Government Policy and Political Will
CRITICAL ANALYSIS OF THE SOCIO-ECONOMIC DETERMINANTS OF MALNUTRITION IN SUB-SAHARAN AFRICA
Malnutrition is a condition whereby normal bodily functions such as growth, physical activity, pregnancy, lactation, and immunity from diseases cannot be performed due to lack of appropriate nutrition (World Food Program (WFP), 2016). There are two forms; under nutrition and over nutrition (Robert et al, 2008) with under nutrition accounting for more than 33% of global infant mortality (Horton, 2014), in fact it is as high as 50% in some developing countries standing at over 50% and 40% in Nigeria and Ghana respectively (United Nations Children’s Education Fund (UNICEF), 2016; Aheto et al., 2015). 795 million people all over the world are chronically malnourished with 780 million living in developing countries. The highest level globally is seen in sub-Saharan Africa with one in every four people being undernourished while only less than 5% of the population are affected in developed countries (FAO et al, 2015). Over nutrition on the other hand occurs when the diet consumed by an individual exceeds his nutrient requirement or the amount of calories needed to remain healthy (National Health Scheme (NHS), 2016), this has also been identified as a major public health problem seen majorly in developed countries ( Zukiewicz, 2014) .
Women and children are more commonly affected by malnutrition (Black et al, 2013). In fact one third of the annual global death of children is as a result of malnutrition, amounting to 2.6 million children (Robert et al, 2008). Despite the fact that the prevalence of malnutrition in sub-Saharan Africa have declined from 33.2% in 1990/92 to 23.2% in 2014/16, malnutrition still remains a challenge as the number of undernourished people in this region have actually increased due to high population growth rate (World hunger and poverty facts and statistics (WHPS, 2015). Despite the Significant progress made globally in improving food security and nutrition (FAO, 2013), same cannot be said for Sub-Saharan Africa (Mabhaudhi, 2016) as such it of paramount importance to identify the determinants that lead to malnutrition in this region in order to apply appropriate strategies to overcome them (Raphael O. et al 2011). UNICEF identified political, environmental, economic, social and cultural factors as the prime causes of under nutrition, noting that they are intricately connected to each other (Robert et al, 2008). It is however necessary to note that these determinants are quiet numerous and diverse, as such this essay will only focus on Poverty, lack of education, government policy and political will, at the same time attempt to show their interrelationship with each other and identify possible strategies to overcome them.
There have been significant progress globally in reducing the level of extreme poverty since achieving the Millenium Development Goals (MDGS) target of reducing by half the global poverty rate in 2010. However, it has been estimated that 900 million people live below $1.9 a day in 2012 declining to 700 million people in 2015 which is still unacceptably high especially in sub-Saharan Africa which carried the largest global poverty burden (42.7%) in 2012 (World Bank, 2016; WHPS, 2015). Poverty is an important factor contributing to the lack of access to nutritious food, education, good health care and healthy living environment in sub-Saharan Africa, thus it sets a continuous trend of negative events (Luchuo, 2013). The number of people in extreme poverty in sub-Saharan Africa have been on the rise and this has been identified partly to be responsible for the degree of malnutrition (WHPS, 2015).
There is a strong correlation between the degree of malnutrition and household income, whereby households with low income have higher incidence of children with malnutrition as opposed to those with high income (Luchuo, 2013; Raphael et al., 2011). Most farmers in rural communities practice subsistence agriculture and do not have the capacity to access good agricultural machineries, fertilizers, storage fertilities and means of transportation due to poverty.
It has also been observed that children that suffer from malnutrition have poor cognitive and intellectual development in early childhood development resulting in poor classroom performance and subsequently grow to be less productive members of the society with resultant perpetuation of the poverty cycle in the community. This shows us one of the links between poverty and malnutrition, as such it has been hypothesized that breaking the cycle of malnutrition in early childhood will go a long way stopping inter-generational poverty in poor rural communities (Mabhaudhi, 2016; Burchi, 2011).
Most diet in sub-Saharan Africa is mainly cereal based with minor amount of proteins, vegetables and fruits. These foods are either too expensive to purchase, not available within their immediate environment or are just not considered as important as other pressing household needs (Chastre, 2007).
Agriculture is the main source (70%) of food consumed by people in sub-Saharan Africa in addition to acting as a key source of livelihood and income. In fact, evidence suggests that improving income from agricultural production is more effective in reducing poverty and hunger when compared to other sectors, this is because poverty is seen more commonly in rural agricultural communities that rely more on agriculture for their survival ( Sassi, 2015; FAO, 2012; Livingston, 2011). This will in turn enhance food security and reduce malnutrition (World Bank, 2008). This is further strenghthened by the fact that the level of undernutrition is negatively correlated to per capita income as such, economic empowerment is an effective way of improving the nutritional contents of diets and reducing the prevalence of malnutrition (FAO, 2012).
Most communities in sub-Saharan Africa do not have access to basic amenities such as good sanitation facilities and hygienic water supply as such are predisposed to diseases such as cholera, diarrhea and intestinal worms which can ultimately lead to malnutrition or even death. (Sassi, 2012, 2014). The world health organization identified diarrhea as the second leading cause of death in children under five years of age, killing about 760,000 children every year with over 1.7 billion cases annually. It has also been identified as the leading cause of malnutrition in children under five years of age. A significant proportion of diarrheal cases can be prevented with the provision of hygienic and safe drinking water, adequate sanitation and hygiene. However, these are not available to most communities in developing countries especially in sub-Saharan Africa (WHO, 2013).
One in every four children in sub-Saharan Africa is not in school, amounting to about 32 million children of primary school age, which represents 45% of the total out of school population globally and 54% of these children are girls. It has also been found that only one third of the youths attend secondary school and 38% of adults in sub-Saharan Africa cannot read or write with 60% of them being women (UNESCO 2010). It has been estimated that in 2015, about 481 million women 15 years and over, do not have access to basic literacy skills, forming 64% of the total number of people who are illiterate globally, a percentage that has remained unchanged since 2000, this shows us the extent of gender based inequalities in education especially in developing countries (Galguera, 2015; UNESCO 2010). Lack of education is a key factor with profound impact on nutrition, sanitation, personal hygiene and disease prevention techniques, all of which define the nutritional and health status and wellbeing of the community.