Young children who are skin and bones are called “wasted”. The root of the verb “waste” is “to devastate, ruin”, which sadly is all too apt. Severely wasted children are 12 times more like to die of common diseases than children who are not malnourished. And for the survivors, their lives are ruined in the sense that they are more likely to drop out of school, more likely to live in poverty as adults, and more likely to suffer diet related chronic disease later in life.
The numbers and trends on global levels of child wasting are deeply concerning. Before COVID-19, the number of wasted children was inching down, albeit slowly and even then, not everywhere. In 2019 the global total stood at 47 million. Tragically, during 2020/21 those numbers likely jumped due to COVID-19. The pandemic caused income losses, health system overloads and food system disruptions in rich and poor countries alike. In the coming 18 months, it has been estimated that we will see a 27% increase, or 13 million more wasted children - unless something changes.
But what, exactly, needs to change? Well, more money is needed: a doubling of current spending, say current estimates. But we also need to change the way we spend money. We argue that if we do not change or “reset” the way we tackle wasting then the above projections will become destiny and more young children will suffer and die, regardless of increased resources.
Change needs to happen in the following six areas:
Greater focus on prevention : because wasting is associated with acute episodes of food deprivation and illness-- even though it can persist for months and re-occur over many years-- it tends to be treated as a humanitarian issue. This means that the focus is on treatment and there is too little emphasis on prevention or on reducing the risk of relapse after treatment. And the most fundamental prevention is to invest in maternal nutrition and health because wasting often has its origins in poor foetal growth during pregnancy.
More compelling advocacy : wasting is an orphan issue within nutrition. It is difficult to know precisely why. It may be that some feel that pushing too hard on wasting takes attention away from the issue of stunting. It may be the absence of annual trends in the data--the currency of advocacy—which are too challenging to construct for wasting given its seasonality. Whatever the cause, we need strong advocacy for action on and accountability for wasting. Wasted children are at higher risk of death than stunted children and when both conditions are present, the child’s chances of survival narrow significantly. We need to act more quickly to ensure that photographs of children who are clinging to life, who are skin and bones, no longer need to make the evening news.
Technical programming that focuses on outcomes : programming has been too reliant on weight loss as a diagnosis and rapid weight gain as a sign of success. The emphasis needs to shift to functional consequences of wasting and their mitigation and prevention. For example, there is much new science suggesting that it is possible to prevent most children slipping from a moderate case to the severe condition; and that sustained physical recovery not only means preventing relapse but also ensuring a child’s cognitive and developmental recovery.
Policies and guidelines that are updated by cutting edge research : there has been a raft of new operational research in the past 10 years to make wasting guidelines more aligned, effective and cost effective, but not enough of the learning from the research has been embedded in policies, which need modernising. For example, too few national nutrition strategies and plans, which aim to prevent malnutrition in all its forms, mainstream wasting priorities.
New product suppliers that can innovate to drive down affordability : for too long innovation in ready-to-use foods has been stifled by patents and unpredictable demand. The patents have now expired, and innovations are bringing down the price, especially thanks to increased production within the countries with the highest burdens. But funds are needed to ramp up effective programming to reach all children in need of treatment, thereby raising and stabilizing demand for products.
Financing that is part of regular nutrition allocations, not exceptional to them : the funding of wasting prevention and treatment programmes is too dependent on the humanitarian space. This makes funding often extrabudgetary for governments. Funding for all dimensions of preventing and treating wasting must be predictable, geared to increasing programme coverage within existing health services, and increasingly embedded in government nutrition budgets and donor development budgets.
Some of these changes are already underway under the new Global Action Plan (GAP) led by the five key UN agencies; UNICEF, World Food Programme, Food and Agriculture Organization, World Health Organization and United Nations High Commissioner for Refugees. This is an excellent initiative, but not all these changes are happening, and those that are being planned are not moving quickly enough. In addition, resources and expertise from those outside the UN who understand programme implementation is not always being sufficiently utilised and aligned.
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Another definition of the word “wasted” is “abandoned”, as an adjective. Are we really at risk of abandoning these children? Yes. They are the only ones who will suffer if we do not “reset” wasting with urgency. Their whole world is at risk in a way that no-one else’s is, especially in this time of COVID.
Fortunately, there are upcoming opportunities for the global community to come together around this relatively neglected but deadly condition. The December 2021 Nutrition for Growth Summit is the perfect chance for governments, funders, nutrition agencies and nutrition champions from all corners of society to come together and make bold commitments to fund wasting reduction and to change the way that funding for wasting is allocated and managed.
Given the impending tsunami of wasting numbers expected in the wake of COVID-19, current actions on child wasting lack urgency, coherence, and impact. There needs to be a reset, involving new stakeholders, new momentum, new ambition, and new urgency. Let this be that moment: we must not waste the opportunity to end child wasting.
