Nutrition is a dangerously neglected aspect of maternal and child health worldwide, according to a series of studies released [1/16/08] by the British medical journal, The Lancet. VOA's Rosanne Skirble reports the studies call for greater investment in nutrition services and an overhaul of the fragmented systems that too often fail to deliver these essential services.
The most critical time in a baby's life is the period from conception to age two. What happens to a developing child during that interval can predict future health, says Robert Black, Chairman of the Department of International Health at the Johns Hopkins University School of Public Health and lead author of the Lancet series. Black paints a grim picture for babies who are vitamin-deficient, improperly breastfed or not breastfed at all. "These risk factors are responsible for more than one-third, 35 percent actually, of child deaths and 11 percent of the global disease burden."
Black says prenatal problems, stunted growth, and severe wasting account for 2.2 million deaths of children under five. And young children who don't succumb to nutrition-related disease suffer in other ways. Undernourishment leads to poor brain development, reduced cognitive ability, lower school achievement and reduced economic income later on.
Black says these children are also more likely to have chronic conditions like high blood pressure, diabetes and cardiovascular disease as adults. "The key message here is that stunting and wasting in the first two years of life as well leads to irreversible damage into adult life." Black adds, "The prevention of these maternal and early childhood undernutrition conditions will be a long-term investment to benefit both this generation [of children] and the children of this generation"
According to The Lancet reports, the majority of undernourished children live in the poorest countries in Africa and Asia. Professor Black says the Lancet studies provide a compelling case for proven interventions, including breast-feeding, foods fortified with vitamin A and zinc, and management of acute severe malnutrition. "If we implement these at scale we estimate that we could reduce all child deaths by one-quarter in the short term and reduce the prevalence of stunting by 36 months of age by about one third."
Professor Black says nutrition programs must focus more on the first two years of life, but notes that half the ten countries studied had feeding programs for pre-school children and that all 20 had school-age feeding programs. "There is evidence that these programs have some benefits that are non-nutritional — for education, for example, but as nutritional interventions we don't think this is good targeting."
That is a problem, Black says, especially as nutrition programs continue to be grossly under funded. Between 2000 and 2005, $300 million were invested annually in nutrition programs worldwide compared to $5.7 billion each year for HIV/AIDS research and prevention efforts during the same time period.
Kent Hill, the assistant administrator for Global Health at the U.S. Agency for International Development, says nutrition services can also play a key role in supporting broader public health campaigns, especially the fight against HIV/AIDS, malaria and tuberculosis. "These interventions need to be connected," he says. Hill points out that a child and maternal clinic can be a place that supplies not only folic acid, oral rehydration therapy, zinc and "all of the things that relate to nutrition, can also be the place [mothers] get the mosquito nets, where their kids get vaccinated."
The systems that provide nutrition services are often supported by donor organizations, academia, civil society and the private sector. The Lancet authors say this system is "fragmented, dysfunctional and badly in need of reform."
That's a message taken very seriously by Joy Phumaphi, Vice President for Human Development at the World Bank. "Whatever we do, we need to bring all of these interrelated areas together in order to insure that we get the 'bang for the buck' [best use of investment] most importantly [for] the outcomes at country level. I think that really is the bottom line and that is what we need to commit to."
World Bank official Joy Phumaphi adds that if the global community truly wants to make a lasting difference, it must make long-term commitments to improve the education, economic status and political empowerment of women.