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A Silent Tragedy

You Can Make the Difference

Summary

There is a silent tragedy striking families all over the world today. It is not covered on TV news and it is seldom written about in newspapers, magazines or social media. Yet, it is as serious as any major issue facing the world today. It’s called childhood stunting.

The Costs:

Stunting causes severe consequences that effect each of us.

  • Impairs children’s physical and cognitive development
  • Robs them of their future
  • Perpetuates intergenerational poverty
  • Steals trillions from the global economy.

25 percent of the world’s children are seriously and permanently adversely affected by stunting.1

Stunting is Preventable:

Adequate food, nutrition, and protection from disease prevent stunting. Prevention begins with applied parental knowledge about healthy pregnancies, nutritious food and disease prevention.

The Window:

Stunting begins in utero. If it is not stopped within the critical 33 month window from pregnancy to the second birthday, it most often is permanent. These 33 months, sometimes called the first 1, 000 days, are the only opportunity for interventions. At the end of 33 months, the window closes.

Volunteers Make the Difference:

Short-term volunteers, working through Global Volunteers’ Reaching Children’s Potential (RCP) program, provide the knowledge, technology and encouragement parents need to ensure their children’s future.

Positive Results:

When stunting is eliminated, and children receive continued educational support, each can reach their potential. Each child who escapes the grips of stunting unleashes valuable human resources that improve their own lives as well as their community, country and the world. Everyone benefits. Eliminating stunting can break the cycle of poverty – forever!

The Problem

  • The World Health Organization (WHO) reports, “childhood stunting is one of the most significant impediments to human development.”2
  • UNICEF declares, “stunting can permanently impair a child’s physical and cognitive development, trapping them into a cycle of poverty and inequity.”3
  • The Journal of Pediatrics and International Child Health reports that, “stunting is a cyclical process because women who were themselves stunted in childhood tend to have stunted offspring, creating an intergenerational cycle of poverty and reduced human capital that is difficult to break.”6

Definition:

“A height that is more than two standard deviations below WHO’s child growth standards median.5 Simply put, stunting is being too short for one’s age. But it is much more serious than being short. There are devastating consequences.

Consequences:

  • Impaired cognitive ability
  • Intergenerational poverty
  • Decreased school attendance
  • Increased school failure
  • Diminished creativity

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Stunting begins with pregnancy and when it persists beyond the second birthday, it is largely irreversible.4 These critical first 33 months determine every child’s future. Eighty percent of the brain develops and long-term cognitive and physical health is shaped during these months. When a child suffers from multiple bouts of malnutrition, diarrhea, worms or malaria, and there is inadequate language stimulation, the child is often stunted.

Children and families are impacted most directly. But, with one in four children (25%) being stunted, the damage to global economic output and creative activity is enormous – lost productivity, increased health care costs, diminished lives and increased poverty. Consequently, all who occupy this planet are significantly adversely affected by stunting.

There are short-term and long-term consequences of stunting.

Short-term consequences

  1. Health
  2. Mortality
  3.  Morbidities
  1. Developmental
  2. Cognitive, motor, and language development
  1. Economic
  2. Health expenditures
  3.  Opportunity costs for care of sick child

Long-term consequences

  1. Health
  2. Adult stature
  3. Obesity and associated comorbidities
  4. Reproductive health
  1. Developmental
  2. School performance
  3. Learning capacity
  1. Unachieved potential
  2. Economic
  3. Work capacity
  4. Work productivity
  5. Poverty

 

Causes:

Stunting is caused by a complex array of factors, but in summary, it is the result of insufficient food, nutrition and protection from disease during the first 33 months – 1, 000 days from conception through the second birthday – and inadequate parental/caregiver education.

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WHO identifies the myriad of interrelated issues that cause stunting.

  1. Household and family factors
    1. Maternal factors
      • Poor nutrition during pre-conception, pregnancy and lactation
      • Short maternal stature
      • Infection
      • Adolescent pregnancy
      • Mental health
      • IUGR (unborn baby not growing at normal rate) and preterm birth
      • Short birth spacing
      • Hypertension
    1. Home environment
      • Inadequate child stimulation and activity
      • Poor care practices
      • Inadequate sanitation and water supply
      • Food insecurity
      • Inappropriate intrahousehold food allocation
      • Low caregiver education
  1. Inadequate Complementary Feeding
    1. Poor quality foods
      • Poor micronutrient quality
      • Low dietary diversity and intake of animal source foods
      • Anti-nutrient content
      • Low energy content of complementary foods
    1. Inadequate practices
      • Infrequent feeding
      • Inadequate feeding during and after illness
      • Thin food consistency
      • Feeding insufficient quantities
      • Non-responsive feeding
    1. Food and water safety
      • Contaminated food and water
      • Poor hygiene practices
      • Unsafe storage and preparation of foods
  1. Breastfeeding
    • Delayed initiation
    • Non-exclusive breastfeeding
    • Early cessation of breastfeeding
  1. Infection
    • Enteric infection: diarrhea, environmental enteropathy, parasitic worms
    • Respiratory infections
    • Malaria
    • Reduced appetite due to infection
    • Inflammation

 

Stunting Persists:

  • Because families do not have access to the knowledge and technology necessary to prevent stunting and support children’s cognitive and physical development across their lifespan.
  • Because Governments and NGOs lack the funding and/or political will to provide the resources and the personal interaction necessary so parents can learn, embrace and apply the knowledge and technology.

In Africa, Stunting is Increasing:

The global trend in stunting is decreasing, but not fast enough – in 2015, 159 million children under five were stunted.7 (That’s half the total population of the US.) But in Africa, where 32% of all of children are stunted, the number of stunted children is increasing.8 And in Rural Tanzania, it’s estimated that nearly 50 percent of all children are stunted.

A Local Solution

Stunting can be prevented! And local people can make it happen.

  • Significant scientific evidence shows that when pregnant women, mothers and their infants and toddlers receive sufficient food and nutrition and protection from infectious disease, children will not be stunted and will be fully able to learn.9
  • Research demonstrates that the transfer of relevant knowledge and appropriate technology to parents, and weekly home visits conducted to help parents embrace their new knowledge and employ the technology have an extremely positive affect on children’s health and cognition.10
  • Quality preschools significantly enhance children’s primary and secondary educations.11

The Challenges:

  1. To ensure that families learn and adopt the necessary knowledge and technology essential during the first 1, 000 days.
  2. To provide children quality schools throughout their basic learning years – preschool through secondary school.

Volunteers’ Role

At the invitation of community leaders, Global Volunteers engages short-term (1 to 3 weeks) volunteers to help conduct village-based Reaching Children’s Potential (RCP) programs in Tanzania. RCP provides families and communities the knowledge, technology and encouragement needed to combat stunting and ensure children can realize their full potential.12

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  • RCP programs are child-focused, comprehensive, holistic efforts beginning with pregnancy and continuing through the 18th birthday.
  • Volunteers and staff help parents and caregivers deliver the 12 Essential Services – extracted from the UN’s “The Essential Package – which ensure children can reach their full potential.

We’ve arranged the Essential Services in three categories.

Eradicating HUNGER

  • 1. School and Household Gardens
  • 2. Child Nutrition
  • 3. Micronutrient Supplementation
  • 4. Improved Stoves

Improving HEALTH

  • 5. Health, Nutrition and Hygiene Education
  • 6. Malaria, Zika and Denge Fever Prevention
  • 7. Deworming
  • 8. HIV AIDS Education

Enhancing COGNITION

  • 9. General Education
  • 10. Promoting Girls’ Education
  • 11. Potable Water and Sanitation Facilities
  • 12. Psychosocial Support

The 12 Essential Services are interdependent – inextricably interrelated: the effectiveness of one depends upon the delivery of the others. The greatest probability of success comes from a comprehensive strategy that embraces all of the essential services. Eradicating hunger and improving health are foundational to enhancing cognition.

 

Parents and caregivers are responsible for ensuring their children’s futures, but volunteers provide the necessary information, appropriate technology and ongoing support. Volunteers are needed from all backgrounds, professions and experiences.

  • Students
  • Retirees
  • Agronomists
  • Farmers
  • Nutritionists
  • Midwives
  • Physicians
  • Nurses
  • Child Development Specialists
  • Pharmacists
  • Dental hygienists
  • Teachers
  • Psychologists
  • School Administrators
  • Carpenters
  • Masons
  • Plumbers
  • Painters
  • Journalists
  • And everyone else who wants to make a difference

RCP utilizes several educational vehicles to transfer the required knowledge.

  • Parent workshops
  • Home visits
  • Handwashing with soap campaigns
  • Classroom training
  • After school tutoring

And, RCP introduces and employs a variety of appropriate technologies.

  • Household earth box gardens to produce bountiful fresh fruits and vegetables
  • Fuel efficient stoves to eliminate in-house smoke
  • School gardens to improve feeding programs
  • Micronutrient supplements and bio fortified foods to ensure sufficient iron, zinc, folic acid, vitamins, etc.
  • Chicken coops for protein, Water catchment and purification systems for better health, Tippy taps for handwashing
  • Deworming tablets to ensure children benefit from the nutritious foods, Bed nets for malaria protection
  • Quality preschools to establish the foundation for life-long learning
  • School bathrooms to encourage teenage girls’ school attendance and improve health

Parents the world over want what is best for their children and most know they need to know more to obtain what’s best. New parents, especially mothers, crave knowledge. This is why Tanzania community leaders have invited Global Volunteers and you to their villages.

Interactive Workshops:

Volunteer professionals conduct regular interactive workshops at the village RCP Center. Topics focus on food, nutrition, infectious disease and education.

  • Establishing school gardens
  • Ensuring thriving pregnancies and healthy deliveries
  • Promoting breast feeding from the first hour through the first year
  • Aligning household food allocation
  • Constructing stoves and water catchment systems
  • Strengthening the role of women and mothers
  • Increasing earth box garden production
  • Expanding fruit and vegetable production and consumption
  • Raising poultry and goats
  • Preparing nutritious meals
  • Purifying drinking water
  • Practicing personal hygiene
  • Building Tippy Taps
  • Preventing diabetes, diarrhea, malaria, infections, STDs, Zika and Dengue fever
  • Establishing home sanitation structures
  • Applying basic first aid
  • Stimulating infants and toddlers
  • Expanding village schools
  • Fostering psychosocial support
  • Training teachers

Global Volunteers directs this knowledge transfer through culturally appropriate curriculum which volunteers use and adapt based on their experience and expertise.

Home Visits:

Applying new knowledge often requires parents/caregivers to change some behaviors and have access to necessary resources. Behavior change is facilitated by weekly visits with each RCP family conducted by Global Volunteers local staff and volunteers.

  • Embrace their new knowledge
  • Offer pre-and postnatal checkups
  • Reinforce child stimulation techniques
  • Assist with earth box gardens and chicken coops
  • Help construct tippy-taps and water catchment systems
  • Answer questions raised from the workshops
  • Offer psychosocial support

Other Community Work Projects:

Volunteers always work under the direction of village leaders on community projects determined important by the local people. Everyone can be engaged.

  • Caring for children at preschools
  • Tutoring math, science, computer literacy and public health in primary and secondary schools
  • Building and maintaining classrooms, clinics, community centers and dormitories
  • Teaching conversational English
  • Helping local cooperatives cooperatives develop, expand and flourish
  • Assisting at the well-baby clinic
  • Conducting hand washing with soap & water campaigns
  • Constructing “tippy taps” (a very clever and simple hand washing technology)
  • Working alongside local people on community infrastructure projects – schools, clinics and community centers.
  • Teaching public health from the text “Where There Is No Doctor”
  • Establishing earth box gardens
  • Providing noninvasive healthcare at the village dispensary

Volunteers also provide resources that are either scarce or too expensive for local people to purchase.

  • Over-the-counter child pain and fever medicines
  • Neonatal resuscitation devices
  • Soap for tippy-taps and school bathrooms
  • Materials for cooperatives, e.g., cloth for crafts
  • Earth boxes and seedlings for household gardens
  • Chickens and goats

Volunteers are essential:

There is neither sufficient financial resources, political will, nor paid professional expertise available to meet the needs of hundreds of millions of at-risk children. Volunteers change everything!

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Volunteers:

  • Work under the direction of local leaders and hand-in-hand with local staff;
  • Possess necessary expertise;
  • Share their skills and knowledge at the community and household levels;
  • Help families apply their new knowledge and technology;
  • Encourage children and offer inspiring role models;
  • Do not cost anything (no paid compensation and they cover their own expenses);
  • Donate money that helps keep the program funded over the long-term;
  • Bring materials that are scarce in-country, and
  • Are plentiful.

With three decades’ experience engaging 33, 000 volunteers on six continents in 34 countries, Global Volunteers has proven the efficacy of short-term volunteers. For example, when we started working in St. Lucia in 2012, the Anse-la-Raye primary school was ranked 70th out of 89 schools on the island. Five years and several hundred volunteers later, this school ranks 9th in the country. We do not take credit for this remarkable achievement; it was the students, teachers and parents who did all the difficult work. However, this example indicates the type of positive affect short-term volunteers can offer a community. Further, the University of Minnesota’s Humphrey School of Public Affairs evaluated Global Volunteers St. Lucia RCP program and reported the program was highly valued by the local participants and identified earth box gardens and parent meetings/workshops as the most popular components.13

The United Nations concurs in recognizing the importance and constructive engagement of volunteers in development policies and programs.14 The UN reports that, “volunteerism (is) an essential component for the sustainable, equitable progress of communities and nations, ” and is crucial to human development. 15 Moreover, in the absence of volunteers, it is not possible to get all the necessary work accomplished. Volunteers are the missing resource; there simply are not enough government or private sector resources to achieve what needs to be done. Global Volunteers know how to effectively engage volunteers. That is why we are taking the lead on eliminating stunting and unleashing untapped human potential.

We have started this program in rural Tanzania. Taking our learnings from five years of work in St. Lucia, and in cooperation with our longtime partner, the Evangelical Lutheran Church of Tanzania (ELCT), Global Volunteers is in the early stages of conducting RCP programs in 200 villages in the Iringa Region of Tanzania. We will demonstrate that stunting can be eliminated with the intervention of short-term volunteers working under the direction of local leaders, and hand-in-hand with parents and caregivers. When this demonstration is successful, we will encourage other NGOs to work with us as we expand the program worldwide.

Nearly one million Americans volunteer internationally every year, most for two to four weeks.16 With sufficient funding, we can recruit 18, 000 volunteers annually to serve 200 villages during the initial phase of the Tanzania demonstration, increasing from 100 in the first year. Consistent with Global Volunteers 33 years’ experience, research shows that American volunteers are primarily employed college graduates with higher incomes; although, students and retirees participate in significant numbers. Moreover, because the Tanzania RCP Demonstration Program enables volunteers and donors to directly and dramatically change the face of the planet, we expect widespread participation.

 

When parents and caregivers know what to do to keep their children nutritiously fed and healthy, when they have the appropriate technology and resources to do so, and when they can apply the knowledge and embrace the technology, their children are not stunted. When educated, those children will realize their full potential and the entire world will benefit.

Why Tanzania

The number of stunted children continues to increase in Africa. Furthermore, it is estimated that 40 to 50 percent of rural Tanzanian children are stunted.17 Showing the effectiveness of the RCP program in an area where stunting is most prevalent will encourage others to adopt this model in communities worldwide.

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Global Volunteers has been invited by the ELCT, our partner in Tanzania for 30 years, to conduct RCP programs in the Iringa Region. In addition, the Tanzanian government has encouraged us to move forward on this effort, and village leaders are supportive.

Global Volunteers and the ELCT have successfully collaborated on numerous projects in the Iringa Region. Both parties have developed a deep admiration and respect for the other. The ELCT goals are to eradicate ignorance, disease and poverty. Together, our organizations strive to help children reach their potential. Eliminating stunting and supporting children throughout their development achieve our shared goals.

After three decades of catalyzing community development, Global Volunteers has confirmed that any successful “outsider” contribution requires local people be represented by a trusted and respected local organization. The ELCT has a physical presence in most villages, cooperates with other faith-based organizations – Christians and Muslims – in this primarily Christian region of Tanzania, and has the trust and respect of virtually all villagers. This trusted status is a critical component – the piece that makes entrée into communities and homes, and therefore the RCP program, possible.

In the Tanzania RCP program, the ELCT selects participating villages, motivates family involvement, interacts with government agencies, and ensures the culture is honored. Global Volunteers provides executive leadership, ensures compliance with the RCP model, constructs RCP centers, manages finances, and recruits, prepares, manages and engages volunteers. In addition, the ELCT will continue to conduct well-baby clinics, and run health centers, preschools, primary and secondary schools and a university. Global Volunteers will continue to serve all these venues.

 

Logistics

Living in a rural East African village is both immensely exhilarating and enormously rewarding, but it can be challenging. We have removed most challenges by constructing our own Volunteer Center in Ipalamwa.

Lodging:

Volunteers stay in the new Volunteer RCP Center built by Global Volunteers specifically for volunteers. Every effort has been made to ensure as much comfort as possible.

  • Spacious double and single occupancy rooms
  • Western-style private bathrooms with showers
  • Hot and cold water
  • Electricity
  • Bed nets
  • WI-Fi
  • Veranda overlooking a lush verdant valley.

Meals:

Delicious meals are prepared by our staff and include local cuisine and American favorites. Fresh fruits and vegetables, drinking water, coffee and tea are always available, and you can bring your favorite snack from home.

Transportation:

Volunteers fly to Dar es Salaam and then take a one-hour flight to Iringa on Air Tanzania. Global Volunteers’ staff pick up volunteers at the Iringa airport and drive to Ipalamwa.

Ipalamwa

  • This beautiful rural village is situated in the highlands about a two hour drive from Iringa in south central Tanzania, with a population of about 5, 000.
  • It is an economically impoverished, but spiritually and culturally rich community.
  • The Ipalamwa Volunteer RCP Center has a full kitchen for demonstrating nutritious meal preparation, and a large space for team meetings, parent workshops and community information exchanges.

Free Time

  • Weekends and evenings are free to meet with local people and enjoy the culture.
  • Many volunteers take a weekend safari in Ruaha National Park and Game Reserve, East Africa’s largest park, about 40 miles from Iringa. It is home to 10, 000 elephants and over 500 species of birds, plus thousands of giraffes, lions, buffalos, cheetahs, leopards, hippos and antelopes.

Program Integrity

The Tanzania RCP Demonstration Program is led by local people and not by people who live far away and do not understand the local culture. Further, we follow the guidelines required of rigorous experimentation, including collecting appropriate baseline data, protecting individuals’ privacy, comparing villages that are part of the demonstration with similar villages that are not affected by the interventions, and producing statistically significant results.

When the Tanzania RCP Demonstration Program is successful, Global Volunteers will expand its reach to other parts of Tanzania, throughout Africa and across the globe – wherever we are invited. This effort will literally change the world. It only requires 2% of the developed world population to volunteer two to three weeks a year for one generation (25 years) to reach every vulnerable child on earth. On Earth! Each of us knows at least two people out of 100 who, if persuaded they could help even one child and change the face of the planet, would step up and participate.

End Notes

End Notes

  1. Levels and trends in child malnutrition. (2015, July). Retrieved from: http://www.who.int/nutgrowthdb/jme_brochure2015.pdf
  2. Global Nutrition Targets 2025, Stunting Policy Brief. (2014). Retrieved from: http://apps.who.int/iris/bitstream/10665/149019/1/WHO_NMH_NHD_14.3_eng.pdf
  3. Survey shows sharp drop in stunting in Tanzania. (2015, April). Retrieved from: http://www.unicef.org/media/media_81517.html
  4. Global Nutrition Targets 2025, Stunting Policy Brief. (2014). Retrieved from: http://apps.who.int/iris/bitstream/10665/149019/1/WHO_NMH_NHD_14.3_eng.pdf
  5. Global Nutrition Targets 2025, Stunting Policy Brief. (2014). Retrieved from: http://apps.who.int/iris/bitstream/10665/149019/1/WHO_NMH_NHD_14.3_eng.pdf
  6. Humphrey, J.H., Prendergast, A.J. (2014, April). The stunting syndrome in developing countries. The Journal of Pediatrics and International Child Health. 34(4): 250–265. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4232245/#chemicals-bioassays
  7. Levels and trends in child malnutrition, UNICEF – WHO – World Bank Group joint child malnutrition estimates. (2015) Retrieved from: http://www.who.int/nutgrowthdb/jme_brochure2015.pdf
  8. Improving childhood nutrition- The achievable imperative for global progress. (2013, April). Retrieved from: http://www.unicef.org/gambia/Improving_Child_Nutrition_-_the_achievable_imperative_for_global_progress.pdf
  9. Baker-Henningham, H., Black, M.M., Chang, S.M., Gardner, J.M., Grantham-McGregor, S., Hamadani, J.D., Walker, S.P. (2011, October). Inequality in early childhood: risk and protective factors for early child development. The Lancet: Vol 378. Martorell, R., Horta, B.L., Adair, L.S., Stein, A.D., Richter, L., Fall, C.H., et al. (2010). Weight gain in the first two years of life is an important predictor of schooling outcomes in pooled analyses from five birth cohorts from low- and middle-income countries. Journal of Nutrition Vol.140: p. 348–54. Oot, L., Sethuraman, K., Ross, J., & Sommerfelt, A.E. (2016). The Effect of Chronic Malnutrition (Stunting) on Learning Ability, a Measure of Human Capital: A Model in PROFILES for Country-Level Advocacy. Washington, DC: FHI 360/FANTA. Walker, S.P. et al. (2011). Inequality in Early Childhood: Risk and Protective Factors for Early Child Development. Lancet. Volume 378, (9799), pp. 1325–1338. Kudzai, Chinyoka. (2014). Impact of Poor Nutrition on the Academic Performance of Grade Seven Learners: A Case of Zimbabwe. International Journal of Learning & Development. Vol. 4 (3).
  10. Armstrong, R., Bhutta, Z.A., Rasheed, M.A., Rizvi, A., & Yousatzai, A.K. (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial: Lancet 2014; 384: 1282–93.
  11. Brooks-Gunn, J., Burchinal, M.R., Espinosa, L.M., Gormley, W.T., Ludwig, J., Magnuso, K.A. Zaslow, M.J. (2013). Investing in Our Future: The Evidence Base on Preschool Education. Child Development, Vol 84(5).
  12. The Essential Services Prospectus, Global Volunteers. (2011). Retrieved from: https://globalvolunteers.org/essential-services/prospectus/
  13. Global Volunteers Reaching Children’s Potential Program Assessment. (2015). Retrieved from: https://globalvolunteers.org
  14. Achieving the global goals: why volunteers are important. (2016, March). Retrieved from: http://www.unv.org/en/what-we-do/mdgspost-2015/doc/achieving-the-global-goals.html
  15. State of the World’s Volunteerism Report. (2011). Retrieved from: http://www.unv.org/fileadmin/docdb/pdf/2011/SWVR/English/SWVR2011_full.pdf
  16. Lough, Benjamin J. (2015, March). A Decade of International Volunteering from the United States, 2004-2014. Retrieved from: https://csd.wustl.edu/Publications/Documents/RB15-18.pdf
  17. Conversation with Hon. Ummy Mwalimu, Tanzania Minister for Health, Community Development, Gender, Elderly and Children (2016, September 2). Dar es Salaam, Tanzania.
  18. Tanzania Population. (2016). Retrieved from: http://worldpopulationreview.com/countries/tanzania-population/
  19. Global Volunteers Essential Services. (2016). Retrieved from: https://globalvolunteers.org/essentialservices/prospectus/
  20. Global Volunteers Volunteer Manual. (2016). Retrieved from: http://service.globalvolunteers.org/volunteerreference/volunteer-manual.pdf
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