Roland Kupka is the UNICEF regional nutrition adviser for East Asia and Pacific and provides strategic support to UNICEF’s nutrition programs across 14 countries.
He previously served as senior nutrition adviser at UNICEF Headquarters in New York and as nutrition specialist and acting regional nutrition adviser in the UNICEF regional office for West and Central Africa.
In a previous role, Kupka worked as research scientist and assistant professor in the Department of Nutrition at the Harvard T H Chan School of Public Health.
For the last 20 years, his work has focused on devising strategies for better diets and nutrition for maternal and child health and has produced more than 75 publications.
He completed his doctoral training in nutrition and epidemiology at Harvard University.
Kupka granted an interview to UNICEF on the form of malnutrition known as wasting, and that United Nations agency provided it to Asia Times.
Moumita Dastidar: What is wasting? How is it related to malnutrition?
Roland Kupka: Wasting, especially in its severe form, is the most immediate, visible, and life-threatening form of malnutrition. It is caused by a lack of nutritious food and repeated bouts of diseases. It is typically shown by a child’s weight being much lower than expected for their height.
Alarmingly, children with severe wasting are up to 11 times [as] likely to die [as] children with no wasting. This is because severe wasting turns common childhood illnesses into fatal diseases. Children who are severely wasted succumb to diseases because their bodies provide virtually no protection against infections.
Malnutrition can take several forms. In addition to wasting, malnutrition can occur in the form of stunting and deficiencies in specific vitamins and minerals (micronutrient deficiencies). At the same time, overweight and obesity are becoming forms of malnutrition of increasing concern.
It is possible for children to have more than one form of malnutrition at the same time. For instance, wasting and stunting often occur together, with dire consequences for child health and development.
MD: Wasting in children is one of the leading life-threatening conditions and globally every year, an estimated 1 million children’s lives are lost due to wasting. Yet it is rarely talked about. Why is that?
RK: When you meet a child who is suffering from this deadly form of malnutrition, as I have, you never forget it. And yet wasting still does not receive the attention it deserves. I believe there are quite a few reasons this is the case.
First, this region has seen significant economic growth in recent decades, leading to improvements in overall living standards for many families. However, many vulnerable families are not benefiting from such overall improvements. Furthermore, the effects of the Covid-19 pandemic have further increased poverty and inequalities.
There is also a misconception that wasting only occurs in emergency contexts, such as floods, droughts and conflicts. However, only about a quarter of children with severe wasting globally live in such contexts. Severe wasting is most concentrated among the youngest girls and boys in the poorest and most neglected areas – rural and urban areas which are far from the news cameras.
In some communities, malnutrition, including wasting, unfortunately has a lot of stigmas associated with it. Families may be hesitant to seek help due to social shame, and this can further worsen the condition of children who need treatment.
Finally, the severity and consequences of childhood wasting are not always recognized. As a result, many children with wasting miss out on being diagnosed in their communities or when they visit health centers.
MD: In East Asia and the Pacific alone, there are 4.9 million children with wasting. How do parents and caregivers prevent their children from wasting?
RK: It’s important to remember that prevention of wasting is far better than treatment.
Here are a few of the many things that parents can do to prevent wasting in their children:
Ensure nutritious diets and antenatal care services for women during pregnancy. These are key for healthy fetal growth and development, and they reduce the risk of the child being born with a low birth weight, which increases the risk of wasting.
Make sure children are exclusively breastfed for the first six months and continue breastfeeding up to two years of age and beyond.
Starting at six months, provide nutritious and diverse first foods with different textures and tastes, such as fruits, vegetables, and animal-source foods (eggs, fish, dairy) to meet their nutrient needs.
Maintain good hygiene practices when handling and preparing food to prevent food-borne illnesses, which can lead to malnutrition. Wash hands, fruits, and vegetables thoroughly.
Seek regular medical care including prompt treatment of illness, routine vaccinations and growth monitoring.
If prevention fails, treatment of severe forms of wasting is crucial.
MD: Can wasting be treated at home? When do you think parents should seek medical attention?
RK: Severe wasting is a life-threatening condition for children. Children with severe wasting should receive immediate medical attention. Fortunately, most children with severe wasting can be treated as outpatients with medications, nutritional treatment, and psychosocial support.
This treatment needs to be provided by a skilled health worker who can provide care until a child recovers. Some children with severe wasting and who are acutely ill will require hospitalization for a brief period, before being transferred to continue medical and nutrition treatment as outpatients.
MD: How does UNICEF help in managing wasting in children?
RK: Our work with governments and partners is always guided by the principle of preventing wasting first. When prevention has not worked, then early detection and treatment are essential.
UNICEF has a presence in nearly all countries in East Asia and the Pacific and is working closely with governments to put in place policies and programs for the early detection and treatment of wasting. So far, in collaboration with partners, we have been able to introduce services for early identification and treatment of childhood wasting as essential services in primary health care in 11 countries.
We have also been advocating with countries to produce ready-to-use therapeutic food (RUTF), the main life-saving treatment for children with wasting. Some countries have domestic production of local RUTF – for example, using fish powder instead of milk. Other countries are now following suit.
One of the challenges we face is that frontline workers and partners may not always have the right skills and knowledge to treat wasting. We have just launched a free course for anyone interested in knowing more about the treatment of childhood wasting: the Care for Children with Wasting in East Asia and the Pacific e-learning course.
MD: How can we help others to know more about wasting?
RK: We can use a combination of advocacy, education, and community engagement to help people understand and tackle wasting better.
We can collaborate with and train health-care providers so that they have the right skills and knowledge to manage wasting effectively.
Media have an important role to play in spotlighting the issue of childhood wasting – a life-threatening condition which is simply not talked about enough. As media partners, you can help us reach more people, especially parents and caregivers to help them prevent and seek treatment for wasting in children.
Last, we need to engage and educate communities and parents so that it can be prevented or treated on time, especially for those children who are at higher risk of severe wasting, related illnesses, and deaths.
In short, we have the knowledge and the tools to prevent and treat wasting. Now, we need to work towards a world where no child suffers from this life-threatening condition.