Food fortification way to go

Shamiso Yikoniko
ONE in three children in Zimbabwe suffers from chronic malnutrition,  which hampers the growth and development of children.Child hunger, though a very significant issue, is an evil which at times goes unnoticed. It has been proven that poor infant and young child feeding practices, illnesses and poor maternal health result in malnutrition.

As if that is not enough, malnutrition increases the likelihood of non-communicable diseases such as cancer, diabetes and cardiovascular diseases in later life. Health surveys indicate that there are several contributing factors that cause chronic malnutrition or stunting in children.

The Micro-nutrient survey (2012) indicates that stunting stands at 30 percent, Vitamin A deficiency at 21 percent, iron deficiency at 72 percent and anaemia at 31 percent in children under five. The appalling circumstances are that these deficiencies are more rampant in the rural areas as compared to urban areas. However, Government has made it mandatory for all companies to fortify maize meal, wheat flour, cooking oil and sugar with effect from July 1, 2017 and they are expected to comply as a measure to beat malnutrition.

Food fortification involves replacing nutrients lost during food processing to increase nutritional value. Health and Child Care ministry director for family health, Dr Bernard Madzima, said poor infant and young child feeding practices, illnesses and poor maternal health result in stunted growth.

“Stunting does not come easy, it happens over time, and it means that a child would have endured painful and unbearable cycles of illnesses, depressed appetite, insufficient food and inadequate care,” he said.

“This vicious cycle is itself a result of poverty and the consequent inability of families to adequately care for their children. A lack of clean water supply in poor communities, or a long distance between home and health clinic affects the level of care that can be given.”

Malnutrition presents itself in three ways: stunting (shorter than average height), wasting (having a low weight for one’s height) and being underweight (having a low weight for one’s age). Dr Madzima applauded food fortification but, however, bemoans the lack of funding to see the success of the programme.

“The food fortification programme aims to address micro-nutrient deficiencies which will help the country address the problem of malnutrition,” he said.

“Micro-nutrients which are being added are Vitamin A, zinc, iodine, iron and folate. Though we have had a buy-in from major food producers, a huge challenge still remains in terms of funding as well as making small-scale millers comply.”

Malnutrition is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems.

A health expert who agreed to speak on condition of anonymity explains that micro-nutrient deficiencies result in increased morbidity, child and maternal mortality.

“Vitamin A deficiency results in blindness and increased childhood mortality; iron deficiency results in poor cognitive development and impacts future

productivity while folic acid deficiency results in birth defects, disability and increased health care costs,” they said.

Dr Madzima added that if these infirmities are not addressed within the first two years of life, stunting is irreversible. Moreover, exclusive breastfeeding remains a challenge in Zimbabwe resulting in a significant number of malnourished, stunted growths of children and high child mortality rate.

One in three babies receives exclusive breastfeeding in their first six months of life. According to the Multiple Indicator Cluster Survey (MICS) 2014, only 41 percent of Zimbabwean women practice exclusive breastfeeding.

Approximately 1,3 million deaths could be prevented each year if exclusive breastfeeding rates are increased to 90 percent. The major challenge to exclusive breastfeeding is that lactating mothers often mix breastfeeding with other foods and water during the first six months of a baby’s life.

Breastfeeding supports infants’ immune systems and helps protect them from chronic conditions such as obesity and diabetes. The national nutrition survey (2010) signifies that the low rate of exclusive breastfeeding, poor dietary diversity and minimal acceptable diet also contribute to malnutrition in children. The health survey said malnutrition leads to significant loss in human and economic potential.

“The performance of a country’s socio-economic sector is a reflection of the population’s nutritional well-being. Children who are malnourished are more vulnerable to infectious diseases that prolong their under nutrition and further hinder their full cognitive and behavioral development.

“As a result, undernourished children have reduced ability to learn and concentrate in school, ending up with fewer opportunities to access jobs. In the end, the country suffers immense losses in productivity and incurs increased societal costs in education and health care.”

Although malnutrition rate in Zimbabwe is still lower than in other sub-Saharan countries it has increased over the past 15 years.

According to UNICEF an estimated 161 105 children die before their fifth birthday. Following recommendations by the Paediatric Association of Zimbabwe and other stakeholders like the World Health Organisation and UNICEF, Government introduced micro-nutrient powders at the onset of 2015 for infants between the ages of six months and two years as a measure to curb malnutrition.

Micro-nutrient powders contain zinc, Vitamin A, iron and other relevant micronutrients and these are mixed with porridge or soup and fed to the children as part of their diet.

Moreover, through the recently launched Health Development Fund, UNICEF procures and distributes to all health facilities in the country micronutrient supplements.

“Vitamin A supplement is being administered to children between six and 59 months; iron and folic acid for pregnant women and zinc for management of diarrhoeal diseases,” added the health expert.

“Iodine test kits are also being distributed for monitoring the universal salt iodisation to ensure that the Zimbabwean population has access to and utilise iodised salt.”

Food fortification has already been used in salt and Zimbabwe no longer has problems of goitre since iodised salt was introduced.

Research shows that an estimated 25 percent of child deaths are attributable to nutritional deficiencies. Moreover, Government is committed to ensuring that the National Nutrition Strategy (2014-2018) is implemented on evidence-based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation.

In 2011, the WHO issued guidelines on the use of micro-nutrient powders in children as efforts to make informed decisions on the appropriate nutrition actions to reduce child mortality, eradicate extreme poverty and hunger.

Malnutrition is an underlying cause of death of approximately 2, 6 million children each year – a third of child deaths globally. UNICEF is working closely with the Ministry of Health in carrying out a mass screening exercise for malnutrition in children under five years of age, especially in the country’s 10 worst drought affected districts. The exercise is in response to a recent Zimbabwe Vulnerability Assessment Committee (ZIMVAC) report, which revealed that 2,8 million people (30 percent of the rural population) of which 1,4 million are children urgently need food assistance.

Although the casual factors are many, malnutrition is one of the leading underlying causes of under-five deaths. However, there are concerns in some sectors not being ready to kick-start the food fortification programme.

To this, Health and Child Care ministry’s deputy director of nutrition, Mrs Annscaria Chigumira is on record reiterating that those who do not comply with the new regulations risk being banned from producing.

“The onus is on individual companies to apply for a waiver from the Permanent Secretary. If they do not apply for a waiver and they do not comply, they will definitely be stopped from producing,” she said.

Companies that have since indicated their readiness to start the food fortification programme are National Foods, Grain Marketing Board, Mega Foods, Tongaat Hulett, Blue Ribbon, Parrogate, Gutsamhuri, Uni-Foods and Zim Source Foods.

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