MALNOURISHMENT

Prior to the current public health crisis of COVID-19, which is gripping both the developed and developing worlds, a different public health crisis was ravaging many of the most vulnerable people on Earth. The global malnutrition crisis worsened over the course of the pandemic, afflicting an estimated 233.5 million children under five who live predominantly in the developing world, according to 2020 data (UNICEF et al., 2021). 

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Malnutrition can be defined as poor nutrition because of an inadequate or unbalanced intake of nutrients (Merriam-Webster, 2021). According to a joint document by UNICEF/WHO/World Bank Group, malnutrition in children under five can take the forms of stunting, being overweight, and wasting (UNICEF et al., 2020). Stunting refers to the results of severely poor nutrition in-utero and early childhood which prevents children from attaining their full possible bodily functions, such as height and cognitive abilities (UNICEF et al., 2020). 

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Malnutrition in the form of being overweight may confuse some readers, indeed an overweight child is also a malnourished child. To understand this, we can refer to the part of the definition of malnutrition which includes an unbalanced intake of nutrients as a sign of poor nutrition (Merriam-Webster, 2021). Malnutrition in the form of being overweight is the result of a child’s energy intake exceeding their energy requirements and can put the child at risk of diet-related illness later in life (UNICEF et al., 2020). Lastly, wasting refers to a child which is too thin for their height and has either rapidly lost weight or is unable to gain weight, putting the child at an increased risk of death (UNICEF et al., 2020).

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Prior to the pandemic, the number of children in all three categories of malnutrition stood at stunting: 144 million, wasting: 47 million, and overweight: 38 million, using 2019 data (UNICEF et al., 2020). During the COVID-19 pandemic, the number of children in all three categories of malnutrition stood at stunting: 149.2 million, wasting 45.4 million, and overweight: 38.9 million, using 2020 data (UNICEF et al., 2021).

Malnutrition can impact resistance to disease and even result in a vicious cycle of infection that can further exacerbate malnutrition (Bhaskaram, 2002).

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Malnutrition is most present in underprivileged child populations in developing economies (Bhaskaram, 2002). It is for this reason, underprivileged child populations in developing economies are some of the most vulnerable to COVID-19. 

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Although research suggests that direct risk to children in developing and developed countries is limited (Zar et al., 2020). The pandemic has significantly impacted child populations in developing countries in indirect ways, such as increased poverty and disruptions to school meal programs which provide food security for at-risk youth (Zar et al., 2020). These disruptions, which have exacerbated the malnutrition crisis, have had some researchers question the cost-benefit payoff of school shutdowns (Mayurasakorn et al., 2020). COVID-19 pushed weak healthcare systems over the edge in low-and middle-income countries with endemic malnutrition, exposing existing inequalities such as those in access to economic and health care services (Kingsley et al., 2021). Although malnutrition can take different forms, the strategies for prevention apply to nearly all three forms of malnutrition (UNICEF et al., 2021).

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Sufficient maternal nutrition before and during pregnancy, as well as when breastfeeding during the first two years of a child’s life are important in preventing malnutrition (UNICEF et al., 2021). Nutritious, diverse, and safe food options in early childhood while supported by a safe environment provides children with a strong basis to continue healthy development in later life (UNICEF et al., 2021). 

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The world food programme (WFP) has also developed new guidelines to ensure malnutrition prevention services can adapt to the logistical issues posed by COVID-19. Protocols such as transitioning from a more centralized delivery of services from a health facility (i.e., large service centre) approach to a more decentralized community-based approach (i.e., mobile clinics) (World Food Programme, 2020). This puts resources where people are before any movement restrictions (such as shutdowns/lockdowns) can unexpectedly disrupt operations, allowing for the continued delivery of services (World Food Programme, 2020).