A Systems Approach in the Prevention of Undernutrition among Children under Five in Tanzania

By Lazaro Mbogela – Health Manager

Globally, childhood undernutrition continues to be a significant issue, especially among children under the age of five. According to the 2023’s estimates from the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF), approximately 148.1 million children under five experienced stunted growth, 45 million suffered from wasting and 37 million were overweight. Undernutrition among children occurs when there is an insufficient intake of the caloric or energy content of food and nutrients to meet children’s needs to maintain good health. Undernutrition manifests as wasting or low body weight for height (acute malnutrition), stunting or low height for age (chronic malnutrition), underweight or low weight for age and mineral and vitamin deficiencies.

Children in Sub-Saharan Africa (SSA) face a significant challenge with stunting, with an average prevalence of 41%. The situation is particularly severe in East African countries, where the prevalence of undernutrition among children under five varies from 21.9% in Kenya to a staggering 53% in Burundi. Reports from Tanzania indicate that generally, 30% of children under five are stunted, and 9% are severely stunted; 3% of children under five are wasted, while 4% are overweight; 12% of children under five are underweight, and 3% are severely underweight. Childhood undernutrition is notably widespread in the southern and southern west highland regions of Tanzania, despite their abundance in food crop production. The prevalence of undernutrition in these regions is higher above the national average of 30%; for instance, Ruvuma has an average of 36%, Songwe (32%), Iringa (57%), Rukwa (50%) and Njombe (50%) as discussed (Gasto Frumence, 2024)as pointed out in the Tanzania Health Environment Food Policy for 2021 (Sally Mtenga, Francis Levira and Farida Hassan, 2021). “The country is still behind in addressing undernutrition, obesity and NCDs, food safety and healthy food indicators. The Food and Nutrition policy (1992) provides a profile of the nutritional healthrelated problems such as anaemia, Vitamin A deficiency, iodine deficiency, protein-energy malnutrition, for children and adults. However, this policy remains outdated and it does not include other emerging non-communicable nutrition challenges such as obesity and unhealthy food. The Tanzanian National Non-Communicable Disease Strategic Plan (2016-2020) acknowledges that NCD prevention in Tanzania is hampered by the absence of concrete policies such as multi-sectoral responses to diseases and lack of legislation and /or enforcement mechanisms. Thus, there is a need to strengthen policy formulation, legislation, and interventions to promote healthy diets as a key strategy in the fight against NCDs. However, there is a paucity of policy and regulatory data to support the implementation of healthy food policy infrastructure in the country. The crucial entry point for successful development or strengthening of policies and interventions is to understand what NCD-related food environment polices exist in Tanzania.”

Several studies conducted in both urban and rural areas of Tanzania revealed socio-economic, demographic, children feeding practice, maternal and water hygiene and sanitation characteristics as causes for child undernutrition. Specifically, the causes for undernutrition for under-fives included inappropriate feeding practices such as delaying the onset of breastfeeding and shortening the duration of breastfeeding, inadequate maternal dietary intake before conception or during pregnancy, distance to the water, inadequate literacy and big household family size. Other reported causes include the following: inadequate knowledge on feeding practices among caregivers/mothers and social–cultural factors such as gender inequality related to dietary practices and masculinity, women’s excessive workload—characterized by multiple domestic roles—cultural taboos prohibiting women and girls from eating certain types of nutrient-dense foods such as eggs and fish and excessive alcohol use among mothers or caregivers.

The causes of undernutrition for under-fives in Tanzania align with UNICEF conceptual framework of malnutrition, which indicated three levels of causes of malnutrition. The first level is the basic causes, which is also the focus of our study, including causes such as the availability and control of resources (human, economic and organizational), political factors, cultural factors, environmental factors and social factors. The second level is underlying causes which include insufficient household food, inadequate maternal care/childcare and insufficient health services/unhealthy environment. The third level is immediate causes such as inadequate dietary intake and diseases.

The involvement of multiple systems such as food, education, health, agriculture and social protection plays an important role in tackling barriers to eliminating malnutrition among under-fives. Examples of barriers identified thus far include inadequate awareness of under-fives’ nutritional issues, poor accountability and functionality and provision of strategic leadership for scaling up nutrition, and inadequate malnutrition and poverty alleviation and reduction in social and economic inequality. A systems approach adopted by the CCDO Team in Tanzania recognizes that ending malnutrition in all its forms calls for a shared responsibility to tackle the multiple determinants of child malnutrition such as employment status, poverty level, education level, food insecurity, government policies and social economic inequalities. This is because in Tanzania there are limited studies focusing on the identification of various culturally-sensitive strategies in combating persistent undernutrition for under-fives. Therefore, the CCDO is calling the development donors/partners interested to fund us in carrying-out this research project which aimed at exploring culturally-sensitive strategies for the elimination of child undernutrition in Rukwa, Iringa, Ruvuma, Songwe and Njombe regions located in the Southern Highlands in Tanzania.

The supported funds will enable us to do the following;

Engaging of traditional birth attendants and tradition healers in averting negative cultural practices
Creating Village by-Laws to Discourage Harmful Cultural Practices
Establishing Local Economic Groups to Empower Women Economically
Strengthening the Implementation of Village Health and Nutrition Days
Making the Nutrition Issue a Standing Agenda in Ward Development Committee Meetings
Establishing radio programs with nutrition messages delivered for dietary behavior change

In the implementation of this project, The CCDO intends to use the following different approaches/strategies

Continuous Provision of Education on Breastfeeding to Women
Developing ready-to-use therapeutic foods (RUTFs) based on locally available food ingredients.
Allocation of a special budget for implementing nutrition-based activities within councils since LGAs are supposed to allocate TZS 1000 (USD 0.38) per under-five child for implementing nutrition-based activities in councils; however, not all councils had been allocated such funds, and even though some councils have been allocated the funds, they did not disburse the full amount for implementing the planned interventions as expected.
Establishing farming classes (or schools) to train community members on farming diversified foods to improve access to nutritionally diverse diets.
Strengthening school feeding programs
Creating an enabling environment for nutrition professionals to effectively carry out their duties and responsibilities.
Initiating campaigns to educate communities on the estimation of food availability throughout the year.
Mainstreaming nutrition into primary school education curricula.
Creating national forums for discussing nutritional issues.
Coordinating multi-sectorial nutritional activities.
Conducting regular supervisions of the implementation of nutritional interventions at lower levels.
Identify community/social impact on health (long term unemployment; lack of community engagement, health and physical/ mental issues).
Create virtual model for CCDO connected (urban) farm for local community (net zero food systems).
Enable local communities to experience working in connective Farms through accessing virtual farm experience recording findings to see if positive impacts on social inclusion health food.

THANKSGIVING TO WATER FOR AFRICA

“Written by Peace Flame Pre & Primary School under the supervision of Children Care Development Organization towards Water For Africa with their body members including Phil Hepworth and Nestory Sanga.”

Children Care Development Organization (CCDO) gives her gratitude, it is essential to take a moment to reflect on the blessings we have received throughout the years. One of the most significant gifts we have been fortunate enough to receive is the support from your organization in helping us with our well. Your assistance has not only provided us with access to clean water but has also transformed our community’s quality of life.

We would like to express our heartfelt thanks for your unwavering commitment and generosity. The resources and expertise you provided were instrumental in the successful completion of our well project. Your team’s dedication and hard work ensured that we could overcome various challenges, from planning and logistics to execution. It is evident that your organization prioritizes making a positive impact in communities like ours, and for that, we are incredibly grateful.

The well has become a vital resource for our community, significantly improving health standards by providing access to clean drinking water. This change has led to a reduction in waterborne diseases and has allowed families to spend less time collecting water, enabling children to focus on their education and adults to engage in productive activities like irrigation . The ripple effect of your contribution extends beyond just physical health; it fosters a sense of hope and empowerment within our community.

In this season of Thanksgiving, we want you to know how much your support means to us. We are thankful not only for the tangible benefits that come from having a reliable source of water but also for the partnership we have developed with your organization. Together, we are making strides toward a healthier future, and we look forward to continuing this journey with you.

Thank you once again for everything you have done for us. We wish you all a wonderful Thanksgiving filled with joy and gratitude.

Support Community Based Adaptation to Cope With Climate Change

This project’s primary objective was to strengthen the capacity of farmers and pastoralists in coping with the effects of climate change and addressing drivers of deforestation and forest degradation through community-based interventions. The project based on three divisions which are Pawaga, Kalenga and Isimani in Iringa Rural District. These divisions constitute major water shed for the great Ruaha River. However due to unsustainable land management practices and insufficient rains as result of climate variability, inflow of rain into Great Ruaha river has fallen to its lowest levels, Hence crop production too has also fallen down, putting villagers and their livestock to vulnerable socio-economic conditions. Therefore CCDO in this project Increased awareness and understanding on the broader concept of climate change through village level meetings, Identify and support conservation of water sources, Establish woodland management on sustainable basis, Promote wider use of indigenous knowledge in addressing the impacts of climatic change through strengthening the capacity of farmers and pastoralists in coping with the effects of climate change and addressing drivers of deforestation and forest degradation through community based initiatives also Empower women, youths and School children on sustainable development through supporting conservation of water sources. This increased water availability throughout the year and hence reduced water fetching tasks to women and children

Activities Performed

Conduct village meetings in all 3 divisions for climatic change awareness.
Identify 10 key water sources in order to be conserved.
Draw and implement rehabilitation plans.
Establish and train water source user committees for each water source.
Establish woodlots owned and managed by schools and youth groups for conservation and practical environmental literacy.
Distributing trees to different places such as pine trees seedling and avocado trees seedling at Makete ward specifically Kidope, Iniho, Mwakavuta Secondary, Kidope health center and Primary schools.

TARGETS ON ENVIRONMENTAL SUSTAINABILITY

The Children Care Development Organization (CCDO) is dedicated to environmental sustainability through impactful projects that address pressing ecological challenges. With a strong commitment to creating long-term, sustainable solutions, CCDO seeks partnerships with institutions and funders to scale our efforts in environmental preservation and community empowerment. Our targets outline measurable goals designed to foster resilience, promote biodiversity, and combat climate change in a holistic and inclusive manner.

Promoting Sustainable Agriculture and Agroforestry

Target: Implement sustainable agricultural practices on at least 500 hectares of community-managed farmland over the next three years, benefiting over 2,000 small-scale farmers.

Objective: Promote soil health, water conservation, and biodiversity through agroforestry and regenerative farming practices. Our aim is to reduce carbon emissions and promote food security in rural communities, improving livelihoods while restoring ecosystems.

Key Activities:

Training farmers in organic farming, crop rotation, and sustainable water management.
Planting native tree species to restore degraded lands and improve carbon sequestration.
Establishing farmer cooperatives to strengthen market access for sustainably produced crops.

Reforestation and Habitat Restoration

Target: Restore 10,000 hectares of deforested or degraded land by planting 1 million native trees over the next five years.

Objective: Reforestation will combat desertification, restore biodiversity, and create carbon sinks, contributing directly to climate change mitigation. Local communities will be engaged in the restoration process, ensuring sustainable management and stewardship of forest resources.

Key Activities:

Mobilizing local communities to participate in reforestation and habitat restoration initiatives.
Collaborating with local governments to secure land rights for forest restoration projects.
Monitoring and evaluating ecosystem recovery through biodiversity surveys and carbon offset measurements.
Clean Energy Transition in Rural Areas

Target: Facilitate the transition to clean, renewable energy sources in 200 rural households and 50 schools by the end of 2026.

Objective: Promote energy access while reducing reliance on fossil fuels. By introducing solar and wind energy solutions, CCDO aims to reduce greenhouse gas emissions and improve the quality of life for communities with limited energy access.

Key Activities:

Installing solar panels and wind turbines in households, schools, and public facilities.
Training community members on the maintenance and repair of renewable energy systems.
Partnering with local governments and energy companies to ensure affordable and sustainable energy solutions.

Waste Management and Recycling Initiatives

Target: Implement comprehensive waste management and recycling programs in five urban centers by 2027, reducing landfill waste by 40%.

Objective: Address the growing issue of urban waste through education, infrastructure development, and community engagement. The focus will be on promoting waste segregation, recycling, and responsible waste disposal to improve environmental health.

Key Activities:

Establishing recycling centers and waste segregation systems in partnership with local municipalities.
Educating communities on the importance of waste reduction, reuse, and recycling.
Developing waste-to-energy projects that convert waste materials into renewable energy sources.

Water Conservation and Management

Target: Improve water access and conservation in 100 rural communities by constructing rainwater harvesting systems and protecting natural water sources by 2025.

Objective: Ensure water security through the promotion of sustainable water management practices. This initiative aims to combat the effects of droughts, reduce water wastage, and provide clean drinking water to communities facing water scarcity.

Key Activities:

Installing rainwater harvesting systems in schools, homes, and agricultural areas.
Protecting and rehabilitating natural water sources such as rivers, springs, and lakes.
Educating communities on sustainable water use and the importance of watershed management.

CCDO’s targets are ambitious yet attainable with the right support. We invite institutions and funders to join us in creating lasting environmental change. Together, we can develop sustainable solutions that uplift communities, restore ecosystems, and combat climate change. Through strategic partnerships and shared commitment, these targets will translate into measurable impacts, setting the foundation for a greener, more resilient future.

SUPPORT CCDO

By investing in CCDO’s environmental sustainability projects, you will be contributing directly to impactful, community-driven initiatives that align with global sustainability goals. We look forward to partnering with like-minded institutions to secure a brighter, more sustainable future.

THE ROLE OF VOCATIONAL TRAINING IN CREATING EMPLOYMENT TO DISADVANTAGED YOUTH

Children Care Development Organization (CCDO) has successful launch a vocational training center which offers employment opportunities to large group of disadvantaged youths around Iringa region. The aim of this Vocational Center is to increase youth participation in social matters that concern their life, fight against poverty and reduce crimes among youth such as drug abuse and robbery.

A SHORT STORY FROM ONE OF THE BENEFICIARY OF THE VOCATIONAL TRAINING

“My name is Fabrey Mbogella born in 2000. I was born into a family that didn’t have much, and from a young age, I knew what it meant to go without. My parents did their best, but the truth was, we struggled. I watched my friends have things I could only dream of, and it lit a fire in me to work hard, to break the cycle.

I focused on my studies, knowing that education was my only way out. Then, one day, my hard work paid off. I still remember the day I got the letter from CCDO. They were offering me a scholarship to pursue my certificate in carpentry at Don Bosco Vocational Training Center situated at Iringa region. I could hardly believe it—someone saw my potential and was willing to help me build a future. That scholarship changed everything for me. It was like a door to a world I never thought I’d step into.

After completing my studies, I didn’t know what was next. But CCDO didn’t just give me a scholarship; they believed in me even after. They handed me the responsibility of running a vocational training center. I was given machines and equipment, the tools to teach others what I had learned. At first, I was overwhelmed—me, leading a whole center? But with time, I grew into the role. I successful trained 85 youths since 2022. Some of my students got job opportunities from different places while others are self-employed. I recommend other youth to come and receive trainings at CCDO because it is free and can help them get job opportunities or even employ themselves and get out of poverty.

Now, I look around and see how far I’ve come. I no longer worry about the things I once did. I can afford most of the things I need and want in life. The struggles of my past are still there, but now they’re reminders of where I started, not of where I’ll end up. More than anything, I’m happy—happy that I’ve not only found my way but that I can help others find theirs too.”

CCDO we are happy to get involved in changing the life of hundreds of youth around the country. We are willing to return more to the community and make the coming generation proud of our efforts. We believe that everyone has the ability to be better. Our targets towards 2028 is to create job opportunities to 200,000 youths across the country.

ENHANCING MATERNAL AND CHILD HEALTH IN TANZANIA

In Tanzania, maternal and child health care remains a critical issue, especially in rural and low-income communities. Despite some progress in reducing maternal and infant mortality, many challenges persist. According to recent reports, Tanzania’s maternal mortality rate is still high, with many women lacking access to adequate healthcare during pregnancy, childbirth, and postpartum periods. Poverty, lack of healthcare infrastructure, cultural practices, and limited education about maternal and child health contribute to the ongoing crisis. Many mothers in low-income regions face significant challenges in raising their children, including poor nutrition, lack of clean water, limited access to quality healthcare, and inadequate education on best practices for child care. These factors contribute to high infant mortality rates, malnutrition, and preventable diseases among children. This project addresses these challenges by enhancing maternal and child health care in underprivileged regions of Tanzania, focusing on providing essential services, education, and support to ensure healthy pregnancies and better care for newborns and young children. The overall goal of this project is to improve maternal and child health outcomes in low-income regions of Tanzania by providing affordable healthcare services, education, and resources.

As CCDO we work hard to solve the challenges that face pregnant women before and after delivery through; improving access to maternal health services by establishing or enhancing healthcare facilities in rural areas and providing essential medical supplies, reducing maternal and infant mortality by ensuring skilled health personnel are available for antenatal, delivery, and postnatal care, educating mothers and families on child health, nutrition, and proper child-rearing practices, to combat malnutrition and preventable diseases, supporting vulnerable mothers with access to community-based maternal care, transportation for emergencies, and family planning services and empowering women by providing them with skills and resources to improve their socioeconomic standing, reducing the financial burden on households.

In struggle to support maternal and child care we have witnessed the core sources of their obstacles including limited access of healthcare especially in rural areas in which contribute to lack of adequate infrastructure limited access to clinic or hospitals resulting them to travel a long distance in searching for medical care. Poverty also is among the major obstacle to most of the families as it leads to failure paying for health treatment. This goes together with increased malnutrition rate causing poor growth to children. Other challenges which mothers face include; cultural barriers, inadequate education on maternal and child healthcare together with presence of few trained healthcare personnel.

In fighting these challenges CCDO has established a maternal healthcare situated at Nduli in Iringa region which aim to provide care to people across Nduli, Mgongo, Kising’a, Igingilani, ilambilole and Kiwele, training health workers and traditional attendants to improve quality of care and ensure safe delivery to mothers, creating health education outreach to people around the area, providing nutritional support, assisting them with emergency transport and establishing socioeconomic activities such as poultry farming, small scale farming, horticulture and tailoring activities in order to boost their income.

We expect to have improved maternal and child healthcare to reduce maternal and infant mortality rates, increase healthcare access in rural areas through our introduced maternal and child healthcare center, improving nutritional support to the most vulnerable families in order to have healthier children and to empower women in socioeconomic participation with the aim to reduce dependence.

With all the efforts we apply to the community still we face some challenges that keep dragging us behind. We wish to save the life of thousands of women in our region but we encounter some challenges including having few medical equipment in our building setting, few health personnel, lack of enough fund to expand the service and low support from the nearby institutions.

CCDO is geared to help the community and we hereby welcome individuals, investors, institutions and cooperates from different places across the world to come and join us in this struggle of saving the life of these vulnerable groups.

A WORD TO OUR DONOURS, SUPPORTERS AND FUNDERS

Since the establishment of Children Care Development Organization (CCDO) on April 13^th, 2010, we have been working with different institutions which showed their support to what we have been doing and gave us hope. In a world where so many are in need, the contributions of donors, supporters, and funders play a vital role in transforming lives. Whether it’s fighting poverty, promoting health, supporting education, or advocating for environmental sustainability, your generosity enables organizations like ours to continue the work of uplifting communities. CCDO takes a moment to express our deepest gratitude for your unwavering support.

Your contributions are the backbone of our projects. Thanks to your generosity, we have been able to provide essential services, build community infrastructures, support maternal and child health initiatives, promote environmental conservation, and empower countless individuals with education and vocational skills. Every dollar, every asset and every tool you donate is an investment in the betterment of society, and we ensure that your contributions reach those who need them the most. Your kindness has brought hope to families who thought they had no future, and we thank you for being their beacon of light.

We have been getting support from different corners of the world. We have received funds from different institution and organization like United Nation Development Programme (UNDP), Lattanzio group in Italy, African Women Development Fund (AWDF), Tanzania Forest Fund (TFF) and China Henan International cooperation Group Co. Ltd (CHICO). We also received material support from TWAM Tools With a Mission in England who supported us different types of Sewing and carpentry tools, builders kit, ground worker kit, small agricultural tools, motor mechanics and garage kits, plumbers kits, electricians kits, electrical drills and power tools, industrial sewing machine; Workaid in England who provided us with different types of sewing machines, knitting machines and carpentry machine; World Computer Exchange from United States of America who supported us with computers; Stichting Diennstencentrum Gered Gereedschap in the Netherlands provided us different workshop tools (educational tools for carpentry, sewing machine and farming tools). All these supports meant something for us and the community around us.

Your advocacy and belief in our mission have been invaluable. You’ve shared our work with others, volunteered your time and participated in our events, you’ve been an essential part of our progress. You have extended our reach far beyond what we could achieve alone. You’ve helped us spread awareness about critical issues, rallied communities, and provided the encouragement that fuels our efforts. It is because of your constant support that we have been able to stay resilient in the face of challenges, knowing that we are not alone in our mission.

We also thank Professor Michael Provitera and Jeanne Busser under the Coalition of Children’s Book Authors for their great support. We are grateful for the donation of hundreds of books for the most vulnerable children and for our Peace Flame Primary School. Your contribution helped in eradicating illiteracy rate.

**Prof. Michael Provitera from Bally University in USA**

Your strategic investments in our programs have allowed us to scale up our efforts, innovate solutions to pressing problems, and extend our impact to regions previously beyond our reach. With your help, we have been able to fund long-term projects like Peace Flame Pre & Primary school, vocational training center and maternal and child healthcare center that foster sustainable change, ensuring that the work we do today will continue to benefit communities for generations to come. Your trust in our vision has made all the difference.

Together, we have created real change. From providing clean water and improving sanitation to ensuring children receive quality education and supporting vulnerable groups like women, none of this would be possible without you. Each project we undertake is a testament to your commitment to making the world a better place.

At a time when global challenges seem more daunting than ever, your support gives us the strength to continue. It reminds us that there are people like you—individuals and organizations who believe in the power of compassion, who understand that helping others is not just a duty but a privilege.

We are honored to have you as partners in this journey of social welfare and community development. As we move forward, expanding our reach and deepening our impact, we know that together we can achieve even greater things. Thank you for believing in us, for standing by us, and for making the world a better place, one act of kindness at a time.