Regional Perspective: Eastern and Southern Africa (ESA)

Charity Zvandaziva is a Regional Nutrition Specialist for UNICEF ESA Regional Office (ESARO)

Chloe Angood is a Knowledge Management Consultant working for UNICEF ESARO

Christiane Rudert is the Regional Nutrition Advisor for UNICEF ESARO

Poor diets are a key driver of stunting in young children in the ESA region. Only 24% of children aged 6–23 months achieve MDD, only 14% achieve MAD and 43% consume no fruits and vegetables (UNICEF, 2022). While the prevalence of continued breastfeeding at the age of two is high in ESA (70%), there is inter-regional variation, with a much higher prevalence in Southern African countries compared to Intergovernmental Agency for Development (IGAD)¹ countries (84% versus 64%). Similarly, while 77% of children are introduced to solid foods at the appropriate time across ESA, this drops to 64% in IGAD countries. Children living in countries that experience chronic food insecurity, poverty and frequent emergencies (such as Comoros, Ethiopia, Malawi, Tanzania and Zimbabwe) are least likely to achieve MAD (UNICEF, 2019). There are also within-country disparities: children in rural areas are more likely to be breastfed at the age of two, but less likely to receive MAD, compared to children in urban areas.

Improving the diets of young children is central to UNICEF’s nutrition strategy in the ESA region. UNICEF supports country actions to improve the diets of young children, including building the capacity of community workforces to counsel caregivers on adequate complementary feeding using the UNICEF community infant and young child feeding (IYCF) counselling cards, delivery of cooking demonstrations, promoting and supporting kitchen gardens and improving the health environment. UNICEF also supports the implementation of social protection interventions that target vulnerable households within the first 1,000 days of life, as well as food systems transformation efforts, to support the availability and accessibility of nutritious foods for young children. This article describes recent actions taken by UNICEF ESARO to support these efforts across the 21 countries in the region.

Regional landscape analysis and consultation

Between 2018 and 2020, UNICEF ESARO partnered with the Johns Hopkins Bloomberg School of Public Health and the Global Alliance for Nutrition (GAIN) to conduct a regional complementary feeding landscape analysis. The objectives were to generate evidence on children’s diets in the ESA region and to provide member states with an understanding of trends, risk factors and policies and programmes implemented at scale. The landscape analysis was undertaken in 10 countries (Ethiopia, Kenya, Malawi, Mozambique, Rwanda, South Africa, Tanzania, Uganda, Zambia and Zimbabwe).

Results revealed that the positioning of nutrition in national development plans, policies and strategies is key to improving the diets of young children, particularly within the first 1,000 days. This process has been greatly supported in the region by the Scaling Up Nutrition (SUN) Movement. However, the availability and accessibility of nutritious diets for children remains a challenge across ESA, as access to some nutrients is particularly constrained. In most countries where the landscape analysis was done, foods rich in vitamin A and vitamin B12 were the most affordable, while foods rich in zinc and iron tended to be least affordable. Across five countries, 20–80% of households could not afford the lowest-cost sources of zinc, including pulses, ruminant liver (beef, goat or sheep), beef and small dried fish. Iron-rich foods were found to be unaffordable to 20–75% of households, with dark green leafy vegetables and pulses being the most affordable iron sources in most countries (Ryckman et al., 2021).

Findings from the landscape analysis were shared with participants from seven countries, the South African Development Community, IGAD, United Nations agencies and other partners during a consultative meeting on improving young children’s diets in June 2019. UNICEF’s global framework for improving young children’s diets was also presented. Following a discussion on best practices for the health, food, WASH, education and social protection systems in the ESA region, critical actions to accelerate progress across these systems were identified.

Regional framework for improving young children’s diets

Based on the critical actions identified, as well as the priority actions identified by UNICEF country teams, a draft Regional Framework for Improving Young Children’s Diets in the ESA region was developed. This framework serves as a planning tool for countries to identify and prioritise actions for improving the diets of young children at the policy, institutional and community levels across the four key systems (Figure 2).

Figure 2. ESA Regional Complementary Feeding Action Framework

Progress in supporting national action on young children’s diets

Between February and July 2021, ESARO conducted five regional webinars with governments, non-governmental organisations (NGOs) and UNICEF country offices and agencies to support the roll-out of the regional framework. These webinars included a ‘deep dive’ into how social protection interventions and food system transformation efforts can contribute to improving children’s diets. The webinars facilitated the identification of country-specific actions to improve children’s diets across all relevant systems. Since this time, 11 countries (Malawi, Zimbabwe, Zambia, Kenya, Uganda, Namibia, South Africa, Rwanda, Mozambique, Madagascar and Angola) have developed action plans for improving complementary feeding, and three countries (Ethiopia, Tanzania and Zimbabwe) have adapted the regional Action Framework into country-specific frameworks. Country-specific frameworks help galvanise multi-sector action and track progress on the implementation of key actions for improving the diets of young children. Discussions are underway in Kenya, Madagascar, Botswana, Uganda, Angola and Eswatini towards the development of similar country-specific frameworks.

Next steps

UNICEF ESARO will continue providing technical support to countries on the development, implementation and monitoring of country complementary feeding Action Frameworks. In complement to this, and in the context of the United Nations Food Systems Summit and the Nutrition for Growth Summit, UNICEF ESARO has intensified engagement with governments and UNICEF country offices on the transformation of food systems for young children. UNICEF ESARO is working with academic and research institutions in the region to profile the content of commercially produced foods and to understand the knowledge, attitudes and perceptions of caregivers on the use of these products. This information will contribute to transforming food systems for young children in the region and to building nutrition resilience. A few countries have expressed interest in partnering with local industries to produce healthy and nutrient-rich complementary foods, including fortified local porridge and egg and fish powders. Technical support and advocacy will continue to support these efforts.

For more information, please contact Charity Zvandaziva at czvandaziva@unicef.org.

References

Ryckman T, Beal T, Nordhagen S et al (2021) Affordability of nutritious foods for complementary feeding in Eastern and Southern Africa. Nutrition Reviews, 79, 4 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7948081/

UNICEF (2019) The State of the World’s Children 2019. Children, Food and Nutrition: Growing Well in a Changing World. United Nations Children’s Fund. https://www.unicef.org/reports/state-of-worlds-children-2019

UNICEF (2022) UNICEF Global Database on Infant and Young Child Feeding. United Nations Children’s Fund https://data.unicef.org/topic/nutrition/diets/