A new analysis by UNICEF has highlighted a major burden of at-risk infants under six months in the Eastern and Southern Africa Region (ESAR), driven by high rates of low birth weight (LBW), wasting, stunting and underweight in this age group.
The study, conducted by UNICEF’s Eastern and Southern Africa Regional Office (ESARO), examined health and nutrition policies across five countries — Burundi, Ethiopia, Kenya, Madagascar and Malawi — where undernutrition rates among children under five are particularly high. The findings indicated an urgent need for policy interventions and improved healthcare services to address gaps in care and implement the 2023 WHO guidelines on infant nutrition.
According to the report, an estimated 5.5 million infants under six months in ESAR suffer from undernutrition. This includes 1.6 million stunted, 0.6 million wasted, 0.8 million underweight and 2.5 million (14.3 per cent) born with low birth weight. However, these figures likely underestimate the total number of at-risk infants due to inconsistent data collection on other risk factors.
Malnutrition in this age group is often overlooked in healthcare planning and service delivery, leaving infants highly vulnerable to illness, developmental challenges and long-term non-communicable diseases.
The study found that wasting prevalence among infants under six months is highest in Ethiopia (9.4 per cent) and lowest in Kenya (3.5 per cent). Stunting rates vary from 12 per cent in Kenya to 25 per cent in Burundi and Madagascar, while underweight prevalence ranges from 8 per cent in Malawi to over 13 per cent in Burundi and Madagascar.
The study also identified widespread undernutrition among women and adolescent girls in the five countries. On average, a third of women of reproductive age are anaemic, while underweight prevalence among women aged 15-49 ranges from 7.2 per cent in Malawi to 22.4 per cent in Ethiopia. Adolescent girls aged 15-19 are particularly affected, highlighting the intergenerational cycle of malnutrition.
Household poverty and food insecurity, inadequate maternal nutrition during pregnancy and lactation, suboptimal breastfeeding practices, adolescent pregnancies, HIV (human immunodeficiency virus) status and birth complications were identified as primary contributors to undernutrition in infants under six months.
The analysis found that while most countries have policies addressing at-risk infants and their mothers, significant gaps remain. These include:
A lack of comprehensive definitions and protocols for outpatient management.
Inadequate linkages to supportive care and multi-sectoral interventions.
Limited guidance on feeding support for infants with disabilities.
Insufficient focus on maternal mental health.
National stakeholders cited challenges such as insufficient human resources, inadequate healthcare infrastructure and shortages of materials and supplies as key barriers to implementing national guidelines effectively.
The 2023 WHO guideline provided expanded recommendations for managing at-risk infants, including clearer assessment criteria for inpatient versus outpatient care. UNICEF suggested that upcoming policy revisions incorporate these updates while addressing resource constraints to strengthen nutrition programmes across ESAR.
By closing these gaps and enhancing healthcare services, UNICEF stressed that millions of infants and mothers across the region could benefit from improved nutrition and health outcomes.