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Stunting & Wasting in South Asia- Reflections from a Regional conference

By Charulatha Banerjee on 7 June 2017

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Over the years the scope of ENN’s work has expanded beyond a focus on humanitarian contexts to encompass a broader set of issues around drivers of wasting and stunting in both high burden and emergency contexts. We are also increasingly interested in the evolving policy and programming environment around malnutrition treatment and prevention. ENN is currently engaged in exploring the relationship between wasting and stunting (see the recent blog piece by Carmel Dolan here), stunting in emergencies, and on how stunting or wasting focused initiatives interact in practice.

While my work with ENN is focused on the scaling up of programs to reduce stunting (looking at SUN countries within the Asia region), the evolution of the scaling up of acute malnutrition and treatment and prevention programs is also of interest. To this end, in mid-May I attended the regional conference Stop Stunting | No time to waste – Scaling Up Care for children with Severe Wasting in South Asia in Kathmandu. It was organised by SAARC and UNICEF ROSA and brought together country teams from 7 SAARC countries (India was absent at the conference).

The 2016 Joint Child Malnutrition Estimates revealed that 52% of the 52 million wasted children worldwide live in South Asia of which 9 million are severely wasted. While prevalence of stunting is declining at a slow pace, there are still 61.2 million stunted children in this region.  

In South Asia, the gap between children needing specific treatment for severe acute malnutrition and those receiving it is very wide. Facility based treatment which is critical for wasted children with complications, is very limited in reach. Community Based Management of Malnutrition (CMAM) is currently being implemented in only 3 countries in South Asia (Afghanistan, Pakistan and Nepal) with limited coverage. This leaves most children with no access to specific treatment. It also appears that recovery after treatment, be it facility or community based, is not sustained, which is possible only when children and carers have access to food, a clean environment and primary health care services.

The meeting held in Kathmandu took into consideration these complex and diverse settings. I present a few points which from my perspective made this meeting different from others that I have attended on acute malnutrition in the region:

The discussions raised several issues, most important of which are the lack of consensus on screening methods, the lack of reliable coverage data, food insecurity, and seasonality and frequent natural disasters and their implications for wasting prevalence.

A thought on what is hindering scale up of CMAM in the region. Some stakeholders in India and South Asia perceive RUTF as a quick fix and a magic formula which does not provide sustainable impact and therefore resist efforts to roll out product based programmes. However, those who advocate for the use of RUTF see it neither as a magic formula nor as a product to be used in isolation; but as one of many components of Community Based Management of Acute Malnutrition.  

To overcome the impasse, a meeting of technical experts from the region is needed to draw up clear evidence based guidelines which is sensitive to the varied contexts in the region. One sincerely hopes that this will also bring Indian policy makers, technicians and implementers to the table. To address stunting, in addition to scaling up of nutrition sensitive interventions the importance of scaling up specific treatment for wasting must not be forgotten. There is no time to waste.

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