Identifying and tackling the social determinants of child malnutrition in urban informal settlements and slums: a cross national review of the evidence for action
Urbanisation can bring many benefits the rate of change but in many developing countries the rate of change has been so fast and so dramatic that many cities have been unable to cope. Rapid, unplanned urbanisation has led to widespread social inequity and stratification, the rapid growth of informal settlements and slums, environmental degradation, heavy migrant inflows, and breakdown of the social support systems and networks.
It is not surprising, therefore, that there is a strong and well established link between child malnutrition and various dimensions of disadvantage in the urban setting. Child undernutrition has become an endemic problem in many poor urban areas of developing countries, jeopardizing the physical and mental development of growing children.
At the same time, social conditions and globalisation create the emerging risk of child overweight and obesity due to consumption of inappropriate foods, promoted as a part of the processes of globalization of food production systems, and lack of physical activity linked to changes in occupational and leisure activities. Many cities in the developing world are therefore facing a double burden of child under-nutrition and obesity and municipal governments are uniquely positioned to play a leading role in addressing these problems.
The primary aim of this structured literature review is to synthesize what is known about the effectiveness of interventions to reduce child malnutrition through changing the social determinants in poor urban areas of developing countries. The review focuses on child malnutrition because studies have shown that the early childhood years are the most critical. The importance of nutrition intervention throughout the lifecycle is also acknowledged.
A secondary aim is to draw out the implications of the findings for the further development of a three year research study known as the NICK Project (Nutritional Improvement for children in urban Chile and Kenya). This project aims to help two cities, Mombasa and Valparaiso, reduce child malnutrition in children less than five years of age living in poor urban areas of these cities by intervening at the municipal level to broaden community and stakeholder participation and provide exemplars of successful small-scale interventions that can change the social determinants. If successful, the innovative approach used in this study could serve as a useful guide for action in the cities of other high burden countries.