Anushree Shiroor, from RESULTS nutrition team, assesses new figures released this week on the number of hungry people in the world. But hidden hunger is another issue that needs increased attention.
Working with UNICEF gave me the opportunity to visit several rural communities. I spent a lot of time interacting with women, children, and grass root health functionaries, to understand health and nutrition services offered and their uptake. One of these was red coloured tablets which were commonly known to ‘help make blood in the body’. The functionaries, Anganwadi workers and ASHAs, repeatedly explained the importance of these red tablets, i.e. Iron and Folic Acid (IFA), to pregnant and lactating women, and adolescent girls. They also counselled them on dietary intake of green leafy vegetables and other iron rich sources.
So, why is this so important?
Today, on World Food Day, we note the descending trend of absolute hunger in the world. Figures in the new Global Hunger Index (GHI) Report released this week show that chronic undernourishment due to hunger has fallen from 842 million in 2013 to 805 million people. But hidden hunger is a great reason to worry.
- Over 2 billion people suffer from ‘hidden hunger’– deficiencies of essential vitamins and minerals, otherwise known as micronutrients. One in two pregnant women in developing countries is anaemic. This results in adverse birth outcomes including contributing to the 20% rate of maternal deaths in these countries1. Infants born to anaemic mothers are mostly underweight, most likely to be anaemic, and at high risk of varying degrees of physical and cognitive impairment.
- Globally, 40% of children under the age of five are anaemic. Iron deficiency is the most important cause of anaemia.
- Diarrhoeal disease is the second largest killer of children under the age of five. Zinc deficiency exacerbates the frequency and duration of diarrhoeal episodes.
- Nearly 18 million babies are born with brain damage due to iodine deficiency every year.
We call this hunger ‘hidden’, as it does not manifest as the palpable starved, wasted, or pot-bellied image of undernutrition. Physical manifestations may appear only at later stages (for example, blindness in young children due to Vitamin-A deficiency), but irreversible impairment to immunity, growth and development sets in at early stages.
One of the main causes of hidden hunger is poor diet – not just an absolute lack of food. Consuming only one or two types of food (often staple foods which are not rich in a variety of nutrients), is an inadequately diverse diet. Such diets cannot provide vital micronutrients in the required amounts.
Other causes of hidden hunger include infections such as diarrhoea which result in rapid nutrient loss from the body, and worm infestations which prevent absorption of nutrients from the food. Poor sanitation and hygiene environments and practices are commonly responsible for such conditions.
Women and young children are most vulnerable to micronutrient deficiencies and their consequences, due to higher nutrient requirements, and their often neglected status. Hidden hunger is responsible for about one third of child deaths due to undernutrition, which itself underlies around 45% of global child mortality.
Hidden hunger has massive health and economic costs for individuals and countries alike. Children with micronutrient deficiencies are unable to achieve their full growth potential, and suffer from frequent episodes of infections. Their educational achievements are compromised, and they also have reduced work productivity as adults. This perpetuates the inter-generational cycle of poverty, undernutrition, and disease. This ultimately also hinders economic growth. Micronutrient deficiencies are estimated to cost developing countries between 0.7 and 2% of their GDP every year.
The importance of those red IFA tablets cannot be emphasised enough! As Lawrence Haddad, expressed at the launch of the GHI report, “Most malnutrition is hidden. Micronutrient malnutrition is cloaked in invisibility”. We have a lot to achieve in addressing hidden hunger.