July 10th, 2019
The Double Burden of Malnutrition is a key issue in global health. Choices International, working with national health authorities and nutrition platforms, wants to know how this issue is perceived and addressed on a national level. To answer that question, Semnen Lambert, masters student in International Public Health at the Vrije University Amsterdam and coming from Nigeria, did her internship at Choices. Here is what she found.
While being a medical doctor coming from conventional medicine which focuses on disease treatment, I have always had an interest in preventive medicine. Even more so, now the current epidemiological transition with top 10 causes of death being Non-Communicable Diseases (NCDs) such as diabetes, heart diseases and cancers, calls for more emphasis to be put on prevention. I wrote my masters project on the Double Burden of Malnutrition (DBM) which includes the co-existence of overnutrition such as for overweight and obesity; undernutrition such as wasting, stunting and micro-deficiencies, and diet-related NCDs on an individual, community or population level. The DBM is increasingly becoming prevalent in especially low- and- middle- income countries (LMICs). Tackling this problem will be essential in achieving the Sustainable Development Goals (SDG) 2.2, to end malnutrition and all its forms by 2030. Therefore, the aim of my study was to give recommendations to the Choices International Foundation on their advisory work on tackling the DBM in Nigeria, which is my home country. My main research question was: How do international organizations influence the development of the DBM policies in Nigeria?
I did a policy analysis of international organizations including WHO, FAO, World Bank, WFP and Global Panel on Agriculture and Food systems on the DBM policies recommendations in comparison with the current food and nutrition policy in Nigeria. The result from the policy analysis showed that the international organizations all had an elaborate set of integrated policy recommendations on addressing the DBM. Furthermore, it showed that some DBM policies recommended by international organizations for national policy-making were excluded in the food and nutrition policy in Nigeria. Consequently, I did a further exploration by interviewing stakeholders involved in the development of food and nutrition policies in Nigeria on policies excluded that are relevant to the Choices International Foundation. I interviewed ten stakeholders from different sectors: Government, Non-Governmental Organizations (NGOs), the scientific community and private sectors. Overall, the results of my study showed that the food and nutrition policy in Nigeria mostly had strategies towards addressing undernutrition and lacked specific strategies for overnutrition and diet-related NCDs. To tackle the DBM, undernutrition, overnutrition and diet-related NCDs all need to be addressed. As a result, there is a need for a comprehensive integrated strategy in Nigeria that addresses all these forms of malnutrition. However, many malnutrition problems are context specific which is indicated by the differences in translation of international policies into national policies. Hence, recommendations were given to the Choices International Foundation based on lessons learnt in this study as strategies to tackle the DBM in Nigeria. These recommendations are (1) Inclusion of specific strategies for preventing overnutrition and diet-related NCDs in the food and nutrition policy such as front of pack labelling, reformulation policy and marketing regulations. (2) Creating awareness on the importance of prioritizing the growing prevalence of the DBM in Nigeria, both the government and consumers should be educated using strategies such as social marketing campaigns, behavioural change programs and dietary diversification taking into account local foods. (3) The government should leverage on the SUN Business Network operating in Nigeria to increase the degree of involvement of food companies in the development and implementation of food and nutrition policy in Nigeria. (4) Increase of sustainable investment in nutrition activities, especially by the government with additional funding from the development partners and private sectors. (5) Improvement of multi-sectoral coordination for nutrition activities. (6) Strengthen the monitoring, regulation and evaluation systems for capacity building to facilitate the implementation of food and nutrition policies and regulations. (7) Improvement of data collection and frequency to enable the development of well-informed food and nutrition policies.
In conclusion, the main challenge in Nigeria is not the policies but the implementation of these policies, mainly due to inadequate funding. That said, International organizations should consider the cost implication of recommended DBM policies, especially in LMICs. This will ensure easier national adaptation of these recommended policies in low-income settings. Overall, improvement of nutrition is not only essential to achieving the SDG 2.2, elimination of malnutrition and all its forms. It plays an integral role in sustainable development, at least 12 of the 17 SDGs include indicators that are relevant to nutrition. Thus, it is important to reach global nutrition targets for global sustainable development.