Regional Perspective: West and Central Africa

Simeon Nanama is the Regional Nutrition Advisor at the UNICEF West and Central Africa Regional Office (WCARO)

Arnaud Laillou is a Regional Nutrition Specialist (prevention unit) at WCARO

John Ntambi is a Regional Nutrition Specialist (prevention unit) at WCARO

West and Central Africa (WCA) is home to only 13.8% of the world’s children, yet contributes to 19.6% of the global stunting burden. Despite a nearly 10% reduction in stunting prevalence over the past 20 years, the absolute number of stunted children in the region has increased from 23 million to 29 million due to high population growth (UNICEF, 2022). To achieve the 2030 Sustainable Development Goal, the region would at least need to triple the current annual rate of stunting prevalence reduction from 1.4% since 2015 to 3.7%.

The consequences of malnutrition are well documented and include increased risk of mortality, poor cognitive development, poor school performance, limited productivity and non-communicable diseases. These individual-level consequences have macro-level implications for economic development. For example, in a recent analysis, the UNICEF West and Central Africa Regional Office (WCARO) showed that the economic loss due to malnutrition in West African countries amounts to at least USD36 billion per year (Horton & Steckel, 2013).

While 18 of the 24 countries in the WCA region have national policies of complementary feeding (Na et al., 2020), a meta-analysis of the latest demographic health surveys conducted by UNICEF and the University of Göttingen in 22 countries showed that only 18% of children aged 6–23 months consume five food groups or more (Volmer et al., 2022). In addition, 39% of children receive two or fewer food groups daily. The proportion of children receiving the recommended five food groups or more could be doubled by ensuring that an additional food group or two is added to the daily diet of the 43% of children who currently consume three or four food groups per day, with a focus on animal source foods, legumes, and other fruits and vegetables that are consumed less often.

Unfortunately, limited finances and physical access (i.e., distance and expensive transport to markets) were two of the challenges to increasing childhood dietary diversity identified in a landscape analysis conducted in 2021 by UNICEF WCARO. Before the 2022 inflation, food prices were already a key determinant of household food access in Africa, being 30–40% higher than in other areas of the world at comparable levels of GDP per capita (Allen, 2017). The landscape analysis highlighted the relevance of this for ensuring access to nutritious foods for children, with the most nutritious foods (e.g., animal sources) often being the most expensive.

Historically, efforts to improve young children’s diets have focused on enhancing caregiver knowledge and practices, usually through nutrition education and counselling. These services are an important part of the solution to this problem but will not lead to dietary changes unless nutritious foods are locally available, accessible, affordable and desirable to families (UNICEF, 2021). Efforts to improve young children’s diets must further ensure food systems respond to their specific needs. A rights-based approach to improving children’s access to nutritious food through social protection schemes may help to ensure that marginalised and vulnerable populations – who are disproportionately affected by malnutrition – have equitable access to local products.

The WCA region is composed of a wide variety of ecosystems and an equally high number of food production systems. Unfortunately, nutrient-dense foods essential for young children aged 6–23 months – including animal source foods, fruits and legumes – are not widely available in rural areas, and only at a significant cost in urban areas. These foods are also subject to significant postharvest losses in sub-Saharan Africa (33.4% for fruits and vegetables, and 21.2% for animal source foods), which could be reduced through minimal processing for the benefit of children’s diets (Kuiper & Hao, 2021).

Working through game-changing initiatives from other regions aimed at strengthening the food system and supporting the local, sustainable supply of safe nutritious and affordable complementary food for young children will contribute to improving diets and reducing stunting. For example, in Ethiopia, dehydrated egg powder has been assessed to improve the affordability of a nutritious diet for young children (Baye et al, 2021), supplying 42% of daily needs for animal protein (Abreha et al, 2021). Documenting knowledge on how to effectively engage with local producers to increase the availability of nutritious, stable, healthy and low-cost food for children aged 6–23 months can contribute to developing child-centred food systems.

As is the case around the world, in the WCA region, many commercially available complementary foods have nutrition profiles that do not follow international and regional recommendations or specifications – they are too sweet, too salty and/or have unhealthy fatty acid profiles (Pries et al, 2017). The development and/or innovation of commercially available complementary foods for young children, including all foods and drinks for infants and young children that are not breastmilk substitutes, should adhere to World Health Organization (WHO) guidance on ending the inappropriate promotion of foods for infants and young children (WHO, 2016), and should be promoted only if they meet relevant standards for composition, safety, quality and nutrient levels and are in line with national and regional dietary guidelines.

Over the coming years, regional partners will be working on a more specific set of regional guidelines for younger children and on the systems to enforce them at the national and regional level. This development should be done in close collaboration and under the leadership of ECOSHAM, the ECOWAS Standards Harmonisation Mechanism, with next steps to support national implementation.

For more information, please contact Simeon Nanama at snanama@unicef.org

References

Abreha E, Getachew P, Laillou A et al (2021) Physico-chemical and functionality of air and spray dried egg powder: Implications to improving diets. International Journal of Food Properties, 24, 1, 152–162.

Allen T (2017) The Cost of High Food Prices in West Africa. West African Papers. http://dx.doi.org/10.1787/c2db143f-en

Baye K, Abera A, Chitekwe S et al (2021) Whole egg powder makes nutritious diet more affordable for Ethiopia: A cost of the diet and affordability analysis. Maternal & Child Nutrition, e13274.

Horton S & Steckel R (2013) Malnutrition: Global economic losses attributable to malnutrition 1900–2000 and projections to 2050. In The Economics of Human Challenges. Cambridge University Press.

Kuiper M & Hao D (2021) Using food loss reduction to reach food security and environmental objectives – A search for promising leverage points. Food Policy, 98, 101915.

Na M, Kodish S & Murray-Kolb L (2020) Regional Landscape Analysis of Trends and Factors of Young Children’s Diet in UNICEF’s West and Central Africa Region. UNICEF WCAR. https://www.unicef.org/wca/reports/regional-landscape-analysis-trends-and-factors-young-childrens-diets

Pries A, Huffman S, Champeny M et al (2017) Consumption of commercially produced snack foods and sugar-sweetened beverages during the complementary feeding period in four African and Asian urban contexts. Maternal & Child Nutrition, 13, S2, e12412.

UNICEF (2021) Fed to Fail? The Crisis of Children’s Diets in Early Life: 2021 Child Nutrition Report. https://www.unicef.org/reports/fed-to-fail-child-nutrition

UNICEF (2022) Malnutrition Database. https://data.unicef.org/topic/nutrition/malnutrition/

Volmer L, Ntambi J & Nanama S (2022) Complementary Feeding Landscape Analysis for the West and Central Africa Region. UNICEF, Dakar.

WHO (2016) Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children. WHO, Geneva.