Gently laying three-month-old Benjamin on a board to measure his length, Elizabeth Mumo, 28, is grateful for the weekend clinics in a makeshift health facility, run by a retired nurse, that help keep her baby healthy.
In a single visit to Alice Clinic, the only health care available to most residents in the poor settlement on the outskirts of Kenya's capital Nairobi, Benjamin can be immunized, weighed and measured. When asked what she feeds him, Mumo says only breast milk for six months "of course" – something the clinic taught her when her first child was born.
Nurse Lida Juma says post-birth visits like this are critical to reversing the tide of children who are "stunted" by undernutrition – intellectually and physically maimed for life, if they survive at all. At one time, Alice Clinic offered nutritional counseling, including demonstrations on how to add vitamin and mineral-rich traditional vegetables to the maize-meal porridge that is the basic local diet, but grant funds dried up.
Clinic nurses would like to provide essential micro-nutrients to pregnant mothers and to all children for their first 1000 days, but that, too, requires resources that don't exist. Government-supplied sachets of vitamins have arrived sporadically and in too small quantities to meet the need. "It has a negative effect, because you're not actually implementing what you're told to do, but we just don't have enough," Juma laments.
Undernutrition is the single largest contributor to child deaths worldwide – and stunting takes a further toll, both to people and to their nations' prospects for prosperity.
"A mother who has very poor nutrition - if her child is not one of the 2.5 million children who die at birth or before birth - then she is going to have a stunted child," said Joy Phumaphi, trustee of the Children's Investment Fund Foundation (CIFF), an independent philanthropic organization. "This child will have limited cognitive development and very poor learning outcomes at school. They are not going to be able to get a skill which can give them access to better employment so they can break out of the poverty trap.
"Now you take this and you multiply it by millions and millions, so you have whole communities whose ability to develop is stunted, and it's not just the individual. It is the community's ability to pull itself out of poverty and the country's potential for economic growth and development.
"It is unrelenting."
CIFF, along with the governments of the UK and Brazil, are co-hosting a high-level international meeting, Nutrition for Growth, today in London. The event brings together business leaders, scientists, governments and civil society to make financial and political commitments to combat malnutrition worldwide.
It follows the release on Thursday of a new Lancet series on maternal and child nutrition that examines the problems associated with undernutrition and interventions that have been successful in fighting it. A similar report released by The Lancet in 2008 was instrumental in helping push nutrition higher on the development agenda. It highlighted the importance of nutrition in the first 1,000 days of life as critical to a child's development.
Hunger and malnutrition are the number one risk to global health — greater than AIDS, malaria and tuberculosis combined, according to the United Nations. Nearly half of all child deaths can be attributed to undernutrition, or "the synergy of nutrition and infection that leads to deaths," as The Lancet calls it. Chronically malnourished children are, on average, nearly 20 percent less literate than those who have a nutritious diet, according to a recent Save the Children report.
"The key thing about the commitments being made this weekend is that they are quantified public commitments, which will be accountable. That means if a government says, 'We're going to reduce levels of chronic undernutrition or stunting over the next five years by 20 percent from the current level,' then that commitment will be very much taken on board by national and international civil society groups," said Dr. David Nabarro, coordinator of the Scaling up Nutrition (SUN) movement, about the Nutrition for Growth event. "There will be expectations that the efforts are made to try to fulfill the commitment. And if the commitment is not fulfilled, then there will be some kind of explanation needed."
SUN is an effort by 40 countries to put nutrition higher on their political agenda and to get improvements in nutrition, especially for women and children. Of those countries, 15 of them are rapidly reducing the prevalence of chronic malnutrition, and 10 of them are in Africa, said Nabarro, who is also special representative of the UN secretary-general for Food Security and Nutrition.
"The great thing is these are countries where we've seen strong political leadership, good working across different sectors of government, a real focus on the needs of people, particularly women, engagement of the different stakeholders and attention to results," he said. "I expect to see most countries in Africa over the next five years using similar methods and starting to demonstrate real reductions in chronic malnutrition, reductions in anemia during pregnancy, certainly reductions in acute undernutrition that are so dangerous for children - and also improvements in the capacity of communities to avoid the other side of malnutrition which is obesity."
A year ago, a panel of economic experts published recommendations as part of the 'Copenhagen Consensus' on the most cost-effective ways to allocate money to respond to the world's biggest challenges. The panel, which included some of the world's most distinguished economists and Nobel laureates, recommended fighting malnutrition as the top priority for policymakers and philanthropists.
Panelists said that for less than 700 million dollars annually, it would be possible to eliminate vitamin A deficiencies in pre-school children, eliminate iodine deficiency globally and dramatically reduce maternal anemia during pregnancy.
Even in very poor countries, and using conservative assumptions, researchers determined that each dollar spent reducing chronic undernutrition has a 30-dollar payoff.
Yet, despite the availability of relatively simple and extremely cost-effective interventions to address malnutrition, very few countries effectively implement these proven interventions at scale.
"To make all of these different types of approaches to nutrition happen successfully," said Nicholas Nisbett of the Institute of Development Studies (IDS), requires a wider enabling environment.
"You need a political and policy environment conducive to action on nutrition, and for the right resources to be dedicated towards tackling undernutrition, and the right political will and commitment from policy-makers and bureaucrats all the way down to the ground level. You need the support of the media, and you need the support of the general public as well."
The countries that have achieved high coverage of key interventions against undernutrition "are those countries that are involving lots of different stakeholders in the effort and are also running a regular program of monitoring and checking to see what's going on", Nabarro said. "It is very variable, and some countries still have a long way to go."
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He said one intervention that has been particularly tricky is the treatment of severe acute malnutrition.
"It's expensive, it's difficult. But if you look at a country like Niger, which is not a wealthy country, they've got a fantastic program of expanding and tracking the quality of care for children with acute malnutrition," Nabarro said. "What I'm seeing is that countries are learning from each other and gradually we're seeing a general upscaling in quality right across the continent."
But despite the potential to reduce the scourge of sick and dying children and stunted economies, IDS head Lawrence Haddad says it's "time to step up the outrage."
"There are plenty of ideas" about what to do and how to do it, he points out. "But children can't eat ideology."
This weekend's Nutrition for Growth event marks a moment, organizers say, to move beyond words to transparent, accountable actions.
"What I really hope," says CIFF founder Jamie Cooper-Hohn, is that we will move nutrition firmly into the heart of the agenda, instead of being an outlier issue."
She's optimistic. "I'm convinced," she says of today's global meeting of leaders, "that we will see a big surge of evidence-based intervention", using the new resources pledged at the session. "That's very, very exciting."
Tami Hultman, Lauren Everitt and Samantha Nkirote McKenzie contributed to this report.
