Malnutrition does not begin at birth, but before conception, and its consequences echo across a lifetime, shaping the child’s brain, body and destiny.
A growing body of research is drawing urgent attention to “the first 1,000 days of life”: the period from conception to a child’s second birthday — a window of opportunity that shapes the brain, body and immune resilience, and that determines whether a child will thrive, struggle, or face lifelong health and developmental challenges.
At the centre of this work is Dr Joyce Nyarko, postdoctoral fellow and public health practitioner in the department of nursing science at Nelson Mandela University. She is developing a programme to address malnutrition in the first 1,000 days of life in the Nelson Mandela Bay and Sarah Baartman districts of the Eastern Cape. Her programme frames malnutrition as a preventable condition with structured support from preconception to pregnancy, birth and early childhood.
“The first 1,000 days of life are foundational,” Nyarko says. “If we fail a child during this period, the damage can be irreversible. We are not only talking about underweight babies. We are talking about brain development, immune function, school readiness and future economic productivity. Babies who are undernourished in the womb face higher risks of infection and stunting. Stunted children often perform poorly at school and are more likely to experience chronic illnesses, such as diabetes and cardiovascular disease later in life.
“The science is clear. Before conception we need healthy sperm and ova — in other words, planned families,” adds Prof Wilma ten Ham-Baloyi who collaborates with Nyarko in the department of nursing science. “Before people conceive, both parents must look after what they eat, drink and take. Planned families are a cornerstone of healthy births.”
During the first weeks of gestation, critical organs begin to form; by 16 weeks the brain’s architecture is already taking shape. Neural connections form rapidly, laying the foundation for learning, emotional regulation and cognitive ability. If a mother is malnourished, or exposed to alcohol, tobacco, or drugs, the child’s trajectory is set on a precarious footing before they draw their first breath.
Nutrition in the first days and months of the child’s life is equally critical. “The ‘golden hour’ directly after birth, including skin-to-skin contact and early breastfeeding, helps regulate the infant’s temperature, supports immunity through colostrum and fosters bonding,” Nyarko says. If maternal milk is unavailable, safe replacement feeds are essential, as is the environment: homes with clean water and hygiene dramatically reduce vulnerable infants’ exposure to diarrhoeal diseases and respiratory infections, which compound malnutrition through nutrient loss and poor absorption.
National nutrition education is essential. Nyarko says the “Road to Health Booklet”, given to every newborn at birth, is a guide available at all birthing facilities that shares practical nutrition advice: eat a varied diet with protein, carbohydrates, fruits, and vegetables; choose iron-rich foods; and avoid excess processed items. Fortified staples — bread, flour, salt — are important food sources, especially in underresourced areas.
Nyarko says: “Nutrition and malnutrition is a social, economic and cultural issue. It requires multistakeholder input to address maternal nutrition, provide respectful maternal care during pregnancy, labour and delivery, optimise immunisation and encourage breastfeeding. The timely introduction of appropriate infant foods, immunisation, growth monitoring and early detection of developmental delays are all critical components. Equally important are social protection measures, including income support and food security programmes, particularly in impoverished communities.”
Nyarko’s research includes a scoping review mapping existing interventions and recommendations to prevent and manage malnutrition in all communities. Early findings suggest that fragmented services, gaps in maternal education, poverty and inconsistent follow-up care undermine existing, well-designed programmes.
“We cannot wait until a child presents with severe acute malnutrition,” Nyarko says. “Prevention must start before pregnancy. Family planning services must be accessible. Women must receive nutritional support and education. Healthcare workers must provide respectful, evidence-based maternal care.”
Nutrition and malnutrition is a social, economic and cultural issue. It requires multistakeholder input to address maternal nutrition, provide respectful maternal care during pregnancy, labour and delivery, optimise immunisation and encourage breastfeeding. The timely introduction of appropriate infant foods, immunisation, growth monitoring and early detection of developmental delays are all critical components.
— Dr Joyce Nyarko
Society plays a critical role as teenage pregnancies are a recognised risk multiplier for malnutrition in mothers and children. Reducing teen pregnancies reduces acute maternal anaemia, nutrient depletion, and the likelihood that a mother will experience prolonged nutritional deficits across successive pregnancies.
Community engagement is another cornerstone. Faith-based organisations, NGOs and local leaders can help address key issues, including teenage pregnancies, maternal nutrition, substance use during pregnancy and infant feeding practices.
“Malnutrition is often a silent affliction,” Nyarko says. “A child may not look severely ill, but their growth may be faltering and their cognitive development compromised. Monitoring and early intervention are essential and public-health messaging must be practical and accessible.
Ten Ham-Baloyi says urgency is key: “We must treat this as a public health emergency. If we invest in maternal nutrition, respectful maternity care and early childhood support now, we will reduce preventable deaths, improve educational outcomes and strengthen our economy in the long term.”
Nyarko agrees. “This is about giving every child a fair start,” she says. “It is about breaking intergenerational cycles of poverty and poor health. The first 1,000 days of health determine whether a child survives, thrives and reaches her/his full potential.”
In communities across Nelson Mandela Bay and Sarah Baartman, the message is gaining traction. But the clock is always ticking. From conception to two years, the window is brief and the consequences of inaction can last a lifetime.
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