Program Rationale
Childhood malnutrition and undernutrition remain critical global health challenges, affecting approximately 149 million children under five years old worldwide (UNICEF, 2022). The economic impact is staggering, with malnutrition costing the global economy an estimated $3.5 trillion annually through reduced productivity, increased healthcare costs, and lost human potential (World Bank, 2021). Data on food security and the internally displaced population is far from comprehensive but reveals how the two phenomena overlap. Families that often struggle with conflict, resulting in internal displacement, are at risk for food insecurity, which is associated with a lower nutrient intake, including a lower intake of fruits and vegetables (Hoteit et al., 2021). Insufficient fruit and vegetable intake, particularly in early childhood, contributes significantly to these outcomes, with only 29% of children globally meeting recommended dietary guidelines (WHO, 2023).
Lebanon's compounded crises, including political instability, economic collapse, and the aftermath of the Beirut port explosion, have severely impacted food security and nutrition. The Lebanese pound's 95% devaluation against the USD has driven food inflation to 700% since 2019 (World Bank, 2023). With 78% of displaced families reporting food insecurity and 65% reducing meal portions, children's nutrition has deteriorated dramatically (WFP Lebanon, 2023). Healthcare system collapse, with 40% of professionals leaving the country, has crippled nutrition monitoring services. These intersecting challenges make intervention critical for preventing a generation of children from suffering long-term health consequences.
Recent data shows that 40% of internally displaced children ages 3-5 in Lebanon show signs of malnutrition, and only 15% of them meet daily recommended fruit and vegetable intake requirements (Lebanese Ministry of Public Health, 2023). Sixty-five percent of displaced families report reducing meal portions or skipping meals due to food insecurity (WFP Lebanon, 2023). Nutrition is crucial for the growth and development of children ages 3-5, with a negative association between malnutrition and children’s health and education (Tambe et al., 2023). This situation demands immediate intervention as inadequate nutrition during these crucial developmental years can lead to stunted physical and cognitive development, increased susceptibility to childhood diseases, long-term health complications, and reduced academic performance and future economic potential (Jomaa et al., 2020).
The proposed solution is to create the Early Nutrition Access Program (ENAP) of Lebanon. ENAP of Lebanon aims to ensure that internally displaced children ages 3-5 receive adequate daily servings of fruits and vegetables through a comprehensive approach that encompasses direct nutrition support, parent education and empowerment, and community integration. Direct nutrition support shall include weekly provisions of fresh, locally sourced fruits and vegetables, nutritionally balanced meal supplements, and regular growth monitoring and nutrition assessment. Prentice et al. (2021) demonstrated that direct provision of fresh produce increased consumption by 2.8 servings per day among vulnerable children. The WHO Eastern Mediterranean Regional Office (2022) reported that locally sourced produce programs showed 40% better adherence rates compared to imported food distribution. The Lebanese Pediatric Society's guidelines show that regular assessment reduces severe malnutrition cases by 35%. The parent education and empowerment component shall include nutrition education workshops, cooking demonstrations, and food supply budgeting and meal planning sessions. Thompson et al. (2022) showed that parent nutrition education improved child dietary diversity scores by 25% under similar circumstances. Research from the Lebanese American University showed cooking demonstrations improved food preparation skills and dietary diversity scores (Saad et al., 2022). Furthermore, community integration includes partnerships with local farmers and markets, community garden initiatives, and food preservation training. Food Security studies have demonstrated that community gardens increased fresh produce consumption by 3.2 servings per day. Research from the Lebanese Ministry of Agriculture (2023) showed that food preservation skills extended fresh produce availability by 4-6 months.
Investment in ENAP of Lebanon offers economic benefits and positive social impacts. Preventing malnutrition-related illnesses reduces healthcare costs and the burden on healthcare systems and increases future workforce productivity. This program will empower the community to engage in self-management strategies, thus improving quality of life and decreasing the reliance on healthcare systems. Community resilience and social unity are predicted to be enhanced, as well as improved educational outcomes.
When considering long-term returns, every $1 invested in early childhood nutrition yields a return of $16 in improved health and economic outcomes (World Bank, 2021). For the cost of a cup of coffee per day ($3), we can provide a child with adequate fruit and vegetable nutrition for three days, potentially preventing lifelong health complications (World Food Programme, 2023). By investing in prevention now, we create substantial future savings in both human and economic terms.
ENAP's program success is grounded in an evidence-based approach and builds on proven nutrition intervention models while addressing the specific needs of Lebanon's internally displaced children. ENAP is a sustainable, cost-effective program with measurable outcomes. With proper funding and implementation, this program can significantly improve the health outcomes of vulnerable children while creating lasting positive impact within communities.
References
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Hoteit, M., Al-Atat, Y., Joumaa, H., Ghali, S. E., Mansour, R., Mhanna, R., Sayyed-Ahmad, F.,
Salameh, P., & Al-Jawaldeh, A. (2021). Exploring the impact of crises on food security in Lebanon: Results from a national cross-sectional study. Sustainability, 13(16), 8753. https://doi.org/10.3390/su13168753
Jomaa, L. H., Naja, F. A., Kharroubi, S. A., Diab-El-Harake, M. H., & Hwalla, N. C. (2020). Food insecurity is associated with compromised dietary intake and quality among Lebanese mothers: findings from a national cross-sectional study. Public health nutrition, 23(15), 2687–2699. https://doi.org/10.1017/S1368980020000567
Lebanese Ministry of Agriculture. (2023). Food preservation and security report 2023 (Policy Brief No. 47). Government of Lebanon.
Lebanese Ministry of Public Health. (2023). National nutrition survey 2023: Focus on children under five. Government of Lebanon.
Prentice, A., Thompson, B., & Martinez, S. (2021). Impact of direct produce provision on child nutrition: A global systematic review. The Lancet Global Health, 9(4), e234-e245. https://doi.org/10.1016/S2214-109X(21)00079-X
Saad, R., Mansour, J., & Khalil, H. (2022). Impact of cooking demonstrations on dietary diversity among displaced populations. Lebanese American University Studies in Nutrition, 8(2), 45-62.
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Tambe, A. B., Akeh, M. L., Tendongfor, N., Dhlamini, T., Chipili, G., & Mbhenyane, X. (2023). The predictors of food security and dietary diversity among internally displaced persons’ children (6–59 months) in Bamenda Health District, Cameroon. Conflict and Health, 17(1). https://doi.org/10.1186/s13031-023-00511-2
Thompson, B., Martinez, S., & Ahmed, K. (2022). Parent nutrition education and child dietary outcomes: A meta-analysis. Public Health Nutrition, 25(8), 2178-2195. https://doi.org/10.1017/S1368980022000891
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