IMPROVING RESILIENCE TO NUTRITIONAL SHOCKS

Although undernutrition is trending downward globally, 165 million chil-dren in low-income countries were stunted (that is, had low height for age) in 2011; others suffered from deficiencies in micronutrients. Overall, undernutri-tion contributed to 3.1 million deaths in 2011 (Black et al. 2013). This burden reflects underlying conditions of poverty, limited access to health and sanita-tion, and insufficient time and information for adequate childcare. In addi-tion to being consequences of these protracted obstacles, malnutrition rates are also heightened by climatic, political, and economic shocks. For example, drought and civil unrest (independently as well as jointly) contributed to increased stunting in Zimbabwe, and subsequently this stunt-ing led to reduced schooling (Alderman, Hoddinott, and Kinsey 2006). Moreover, even a modest rain shortfall, far less dramatic than those that gener-ate international attention, may result in reduced linear growth and schooling (Maccini and Yang 2009). Nor are these negative outcomes confined to conflict-and drought-affected economies; the incidence of low birth weight increased with the economic contraction in Argentina in 2001–2002, with both contrac-tion of gross domestic product and reduced health expenditures per capita inde-pendently explaining this outcome (Cruces, Gluzmann, and Lopez Calvo 2012). Addressing the Acute Crisis of Undernutrition One of the first signs of undernutrition observed in crises is an increased rate of wasting, defined as low weight for height but also monitored in terms of upper-arm circumference. A child who is severely wasted has a compro-mised immune system and a heightened risk of dying young. Fortunately, there have been recent strides in managing acute malnutrition by offer-ing nutrient-dense, lipid-based supplements to assist in rehabilitation (Bhutta et al. 2013). Often such supplements are distributed at the community level