WUNRN
Reuters
January 16, 2008
UNDERNUTRITION BEHIND THIRD OF CHILD
DEATHS: STUDIES
By Michael Kahn
LONDON (Reuters) - Undernutrition causes more than a third of child deaths worldwide, but simple programs like promoting breastfeeding and providing supplements could keep some of those children alive, experts said on Thursday.
The new figures, which were taken from surveys of some 139 countries and a re-analysis of existing data, are lower than previous estimates attributing 50 percent of childhood deaths to undernutrition -- a severe form of malnutrition, the international team of researchers said.
_______________________________________________________________________
Maternal
and Child Undernutrition
The
Lancet
More than a third of child deaths and 11% of the total disease burden worldwide are due to maternal and child undernutrition. These and other stark findings are the conclusions of an international collaboration of investigators publishing their findings in The Lancet's maternal and child undernutrition series. The London media launch was chaired by The Lancet editor, Dr Richard Horton, and included short presentations from the authors of each of the five series papers. The series was launched in London on January 16, 2008.
Nutrition
has slipped through the gap
Nutrition is a desperately neglected aspect of maternal, newborn, and child
health. The reasons for this neglect are understandable but not justifiable. In
a comment that opens the maternal and child undernutrition series, The Lancet Editor Dr Richard Horton draws
together the themes of the series, and calls on agencies, donors and political
leaders to step up to this very serious challenge. He says "Undernutrition
is the largely preventable cause of over a third - 3.5 million - of all child
deaths. Stunting, severe waste wasting and intrauterine growth restriction are
among the most important problems. There is a golden interval for intervention:
from pregnancy to 2 years of age. After age 2 years, undernutrition will have
caused irreversible damage for future development towards adulthood". The
comment concludes by saying that the international nutrition system is broken.
Leadership is absent, resources are too few, capacity is fragile, and emergency
response systems are urgently needed.
Over
a third of child deaths and 11% of global disease burden due to maternal and
child undernutrition
More than one third of child deaths and 11% of the total disease burden
worldwide are due to maternal and child undernutrition. Authors of the first
paper in the series say "Maternal and child undernutrition is highly prevalent
in low-income and middle-income countries, resulting in substantial increases
in mortality and overall disease burden." By doing an analysis that
accounted for co-exposure of nutrition-related factors, the authors found that
these factors were together responsible for 35% of child deaths globally and
11% of the total disease burden. The paper concludes by making a compelling
case for the urgent implementation of interventions to reduce their occurrence
or ameliorate their consequences.
Poor
fetal growth or stunting in first two years of life leads to huge negative
consequences in later life
Authors of the second paper of the series conclude that poor fetal growth or
stunting in the first two years of life can lead to irreversible damage,
including shorter adult height, lower attained schooling, reduced adult income
and decreased offspring birthweight for women. The researchers analysed the
association between child and maternal undernutrition with human capitol and
risk of adult disease in low-and-middle-income countries, focussing on five
long-standing studies in Brazil, Guatemala, India, the Philippines, and South
Africa. They showed that indicators of undernutrition at age two years were
related to adult outcomes. Further, they found that children who are
undernourished in the first two years of life, and who put on weight rapidly
later in childhood and in adolescence are at a high risk of chronic diseases
related to nutrition. But they found no evidence that rapid weight gain or
height gain in the first two years life increases the risk of chronic disease,
even in children with poor fetal growth. The authors conclude by saying
"...damage suffered in early life leads to permanent impairment, and might
also affect future generations. Its prevention will probably bring about
important health, educational, and economic benefits."
Maternal
and child nutrition interventions could prevent a quarter of child deaths in
poor communities
Implementation of existing maternal and child nutrition-related interventions
could prevent a quarter of all child deaths in the 36 countries with the
highest burden of undernutrition. Breastfeeding counselling and vitamin A
supplementation are currently the nutrition strategies with the greatest
potential to cut child deaths, comment the authors of the third paper in the
series. The authors studied how a variety of nutritional factors affected
children's growth patterns and risk of death. In populations with enough food,
education about complimentary feeding increased the height-for-age score, while
provision of food supplements increased the score further in food-insecure
populations. Further, the authors also found that management of severe acute
malnutrition using WHO guidelines can reduce case-fatalities related to this
condition by 55%, but this requires admission to a health facility. The authors
add that nutrition strategies on their own are not enough, concluding by saying
"Attention to the continuum of maternal and child undernutrition is
essential to attainment of several of the Millennium Development Goals and must
be prioritised globally and within countries... What is needed is the technical
expertise and the political will to combat undernutrition in the very countries
that need it most."
80%
of world's undernourished children live in just 20 countries
Authors of the fourth paper in the series highlight how 80% of the world's
undernourished children live in just 20 countries, and intensified nutrition
action in these countries can lead to achievement of the first Millennium
Development Goal and greatly increase the chances of achieving goals for child
and maternal mortality. They address seven key challenges for addressing
undernutrition at national level, including; getting nutrition on the list of
priorities, and also keeping it there. The paper looks at the varied situation
within and across Latin American countries, which as a whole have experienced a
large drop in stunting, being underweight, and wasting; and China, where a
multisectoral approach has seen rapid nutritional improvement. The authors
caution that nutrition resources should not be used to support actions unlikely
to be effective in real life setting of a particular country, nor to support
actions that have not been proven to have a direct effect on undernutrition
They conclude by asking "What can be done?...there are no simple
prescriptions to reduce undernutrition, although high coverage with four or
five of the proven interventions would certainly have a sizeable effect",
charging leaders at country level to review their existing strategies and
programmes.
The
international nutrition system: fragmented, dysfunctional and desperately in
need of reform
The final paper in the series states that the international nutrition system -
made up of international and donor organisations, academia, civil society, and
the private sector - is fragmented and dysfunctional, and needs reform, say
authors of the fifth and final paper in the series. They say: "Financial,
intellectual, and personal linkages bind these organisations loosely together
as components of an international nutrition system... we argue that such a system
should deliver in four functional areas: stewardship, mobilisation of financial
resources, direct provision of nutrition services at times of natural disaster
or conflict, and human and institutional resource strengthening." Their
analysis of evidence to date finds that currently, there are substantial
shortcomings in each of the areas above. Fragmentation, lack of evidence for
prioritised action, institutional inertia, and failure to join up with
promising developments in parallel sectors are recurrent themes. Many problems
are systemic within organisations in the field. They suggest five priority
areas for action to create a much stronger international nutrition system, and
call for research leadership in areas that matter. The authors conclude by
saying "The moment is ripe for these reforms. Their implementation would
transform the political salience of undernutrition, and offer the chance of a
better, more productive life to the 67 million children born each year in the
countries most severely afflicted by undernutrition."
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