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time for action a renewed uk commitment to nutrition time for action nutrition for growth 3 why is nutrition so nutrition interventions important to deliver impact on malnutrition it is ...

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   TIME FOR 
   ACTION   
   A RENEWED UK COMMITMENT  
   TO NUTRITION 
                   Time for Action                                                                                                                                                                                                                                                                                                             Nutrition For Growth                                                                            3
                   Why is nutrition so                                                                                                                                                                                                                                                                                                                  Nutrition Interventions 
                   important? 
                                                                                                                                                                                                                                                                                                                                                        To deliver impact on malnutrition it is essential that a 
                   45% of deaths of children under five are linked to                                                                                                                                                                                                                                                                                   broad package of nutrition-specific and nutrition-sensitive 
                                      1                                                                                                                                                                                                                                                                                                                 programmes have the resources required to deliver 
                   malnutrition . Despite progress, 149 million children were                                                                                                                                                                                                                                                                           impact. 
                                                                                                    2
                   stunted in 2020 and 45 million children were wasted . The 
                   pandemic has made matters much worse. It is now                                                                                                                                                                                                                                                                                      Nutrition-specific programmes target the immediate 
                   predicted that an additional 283,000 children under five will                                                                                                                                                                                                                                                                        causes of malnutrition. Generally, these are reported under 
                   die from malnutrition as a result of the pandemic in the                                                                                                                                                                                                                                                                             the basic nutrition purpose code (12240) in the OECD 
                   next three years, equivalent to 225 children dying every day                                                                                                                                                                                                                                                                         Creditor Reporting System (CRS). Nutrition-specific 
                                        3
                   in this period . An additional 3.6 million children are                                                                                                                                                                                                                                                                              programmes are often delivered through the health 
                   predicted to face lifelong health problems due to stunting                                                                                                                                                                                                                                                                           system and include some of the most cost-effective, life-
                   and 13.6 million children are predicted to become wasted                                                                                                                                                                                                                                                                             saving interventions. They are vital to preventing and 
                   (dangerously thin for their height). Not only will this lead to                                                                                                                                                                                                                                                                      treating malnutrition and it is likely that the design and 
                   preventable child deaths, it will put immense pressure on                                                                                                                                                                                                                                                                            budget for these programmes will sit within the Global 
                   health systems and restrict the life chances of millions of                                                                                                                                                                                                                                                                          Health Directorate of the Foreign, Commonwealth and 
                   children.                                                                                                                                                                                                                                                                                                                            Development Office (FCDO), developed by the Nutrition 
                   Malnutrition refers to deficiencies, excesses, or imbalances                                                                                                                                                                                                                                                                         team. Examples, outlined in the table below, include 
                   in a person's intake of nutrients. Although related issues,                                                                                                                                                                                                                                                                          programmes to promote breastfeeding, treat wasted 
                   action on nutrition is different from action on famine.                                                                                                                                                                                                                                                                              children and provide vitamin supplements. 
                   Action on famine means investing in actions like                                                                                                                                                                                                                                                                                     Nutrition-sensitive programmes target the underlying 
                   emergency social protection. Typically, this involves                                                                                                                                                                                                                                                                                causes of malnutrition. They may be reported under the 
                   providing cash or food directly to people in crisis. These                                                                                                                                                                                                                                                                           basic nutrition purpose code in the OECD CRS but they 
                   actions are important to respond to and prevent                                                                                                                                                                                                                                                                                      will predominantly be coded under a different sector. 
                   widespread malnutrition during a famine. But improving                                                                                                                                                                                                                                                                               Nutrition-sensitive programmes, with strong and relevant 
                   nutrition and reducing the number of young children dying                                                                                                                                                                                                                                                                            nutrition objectives, can deliver positive impact for 
                   every year from malnutrition involves actions before a                                                                                                                                                                                                                                                                               nutrition outcomes as well as positive impact for the 
                   crisis occurs, and beyond it. Such preventative actions                                                                                                                                                                                                                                                                              sector they are also focused on. Improved and enhanced 
                   include strengthening health systems, increasing access to                                                                                                                                                                                                                                                                           nutrition-sensitivity is vital to enact changes that can halt 
                   basic nutrition services and improving agriculture and food                                                                                                                                                                                                                                                                          malnutrition developing in societies as well as provide 
                   systems.                                                                                                                                                                                                                                                                                                                             increased impact and return on investment. Crucially, for 
                   The UK has played an active role in tackling malnutrition                                                                                                                                                                                                                                                                            FCDO, the delivery of nutrition-sensitive programmes 
                   since founding the Nutrition for Growth (N4G) initiative,                                                                                                                                                                                                                                                                            requires tailoring non-nutrition programming to also 
                   alongside Japan and Brazil, and hosting the first ever                                                                                                                                                                                                                                                                               target the underlying causes of malnutrition. It requires 
                   Nutrition for Growth summit in 2013. That summit raised                                                                                                                                                                                                                                                                              enhancing objectives for current or future programmes in 
                   £17 billion to address malnutrition globally. Since then, the                                                                                                                                                                                                                                                                        different departments, not replacing them. This can be 
                   UK has been one of the world’s leading donors to nutrition.                                                                                                                                                                                                                                                                          delivered through utilising nutrition advisers early in 
                   UK aid for nutrition is well known for being high impact and                                                                                                                                                                                                                                                                         programme design in nutrition-relevant sectors to 
                                                           4                                                                                                                                                                                                                                                                                            determine if and how a proposal can be improved to also 
                   excellent value for money . Long term decreases in                                                                                                                                                                                                                                                                                   target malnutrition. 
                   malnutrition have occurred in countries where the UK has 
                                                   5
                   invested in nutrition .                                                                                                                                                                                                                                                                                                              Nutrition interventions provide multiple benefits across 
                   However, the UK is currently set to make the biggest cuts                                                                                                                                                                                                                                                                            different forms of malnutrition. The table overleaf shows 
                   to its overseas nutrition work in history. While the aid                                                                                                                                                                                                                                                                             some examples of what can be done to drive progress on 
                   budget as a whole is facing a cut of roughly a third, aid for                                                                                                                                                                                                                                                                        different forms of malnutrition. These should not be done 
                                                                           6                                                                                                                                                                                                                                                                            in silos but be delivered as part of a broad package of 
                   nutrition is set to be slashed by 70% . This will have a                                                                                                                                                                                                                                                                             interventions, particularly considering that different forms 
                   devastating impact on individuals and communities in                                                                                                                                                                                                                                                                                 of malnutrition can co-exist within societies, families, and 
                   many of the world’s most challenging environments.                                                                                                                                                                                  Photo: The Power of Nutrition                                                                    individuals.
                                                                                                                     (ICAN), setting recommendations to the UK Government7,8. 
                   The Tokyo Nutrition for Growth (N4G) Summit 2021 is a                                                                                                                                    9
                   crucial opportunity to pledge commitments that will help                                          The policies and positions set out in those remain current . 
                   reverse the rise in malnutrition caused by the pandemic. The                                      The below consolidates these recommendations and 
                   outcomes of the summit will be decisive for the future                                            explores concrete options for action alongside previous 
                   health, development and economic potential of millions of                                         examples of success. By actioning the recommendations in                                                                                       The UK can help reverse the rise in malnutrition 
                   people worldwide. An ambitious UK commitment to tackle                                            this document, the UK could maximise the impact of its 
                   malnutrition at the summit is essential to further the returns                                    investments in areas such as education, climate and health.                                                                          “caused by the pandemic, save lives and help give 
                   achievable through the UK’s investments in other                                                  It could drive progress on its Key Performance Indicators 
                   development initiatives, including girls’ education, climate                                      (KPIs) to reduce preventable child deaths and improve                                                                                          millions of children the best possible start in life.
                   change, global health resilience and the establishment of                                         education. And by coordinating with its allies and making 
                   universal health coverage (UHC).                                                                  strong commitments at this global summit, the UK can help                                                                                                                                                                                                                                                        ”
                                                                                                                     reverse the rise in malnutrition caused by the pandemic, 
                   This document builds on two previous policy reports from                                          save lives and help give millions of children the best 
                   the International Coalition for Advocacy on Nutrition                                             possible start in life.  
                     Time for Action                                                                                                                                                                                         4                                        Time for Action                                                                                                                                                                                         5
                    Table 1: Examples of nutrition-specific and nutrition-sensitive interventions
                     Examples of                           Stunting                                                                                 Wasting                                                                                                          Micronutrient deficiency:                                                                               Micronutrient deficiency: 
                     undernutrition                                                                                                                                                                                                                                  Vitamin A                                                                                               Anaemia
                     Definition                            Impaired growth and development that children                                            Low weight for height, indicating a severe and                                                                   Insufficient intake of Vitamin A required for optimal                                                   A nutritional deficiency caused by a lack/poor absorption 
                                                           experience from poor nutrition and repeated                                              recent weight loss, often resulting from                                                                         health.                                                                                                 of iron, B12, and/or C, resulting in a lack of healthy red 
                                                           infections.                                                                              insufficient quantity and quality of nutritious                                                                                                                                                                          blood cells.
                                                                                                                                                    food and/or prolonged illness.
                     Why does this                         • Stunting impedes human and economic                                                    • Wasting is associated with higher risk of death                                                                • Vitamin A deficiency is the leading cause of preventable                                              • Anaemia reduces the capacity of blood to carry oxygen 
                                                                                                                                                                                            13
                     matter?                                  development.                                                                             if not treated properly .                                                                                         childhood blindness and increases the risk of death from                                               around the body (even when receiving adequate 
                                                                                                                                                                                                                                                                                                                                                      16
                                                           • It is one of the most significant impediments to                                                                                                                                                            common childhood illnesses such as diarrhoea  and                                                      amounts of calories) and results in severe fatigue, poor 
                                                                                                                                                                                                                                                                                                            17
                                                              cognitive and physical development, causing                                                                                                                                                                respiratory infections .                                                                               concentration, pregnancy complications and increased 
                                                                                                                                                                                                                                                                                                                                                                                                                                     20
                                                              reduced productive capacity and poor health,                                                                                                                                                                                                                                                                      risk of developing heart disease .
                                                              and an increased risk of degenerative diseases 
                                                                                          10
                                                              such as diabetes .  
                     Scale of the issue                    • In 2020, 149.2 million of children were affected                                       • In 2020, 45.4 million children were affected by                                                                • An estimated 48% of children in sub-Saharan Africa and                                                • 613.2 million adolescent girls and women aged 15 to 49 
                                                                                 11                                                                                  14                                                                                                                                                                                         18                                                                                  21
                                                              by stunting .                                                                            wasting .                                                                                                         44% of children in South Asia are Vitamin A deficient .                                                years worldwide are affected by anaemia . 
                                                           • 3.6 million additional children could be                                               • 13.6 million additional children could be                                                                                                                                                                              • 4.8 million additional women and adolescent girls could 
                                                              stunted in the next three years as a result of                                           wasted in the next three years as a result of                                                                                                                                                                            be afflicted with anaemia in the next three years as a 
                                                                               12                                                                                                               15                                                                                                                                                                                                                                     22
                                                              COVID-19 .                                                                               the COVID-19 pandemic .                                                                                                                                                                                                  result of the COVID-19 pandemic .  
                     Example of                            • Infant and Young Child Feeding (IYCF) and                                              • IYCF and relevant complementary feeding.                                                                       • Vitamin A supplementation programmes.                                                                 • Supplementation, fortification and deworming 
                     nutrition-specific                       relevant complementary feeding, particularly in                                       • Prevention, early detection and treatment of                                                                   • Promoting breastfeeding.                                                                                 programmes to include women of reproductive age.  
                     approach                                 the first critical 1,000 days of life.                                                   acute malnutrition including through equitable                                                                                                                                                                        • Fortification of relevant staple foods.  
                                                           • Regular deworming of children, adolescents and                                            access to Ready-to-UseTherapeutic Foods                                                                       • Vitamin A fortification of food. 
                                                              women of reproductive age.                                                               (RUTF). 
                                                           • Micronutrient supplementation, such as                                                 • Community based monitoring and management 
                                                              micronutrient powders or fortified food supp -                                           of acute malnutrition. 
                                                              lements, for adolescents and pregnant women.                                          • Blanket feeding programmes (e.g., during lean 
                                                           • Interventions to improve the quality of diet for                                          season) to supplement dietary intake. 
                                                              women and children. 
                     Example of                            • Integration of nutrition health services into health                                   • Integration of Severe Acute Malnutrition                                                                       • Nutrition sensitive agriculture targeted at improving                                                 • Implementation of gender-sensitive strategies for the 
                     nutrition-sensitive                      system strengthening strategies, such as                                                 services in health system strengthening                                                                           dietary diversity for children and for pregnant and                                                    prevention and treatment of malnutrition, with a 
                                                                                                                                                                                                                                                                                                                                                                                                                                            23
                     approach                                 antenatal and postnatal services and other health                                        strategies.                                                                                                       lactating women.                                                                                       specific focus on anaemia reduction . 
                                                              services, such as sexual and reproductive health                                      • Early warning systems to warn when there is                                                                                                                                                                            • Integration of nutrition health services into sexual and 
                                                              or vaccination services. This can help to lower the                                      an increased risk of wasting.                                                                                                                                                                                            reproductive health services.  
                                                              risk of stunting at birth and prevent infections. 
                                                           • Primary prevention of disease in children under                                        • Subsidies or access to market interventions to                                                                                                                                                                         • Nutrition education and school feeding programmes. 
                                                              2 years, through water, sanitation and hygiene                                           improve access to food.                                                                                                                                                                                               • Improved access to a diverse diet through changes in 
                                                              (WASH) improvements.                                                                  • Climate resilient seeds for nutritious                                                                                                                                                                                    agricultural and food systems, food environments, and 
                                                           • Livelihoods support such as cash transfers that                                           agriculture.                                                                                                                                                                                                             associated interventions. 
                                                              enable people to purchase nutritious food.                                            • Cash transfers and other livelihood activities to 
                                                           • Improved access to girls’ education, targeting                                            increase household purchasing power. 
                                                              retention at school and delaying the age at first 
                                                              birth for a woman, should they choose to become 
                                                              a mother, lowering the risk of stunting at birth.
                     Impact of                              • Lower under-five mortality rates.                                                     • Lower under-five mortality rates.                                                                              • Lower under-five mortality rates.                                                                     • Increased chances for women and adolescent girls 
                     intervention                           • Improved health outcomes for other common                                             • Lower risk of stunting.                                                                                        • Boost vaccines’ efficiency and immune system’s                                                           to reach higher education and economic 
                                                                                                                                                                                                                                                                                        19                                                                                      opportunities.  
                                                               infections (such as pneumonia and malaria).                                          • Improved health outcomes for other common                                                                          response .
                                                            • Increased educational attainment.                                                        infections (pneumonia and malaria).                                                                                                                                                                                   • Decreased chances of pregnant women to have a 
                                                                                                                                                                                                                                                                                                                                                                                baby with low birth weight or cognitive 
                                                            • Increased productivity and economic growth.                                           • Increased educational attainment.                                                                                                                                                                                                            24
                                                                                                                                                                                                                                                                                                                                                                                impairment .   
                                                                                                                                                    • Increased productivity and economic growth. 
                     Time for Action                                                                                                                                                                                         6                                        Time for Action                                                                                                                                                                                         7
                       ICAN UK                                                                                                                                                                                                                                                                                                                                                    Case Study:  
                       Recommendations:                                                                                                                                                                                                                                                                                                                                           Halima, Somalia SHINE Programme 
                       • The FCDO should commit to continue its                                                                                                                                                                                                                                                                                                                   Halima was 17 months old when she was admitted to 
                           ambitious, impactful and effective nutrition-                                                                                                                                                                                                                                                                                                          Hodan hospital in Mogadishu, Somalia, in a very serious 
                           specific programming between 2021 and 2025.                                                                                                                                                                                                                                                                                                            condition, withdrawn and underweight with peeling 
                           This means investing, at a minimum, £600                                                                                                                                                                                                                                                                                                               skin, swollen limbs and brittle hair. Her mother Fatuma, 
                           million over the same period, equivalent to                                                                                                                                                                                                                                                                                                            only 18 years old, has recently fled from a violent 
                           £120 million per year.                                                                                                                                                                                                                                                                                                                                 marriage but was forbidden from taking her daughter 
                                                                                                                                                                                                                                                                                                                                                                                  with her. When mother and daughter were finally 
                       • The FCDO should ensure that, at a minimum,                                                                                                                                                                                                                                                                                                               reunited, Halima had suffered terrible neglect and was 
                           £680 million of nutrition relevant programming                                                                                                                                                                                                                                                                                                         seriously ill.  
                           is tailored to tackle the underlying causes of 
                           malnutrition per year between 2021 and 2025.                                                                                                                                                                                                                                                                                                           At Hoden hospital, Halima’s acute malnutrition was 
                           This is money already being spent on other                                                                                                                                                                                                                                                                                                             treated with the support of the UK funded SHINE 
                           ODA objectives and can be more impactful if                                                                                                                                                                                                                                                                                                            programme. Halima was treated with ready to use 
                           nutrition objectives are added.                                                                                                                                                                                                                                                                                                                        therapeutic food and her mother, Fatuma, was 
                                                                                                                                                                                                                                                                                                                                                                                  supported with a cash transfer scheme designed to 
                                                                                                                                                                                                                                                                                                                                                                                  help her continue to provide her daughter with a 
                     Case Study:                                                                                                                                                                                                                                                                                                                                                  healthy balanced diet.  After five months, the little girl 
                     Suchana                                                                                                                                                                                                                                                                                                                                                      was bouncy, bubbly and a little bit chubby. When she 
                                                                                                                                                                                                                                                                                                                                                                                  recovered, photos of Halima’s treatment, supported by 
                     Part-funded by UK Aid, and implemented by a range of                                                                                                                                                                                                                                                                                                         UK Aid, helped Fatuma win full custody of her in a 
                     partners including Save the Children UK, Suchana aims to                                                                                                                                                                                                                                                                                                     Sharia court.   
                     reduce stunting among children under 2 years of age in                                                                                                                                                                                                                                                                                                       Phot: Fardosa Hussein February 2020, Action Against Hunger Somalia 
                     Sylhet and Moulvibazar district of Bangladesh. It targets 
                     235,500 households, which covers 1.4 million people, with 
                     a set of nutrition-specific and nutrition-sensitive 
                     interventions in order to break the intergenerational cycle 
                     of undernutrition. 
                     Suchana’s key strategies involve: 
                     ● Empowering the households and communities to 
                         practice optimal Infant and Young Child Feeding 
                     ● Diversifying and increasing household income 
                     ● Improving household level food security through home 
                         food production 
                     ● Empowering adolescent girls and women to protect 
                         and improve their nutritional status 
                     ● Improving the quality and availability of nutrition 
                         services at health facilities 
                     ● Increasing government interest and support for 
                         multisectoral approaches and replicating the Suchana 
                         intervention model in other parts of the country 
                     The programme has brought significant positive change. 
                     Households are eating a more diverse and nutritious diet 
                     and are more food secure. 150,307 households received 
                     training on nutrition-rich and climate smart agriculture 
                     practices and 74.9% of households reported that they 
                     were food secure, up from 14.1% at the start of the 
                     programme. Practices of infant and child feeding, and 
                     maternal and child nutrition have improved. 90% of 
                     children 0-5 months were reported exclusively breastfed 
                     in the 24 hours prior to reporting, up from 64%. 
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