Child health and nutrition in Africa

Breast milk is the ideal natural food for optimal growth and safe psychomotor development. This is due to its rich nutrients and protective factors, as well as its biospecificity (the kinetics of its composition change during lactation) and impact on mother-child relationships. These key advantages reduce child mortality rate by 13 per cent in areas where over 80 per cent of women breastfeed exclusively.[9][10][11][1]

Undernourished children have lowered resistance to infection and are at greater risk of common childhood diseases such as diarrhoeal diseases, respiratory infections, recurring sickness and faltering growth, often with irreversible damage to their cognitive and social development.[10] For current and future generations, good nutrition is a cornerstone for survival, health and development. Well-nourished children set off on a better developmental path (both physically and mentally), perform better in school, grow into healthier adults and are able to give their own children a better start in life. Supplementary feeding, when properly implemented, helps to reduce the mortality rate of children under 5 by 6 per cent.[9][10][11][1]

The prevention of malaria through the use of LLINs is a key strategy for rolling back malaria in Africa. According to model-generated estimates based on the number of LLINs supplied by the manufacturers, the number distributed by national malaria control programmes and data from household surveys, the percentage of households with at least one LLIN in sub-Saharan Africa increased from 3 per cent in 2000 to 50 per cent in 2011. Coverage rates of more than 80 per cent can reduce Africa's child mortality rate by 7 per cent.[9][10][11][1]

Hib, meningitis and respiratory infections are frequent and serious on account of their high mortality rates and potential consequences, which include sensorineural damage. These infections can be prevented by vaccination to reduce child mortality by 4 per cent. Hib vaccination is part of the Expanded Programme on Immunization (EPI) together with vaccines against tuberculosis, poliomyelitis, diphtheria, tetanus, hepatitis B, measles and yellow fever. EPI is a key preventive intervention in reducing infant morbidity and mortality; together with the monitoring and promotion of growth, it is a fundamental pillar in child health and development.[11][10][1][9]

The 25 per cent prevalence of HIV in some eastern and southern African countries is a matter of concern. African countries that showed more than 20 per cent adult HIV prevalence in 2011 included Botswana (23.4 per cent), Lesotho (23.3 per cent) and Eswatini (26 per cent) (UNICEF, 2013). Globally, the number of new HIV infections continues to fall annually, although there is considerable regional variation. In sub-Saharan Africa, where most of those newly infected with HIV live, it is estimated that 1.9 million (1,700,000 – 2,100,000) people were infected in 2010. According to estimates, this represents a 16 per cent decrease compared to the number of new infections with HIV in 2001, which was 2.2 million (2,100,000-2,400,000), and a 27 per cent decrease compared to the number of new infections between 1996 and 1998, when the incidence of HIV infection in the region peaked.[12][1]

The vast majority of children are infected before birth, during pregnancy, labour or breastfeeding (if the mother is seropositive). The course of HIV and AIDS is particularly aggressive in children. Without care and treatment, the virus multiplies and destroys the child's immune system, lowering resistance to infections such as pneumonia and other common childhood diseases. Almost half of all children infected by their mothers die before the age of 2. Thanks to a decrease in the price of drugs, increased awareness, the introduction of fixed-dose combinations of anti-retrovirals (ARVs) and more reliable forecasts of demand for paediatric ARVs, several countries have been able to distribute them for use in children, but the coverage rate remains extremely low in Africa.[13][1]

Food fortification is a cost-effective way of ensuring that a population receives adequate nutrients without altering their usual dietary practices.[14] WHO recommends mass fortification of salt with iodine to prevent iodine deficiency in both children and adults.[15] Fortification of other foods such as flour and cooking oil has been suggested and implemented in some countries, but salt iodization has been the most successful in terms of implementation and benefits in Sub Saharan Africa.[16] Micronutrient powders (MNPs) for point of use fortification, contain a mixture of vitamins and minerals. They are added on to ready to eat semi solid foods such as porridge, without altering the original taste. This intervention reduces iron deficiency anaemia in children between six and twenty-three months of age[17]

The role of zinc in strengthening immune defences cannot be underestimated and in areas where effective preventive supplementation campaigns have been implemented, particularly in Africa, the child mortality rate has been lowered by 4 per cent.[9][10][11][1]

Biannual vitamin A supplements can help to reduce mortality among young children by 23 per cent.[11][1]

Oral rehydration is considered one of the greatest revolutions in improving child health and managing diarrhoea. With new oral rehydration solutions containing zinc, child mortality can be reduced by 15 per cent.[9][10][11][1]

F75 and F100 are types of therapeutic milk that is used in inpatient management of severe acute malnutrition.[18] They differ in concentrations of ingredients and amount of energy.[18] Ready to use therapeutic foods (RTUF) are semi-solid foods for outpatient management of malnutrition.[19] These may be used as part of a community based food and nutrition program.[20]

The improved availability of antibiotics to treat pneumonia, particularly in remote areas and among deprived populations, has contributed to reducing the child mortality rate by 6 per cent.[1]

Other curative interventions which can help to reduce child mortality include antibiotics to treat sepsis (6 per cent), the use of artemisinin-based combination therapies to treat malaria (5 per cent) and antibiotics to treat dysentery (2 per cent).[9][10][11][1]

These interventions are highly beneficial to child health and development. However, coverage rates remain low due to underdevelopment and poverty, poor health care systems with limited access to health services (less than 40 per cent in most African countries), a lack of qualified human resources resulting in part from the brain drain to Western and Arab countries, inadequate equipment, an inconsistent supply of medications and basic products with frequent shortages, a poorly structured and barely functioning programme of health promotion, and limited budgets for health (less than the 15 per cent recommended by WHO for most African countries) combined with often unorthodox financial governance.[1]

IMCI is a strategy that integrates various programmes for the survival of children under 5 with a view to improving the practices that are likely to have the greatest impact on their health, growth and development. This is the overarching strategy for achieving MDG 4 (reduction of child mortality), and it is recommended by WHO and UNICEF, particularly in countries with a high child mortality rate. The strategy is simple and, according to the World Bank, cost-effective. It aims to address the main causes of child mortality in settings characterized by (1) a low level of health coverage, with little or no access to diagnostic equipment and treatment, (2) a low level of health monitoring, and (3) weak links between healthcare facilities and communities. IMCI has three components: (1) improving the skills of health care workers, (2) strengthening the health care system, and (3) improving family and community practices.[21][1]

Maternal and neonatal mortality in the Africa region accounts for more than half (51 per cent) of the world's total maternal deaths, with a neonatal mortality rate of approximately 40 per thousand. The causes of these deaths could be prevented or avoided by the proper implementation of strategies for skilled care at birth and emergency obstetric and neonatal care services. With the assistance of WHO, UNICEF, UNFPA and the World Bank, various African countries have developed roadmaps for accelerating the reduction of maternal and neonatal mortality by improving the skills of service providers, standardizing treatment protocols, and developing quality criteria for EmONC.[1][11]

While effective interventions and strategies for improving the health and nutrition status of young children are available, the financial resources required to implement them in Africa are inadequate. It is essential that African governments, their domestic partners (the private sector and civil society) and their partners abroad (bilateral and multilateral cooperation) invest more heavily in mobilizing resources for early childhood development. The focus should be on optimal governance of financial resources with transparent management rules and particular emphasis on equity of care and guaranteed access for the poor.[1]