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Addressing the Double Burden of Malnutrition in Zambia and Indonesia

Zambia and Indonesia are challenged by the double burden of malnutrition (DBM). Along with persisting issues of undernutrition, shifting diets towards foods high in sugar, fat, and salt are causing increasing problems of overweight, obesity and related non-communicable diseases. How can low- and middle-income countries such as Zambia and Indonesia address DBM? What national policy measures have already been undertaken? And what role do international organizations play in this nutrition response? Our intern Inge de Bresser committed to answering these questions as part of her master’s in Global Health.

Addressing the shared drivers behind DBM

On a global level, there is growing recognition that over- and undernutrition are caused by shared drivers, such as poor maternal- and child feeding practices, poverty, and food environments in which cheap but unhealthy foods are abundant. Recognising these shared drivers, the World Health Organization (WHO) recommends integrated or so-called double-duty actions, which are policies, strategies, and interventions that address over- and undernutrition simultaneously (1). For example, measures to achieve food systems in which sufficient quantities of high-quality foods is available, could address both over- and undernutrition. Besides, nutrition education programs could include information on healthy diets to address both micro-nutrient deficiencies and overweight, obesity and diet related NCDs. In order to achieve such double-duty programs in the most efficient way, WHO recommends retrofit, which means the adaptation of existing singe-focussed programs to transform these into programs tackling multiple forms of malnutrition.

Although the need to address DBM has been recognised …

Inge conducted interviews with stakeholders from the government, civil society organizations, academic institutions, and food companies. These revealed that the need to address overweight, obesity and NCDs along with undernutrition, has been recognised. Indeed, both countries were in the process of developing front-of-pack labelling interventions. In addition, Zambia was developing a social behavioural change communication campaign, and in Indonesia national dietary guidelines were in place, as well as community based integrated NCD development posts (so-called posbindus).

… a double-duty approach is lacking

Nevertheless, Inge’s policy analysis revealed that both countries’ nutrition strategic plans were lacking an integrated or double-duty approach. In line with that, international recommendations for double-duty actions were not well-known among stakeholders. The study revealed that both countries’ policy directions were influenced by a complicated set of factors. Among others, lack of resources certainly hampers revision of nutrition policies in Zambia. In both countries, awareness on the severity of the double burden of malnutrition is urgently needed, to soon increase prioritization of nutrition among all ministries and stakeholder groups.

Opportunities for future policies

The good thing is that both countries had elaborated multi-sectoral nutrition strategic plans in place. Besides, majority of double-duty platforms recommended by international organizations were in place, yet currently only focussed on undernutrition. For example, both countries had school-based programs in place that were currently educating children on undernutrition. In future, such program could be retrofitted to comprehend both under- and overnutrition. The report concludes therefore that both Zambia and Indonesia should consider these opportunities and explore how they can achieve double-duty programs in their next nutrition strategic plans. From an international perspective, it is recommended to further promote double-duty actions and provide support to governments in developing policies that address all forms of malnutrition simultaneously. 

With the second Sustainable Development Goal of United Nations aiming to end all forms of malnutrition and the third to decrease premature deaths caused by NCDs by 2030, this study argues to contribute to both global goals. Curious about the report? You can request the full version by emailing bobbie@choicesprogramme.org.

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