Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years

Undernutrition in Malawi is a serious community issue responsible for 48% mortality rate for under-five children. This policy brief presents key drivers and recommendations to address the high prevalence of undernutrition and child mortality.

Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Executive summary
Undernutrition in Malawi is a serious community issue is responsible for 48% mortality rate for
under-five children. Evidence has shown that undernutrition, poverty, and lack of health
knowledge is directly correlated with the socio-economic gradient in society. This policy brief
illustrates key drivers by identifying the modifiable risk from societal, environmental, and
biological factors. A combined effort from government and non-government authorities is thus
needed to access community issues, especially the food accessibility and education. This policy
brief also presents a set of recommendation that suggests an integrated approach of professionals,
social health workers, teachers, and individuals in the society to learn, maintain, and access
resources that helps in maintaining quantity and quality of food to overcome the high prevalence
of undernutrition and child mortality.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Sustainable action on the burden of malnutrition
Within the scope of sustainable development goals, United Nations aims to trigger sustainable
action to eradicate concern of malnutrition in Malawi (Nino 2015). The effort includes factors
linked with malnutrition such as poorly resources and improper nutritional service, food
insecurity, inappropriate feeding practice, lack of hygiene, female illiteracy, early-stage
pregnancy, and poverty, and political marginalization that excludes children and mother to
access health and commodities. This policy brief illustrates the potential of actions that aims to
contribute to an intensified effort by addressing both nutritional services as well as the cultural
factors through common interventions.
Statistical brief on undernutrition fact in Malawi
One of the major in public health and development challenge in Malawi is child undernutrition,
which has made poor progress in the past few decades since 1995. The average mortality rate for
under-five children during the period 1995 to 2015 is 48%. According to the National Statistical
Office 2016, these statistics is more than 25 times than the expected level for a well-nourished
and healthy population (Kaimila et al. 2019). This is an alarming concern because if the current
trend of child undernutrition in Malawi persists, the nation will fail to achieve the development
goal by 2020, of reducing child mortality by more than 60%. Findings from the demographic and
health survey in Malawi 2016, indicates that 36% of mortality incidents which are occurring
before the age of 5 years is related to both moderate and severe malnutrition (Yaya, Bishwajit &
Shah, 2016). It is surprising to learn that the contribution of moderate malnutrition is 28%,
whereas the contribution from severe malnutrition is lower as 8%, as indicates by ORC Macro,
2016 (Moise et al. 2017). This suggests that even if the child is lightly malnourished, the risk of
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
mortality is high. Trend of nutritional status in Malawi during 2004 to 2014 is shown in Figure 1
(Cornia, Deotti & Sassi 2016).
Figure 1: Trend of nutritional status in Malawi during 2004-2014.
Among the other factors, poor nutritional service and inaccessibility of health facilities to the
community member is a leading factor that contributes higher vulnerability of infant and under-
five child health. Pregnant mothers who are undernourishment from conception till age-two of
the child is a leading factor responsible for the high risk of illness and impaired cognitive
development. This is also attributed to lower education, poverty, and lack of knowledge for
effective health management among community members. Harris et al. (2018) also found that
anemia alone is associated with 3.5% followed by poor vaccination (2.8%) for infant death.
Other factors contribution to under-five death is shown in figure 2 (Liu et al 2015). Ultimately
these factors are responsible for increased burden and influence on the achievement of the
nation. Overall, these facts suggest that child malnutrition deserves significant attention.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Figure 2: Causes of under-five deaths in Malawi.
Fact Sheet
 Population under-five at Malawi is 2.9 million, among which 1,42,000 children are
suffering from acute malnutrition and 1.2 million are suffering from chronically
malnourishment condition.
 The worsening situation arises during 2015-16, due to the insecurity situation of food
and nutrition in the country.
 According to the report of the Cost of Hunger in Africa (CoHA), 23% of child
mortality is due to undernutrition and its annual GDP loss is 10.3%.
 Rate of infants born with low birth weight in the last five years is 15%.
 Rate of anemia among children and women (in reproductive age) is more than 20%.
Rationale for requisite action
Sustainable measures from agencies including stakeholders from government and non-
government organizations are required to work together for combined action. The requisite
action includes the following measures:
 Protection and promotion of exclusive breastfeeding practice.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
 Family education is essential to adopt healthy behavior of food, hygiene, vaccination, and
routine health assessment.
 Poverty-related issues should be corrected by promoting self-employment, offering free-
health check-up facilities, and nutritional aid to community members.
 Maternal nutrition and antenatal care programs are required to be initiated with the
support of the community and social health workers.
 Programs for food policies must be launched in partnership with school teachers.
 Marketing regulations need to be reviewed where social responsibility from national and
multinational companies should be emphasized on nutritional status.
Shared drivers
The shared drivers are primarily associated with socio-economic, biological, and environmental
factors that contribute to the prevalence of child undernutrition.
Socio-economic factors
Poverty is the driver of malnutrition and infant mortality in the nation. It is the major risk factor
that drives undernutrition and malnutrition-related complications in society. Evidence from the
demographic studies suggests that a strong correlation between poverty, inequality, food
insecurity, and infant mortality with the gradient of socioeconomic status in the country. The
poor socioeconomic status also results in a lack of educational attainment, health literacy, for
nutritional support during pregnancy and early childhood, and negligence of hygiene across the
life course.
Biological factors
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
The preventable risk for undernutrition is deeply associated with what are maternal and early
childhood nutrition. Blood nutrition during pregnancy increases the risk of maternal anemia, low
birth weight, abdominal adiposity, preterm birth, and metabolic disorders. The dietary habits
have a strong impact during fetal development, cognitive capabilities, and immune function. In
utero malnutrition is also known to have a serious impact on hormonal, anatomical, and
developmental changes in the fetus. Hence, rapid nutrition transition and abduction of food
during fetal development should we monitor appropriately, in order to reduce the prevalence of
infant mortality.
Environmental factor
The environmental factors affect the ability of people to access the nutritional level and adopt
healthier behavior. The important element in this scope includes food, health, working condition,
living style, and social structure. Food habit can affect the risk of an adequate and balanced diet
required for development, cognition, and immunity status. Health environment includes
affordable, preventive care, and curative support for health requirement. Primary care and
availability of healthcare professionals in the society is thus a keen requirement for overcoming
the suffering of under-nutrition and pediatric health. Similarly, the access to drinking water,
sanitation, food hygiene, and protection from transmitted or communicable diseases are an
important factor that increases the risk of infant health. Other factors include social structure
such as healthier dietary practice, breastfeeding, washing hands, routine health check-ups, and
vaccination. The stereotype belief in society about health perception, health-seeking habits, and
health-education are also important to be improved with the effort from both government and
non-government agencies to reduce the concurrent risk.
Shared platforms
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
The drivers between malnutrition and delivering of sustainable action emerge as a potential
platform, which is discussed in this section.
Guideline for nutritional practice National policies for undernutrition,
vaccination, and diseases
Implementation of clear, focused, and
evidence-based dietary guideline offers a
basic framework to address the malnutrition
issues. The food-based guideline can be used
as policy measures and program to promote
healthy diet habits, quality of nutrition, just
feeding practice, and reduction of
undernutrition incidence.
National demographic studies show that
policies addressing undernutrition, might not
include vaccination, diseases, and
complications that arise with undernutrition. It
should be ensured that community members
must adopt practices including vaccination of
infant, a routine check-up for health
complications, and education-related support
for nutrition and related consequences.
Health management system Nutritional programs and Humanitarian
aids
To address the undernutrition issue at the
household level, the social health support
system must address (i) accessibility to
healthcare facilities; (ii) health education; (iii)
awareness against social stereotype, stigmas,
and disbelief. Sustained care support must be
available to address antenatal and maternal
care for infants and mothers.
These programs mainly focus on food security
and quantity issues that must be accessible to
individuals in this society. The responsiveness
of the program will be enhanced by making
the partnership with schools, colleges, and
non-government organization. This would
ensure that sufficient and quality food will be
available to address malnutrition, unhealthy
diet, and associated health problems in this
society.
Social policies
Supporting policy measures such as are
maternity leave, space for breastfeeding,
enhanced support for maternity health,
financial support, and free food for infants
can have an extensive positive impact on the
existing risk. As a result, the one venerable
population who are at risk of undernutrition,
moderate malnutrition, and poor
socioeconomic status, can be supported.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Actions that can be implemented for practice: Overcoming the shortcomings
Despite over analyzing the measures that can address the undernutrition and below-five mortality
in Malawi, it is essential to focus on, “what actions can be implemented immediately”, “how the
coexistence of poverty with infant mortality be addressed”, and “how to educate community
members for effective health management”. Implementation for practice is an initiative to
consider all the shared drivers and initiative the needful actions that can be managed with the
existing support system. This will not only acknowledge a control of high prevalence of infant
mortality but will also bring new behaviors that can prevent future opportunities to control health
risk.
Action 1
Ensuring existing policies are effective, is the first action to ensure that existing fundamental
policies are benefiting the individuals in society. This includes assessment and review of existing
policies for primary care unit, breastfeeding practices, antenatal care, and financial assistance for
childbirth. As a result of such initiative, it can be ensured that feeding young children, risk of
malnutrition, and health problems such as anemia, infection, and metabolic disorder can be
addressed with existing social healthcare support.
Action 2
Making a retrofit to the existing nutritional support is the second level action call ma which aims
to look into factors influencing undernutrition. Programs which include support from the school
teachers, college associates, and non-government agencies must focus on ensuring a healthy diet,
vaccination, and health education. This will help in avoiding social jargon and stigmas which
prohibit qualitative and quantitative food intake add household level.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
Action 3
De-novo actions for bringing sustainability with social culture, economic factor, and
environmental context. The last action includes the development of new measures that can
improve the cultural, environmental, and socioeconomic factors which have an impact on
undernutrition and related consequences. Engagement of youth, funding support from
international agencies oh, and responsibilities attainment by healthcare professionals is highly
essential in this regard.
Recommendation for the achievement of the sustainable solution
The set of recommendations that have the potential to overcome undernutrition and community
requirement to access food and health services are:
 Proper management of cash flow: The available funds from various agencies for
community aid must be distributed effectively in all districts and villages. Monitoring of
such provision must be accounted for, by the primary care unit.
 Healthcare professionals: Doctors, nurses, social healthcare must integrate together to
offer education, medication, health checkups, and free food or resource to the individual
household level. Collaboration with teachers and non-government organization must be
facilitated.
 Maternity and early childhood care: Special attention must be provided to maternity and
early childhood families. This should include vitamin and medicine supplement, financial
aid, breastfeeding and nutritional education, and resource supplement.
 Documentation and reviewing: Official record must be maintained for documentation and
reviewing the outcomes of health measures. Details of individual, their need, challenges,
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
outcomes, and accessibility of services must be included in these documents for further
review.
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Policy Brief: Undernutrition in Malawi: Leading cause of death for under 5 years
References
Cornia, G.A., Deotti, L. and Sassi, M., 2016. Sources of food price volatility and child
malnutrition in Niger and Malawi. Food Policy, 60, pp.20-30.
Kaimila, Y., Pitman, R.T., Divala, O., Hendrixson, D.T., Stephenson, K.B., Agapova, S., Trehan,
I., Maleta, K. and Manary, M.J., 2019. Development of acute malnutrition despite nutritional
supplementation in Malawi. Journal of pediatric gastroenterology and nutrition, 68(5), pp.734-
737.
Liu, L., Hill, K., Oza, S., Hogan, D., Chu, Y., Cousens, S., Mathers, C., Stanton, C., Lawn, J. and
Robert, B.E., 2015. Levels and causes of mortality under age five years. International Bank for
Reconstruction and Development, World Bank. Reproductive, maternal, newborn, and child
health: disease control priorities, 2, pp.71-83.
Moise, I.K., Kalipeni, E., Jusrut, P. and Iwelunmor, J.I., 2017. Assessing the reduction in infant
mortality rates in Malawi over the 1990–2010 decades. Global public health, 12(6), pp.757-779.
Nino, F.S., 2015. Sustainable Development Goals—United Nations. United Nations Sustainable
Development. Available at
https://sustainabledevelopment.un.org/content/documents/21252030%20Agenda%20for
%20Sustainable%20Development%20web.pdf on 11 May 2015.
Yaya, S., Bishwajit, G. and Shah, V., 2016. Wealth, education and urban–rural inequality and
maternal healthcare service usage in Malawi. BMJ global health, 1(2), p.e000085.
Harris, C., Mills, R., Seager, E., Blackstock, S., Hiwa, T., Pumphrey, J., Langton, J. and
Kennedy, N., 2018. Paediatric deaths in a tertiary government hospital setting,
Malawi. Paediatrics and international child health, pp.1-9.
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