MALNUTRITION is the underlying cause of 35 percent of deaths in children younger than five years of age on the African continent, and Lesotho is no exception. Severe malnutrition kills, while less acute cases increase susceptibility to and mortality from such infectious diseases as diarrhoea, pneumonia and tuberculosis among others.
As part of efforts to turn the tide on undernutrition, October has been marked as International Nutrition Month. The commemorations have more resonance in Lesotho since King Letsie III is the African Union (AU) Nutrition Champion as well as Food and Agricultural Organisation Nutrition ambassador.
In this wide-ranging interview, Food and Nutrition Coordinating Office (FNCO) Food and Nutrition Coordinating Officer, Tiisetso Elias, talks to Lesotho Times (LT) Reporter Pascalinah Kabi about the importance of joining forces to assist His Majesty address nutrition challenges in his own country.
LT: What prompted the commemoration of International Nutrition Month?
Elias: There are so many issues that inspired the world to earmark a month for nutrition. Over the years, nutrition has been seen as a health and agricultural issue.
For most people, health and agriculture are the fields that immediately come to mind when they hear about nutrition.
But over time, there was a realisation that most of the interventions and programmes put in place were really not delivering the expected dividends. When we re-examine our traditional programmes, we find that the nature of malnutrition itself is so diverse and multi-sectoral.
For example, we have the United Nations Children’s Fund (UNICEF) Conceptual Framework and it shows that once you take nutrition as either a health or agricultural problem, it means that whatever interventions that you are going to do will derive from these two sectors and whatever impact that you will see, you will see it looking at it through only these two.
Now the Conceptual Framework will give you a conventional approach based on evidence. For instance, it will conclude that a person’s nutritious status is not good based on looking at them.
This is something that is evident and it means that the interventions will only address those things that are evident and this is just a tip of an iceberg.
For example, a person’s educational background contributes immensely to their nutritious status. Water, hygiene and sanitation are also very crucial to ensure that good nutrition is attained. Infrastructure and accessibility of health services all have an impact on nutrition. Therefore, if your programme only addresses the visible impacts – negative or positive – of malnutrition, saying it would have fallen short would be putting it very lightly.
This is because you will not really have addressed nutrition at all and to top it, you will find that the kind of interventions available in these two sectors are largely addressing nutrition problems only after the negative impact has already been done.
Our traditional approaches are curative rather than preventative. The most effective way of addressing malnutrition is preventative and can save a lot of money used for addressing it. We have different types of malnutrition like stunting which negatively affects the economic dividends the country gets from the investments it made for addressing malnutrition. Stunting is only reversible within the first 1 000 days of life that is the only window you have.
LT: From when are the first 1 000 days of a person’s life counted?
Elias: The first 1 000 days start from the conception period, the minute a mother falls pregnant. Nutrition is very crucial from the minute of conception. So the 1 000 days include the nine pregnancy months up to the second birthday of that child. Now, if you get it wrong within that window and the child gets stunted, you can never reverse that.
LT: How does a parent assess if their child is malnourished or not and if it’s hidden like you said, what needs to be done to ensure that children are not malnourished?
Elias: We advocate for balanced diets. Much as we have been criticising the traditional way of doing things, there are also traditional ways of doing things that have been tried and tested for efficiency and we still know that they are efficient.
For parents and everybody else, they need to ensure that they provide balanced diets for households. There are many ways of determining that – traditional recommendations of ensuring that a plate covers several groups of foods that is balanced. You can, for example, look at colours of foods depending on age.
It does not require a rocket scientist really. The major problem most people face is the inability to afford most of the nutritious foodstuffs.
Added to that, improvements in technology do not necessarily translate into better nutrition.
So we should not assume that having access to food is enough in addressing malnutrition.
Even if one believes that they have a balanced meal, at times it is no longer balanced because the same technology used for cooking may deprive the meal of all those essential nutrients through overcooking, frying too much and adding seasoning. As a result, we are seeing problems that were never there before, hence we have a double-burden of malnutrition.
Being malnourished does not end at being emaciated but also entails overeating which leads to obesity and the related ailments like heart diseases. There is now a realisation that our mind-set and approach to issues of malnutrition need to change to enable us to maximise our economic investments in nutrition.
This new school of thought is what inspired the earmarking of October as Nutrition Month. It can no longer be business as usual. We have to change the way we address nutrition to attain the Sustainable Development Goals. Addressing malnutrition has a lot to do with advocacy.
LT: How is Lesotho commemorating October as Nutrition Month?
Elias: Much as we have earmarked October as Nutrition Month, it does not mean we expect nutrition activities to only take place during that time. We expect everyone to be aware of issues related to nutrition at all times and really advocate for addressing those issues throughout the year.
However, we have activities lined up in October and others will continue even in the month of December. As we are celebrating Nutrition Month, it is during His Majesty’s Championship for the AU, so the activities lined-up have a lot to do with activities of His Majesty as Nutrition Champion.
We have put together a committee because we agreed that we ourselves have got to make use of His Majesty as the AU Nutrition Champion at the national level and we are lucky that His Majesty is willing to do that because he values his continental leadership on nutrition issues and wants to make sure that his country is a flagship of his work at the continental level.
The committee has identified several line ministries which have come up with a programme for His Majesty. I think everyone knows how crucial nutrition is and His Majesty wants to advocate for every Mosotho to have vegetables in their yard. Traditionally, it is either people have vegetables as a way of decoration while others have been inspired to sell them; you can hardly find people who have vegetables simply because they want to have it at all times.
So this inspired His Majesty’s thinking and he strongly feels that every Mosotho should have vegetables in their yard primarily because they want to have nutritious foods. However, having vegetables does not necessarily mean the nutrition status of that family has positively improved hence His Majesty’s programme seeks to ensure that every Mosotho plants vegetables for the sole purpose of eating a vegetable every day.
He wants to show the importance of eating a vegetable each day in terms of nutritional status. This will be done in a competition form though the idea is not for people to compete but encourage one another to eat nutritious foods. All the ten districts are taking part in this competition and a panel will visit and assess them by the end of October.
A district that will win will be our nutrition champion and in terms of advocacy, we are working hard to identify our very own local nutrition champions in different sectors as a form of ensuring that it is not business as usual.
The winning district will host a high-level national nutrition celebration in December. We have also identified districts with high rates of malnutrition, with stunting being the dangerous type of malnutrition. Mokhotlong, Qacha’s Nek, Thaba-Tseka, Quthing and Berea districts have very high levels of malnutrition and His Majesty is going to run a small stock project at the community level; working closely with His Majesty’s Office.
LT: With the Cost of Hunger Report stating that Lesotho spends M1.9 billion to address malnutrition and 33.3 percent of children below five years stunted, His Majesty has faces immense challenges at home as a continental champion of nutrition. As FNCO, how are you helping him win the fight against malnutrition in his own country?
Elias: The Cost of Hunger Study is an eye-opener and an advocacy tool for more investments in nutrition which I am very passionate about. For most countries, one finds that ministries responsible for allocating funding to nutrition are a bit distant from it.
So one begins to wonder how they justify allocations they give to nutrition each year and the cost of hunger really tells them that nutrition is an economic problem.
So Cost of Hunger helps people given the responsibility to allocate the national budget to nutrition, to see the human face of malnutrition as it tells them the evidence-based story in three scenarios – the cost of not doing anything (business as usual) and the cost of targeting to reduce malnutrition especially stunting by five percent. This is what happens when you address malnutrition preventatively.
The continental countries adopted the Cost of Hunger Study and have committed to reduce stunting by 10 percent by 2025. The study shows how much resources, in monetary terms, will be saved and such money can be used for service delivery such as construction of roads.
So, just to have carried out that study is a very important step towards helping His Majesty to improve Lesotho’s nutrition status as he goes around the continent advocating for good nutrition. However, the cost of hunger is a tool to advocate for more investment.
Through His Majesty’s office, we are also working hard to secure a slot where we will be able to address Members of Parliament on nutrition. As we speak, there is a lot of momentum among stakeholders, probably trigged by the launch of Nutrition Policy, the study itself and His Majesty’s role as nutrition champion and ambassador.
In the nutrition fraternity, we have also made a pledge that there is no way Lesotho cannot do be better in nutrition issues when His Majesty is nutrition champion. We see ourselves as champions as well and we are doing this in partnership with the AU. We need His Majesty to be able to make home-grown examples when championing nutrition in Africa.
However, there are challenges and one outstanding one is access to His Majesty. This is just a personal observation that the continent is able to access His Majesty more than we are able to yet he is our very own champion. We are now in talks with His Majesty’s Office to try and relax protocol.