Insufficient diets are an everyday fact of life for hundreds of millions of children. Malnutrition is not merely the result of too little food. It is a pathology stemming principally from a lack of essential nutrients that causes growth to falter and increases susceptibility to common diseases.

UNICEF estimates that there are nearly 195 million children suffering from malnutrition across the globe. Most of the damage caused by malnutrition occurs in children before they reach their second birthday, in the time when the quality of a child's diet has a profound impact on his or her health and physical and mental development.

Breast milk is the only food babies need for the first six months. After this time, breastfeeding alone is not sufficient, however. Thereafter, the types of foods that are introduced into the diet are of paramount importance. Diets that do not provide the right blend of energy—including high-quality protein, essential fats and carbohydrates, vitamins and minerals—can impair growth and development, increase the risk of death from common childhood illness, or result in life-long health consequences.

Malnutrition plays a huge role in child mortality because the immune systems of these children are less resistant to common childhood diseases. This is why a common cold or bout of diarrhea can kill a malnourished child. In fact, malnutrition contributes to at least one-third of the eight million annual deaths of children under five years of age.

In places where families have little or no access to highly-nutritious foods, behaviorial changes alone—education about proper food choices, hand-washing, and breastfeeding, for instance—are not enough to address the problem. Such strategies are insufficient because in the world’s “malnutrition hotspots”—the Horn of Africa, the Sahel, and South Asia—many families still lack access to energy-dense, nutrient-rich foods such as milk, meats, and fish, which can provide the 40 essential nutrients a young child needs to grow and be healthy.

Unfortunately, most current food aid programs for developing countries rely almost exclusively on the fortified cereal blend of corn and soy that may relieve a young child's hunger but does not provide proper nourishment. These are foods donor countries would not use for nutrition programs within their borders. International donors must end this double standard. They should only support programs that respect the minimal nutritional needs of infants and young children and work with countries most affected by the crisis to put access to nutrient-rich foods at the center of their efforts.

Some strategies to address malnutrition are showing promising results. Some countries, including Mexico, Thailand, and Brazil, have reduced early childhood malnutrition through direct nutrition programs that ensure infants and young children from even the poorest families have access to quality foods, such as milk and eggs. Through such programs, substantial progress has been made towards freeing children from the consequences that come with malnutrition at an early age.

Between 2001 and 2005, MSF's therapeutic feeding program in Maradi, Niger, offered treatment for severe acute malnutrition (SAM) centred on the use of Ready to Use Therapeutic Food (RUTF) and the outpatient management of all uncomplicated cases. During the malnutrition crisis in 2005, the program demonstrated its capacity to handle large numbers of patients while maintaining highly satisfactory results. More than 40,000 severely malnourished children were treated in Maradi region alone, with a cure rate above 90 percent.

The 2005 crisis in Niger led to an increased understanding of how to extend malnutrition treatment to large numbers of affected children and RUTF is now widely used in MSF malnutrition program. In Niger, a national protocol favouring outpatient treatment with RUTF for severe acute malnutrition was adopted in July 2005, and for the first time, in 2006, the treatment of malnutrition was integrated into the national action plan against food insecurity. The government of Niger, United Nations (UN) agencies and international donors went forward with a plan to treat 500,000 acutely malnourished children during 2006. Nutritional surveillance was added to the early warning system, and Niger has reaffirmed its commitment to reduce child mortality rates as a public health priority. With assistance from the World Bank, the government has moved to implement free health care for children less than 5 years of age and for pregnant women.

The World Bank now estimates that $11.8 billion would be required to adequately combat malnutrition in the 36 high-burden countries where 90 percent of malnourished children live. And yet international assistance over the past decade has amounted only to an estimated $350 million annually. While conducting its own malnutrition treatment programs on the ground, MSF is also advocating that international and governmental donors direct an additional $700 million to combat malnutrition in the 32 countries with the highest prevalence among their child population under five.

MSF’s Nutrition Activity at a Glance 

In 2009, MSF ran more than 136 programs in 34 countries and treated 208,889 children younger than 5 years of age for SAM. This represents a 13 percent increase from 2008 and an almost four-fold jump since 2005, when MSF treated just over 60,000 severely malnourished children. The number of programs remains essentially the same as in 2008.

There was no large scale nutrition emergency in 2009, as there was the previous year in Ethiopia, but there were several smaller scale nutritional emergencies. In Burundi, in the first half of 2009, MSF treated 514 children. MSF responded to what initially appeared to be a nutrition emergency in northwestern Kenya in March. And in June, health authorities in Central African Republic requested assistance for a nutritional emergency in the southwestern sector of the country. Additionally, new nutrition programs were launched in northern Nigeria, Guinea Conakry, Djibouti, India, and Mali.

There were 45,459 children under 5 treated for moderate acute malnutrition. This represents a 58 percent drop compared to 2008 (more programs have transitioned to World Health Organization 2006 standards, which puts up to 40 percent of the “old moderate” measurments for malnutrition in the category of severe). Virtually all of these moderately malnourished children were in Niger (21,024), Ethiopia (7,999) and Somalia (4,431). All the children treated in Niger received RUTF.

As of June 2010, MSF nutrition programs were running in 36 countries, including 23 in Sub-Saharan Africa, 8 in Asia, 4 in Latin America, and 1 in the Middle East. New programs began in Haiti, Columbia, Nigeria, and Bangladesh. Programs in Zambia, Zimbabwe, Malawi, Mozambique, and Swaziland are linked to HIV treatment programs, although many also treat non-HIV infected malnourished children.

Virtually all MSF nutrition programs now combine inpatient and outpatient care so as to increase coverage and minimize the stress and opportunity costs for families that have characterized the care of malnourished children for so long. In general, 70 to 80 percent of children with SAM can be managed exclusively as outpatients.

More than 90 percent of projects now use the World Health Organization 2006 growth standards. The only projects that continue to apply the NCHS growth references are in Ethiopia (due to Ministry of Health resistance), DRC, and South Sudan.

In 2010, MSF partnered with the VII photo agency to launch “Starved for Attention,” a traveling multimedia exhibition wherein some of the world’s top photojournalists traveled to malnutrition hotspots—including DRC, Djibouti, Burkina Faso, Bangladesh, India, Mexico, and the United States—to highlight situations central the overall discussion of the affliction. The exhibition included a signature drive for a petition calling on developed nations and large-scale food donors to stop sending nutritionally deficient foodstuffs overseas to developing nations where malnutrition was widespread. And MSF staged events, press conferences, and conferences in the days leading up to World Food Day, on October 16, to further highlight the issues that affect so many around the globe.