UNICEF calls for young children to be prioritized in nutrition scarcity contexts

03 Apr 2024 --- A guidance note by UNICEF highlights the need for age prioritization, an emerging approach to malnutrition involving the deliberate dedication of nutrition resources to the youngest children in communities facing the highest risk. The approach may increase the population-level impact on child survival and growth.

Annually, close to five million children under the age of five worldwide die from preventable causes, with 45% of deaths caused by undernutrition.

One of the key messages spotlighted in the note is that child mortality remains concentrated in the first two years of life. While maternal and child nutrition programs have contributed to the decreasing global rates of child mortality and malnutrition, the lack of resources and data impedes population-level optimization. 

The authors argue that age prioritization allows preventive nutrition programs to increase their population-level impact on child survival. They assert that prioritizing the youngest children, where resource scarcity is rampant, is justifiable while acknowledging that it should be monitored closely. 

Prioritizing delivery 
The UNICEF report states that in locations with limited access to resources and data on where exactly children are exposed to the highest risks, nutrition preventive programs should seek to optimize child survival by putting children most in need of nutrition interventions first. 

Annually, close to five million children under the age of five worldwide die from preventable causes, with 45% of deaths caused by undernutrition.This assertion may be controversial due to the complex ethical considerations surrounding prioritization; the report points out while acknowledging that every child has the right to adequate nutrition. At the same time, in situations where resources are insufficient to reach all children under the age of five, it is argued that allocations to the children most at risk are most equitable. 

Age is outlined as one of the most impactful factors for undernutrition and mortality, while other relevant indicators include poverty levels, rural living, exposure to conflict and other measures of vulnerability.  

Evidence reveals that many nutrition programs that attempt to cover all children under the age of five are not effective at reaching high-risk children. One example is that vitamin A supplementation programs tend to reach children consuming diets rich in vitamin A rather than those who need it most. 

Program implementation
The aim of early childhood nutrition programs is to optimize outcomes through prioritization when necessary and should be clearly communicated by the program managers and frontline workers.

Where resources are scarce, programs may choose to completely terminate services to children over two and direct resources to the youngest children facing the highest mortality risk. 

For programs operating in a less constrained context, a more phased-out approach is recommended. This could allow for the comparison of districts to determine to what extent prioritization may serve to improve equity and child survival. 

Funding shortages are affecting multiple UN agencies and humanitarian organizations operating in resource-low contexts, leading to the increasing need for prioritization.

By Milana Nikolova