network on stunting – action oriented, propose that NI could help pull this together, cross country learning. Maybe there’s funding for it…(a) build plan (b) knowledge and lessons exchange (c) field exchange visits.
Financing: World Bank and AfDB increasing financing for nutrition, Importance of DRM, Driving global investment, stunting part of WHA, key driver of SDGs

24. Conclusion
Stunting is major public health problem for Africa with health and non health long term effects.
Progress in reduction of stunting has been slow
Proven specific and sensitive nutrition interventions exist but need scaling up.
Tackling stunting requires bold multi-sectoral action, leadership and financing.

25. THANK YOU