Why do most children affected by acute malnutrition go untreated?

Around the world, more than 45 million children under the age of five experience acute malnutrition at any given time. For children, being malnourished can lead to a range of health problems and can be fatal. Around two million of these children will die as a result annually. 

The surging global hunger crisis is dire, and particularly dangerous for children. But there is a solution: Treatment with a high protein peanut paste known as ready-to-use therapeutic food (RUTF) has shown to be highly effective.

More than 90 percent of malnourished children treated with RUTF recover, but this simple, effective solution is still out of reach for many. Four of five children with acute malnutrition don’t receive the treatment they need due to a lack of funding and an uncoordinated, overly-complicated global response.

The International Rescue Committee (IRC) treats children experiencing acute malnutrition in over 20 countries. Scaling up our approach will benefit more children in need and save lives.

Most complex global problems don’t have a simple solution, but this one does. Read on to learn more about acute malnutrition, why children aren’t receiving the treatment they need, and how we can address this crisis.

What is acute malnutrition?

There are many forms of malnutrition, with acute malnutrition being the deadliest. Children who suffer from this condition, also known as wasting, are too thin for their height and become more vulnerable to other diseases. They are 11 times more likely to die than healthy children.

Even if a child survives acute malnutrition, they can still face long-lasting harmful effects from it. Acute malnutrition can negatively impact physical and mental development, especially in children under the age of five who are in a critical period of growth.

“This is a grim reality. The world cannot afford to stand back and watch,” says Elijah Okeyo, the IRC’s Uganda country director.

Hafsat* holds her 10-month-old son, Muhammad, moments before he is discharged from the Mashamari Stabilization center in Borno, Nigeria, after recovering from acute malnutrition.

Photo: KC Nwakalor for the IRC

What factors contribute to acute malnutrition?

Global rates of food insecurity have more than doubled since 2020, with climate change and conflict contributing significantly to this rise. 

Many countries with high rates of children experiencing acute malnutrition suffer disproportionately from the effects of climate change, which has increased the severity of droughts and floods, destroying food supplies. Climate shocks also damage critical infrastructure, limiting access to clean water and sanitation. In such cases, diseases can spread rapidly, weakening children’s immune systems and impairing their ability to absorb vital nutrients, thereby exacerbating the effects of malnutrition. . 

Countries like Somalia, which is set to enter its sixth consecutive failed rainy season, are feeling the impacts firsthand. “Nearly two million children in Somalia are at risk of malnutrition, while at least 3.5 million livestock have died, destroying livelihoods and reducing children’s access to milk and meat,” warns Shashwat Saraf, the IRC’s regional emergency director of East Africa.

Conflict disrupts agricultural production and displaces people, leaving them without regular access to food, shelter or water. Food is sometimes weaponized during conflicts, leading to blockades or destruction of food supplies, causing hunger and malnutrition among civilians. Conflict also makes it difficult for organizations like the IRC to provide support in affected areas and for parents to travel with their children to clinics for treatment safely.

In 1998, Judith (seated) fled her home amid war in modern-day South Sudan. Since then, she has lived in the Kakuma refugee camp in Kenya. Judith took her daughter, Vanessa, to be screened and treated for malnutrition at an IRC-supported clinic after she became ill.

Photo: Patrick Meinhardt for the IRC

Why are children in need not receiving treatment?

Even though treatment for acute malnutrition is readily available, historically, 80 percent of children in need do not receive this life-saving care, and between one and two million preventable deaths occur each year. A complex, overly-bureaucratic approach to treatment and a lack of sustained funding prevent the vast majority of children from receiving the help they need.

“The current system for treating acute malnutrition is complex and costly and fails to reach the majority of children,” explains Jeanette Bailey, director of nutrition research and innovation at the IRC.

Currently, children with severe acute malnutrition and moderate acute malnutrition are treated with different products through different programs, which are distributed and administered by different international organizations. This strategy is overly complex and hinders efforts to meet a mounting global hunger crisis for which quick and direct action is needed to save lives.

A lack of sufficient, coordinated and accountable funding also impedes plans to prevent and treat acute malnutrition. Addressing acute malnutrition is an issue with broad political support from different factions and ideologies, as demonstrated by politicians working across party lines in the United States Congress to pass the Global Malnutrition Prevention and Treatment Act in October 2022. In addition, polls show that the majority of young Americans support taking international action to reduce food shortages.

A young child experiencing acute malnutrition receives treatment at an IRC health center in Mangalmé, Chad.

Photo: Timothy Nesmith for the IRC

How does the IRC address acute malnutrition? 

The IRC has developed, tested, and piloted a combined approach that is simpler, less expensive, and offers more comprehensive treatment, with the potential to reach more children with life-saving care.We treat all children experiencing malnutrition with RUTF, the high protein peanut paste, and adjust dosage based on the severity of malnutrition. Our simplified protocol also empowers community health workers and parents to diagnose and treat acute malnutrition.

How does the IRC deliver treatment for malnutrition?

For many mothers and caretakers with children who suffer from acute malnutrition, traveling far distances to health clinics can be an insurmountable barrier, so it is vital to bring care close to their homes. The IRC empowers local healthcare workers to deliver care directly to children, overcoming barriers to accessibility.

The IRC trains community healthcare workers and parents to use a tool that measures a child’s mid-upper arm circumference (MUAC) to screen them for malnutrition. The IRC has introduced color-coded MUAC tape so that communities with low literacy and numeracy rates are not excluded, aiming to increase the number of children who receive an accurate diagnosis and treatment. 

“We are trying to reach mothers and children who are facing malnutrition so that we can provide them with health services and educational trainings,” says Agha, an IRC community health care worker in Afghanistan. “We want to raise awareness and guide them to care for their own health and prevent malnutrition in the future.”

Our simplified protocol is also crucial in times of emergency when a quick and efficient response is needed.

Fatima Wakilamtu, an IRC nutrition officer, teaches Biliksu* how to use mid-upper arm circumference tape to screen her child for malnutrition at their home in Maiduguri, Nigeria.

Photo: KC Nwakalor for the IRC

How effective is the IRC's approach?

Evidence proves that our approach is reliably and consistently effective. A recent IRC study, conducted in partnership with the Mali Ministry of Health, looked at more than 27,000 children treated for acute malnutrition with our streamlined approach. 92 percent recovered. Another study conducted in Somalia in 2018 found that 98 percent of children who received treatment from the IRC recovered. 

Not only are our methods of addressing malnutrition effective, they are also efficient. The IRC’s approach uses 30 percent less RUTF and costs up to 20 percent less per severely malnourished child treated. This means we can treat more children with fewer resources.

We are also developing strategies to support the local production of RUTF. This would allow treatment to be readily deliverable in the regions that need it most while simultaneously benefitting local economies.

How can we treat more children experiencing acute malnutrition? 

The IRC’s primary goal is to scale up our simplified protocol to reach more children suffering from malnutrition. This is particularly critical to reach children in areas hit hard by hunger crises in East and West Africa, and South Asia. 

An annual investment of $2 to $3 billion, a fraction of the trillion dollar annual US federal budget, could be used over the next decade to set treatment targets, scale up the IRC’s malnutrition treatment and catalyze further investment.

This is an opportunity for countries like the United States to demonstrate leadership on a global stage by supporting an effective approach to addressing malnutrition.

“Defeating malnutrition is an opportunity for the kind of bipartisan action that would signal to Americans and international partners that the country can still think big and think broad,” says David Miliband, IRC president and CEO.

In Yemen, IRC health worker Dr. Abdul-Ghani Mohammed checks up on seven-month-old Rawan, whose mother took her to visit an IRC clinic when she noticed signs of malnutrition. The reading on the mid-upper arm circumference tape indicates that Rawan is experiencing moderate malnutrition.

Photo: Mujahed Alazraqe for the IRC

How can I help stop acute malnutrition?

Although a proven treatment for malnutrition is ready, an effective response and a reliable stream of funding are needed to treat the over 45 million children experiencing acute malnutrition around the world.

Consider donating to the IRC to help us address this and other crises around the world. 

*Some last names excluded for privacy