A “blueprint to achieve a better and more sustainable future for all”, the UN Sustainable Development Goals call for, among many things, clean water and sanitation for all (goal #6) and an end to hunger (goal #2) by 2030. African countries have also committed to implement the African Union Agenda 2063, a vision and plan to build a more prosperous Africa in 50 years. Yet natural disasters and recurrent droughts are compromising the efforts of many countries throughout the continent. In rural Zimbabwe, over 70% of children live in abject poverty and 5.5 million people are facing starvation. Economic and political instability have exacerbated a food crisis in a country where nearly 90% of infants experience malnutrition, especially stunted growth.
Improving child growth and development is essential to ensuring that all children survive, thrive and lead transformative lives irrespective of where they live1, yet stunting affects 22% (149 million) of children under the age of 5 globally2. Stunting is largely irreversible beyond 2 years of age3,4 and affects the entire life-course5 through increased mortality6, exacerbation of disease frequency, duration and severity7, reduced scholastic performance8, lower adult earnings9-11 and long-term risk of chronic diseases such as obesity and cardiovascular diseases12. It also persists across generations since women who were themselves stunted in childhood tend to have stunted children13,14, creating a near unbreakable cycle of poverty and reduced human capital.
The World Health Assembly has set the target of reducing stunting by 40% by 2025. However, the determinants of stunting are poorly understood15 and the effectiveness of existing programs to reduce its incidence is limited16. Even the most intensive nutrition intervention has only led to 20% stunting reduction17. UNICEF’s causal framework for child undernutrition3 suggests that stunting occurs within a complex interplay of distal and both acute and chronic environmental stressors, including food and water insecurity. For instance, inconsistent access to or lack of food or water, inadequate nutrient intake, poor physical and mental health of care-givers, unhygienic handling of food and unsafe water, are all influenced by resource insecurity and may determine the extent to which households adopt and maintain nutrition recommendations. Nevertheless, there remain important gaps in impact assessments of nutrition interventions and pathways to improved child growth as they relate to food and water insecurity.
Nadia Koyratty, PhD Candidate in the Department of Epidemiology and Environmental Health is working with local Zimbabwean partners, including the Zvitambo Institute for Maternal and Child Health Research in Harare and the Zimbabwe Ministry of Health and Child Care, to understand the impact of food and water insecurity among rural farming households. Supported by the Community for Global Health Equity and the Bill and Melinda Gates Foundation, Koyratty travelled to Zimbabwe to deepen her understanding of the complex causal framework for food and water insecurity and undernutrition – specifically how food and water insecurity affects uptake and maintenance of adequate nutrition practices and, in turn, physical growth of infants and young children under 5 years.
Dr. Laura Smith, Assistant Professor of Epidemiology and Environmental Health and Community of Excellence in Global Health Equity, oversees her work. She has a long-standing partnership with collaborators in Zimbabwe and is currently Associate Director for Nutrition at Zvitambo. Dr. Smith investigates mycotoxin exposure – toxic molds that contaminate staple foods like maize and groundnuts – in pregnancy and birth outcomes and the potential link between mycotoxin exposure to gut dysfunction and stunting among children in Zimbabwe through the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial.
Through her partnership with Zvitambo, Dr. Smith and Koyratty are developing scales to measure food and water insecurity in rural subsistence farming households in Zimbabwe. Food and water insecurity are multi-dimensional concepts consisting of i) availability (e.g. food stocks, land for crops and livestock, food aid, water volume) ii) access (market distance, resources to obtain food, distance to clean and safe water sources, affordability) iii) utilization (food quality and diversity, food and water safety, storage) and iv) supply stability (experience of social, economic or environmental shocks that make is difficult to meet food and water needs). However, current food and water (in)security metrics are incomplete and underdeveloped – they focus on the experienceof food and water insecurity, such as feelings of worry or shame. While useful in certain situations, these tools are not comprehensive enough and may underestimate the true prevalence of insecure households. Zimbabwe Holistic Household Insecurity Scales (ZHHIS), ZHHIS-FOOD and ZHHIS-WATER, will be more holistic and representative of the rural Zimbabwean household.
Koyratty and Dr. Smith plan to characterize food and water insecurity using the ZHHIS-FOOD and ZHHIS-WATER measures to understand how they affect adoption of adequate nutrition behaviours. With this data, their team can implement innovative and sustainable approaches to both nutrition-sensitive and nutrition-specific interventions to prevent growth retardation, accelerate progress on reducing child stunting, and pave the way for healthier populations. This data can also inform the work of organizations that provide aid, cash or in-kind assistance, and social support, as well as global health professionals who lead supplementation programmes, agriculture interventions and sanitation programmes.
Koyratty reflects on the kindness and generosity of her hosts. Her experience in Zimbabwe helped her to understand many of the problems facing the population. She also had opportunities to enjoy the amazing wildlife: birds of all shapes, sizes and colors in her garden during lunch, and lions, elephants, rhinos, giraffes and hippopotamus at local wildlife reserves.