The first few years of a child’s life have a critical impact on their long-term development.
A new programme from Concern Worldwide, the international humanitarian organisation, is helping to transform the lives of some of the world’s most vulnerable children.
ERNE, which stands for Enhanced Responses to Nutrition Emergencies, is a three-year programme funded by ECHO, the EU’s humanitarian aid wing.
ERNE aims to reduce the incidence of malnutrition among children under five years of age and pregnant women by preventing it from happening in the first place, and by ensuring that those suffering from the most acute forms of malnutrition have access to lifesaving treatment and care.
The World Health Organisation estimates that 45 million under-fives are currently “wasted”, a term used to describe malnourished children who are much thinner than they should be for their height.
It’s a shocking figure, equivalent to the population of Spain. Roughly 149 million children are “stunted”, meaning they are abnormally short for their age.
Wasting and stunting are caused by children having an inadequate diet or falling sick or, most often, both.
“Undernourished children catch infections more easily and have a harder time recovering because their immune systems are impaired,” explains Kate Golden, senior nutrition advisor at Concern Worldwide. “If not addressed, wasting can be fatal. Severely wasted children are nine times more likely to die than those with a healthy weight.”
Stunting occurs more gradually. The child survives, but its effects can last a lifetime because it cannot be reversed once a child reaches its second birthday, and the consequences extend well beyond height.
“The tell-tale sign of stunting is shortness, but it’s not just about height, it can be a marker for stunted development of a child’s organs, such as their heart or brain. Evidence shows this can affect children’s ability to achieve higher levels of schooling and their work capacity, with a direct economic impact on GDP - all because a child hasn’t had enough nutrition in their first 1,000 days of life,” she says.
That’s how short the window of opportunity is for intervention. “It’s from conception to the age two,” Golden explains.
“A lot of malnutrition happens in pregnancy, which is why we also focus on ensuring good nutrition and health practices for pregnant mothers and mothers with new borns.”
The ERNE programme is working to break this cycle. It aims to reach 500,000 vulnerable children over the three-year lifespan of the programme, which is rolling out in five countries: Niger, the Democratic Republic of Congo, Ethiopia, South Sudan and Sudan.
In each of the five countries, Concern is helping to build the capacity of government health staff to deliver essential nutrition and health services, including improving water sources and latrines in health facilities. They are also working with health centre teams to better anticipate when seasonal surges in cases of malnutrition are likely to take place so they are better prepared with the additional staff, nutrition rations, and medicines needed to deliver treatment to all who need it.
“In many locations, there are predictable surges when cases double, or even triple, such as during the ‘hunger gap’ when the last harvest has been eaten and people are awaiting the next harvest,” she says.
Roughly 80 per cent of wasted children in the world today are not able to access treatment
“It could also be when malaria cases are peaking or when there are outbreaks of diarrhoea or families have returned from a month after cultivating a distant field or seeking pasture for their animals. Many come back with children who are sick and malnourished,” Golden says. ”It is similar to the ‘flu season’ in Ireland, but each community has its own surge factors.”
Until the early 2000s, nearly all treatment for malnutrition involved a trip to a distant feeding centre. Because services were far from children’s homes, many were not brought for treatment or when they were, their siblings at home suffered because their mother often had to stay with them for up to a month to recover.
Twenty years ago, Concern, in partnership with Valid International and supported by Irish Aid, revolutionised the treatment of child malnutrition by introducing the community based management of acute malnutrition (CMAM). Two innovations made this possible.
The first was the invention of ready-to-use therapeutic foods made of peanut butter, packed with vitamins and minerals, that allowed children to receive weekly treatment at their local health centre and recover at home with a take-home ration.
The second is the MUAC band, a colour-coded strip that measures a child’s mid-upper arm circumference, which alerts a parent that their child is malnourished and must be taken to the local health centre for treatment.
“These mean that most children can be safely treated at home, and not 50km away in a clinic,” she says. Despite this progress, it is estimated that roughly 80 per cent of wasted children in the world today are not able to access treatment. Much more must be done.
Covid-19 has complicated the logistics of programme delivery, but the partnership with ECHO has been a huge help because it enables us to plan over three years, ERNE’s global programme co-ordinator, Aoife Black says; “We are really excited to be able to take our lifesaving work to scale in five countries and to work in depth with people and communities to bring about lasting change.”
Preventing malnutrition is a major part of the programme. One key strategy is bringing mothers of the same age together for peer support and as a forum for basic education around handwashing, and cooking demonstrations showing how to make the most of local foods to enrich their children’s diet.
Father support groups are being piloted too, to engage fathers more in improving the nutrition of young children and their partner. “This requires a more gradual approach, taking into account local cultural norms where child care is seen as very much the domain of women,” Golden says.
We are working with communities to find innovative ways to close the hunger gap
The ERNE programme also provides small cash payments directly to vulnerable parents to help them through short-term crises, such as floods or droughts or the lean season, which can put their children at risk. “Who better to decide how to stretch limited resources to cover the most urgent needs than the parents themselves?” she asks.
This small amount of cash could help ensure a parent in need doesn’t have to sell valuable long term assets such as livestock simply to make it through to harvest.
“We are working with communities to find innovative ways to close the hunger gap,” says Golden, “because there are 150 million children who are malnourished in the world today, through absolutely no fault of their own.”