Child malnutrition is a largely hidden crisis, less visible than food shortages and different in the sense of urgency that hunger brings.
But its effects become clear as children age: children who are malnourished are weaker and more prone to suffering from a deadly cycle of illness and disease.
Inadequate nutrition in the early years of life not only blunts intellect and saps productivity and potential, but can affect the following generation when poorly nourished mothers have low birth weight infants.
The poor nutritional status of Cambodia’s children poses serious long-term consequences for the physical and cognitive development of the country’s population, and therefore for productivity and economic development.
Despite strong economic growth and rapid poverty reduction, the high incidence of chronic childhood malnutrition in Cambodia has not improved over the past five years and may even be worsening.
The 2010 demographic and health survey shows 28 per cent of Cambodian children under five years old as underweight, with no improvement from 2005.
Worryingly, there was an increase in the incidence of severe malnutrition over the same period, with the incidence of wasted (thin) children rising from 9 per cent to 11 per cent.
At 40 per cent, Cambodia has the second highest prevalence of children in Southeast Asia who are stunted, meaning they are too short for their age.
There is strong international evidence that stunted children enroll in school later, do less well academically, leave school earlier and make less future income than their non-stunted counterparts.
In other words, malnutrition also stunts economic growth. In 2011, the United Nations estimated that Cambodia loses more than US$146 million in GDP every year due to the impacts of vitamin and mineral deficiencies alone.
A child’s future is greatly determined by the quality of her nutrition in the first 1,000 days, starting from conception up to her second birthday. A child conceived today will complete schooling around the year 2030.
If her cognitive abilities are seriously impaired by inadequate nutrition in the first 1,000 days, then her productivity level as she enters the work force in 2030 will be significantly below potential, and likely well below the requirements of an increasingly sophisticated economy.
Malnutrition is caused by more than a lack of nutritious food. Poverty, open defecation, inappropriate feeding practices, mothers’ education and nutritional status are all risk factors for childhood malnutrition.
According to recent demographic surveys, more than half of all Cambodian households have no access to a toilet; and more than two-thirds of rural households defecate in the open.
ADB’s Asian Development Outlook 2013 identifies child malnutrition and the problem of the first 1,000 days as a critical development challenge for Cambodia (see www.adb.org/publications/series/asian-development-outlook).
The key to preventing the crisis of the first 1,000 days is to develop an interlocking series of interventions that provide better food security, nutrition, sanitation and hygiene.
This could include improving access to sufficient quantity, quality and variety of food through homestead food production, targeted social transfers and promotion of fortified foods; promoting breast-feeding and appropriate feeding practices; and strengthening basic health services and micronutrient supplementation for women and children.
Identifying and managing child malnutrition through growth monitoring would help pinpoint problem areas. Government could also help decrease nutrient loss by improving the environment and sanitation and hygiene, and by increasing awareness of better food processing and storage techniques.
This ambitious agenda should not be just the responsibility of the government. Progress is possible only if partnerships are developed involving government, civil society, the private sector, researchers and communities.
The Asian Development Bank (ADB) is contributing to this agenda through a number of investments. The Emergency Food Assistance Project (EFAP) includes a new community-based nutrition and livelihood program in 100 communes around the Tonle Sap.
Previous EFAP social safety nets included targeted rice distribution and school feeding.
EFAP has also increased rural incomes through a large cash for work program. Nearly 40,000 participants in seven provinces were able to secure an average of 30 days of work to improve 448 rural roads and 47 irrigation canals.
Improvements in sanitation and hygiene were a key outcome of the Tonle Sap Rural Water Supply and Sanitation Sector Project, with more than 500,000 villagers gaining access to safe water and about 250,000 gaining access to a durable and hygienic latrine.
The Second Rural Water and Sanitation Sector Project aims to reach an additional 400,000 people. Sanitation and hygiene promotion is also a feature of the Second Communicable Diseases Control Project, which is testing a community-based model health village approach in 180 poor border villages.
The project includes mass drug administration to combat parasitic worms (helminthes) in 10 provinces.
Together with government and other stakeholders we can help ensure that as the country grows, Cambodia’s children have better access to nutritious food, safe drinking water and clean environments so they can enjoy the bright future they deserve.
Peter John Brimble is ADB Deputy Country Director and Senior Country Economist for Cambodia. Karin Schelzig is ADB Senior Social Sector Specialist.