'Crisis' is an over-used word. But the global crisis of childhood acute malnutrition deserves that description. Even before the arrival of COVID-19, nearly 50 million children under the age of five were already suffering from acute malnutrition, and the International Rescue Committee (IRC) estimates 18 million of them are in crisis-affected contexts like Yemen of South Sudan. What's more, the proportion getting help has barely changed in twenty years.
Acute malnutrition is a life-threatening condition that in its most severe form makes a child 10 times likelier to die from illness than a healthy child. Malnutrition is the underlying cause of nearly half of all child deaths, costing nearly 3 million children their lives in 2019 alone. These are children who live almost entirely in low-income countries.
COVID-19 will compound the problem. It is a health emergency and an economic emergency, driving more hunger and in the worst cases malnutrition. Food insecurity and poverty, two main drivers of acute malnutrition, are rising. The United Nations projects people experiencing acute hunger will rise this year to 265 million, and rising rates of acute malnutrition are one of the factors driving the United Nations' astonishing prediction of global child deaths increasing by 6,000 a day this year.
The tragedy is that we have extremely effective tools to treat malnourished children. Effective treatment—a peanut butter paste fortified with essential vitamins—was developed nearly 25 years ago. Children given this paste, called Ready to Use Therapeutic Food (RUTF), can rapidly regain weight, restoring their health in a matter of weeks. The challenge is making this specialized treatment widely available to the children who need it. Today, only 25 percent of children who need treatment can access it.
Children aren't able to access the treatment they need for clear reasons. Treatment for severe acute malnutrition is currently available only at health facilities, meaning caregivers must travel long, sometimes dangerous distances to reach the lifesaving care their child desperately needs. And a complex delivery system divides the treatment of severe and moderate malnutrition between two different UN agencies, who use different treatment products, and supply chains- which in practice has meant treatment for some children is stopped too soon, and for many others, it is not available at all.
Over the last five years, the IRC has developed a new approach that offers the promise of a simpler, less expensive, and more comprehensive treatment. The IRC, with our partners Action Against Hunger and the London School of Hygiene and Tropical Medicine, and funded by USAID and the Children's Investment Fund Foundation, rigorously tested a new approach that would combine and simplify treatment using one streamlined approach that treats all children with acute malnutrition together until recovery.
This approach was tested in a randomized control trial in Kenya and South Sudan, whose results have just been released in PLOS Medicine. Our study found that this approach was as effective at recovering children as the traditional treatment method, and offers significant cost savings. It is also simpler for health workers and ensures children are treated before they deteriorate into the more dangerous form of severe malnutrition. This research has the potential to be a game-changing innovation for malnourished children.
And this is not the only innovation that we believe can bring treatment where it is needed most. Where today, trips to health facilities are a necessity, we are now working to support care in the community, delivered by community health workers. Instead of taking the children to the service, we are taking the service to the children. We're building on our partners' research that will help parents assess and diagnose their children for acute malnutrition right in their home, using a simple colored tape to measure the circumference of the upper arm.
Taken together, we believe these interventions could dramatically expand the number of children accessing treatment. IRC models project that widespread use of these tools coupled with increased resources could increase treatment coverage from 25 percent to 75 percent in humanitarian contexts, reaching millions of currently unreached children.
And these approaches are also important in the context of today's pandemic. These approaches hold the potential to increase coverage of life-saving treatment at a time when Covid-19 threatens lives and makes accessing care at health facilities even more untenable. As a result, these approaches have been incorporated into global guidance from UNICEF for countries to use in maintaining critical nutrition programs during the pandemic. It is of the utmost importance that these approaches are scaled now as part of the response to COVID-19.
Global donors too have a critical role to play. Global nutrition programs remain deeply under-funded. In 2017, global donors spent only $347 million USD on acute malnutrition- compare this to the $8 billion USD spent in 2018 on global HIV efforts. We urge global donors to expand their support for critical nutrition efforts and make ambitious commitments to nutrition funding at next year's Nutrition for Growth summit. With widespread hunger and malnutrition sharply rising due to COVID-19, fully resourcing nutrition efforts has never been more important.
In these difficult times, these new approaches offer hope—hope that should be matched with action to ensure malnourished children are not left waiting another day for treatment.
David Miliband is CEO and president of the International Rescue Committee (IRC).
The views expressed in this article are the author's own.
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