Globally, childhood undernutrition continues to be a significant issue, especially among children under the age of five. According to the 2023’s estimates from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), approximately 148.1 million children under five experienced stunted growth, 45 million suffered from wasting and 37 million were overweight. Undernutrition among children occurs when there is an insufficient intake of the caloric or energy content of food and nutrients to meet children’s needs to maintain good health. Undernutrition manifests as wasting or low body weight for height (acute malnutrition), stunting or low height for age (chronic malnutrition), underweight or low weight for age and mineral and vitamin deficiencies.
Children in Sub-Saharan Africa (SSA) face a significant challenge with stunting, with an average prevalence of 41%. The situation is particularly severe in East African countries, where the prevalence of undernutrition among children under five varies from 21.9% in Kenya to a staggering 53% in Burundi. Reports from Tanzania indicate that generally, 30% of children under five are stunted, and 9% are severely stunted; 3% of children under five are wasted, while 4% are overweight; 12% of children under five are underweight, and 3% are severely underweight. Childhood undernutrition is notably widespread in the southern and southern west highland regions of Tanzania, despite their abundance in food crop production. The prevalence of undernutrition in these regions is higher above the national average of 30%; for instance, Ruvuma has an average of 36%, Songwe (32%), Iringa (57%), Rukwa (50%) and Njombe (50%) as discussed (Gasto Frumence, 2024)as pointed out in the Tanzania Health Environment Food Policy for 2021 (Sally Mtenga, Francis Levira and Farida Hassan, 2021). “The country is still behind in addressing undernutrition, obesity and NCDs, food safety and healthy food indicators. The Food and Nutrition policy (1992) provides a profile of the nutritional healthrelated problems such as anaemia, Vitamin A deficiency, iodine deficiency, protein-energy malnutrition, for children and adults. However, this policy remains outdated and it does not include other emerging non-communicable nutrition challenges such as obesity and unhealthy food. The Tanzanian National Non-Communicable Disease Strategic Plan (2016-2020) acknowledges that NCD prevention in Tanzania is hampered by the absence of concrete policies such as multi-sectoral responses to diseases and lack of legislation and /or enforcement mechanisms. Thus, there is a need to strengthen policy formulation, legislation, and interventions to promote healthy diets as a key strategy in the fight against NCDs. However, there is a paucity of policy and regulatory data to support the implementation of healthy food policy infrastructure in the country. The crucial entry point for successful development or strengthening of policies and interventions is to understand what NCD-related food environment polices exist in Tanzania.”
Several studies conducted in both urban and rural areas of Tanzania revealed socio-economic, demographic, children feeding practice, maternal and water hygiene and sanitation characteristics as causes for child undernutrition. Specifically, the causes for undernutrition for under-fives included inappropriate feeding practices such as delaying the onset of breastfeeding and shortening the duration of breastfeeding, inadequate maternal dietary intake before conception or during pregnancy, distance to the water, inadequate literacy and big household family size. Other reported causes include the following: inadequate knowledge on feeding practices among caregivers/mothers and social–cultural factors such as gender inequality related to dietary practices and masculinity, women’s excessive workload—characterized by multiple domestic roles—cultural taboos prohibiting women and girls from eating certain types of nutrient-dense foods such as eggs and fish and excessive alcohol use among mothers or caregivers.
The causes of undernutrition for under-fives in Tanzania align with UNICEF conceptual framework of malnutrition, which indicated three levels of causes of malnutrition. The first level is the basic causes, which is also the focus of our study, including causes such as the availability and control of resources (human, economic and organizational), political factors, cultural factors, environmental factors and social factors. The second level is underlying causes which include insufficient household food, inadequate maternal care/childcare and insufficient health services/unhealthy environment. The third level is immediate causes such as inadequate dietary intake and diseases.
The involvement of multiple systems such as food, education, health, agriculture and social protection plays an important role in tackling barriers to eliminating malnutrition among under-fives. Examples of barriers identified thus far include inadequate awareness of under-fives’ nutritional issues, poor accountability and functionality and provision of strategic leadership for scaling up nutrition, and inadequate malnutrition and poverty alleviation and reduction in social and economic inequality. A systems approach adopted by the CCDO Team in Tanzania recognizes that ending malnutrition in all its forms calls for a shared responsibility to tackle the multiple determinants of child malnutrition such as employment status, poverty level, education level, food insecurity, government policies and social economic inequalities. This is because in Tanzania there are limited studies focusing on the identification of various culturally-sensitive strategies in combating persistent undernutrition for under-fives. Therefore, the CCDO is calling the development donors/partners interested to fund us in carrying-out this research project which aimed at exploring culturally-sensitive strategies for the elimination of child undernutrition in Rukwa, Iringa, Ruvuma, Songwe and Njombe regions located in the Southern Highlands in Tanzania.