All Hands On Deck

In Sub-Saharan Africa, the scale of undernutrition is staggering; 58 million children under the age of five are too short for their age (stunted), and 14 million weigh too little for their height(wasted). Poor diets in terms of diversity, quality, and quantity, combined with illness and poorwater and sanitation facilities, are linked with deficiencies of micronutrients-such as iodine,vitamin A, and iron-associated with growth, development, and immune function.In the short term, inequities in access to the determinants of nutrition increase the incidenceof undernutrition and diarrheal disease. In the long term, the chronic undernutrition of childrenhas important consequences for individuals and societies: a high risk of stunting, impairedcognitive development, lower school attendance rates, reduced human capital attainment,and a higher risk of chronic disease and health problems in adulthood. Inequities in access toservices early in life contribute to the intergenerational transmission of poverty. Recent WorldBank estimates suggest that the income penalty a country incurs for not having eliminatedstunting when today's workers were children is about 9-10 percent of gross domestic productper capita in Sub-Saharan Africa.Much of the effort to date has focused on the costing, financing, and impact of nutrition-specificinterventions delivered mainly through the health sector to reach the globalnutrition targets for stunting, anemia, and breastfeeding, and interventions for treatingwasting. However, the determinants of undernutrition are multisectoral, and the solution toundernutrition requires multisectoral approaches. An acceleration of the progress to reducestunting in Sub-Saharan Africa requires engaging additional sectors-such as agriculture;education; social protection; and water, sanitation, and hygiene (WASH)-to improve nutrition.This book lays the groundwork for more effective multisectoral action by analyzing andgenerating empirical evidence to inform the joint targeting of nutrition-sensitive interventions.Using information from 33 recent Demographic and Health Surveys (DHS), measures areconstructed to capture a child's access to food security, care practices, health care, and WASH,to identify gaps in access among different socioeconomic groups; and to relate access to thesenutrition drivers to nutrition outcomes.All Hands on Deck: Reducing Stunting through Multisectoral Efforts in Sub-Saharan Africaaddresses three main questions:* Do children have inadequate access to the underlying determinants of nutrition?* What is the association between stunting and inadequate food, care practices, health,and WASH access?* Can the sectors that have the greatest impact on stunting be identified?This book provides country authorities with a holistic picture of the gaps in access to thedrivers of nutrition within countries to assist them in the formulation of a more informed,evidence-based, and balanced multisectoral strategy against undernutrition.