The Hidden EmergencyThe Hidden EmergencyChild Malnutrition in Child Malnutrition in

TanzaniaTanzania

Save the Children Tanzania

Overview of presentationOverview of presentation Lessons from Save the Children’s Lessons from Save the Children’s

research in Lindi District – cost of research in Lindi District – cost of diet and study on extreme povertydiet and study on extreme poverty

What is the impact of malnutrition What is the impact of malnutrition and under-nutrition on children in and under-nutrition on children in Tanzania?Tanzania?

Policy implications Policy implications

The study objectives:The study objectives:

To determine what it would take to ensure all To determine what it would take to ensure all households are able to afford a quality diet, households are able to afford a quality diet, particularly for children under two, in Lindi particularly for children under two, in Lindi Rural DistrictRural District

To develop an increased understanding of extreme To develop an increased understanding of extreme povertypoverty

The aims were to The aims were to feed into two broader related feed into two broader related debates; increasing a sense of urgency around debates; increasing a sense of urgency around the reduction of chronic malnutrition – delivery the reduction of chronic malnutrition – delivery MDG 1 - and the design of social welfare systems MDG 1 - and the design of social welfare systems and social protection within themand social protection within them

Some facts about LindiSome facts about Lindi

Population – 214,885 (2002 census)Population – 214,885 (2002 census) Chronic malnutrition rate – 54.4% Chronic malnutrition rate – 54.4%

(38% national average) – the highest (38% national average) – the highest in the countryin the country

GDP per capita – 150,000 (among the GDP per capita – 150,000 (among the poorest districts in Tanzania)poorest districts in Tanzania)

U1 mortality – 152/1000U1 mortality – 152/1000 Pregnant women mortality – Pregnant women mortality –

166.5/10,000166.5/10,000

Table 8 Combined cash income and Table 8 Combined cash income and food production of household profilesfood production of household profiles

Cash income

Value of food

Income and food

Income and food per person

Older headed, 2 children

65,000 50,000 115,000 38,300

Female headed,

3 children

105,000 75,000 180,000 45,000

Active couple, 3 children

145,000 120,000 265,000 53,000

Table 10 Table 10

Figure 8 Annual household Figure 8 Annual household income and income sourcesincome and income sources

0

20000

40000

60000

80000

100000

120000

140000

160000

Olderwomanheaded

Femaleheaded

Femaleheaded

with trees

Activecouple

Tsh

s

Tree crop sales

Crop sales

Gifts

Other labour

Agricultural labour

Study Findings Children’s diet is influenced primarily by 3 factors: 1. Seasonality - post-harvest vs pre-harvest. 74% of children were fed frequently enough in

July compared to 48% in March. Frequency is not the same as quality.

2. Wealth - At post-harvest time only 65% of children in poorer households were fed frequently enough, compared to 100% in middle/better-off households

3. Age – The frequency of feeding decreases with age. Reports from school children indicated that they only ate once a day, usually at night

The 12 to 23 months age group is of particular concern - only 23% were fed frequently enough pre-harvest and 56% post-harvest. (During this (During this age children should be fed at least 4 times a age children should be fed at least 4 times a day).day).

  Price (Tsh) Quantity Cost

(Tsh)

Food Basket      

Maize / Sorghum 300 229 kg 68,650

Cassava 100 482 kg 48,200

Pulses 275 135 kg 37,200

Fish 100 104 piles 10,400

Vegetables     2,600

Coconut 40 120 nuts 4,800

Non-food basket      

Salt 200 8 packets 1,600

Clothes     10,000

Soap 100 72 bars 7,200

Kerosene 40 208 units 8,320

Matches 30 208 boxes 6,240

Body oil 50 52 tubs 2,600

Utensils     2,000

Bed sheet 1500 2 sheets 3,000

Hand hoe 500 2 hoes 1,000

Social contribution     2,000

Health     3,000

Education     10,000

Annual basket per household ~229,000

Annual basket per person   ~57,000

Table 10 Minimum food and non-food basket

Globally, child under-Globally, child under-nutrition is nutrition is

responsible for half of responsible for half of all child deathsall child deaths

0

5

10

15

20

25

30

35

neonataldeaths

diarrhea pneumonia malaria other AIDS Measles Unknown

% o

f ch

ild d

eath

s

proportion of deaths from being underweight

Source: Black RE, Morris SS, Bryce J (2003) Where and why are 10 million children dying every year? Lancet; 361: 2226-34

What MDG 1 saysWhat MDG 1 says

Eradicate extreme poverty and Eradicate extreme poverty and hungerhungerTarget 1Target 1     Halve, between 1990 and 2015, the Halve, between 1990 and 2015, the

proportion of people whose income is less proportion of people whose income is less than one dollar a day. than one dollar a day.

Target 2  Target 2   Halve, between 1990 and 2015, the Halve, between 1990 and 2015, the

proportion of people who suffer from proportion of people who suffer from hunger (measured by underweight) hunger (measured by underweight)

Infant undernutrition is irreversible Infant undernutrition is irreversible - It happens early and its costs persist throughout - It happens early and its costs persist throughout

life and life and are transferred to next generationare transferred to next generation

0

10

20

30

40

50

60

0 12 24 36 48 60

Underweight Stunting%%

Age (months)Age (months) source: TDHS 1999

Stunting at Age 2 - Stunting at Age 2 - TanzaniaTanzania

ModerateModerate28%28%

SevereSevere23%23%

NormalNormal49%49%

Consequence of StuntingConsequence of Stunting

Reduces Physical Capacity & Reduces Physical Capacity & ProductivityProductivity

1% decrease in height 1.4% decrease in productivity

Source: Haddad & Bouis, 1990

UN

ICE

F/9

1-02

9 J

Sch

ytte

0

500

1000

1500

2000

2500

3000

LostProductivity (TShs billion)

1,2621,262

323323

MentalImpairment

StuntingStunting

AnaemiaAnaemia

Total: 2,822 Billion TShsTotal: 2,822 Billion TShs

1,2371,237

Total Economic Loss from Total Economic Loss from Stunting & Iron/Iodine Deficiency, Stunting & Iron/Iodine Deficiency,

Tanzania 2000-2010Tanzania 2000-2010

Tackling child malnutrition is

Everybody’s business, nobody’s

responsibility

Conclusions of Study Findings Conclusions of Study Findings in Lindi Districtin Lindi District

1. Diet quality/diversity needs improving, either through maximising the existing food available, increasing people’s access with a cash transfer, and/or through a system of supplementation.

2. Feeding frequency/quantity could be improved by a cash transfer scheme. Feeding frequency is constrained by women’s workload, particularly in poor households. Any scheme must take into account other essential needs (not just the cost of diet).

3. Measures to improve children’s diet are particularly essential in the pre-harvest to prevent the seasonal decline.

4. The relevance of cash transfers, supplementation or a combination of both needs further debate to determine what is structurally feasible, sustainable and efficient.

Recommendations

Government and DPG establish nutrition group with high level of ownership and leadership from Presidential level, review / strengthen a nutrition policy and strategy with implementation plan and resources. This will need to include a strategy for high level advocacy for national ,regional and district level decision makers.

GOT/DPG to prioritise social protection programmes within effective national social welfare systems linked to national planning processes. The Social Protection Framework under development needs to be approved, resourced and implemented as a matter of priority.

These systems must provide direct financial and other benefits; particularly to families who are extremely poor in the form of cash transfers - pensions, child benefit, disability allowance, benefit for the chronically sick and nutrition programmes appropriate for different age groups.

GOT and DPG to include civil society at national, district and sub district levels to pilot and test social welfare and protection initiatives as above within national and district planning and budgeting frameworks. This has to include funding

Recommendations

Government and DPG to review and evaluate whether their indirect investments really do tackle malnutrition, reform them accordingly, and ensure they have human resources to do that

Start reporting against the internationally agreed indicator on nutrition and use nutrition indicators to report progress in food security, safety nets and social protection, governance, water and sanitation and health

Districts to include nutrition and other social protection interventions into Council Plans and Budgets