Mortality
Summary
Childhood stunting is a “silent tragedy” affecting families all over the world today. And, while it’s seldom covered on broadcast and print news, it’s as serious as any major issue facing the world today. This is the issue the Reaching Children’s Potential Program directly addresses, and how short-term volunteers are making a long-term difference.
The Costs of Stunting:
24 percent of the world’s children are seriously and permanently adversely affected by stunting.1
Positive Results:
When stunting is eliminated, and children receive continued educational support, each can reach their potential and become contributing members to their society. 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:
Stunting is a straightforward metric. It is defined as a height that is more than two standard deviations below the norm.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.
Short-term Consequences:
Health, Developmental & Economic
Long-term Consequences:
Health, Developmental & Economic
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 1000 days from conception through the second birthday – and inadequate parental education.
Read more about the causes of stunting
WHO identifies the myriad of interrelated issues that cause stunting.
- Household and family factors
- 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
- Home environment
- Inadequate child stimulation and activity
- Poor care practices
- Inadequate sanitation and water supply
- Food insecurity
- Inappropriate intrahousehold food allocation
- Low caregiver education
- Maternal factors
- Inadequate Complementary Feeding
- Poor quality foods
- Poor micronutrient quality
- Low dietary diversity and intake of animal source foods
- Anti-nutrient content
- Low energy content of complementary foods
- Inadequate practices
- Infrequent feeding
- Inadequate feeding during and after illness
- Thin food consistency
- Feeding insufficient quantities
- Non-responsive feeding
- Food and water safety
- Contaminated food and water
- Poor hygiene practices
- Unsafe storage and preparation of foods
- Poor quality foods
- Breastfeeding
- Delayed initiation
- Non-exclusive breastfeeding
- Early cessation of breastfeeding
- 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 their children’s cognitive and physical development.
- 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 are making 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:
- To ensure that families learn and adopt the necessary knowledge and technology essential during the first 1, 000 days.
- 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 or longer) volunteers to help parents and community partners deliver The 12 Essential Services. These services are delivered through village-based Reaching Children’s Potential (RCP) programs. RCP provides families and communities the knowledge, technology and encouragement needed to combat stunting and ensure children can realize their full potential.12 RCP programs are child-focused, comprehensive, holistic efforts beginning with pregnancy and continuing through the 18th birthday.
Everyone is needed; everyone can make a difference. You can help with:
Eradicating HUNGER
- Distribute micro-nutrient supplements and bio-fortified foods
- Promote use of earth box gardens that produce fruits and vegetables
- Build chicken coops
- Conduct parent workshops in your area of expertise
- Promote breastfeeding
- Prepare and serve school lunches
- Establish school gardens
- Build fuel efficient stoves
- Demonstrate and prepare nutritious meals
Improving HEALTH
- Assist at the Ipalamwa General Clinic
- Teach about pre-natal and post-natal care
- Offer preventive health education
- Demonstrate proper teeth brushing and oral care
- Conduct soap and water handwashing campaigns
- Construct basic household handwashing stations
- Accompany our staff on home visits
- Demonstrate basic First Aid
- Conduct parent workshops in your area of expertise
Enhancing COGNITION
- Promote health and nutrition during the 1st 1000 days of life
- Repair, maintain, and expand village schools
- Tutor math, science, and geography in primary and secondary schools
- Teach conversational English
- Care for children at preschools
- Interact with babies and toddlers while parents attend RCP workshops
- Foster psychosocial support
- Teach teachers classroom behavior management
- Promote girls education
- Conduct parent workshops in your area of expertise
Read more about The Essential Services
We’ve arranged the 12 Essential Services – extracted from the UN’s “The Essential Package – 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.
Community Projects
Interactive Workshops:
Volunteer professionals conduct regular interactive workshops at the village RCP Center. Topics focus on food, nutrition, infectious disease and education.
- 1st 1000 days
- Healthy pregnancies and deliveries
- Child’s brain development
- Promoting breast feeding from the first minute through the first year
- Infant care routines
- Stimulating infants and toddlers
- New born and infants health and safety
- Tracking child milestones
- Strengthening the role of women and mothers
- Keeping kids safe
- Nutrition – balanced meals, fruits and vegetables, proteins
- Aligning household food allocation
- Increasing garden boxes production
- Expanding fruit and vegetable production and consumption
- Raising poultry and goats
- Preparing healthy meals
- Purifying drinking water
- Constructing stoves and water catchment systems
- Establishing school gardens
- Practicing personal hygiene
- Deworming tablets
- Importance of handwashing with soap and water
- Using household handwashing stations
- Preventing diarrhea, malaria, infections, diabetes, STDs, Zika and Dengue fever
- Establishing home sanitation structures
- Applying basic first aid
- Promoting girls education
- Expanding village schools
- Fostering psychosocial support
- Training teachers
- Helping local cooperatives develop, expand and flourish
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.
The objectives of the weekly visits are to:
- Help families embrace their new knowledge
- Measure infant’s and toddler’s head circumference and length/height
- Reinforce child stimulation techniques
- Assist with garden boxes and chicken coops
- Help construct household handwashing stations and water catchment systems
- Answer questions raised from the workshops
- Offer psychosocial support
Healthcare:
Global Volunteers constructed a general clinic in Ipalamwa to provide primary care for between 16,000 and 20,000 people with a focus on maternal and child health care. Staffed by two physicians, two nurse-midwives, a lab technician, pharmacist and support staff, the Ipalamwa General Clinic (IGC) has two examination rooms, a delivery room, a 4-bed maternity ward, a 4- bed inpatient ward, a lab and a pharmacy. Nearly every health care professional can be engaged at this facility.
Volunteers:
- Provide patient care
- Assist staff physicians and nurses
- Help at the well-baby clinic
- Administer health screenings and checkups
- Conduct hand washing with soap & water campaigns
Education:
Some villages have preschools and primary schools, while others also have secondary schools. Educators from across the spectrum improve the education of students and teachers in the classroom, tutoring one-on-one or during English language camps. The latter is a great opportunity for high school students to participate in Global Volunteers SAT (Students As Teachers) program.
Volunteers:
- Care for children at preschools
- Tutor/teach math, science, geography, computer literacy and public health in primary and secondary schools
- Teach conversational English
- Conduct English language camps
- Offer teacher training in classroom behavioral management in order to enhance psychosocial support in the schools
Labor:
Every village served benefits from volunteers who can wield a paintbrush, pound a hammer, plant a garden, or construct a latrine.
Volunteers:
- Work alongside local people on community infrastructure projects – schools, clinics and community centers.
- Construct handwashing stations (a very clever and simple hand washing technology)
- Establish garden boxes
- Paint, repair and maintain classrooms, clinics, community centers and dormitories
- Build fuel efficient stoves
- Construct water catchment systems
Volunteers always work under the direction of local leaders on projects determined important by the community. Everyone is needed. Everyone can be engaged. Everyone can make a difference!
Volunteers also provide things that are either scarce or too expensive for local people to buy such as:
- Over-the-counter child pain and fever medicines
- Soap for handwashing stations and school bathrooms
- Materials for cooperatives, e.g., cloth for crafts
- Garden boxes and seedlings for household gardens
- Chickens and chicken coops
Volunteers are also asked to provide monthly financial support ($25 per month or more; students $10 per month) for the village in which they serve to help cover fortified porridge for pregnant women, micronutrients for toddlers, medicines and disposable gloves for the health clinic, and text books for students.
There is neither sufficient financial resources, political will, nor paid professional expertise available to meet the needs of every child, or the hundreds of millions of vulnerable children.
Volunteers change everything!
Read more about the role of volunteers
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 34, 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 garden boxes 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 in Tanzania (ELCT-IRD), 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 volunteers in the first year. Because the Tanzania RCP Demonstration Program enables volunteers and donors to directly and dramatically change the arc of the life of a child and the face of the planet, we expect widespread participation.
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.
Global Volunteers has been invited by the ELCT-IRD, 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 very supportive.
Global Volunteers and the ELCT-IRD have successfully collaborated on numerous projects in the Iringa Region. Both parties have developed a deep admiration and respect for the other. The ELCT-IRD 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.
Read More
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-IRD 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-IRD 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-IRD 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.
Program Logistics & Free Time
Ipalamwa is a beautiful rural village situated in the highlands about a two-hour drive from Iringa in south central Tanzania, with a population of about 2500. It is one of seven economically impoverished, but spiritually and culturally rich communities where Global Volunteers serves. 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 Reaching Children’s Potential Center in Ipalamwa, which includes a very comfortable guesthouse, modern kitchen and dining room, health clinic, staff lodging and a water purification system.
Transportation
Volunteers fly to Dar es Salaam and then take a 1 1/2 hour flight to Iringa on Auric Air or Air Tanzania. Global Volunteers’ staff pick up volunteers at the Iringa airport and drive to 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
- 24/7 electricity via solar with a large diesel fuel generator as back up
- Bed nets to protect from nighttime mosquitoes
- WI-Fi (volunteers purchase inexpensive telephone SIM cards)
- A beautiful veranda overlooking a lush verdant valley
- A star filled nighttime sky that defies description
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. Those who enjoy cooking, can take a turn assisting our staff cooks.
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. The cost is between $300 and $400 per person, thousands less than what a similar safari might cost.
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.
Children want to reach their full potential.
You can make the difference!
All photos were taken by volunteers or Global Volunteers staff. A special note of recognition and appreciation goes to Global Volunteers alumna Abby Raeder for her impactful photography.
End Notes
View End Notes
End Notes
- Levels and trends in child malnutrition. (2015, July). Retrieved from: http://www.who.int/nutgrowthdb/jme_brochure2015.pdf
- 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
- Survey shows sharp drop in stunting in Tanzania. (2015, April). Retrieved from: http://www.unicef.org/media/media_81517.html
- 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
- 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
- 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
- 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
- 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
- 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).
- 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.
- 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).
- The Essential Services Prospectus, Global Volunteers. (2011). Retrieved from: https://globalvolunteers.org/essential-services/prospectus/
- Global Volunteers Reaching Children’s Potential Program Assessment. (2015). Retrieved from: https://https://globalvolunteers.org
- 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
- State of the World’s Volunteerism Report. (2011). Retrieved from: http://www.unv.org/fileadmin/docdb/pdf/2011/SWVR/English/SWVR2011_full.pdf
- 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
- Conversation with Hon. Ummy Mwalimu, Tanzania Minister for Health, Community Development, Gender, Elderly and Children (2016, September 2). Dar es Salaam, Tanzania.
- Tanzania Population. (2016). Retrieved from: http://worldpopulationreview.com/countries/tanzania-population/
- Global Volunteers Essential Services. (2016). Retrieved from: https://globalvolunteers.org/essentialservices/prospectus/
- Global Volunteers Volunteer Manual. (2016). Retrieved from: http://service.globalvolunteers.org/volunteerreference/volunteer-manual.pdf