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Hunger and health

How to address malnutrition through community-led action

Written by Joy Wright 2023

A female Guatemalan health promoter checks a newborn baby held by its mother

Griselda (left) is a health promoter in Guatemala. She helps the women in her community to keep their children healthy and well fed. Photo: Caroline Trutmann Marconi/Tearfund

Three smiling Guatemalan women, one heavily pregnant, hold bowls of food in a kitchen with wooden walls.

From: Food and nutrition – Footsteps 119

How to eat well, address malnutrition and reduce food waste

Sharing a meal with others is an ordinary human experience that provides us with connection and belonging, as well as physical energy and nutrients. But how can community members help each other when there is not enough to eat? 

This is an urgent question in many countries today, and one I found myself asking on a recent visit to Ethiopia, where the worst drought in 40 years is causing a food crisis.

‘Almost one person in every ten does not have enough food.’

Globally, rates of hunger have rapidly increased in the last few years due to a combination of conflict, climate change, the economic effects of Covid-19 and rising food costs. According to the World Food Programme, almost one person in every ten does not have enough food to meet their nutritional needs. Children are particularly vulnerable, with Unicef estimating that about 200 million children are currently affected by malnutrition. 

We can feel powerless in the face of such large-scale needs, and global intervention is necessary. But local, community-led action can significantly reduce the impact of hunger and malnutrition on individuals and households. 

A Kenyan woman wraps a colour-coded tape around the upper arm of a young child

Checking for malnutrition in Kenya. Photo: Will Swanson/Tearfund

Community-led action

Community groups can help in a number of ways. The first step is to find out what the most significant local contributors to hunger and malnutrition are. 

These may include:

  • food insecurity, where food supply is unreliable or unaffordable, perhaps due to conflict, poor harvests or disasters
  • lack of knowledge of nutritional principles, particularly in relation to feeding babies and children
  • inadequate access to water, sanitation and healthcare, resulting in illness and a reduced ability to absorb essential nutrients.

Based on this analysis, community groups might decide to take the lead in one or more of the following areas:

  • Advocacy: Communities know what is needed in their context to address food insecurity and malnutrition. Based on this knowledge, community representatives can advocate for support from local and national government, healthcare services, non-governmental organisations and others.

    For more information on effective community-led advocacy, see Footsteps 118.

  • Providing information: Advice about health and nutrition is most effective when provided by fellow community members who understand what foods are available and the pressures their community is facing.

    Key topics might include: good nutrition in pregnancy; what to feed children under two years old; breastfeeding support; hand hygiene; latrine use; kitchen gardening; and how best to store and preserve food to reduce waste.

  • Connecting people to services: Lives are saved when children with acute malnutrition are treated quickly. Community health workers and family members can learn how to check children for malnutrition. They can then refer them to the nearest clinic.

    Reaching food distributions or health clinics can be difficult for people in rural areas or parents with several children, so organising transport or childcare can be vital.

  • Participatory action: Self-help groups provide opportunities for people to support each other and save small amounts of money. These savings can then be used to buy food during periods of drought or other emergencies.

Two hands hold a plastic tape with red, yellow and green sections

Tape for measuring mid-upper arm circumference (MUAC). When wrapped around the upper arm, green indicates healthy, yellow suggests a potential problem and red indicates malnourished. Photo: Paul Mbonankira/Tearfund


Not having enough of the right foods at the right time leads to malnutrition and weakened resistance to infection. A malnourished child is more likely to get respiratory tract infections, diarrhoea and diseases such as malaria. And they are much more likely to die from these illnesses.

Child malnutrition can be prevented by increasing breastfeeding rates, ensuring young children receive enough nutritious food and improving access to safe water and sanitation.

‘A malnourished child is more likely to get respiratory tract infections, diarrhoea and diseases such as malaria.’

Illness and intestinal worms decrease the body’s ability to absorb nutrients. So vaccination against common childhood diseases and timely treatment for worms are also very important.

Measuring malnutrition

A chart showing expected weight for age is commonly used to check that children are growing properly. However, scales and charts are not always available so, increasingly, a colour-coded measuring tape, known as a MUAC tape, is used.

The tape is wrapped around the upper arm of a child and it provides a quick and simple indication of malnutrition. This is something that community health workers, parents and older siblings can easily learn to do. The tape can also be used to check for malnutrition in adults.

Swelling may be a sign of severe acute malnutrition in children. One way to check for this is to apply normal pressure using thumbs on top of each of the child’s feet for about three seconds. If the skin remains indented for a few seconds after the thumbs are removed, the child needs emergency medical attention.

Treating malnutrition

Acute malnutrition needs to be assessed by a healthcare worker. For severe cases, treatment with a special high-energy nut paste is needed. In milder cases, high-energy foods such as porridge made from grains and legumes can be used. 

If there are complications such as infection or swelling, people need care in a clinic or hospital where they will receive high-energy food, antibiotics and other treatments.

A young child in Burundi eats some porridge off a silver spoon held by an adult

Enjoying a cup of nutritious porridge in Burundi. Photo: Tom Price/Tearfund

High-energy porridge

Use this porridge to treat moderate acute malnutrition in children and adults, or to help someone recover from an illness. Offer it daily, for at least eight weeks. Vary the ingredients according to the types of grains and legumes available in your area. 


  • Two parts legumes, eg soybeans, peanuts, peas or lentils
  • One part wholegrain cereal, eg maize or rice
  • One part of a different wholegrain cereal, eg wheat, millet or buckwheat


  • Clean the legumes and grains.
  • Roast them separately, and then grind them into a fine flour (separately or together). The flour can be stored in an airtight container for up to three months.
  • Stir the combined flour into boiling water and cook. Vary the amount and texture of the porridge depending on the age and condition of the person.
  • Add mashed vegetables and fruits to the porridge to improve the nutritional value and vary the flavour. The flour can also be used for baking breads and biscuits. Do not add salt.


  • Nutrients: Essential substances found in food that the body needs to function properly and maintain good health.
  • Nutrition: The body’s process of taking in food and absorbing energy and nutrients from it.
  • Malnutrition: When the body does not receive the right amount of the right nutrients. It particularly affects children under five and pregnant and breastfeeding women due to their high energy needs.
  • Acute malnutrition: Rapid weight loss due to a sudden lack of nutritious food. Children with acute malnutrition have a low body weight for their height. Acute malnutrition can be classed as moderate or severe.
  • Chronic malnutrition: Weight loss due to longer-term food shortages. Children with chronic malnutrition are often short for their age. Chronic malnutrition can have long-term effects including reducing children’s ability to learn at school.
  • Mid-upper arm circumference (MUAC): A simple, quick way of checking children aged six months to five years for malnutrition using a colour-coded tape to measure the circumference of their upper arm.

Additional resources


Written by

Written by  Joy Wright

Joy Wright is a medical doctor and a health and nutrition advisor for Medical Teams International in Ethiopia, Tanzania and Sudan.

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