The Health Minister Khairy Jamaluddin recently launched the #AnakMalaysiaSihat media program, a strategic collaboration between the Ministry of Health and Universiti Putra Malaysia, to raise public awareness of child stunting and to provide nutritional information for the first 1,000 of life.
This shows the government’s commitment to tackle child stunting, which has been a major public health concern in Malaysia.
According to the 2020 Global Nutrition Report, 21.8% and 9.7% of children under the age of 5 are stunted and wasted, respectively. The prevalence of child stunting is particularly worrying, with 1 in every 5 children below the age of 5 being stunted. In comparison with other upper-middle-income countries, the prevalence of child stunting in Malaysia is nearly 3-times higher.
Child stunting is a serious form of child malnutrition. It inflicts irreversible harm to child growth, especially in terms of linear growth (height), which will leave a long-term impact on their physical and mental health later in life.
The #AnakMalaysiaSihat website provides a comprehensive range of information regarding diet and health for the mother and the child, from pre-conception to 2 years of age. It remains questionable, however, that household financial management is included as part of the #AnakMalaysiaSihat media program.
On the #AnakMalaysiaSihat website, parents are encouraged to manage their finances by investing in insurance or a takaful and education savings scheme, which will help to alleviate financial burden in the event of an emergency and to protect their children’s future. While this may be seen as a piece of practical advice for financially capable households, it appears to overlook the socio-economic factors underlying child stunting.
Child stunting is not merely an undernutrition issue. It also reflects social inequalities.
The major factor of child stunting is inadequate nutrition, which can be a result of the lack of nutritional knowledge, inadequate feeding practices or care, or even poverty and food insecurity. While it can occur to any child regardless of household socioeconomic status, the prevalence of stunting is generally higher among children from low income families.
Parents from the poor or food-insecure households often find themselves unable to provide sufficient, nutritious food to their children, whose nutritional needs are critical for optimal growth and development. There is a large body of research that shows that poor or food-insecure families tend to consume a low-cost diet that mainly consists of energy-dense, nutrient-poor food.
Pregnant women who experience poverty or food insecurity tend to have a poorer nutritional status and a higher risk of adverse birth outcomes, including preterm birth and low birth weight, both of which are significant determinants of child stunting.
Children under the age of 5 are especially vulnerable to malnutrition due to poverty or food insecurity as they do not attend school yet.
Stunting can be intergenerational; Adults who are stunted during childhood are more likely to have stunted children.
It is only realistic to estimate that the rate of child stunting in Malaysia will continue to increase due to the exacerbation of the pandemic on economic security, which contributes to food and nutrition insecurity. The White Flag (#Benderaputih) Campaign was a cry for help; It exposed the borderline and worsening state of food insecurity among the low income people.
A 2020 study conducted by UNICEF Malaysia among low-income families in the urban area revealed that COVID-19 changed the dietary patterns of these families due to reduced income. Some of the dietary changes include increased consumption of instant noodles, decreased intake of fruits, and replacement of animal-based products with eggs as a cheaper source of protein.
This shift in dietary patterns as a food coping strategy to alleviate hunger is not a unique phenomenon during the pandemic but has been prevalent among food-insecure individuals or households even before the pandemic.
The Malaysian Adult Nutrition Survey (MANS), which was a nationwide study conducted in 2014, showed that around 4.88 million (25.0%) adults in Malaysia were already experiencing food insecurity in terms of food quantity insufficiency and variety insufficiency. Around 20% or one in five Malaysian households were unable to feed children with a variety of food and had to rely on cheap and affordable food due to financial constraints.
The rising cost of living coupled with rampant food inflation will further hurt the poor, notably their children.
Child malnutrition associated with food insecurity can contribute to a lifetime of consequences, including lower educational attainment, increased health care costs, and elevated lifelong health risk, leading to a vicious cycle of poverty and poor health.
Despite the significant improvement in the access and quality of care for maternal and child health, the state of child malnutrition, particularly stunting and wasting has not seen much progress over the past decades. This indicates the need for a more comprehensive and multi-faceted approach, focusing on both the nutritional factors and social determinants of child malnutrition.
Educating the families at risk of having stunted children, which include the poor and food-insecure households to manage their finances as one of the approaches to tackle child stunting fails to acknowledge the structural issues they face in accessing and obtaining sufficient, nutritious food to achieve optimal health.
It is emphasizing individual responsibilities and assumes health and financial literacy that leads to poor choices when the bigger problem lies in social and health inequalities.
It is time that we recognise how poverty, but not knowledge deficits, renders people unable to follow healthy eating guidance. Health is less of a priority when people suffer from hunger.
To address the root causes of child stunting more effectively, MOH’s National Strategic Plan to Combat Stunting among Children in Malaysia 2022-2030 should take into account both the health and social determinants, addressing the causes of child stunting across the socio-economic gradient with both universal and choice-based policies. Both short- and long-term strategies are needed to provide immediate relief to the issue and to promote the long-term health of our children.
Children are the future. Safeguarding the health of today’s children means ensuring the health of future adults.
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