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Much of this work was originally produced for UNICEF
Tanzania has made striking progress in many health indicators over the past decade, but there has been little change in the nutritional status of children. The 2010 Tanzania Demographic and Health Survey revealed that about 42 per cent of children under-five years are stunted. This was only two percentage points lower than it was in 2005. Overall, about 3 million children under the age of five years are affected. Such a high incidence means that Tanzania has the third largest number of children who are stunted in Africa.
Stunting is defined as a short height-for-age in a child. It is also known as chronic malnutrition, and indicates that a child has failed to achieve his or her genetic potential for height. Stunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual capacity. It reduces ability to perform physical labour and increases the risk of obesity and diabetes in later life.
Fig 1 Map showing distribution of stunting in Tanzania (TDHS 2010)
The worst affected regions are Dodoma, Lindi, Iringa, Rukwa, Mbeya and Tanga all of which have stunting rates of more than 50%. The regions of Morogoro, Rukwa, Iringa, Mbeya, Ruvuma and Kagera are the most agriculturally productive in Tanzania and yet all report very high levels of stunting
Stunting causes damage that lasts a lifetime. It slows brain development which makes children less capable in school and reduces productivity as they grow into adulthood. It shrinks their earning power and keeps families in poverty. It undermines national development and economic growth. The World Bank estimates that reduced productivity caused by micronutrient deficiencies alone costs Tanzania more than US$500 million every year, equivalent to 2.65% of GDP. The impact of stunting pushes even higher the damage done to the economy by poor nutrition.
The period from conception to two years covers about 1,000 days and is the most critical in determining the future physical and mental development of children. Good nutrition of pregnant mothers and children during this period is vital to prevent stunting.
There is high-level commitment to improving nutrition in Tanzania and some important milestones have been met. In particular, there has been significant progress towards food fortification to reduce micronutrient deficiencies, in establishing budget codes for nutrition and in the placement of nutrition officers or nutrition focal points in more than two-thirds of districts. However, all the experts consulted during the development of this advocacy plan agreed that current progress to date is unlikely to have reduced the proportion of Tanzanian children who are stunted by their second birthday. The government target, indicated in the National Nutrition Strategy, of a reduction in stunting by 17 per cent by 2015 was far too ambitious and will not be met.
According to WHO, with such a high incidence of stunting in Tanzania, a concerted, comprehensive programme is needed to achieve a significant reduction in stunting. Building up and expanding routine services will not be sufficient to achieve results. In particular, the momentum for change must accelerate with a focus on reaching and engaging communities and households. The core aim of this advocacy plan is to support the drive to community-level action through approaches that are affordable, sustainable and appropriate to the local socio-economic and cultural context.
Causes of stunting
During the first 1000 days, from conception to two years, vital stages occur in the mental and physical development of children.
Stunting can happen during this period if:
Mothers are poorly nourished before and during pregnancy. Poor nutrition during adolescence can set the stage for poor maternal nutrition, low birth weight in infants and increased susceptibility to stunting.
Infants are not exclusively breastfed in the first 6 months of life. Giving infants under 6 months other foods or drinks weakens immunity, undermines ability to fight disease and increases risk of exposure to contaminated food/water that can cause diarrhoea and vulnerability to stunting. Other foods also have less nutritional value than breastmilk.
Children aged 6-24 months do not receive a varied nutritious diet and frequent small meals, up to 4-5 times per day depending on the age of the child. Improving complementary feeding for children 6-24 months is possibly the most important action needed for reducing stunting in Tanzania.
Children under 2 years’ experience repeated bouts of diarrhoea and/or malaria which depresses appetite and robs them of valuable nutrients.
The very high level of stunting in some of the most agriculturally productive regions of Tanzania, including Morogoro, Rukwa, Iringa, Mbeya, Ruvuma and Kagera regions, suggests that food security alone will not prevent stunting. Factors that may influence stunting include environmental conditions that may make children more likely to suffer from diarrhoea, hygiene behaviours, and feeding choices. Gender inequality may play a role by limiting opportunities for women to provide adequate care for their children. (Fig 3)
It is also important to understand factors that are currently influencing a reduction in stunting in some regions in Tanzania. Between 2005 and 2010, at least nine regions recorded a significant reduction in stunting. The regions of Mara, Mtwara, Ruvuma and Kigoma regions all reported declines of 12 per cent or more during this period. (Fig.4) These declines may have been due to demographic, socio-economic and or climatic changes as well as programme initiatives. While the overall level of stunting in these regions remains very high, it is important to understand the causes of these declines to help improve programme response.
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Excerpt from Changing the Future in 1000 Days:, an advocacy strategy to reduce stunting in Tanzania, developed for the UN REACH agencies: WFP, UNICEF, WHO and FAO
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