Nutrition Programs Targeting Pregnancy Dramatically Improve Child Survival

Armen Hareyan's picture

A landmark series of research papers on maternal and child undernutrition published in the leading international medical journal The Lancet shows that children will suffer irreversible damage into their adult life if proper nutrition interventions are not delivered before the age of 24 months. The Lancet's Series on Maternal and Child Undernutrition reviews and analyzes the effectiveness and potential impact of nutrition-related interventions and policies in developing countries, and recommends actions to accelerate efforts to improve maternal and child undernutrition.

The five-part series aims to draw international attention to the critical role of early nutrition in the health and development of children and the economic growth of nations. The Series follows a number of earlier important series from The Lancet, such as those on child survival and neonatal health that have shaped policy and action.

"This latest Lancet Series concludes, not surprisingly perhaps, that the international nutrition system is broken," said Dr. Richard Horton, The Lancet editor-in-chief, in his series editorial. "Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are urgently needed. An agency, donor, or political leader needs to step up to this challenge. There is a fabulous opportunity right now for someone to do so. But who?"

New data links poor nutrition to more than 3.5 million child deaths each year--more than 9,500 every day

The Lancet papers quantify the prevalence of maternal and child undernutrition and consider the short-term consequences in terms of deaths and disease burden, as measured by Disability-Adjusted Life Years (DALYs), and long-term educational and economic effects and associations with adult chronic diseases.

"More than 3.5 million mothers and children under 5 die unnecessarily each year in poor countries due to the underlying cause of undernutrition, and millions more are permanently disabled by the physical and mental effects of a poor dietary intake in the earliest months of life," said the series lead author, Dr. Robert Black, Johns Hopkins Bloomberg School of Public Health. "This series provides a new evidence base for expanded nutrition-related programs and interventions, which if implemented at scale would prevent many of these deaths and disabilities."

Undernutrition includes a wide array of effects, including:

-- Intrauterine growth restriction (IUGR) resulting in low birth-weight

-- Stunting, a chronic restriction of growth in height indicated by a low height-for-age

-- Wasting, an acute weight loss indicated by a low weight-for-height; and

-- Less visible micronutrient deficiencies.


Undernutrition is caused by a poor dietary intake that does not provide sufficient nutrients and by common infectious diseases, such as diarrhea. These conditions are most significant in the first 2 years of life.

The research shows that 178 million children under 5 -- the vast majority of which live in Sub-Saharan Africa and South-Central Asia -- suffer from stunting. An estimated 55 million children suffer from wasting, 19 million of whom are affected by severe acute malnutrition.

Stunting, severe wasting and low birth-weight contribute to an estimated 2.2 million deaths annually--representing 21 percent of all causes of death for children under 5 years old. They are also responsible for 7 percent of the total disease burden for any age group, the highest of any risk factor for overall global disease burden.

Among micronutrient deficiencies, vitamin A and zinc are the greatest contributors to disease burden because of their direct effects on child health. Sub-optimal breastfeeding increases the risk of poor nutrient intake and illness and was estimated to be responsible for 1.4 million child deaths.

Together, stunting, severe wasting, low birth-weight and micronutrient deficiencies are responsible for more than one-third--approximately 35 percent--of under-5 child deaths and 11 percent of the global total disease burden.

Study shows that nutrition in first 2 years of life is more critical to long-term health than previously thought

Conditions such as stunting, severe wasting and low birth-weight in the first 2 years of life cause irreparable harm by impeding physical growth and--if followed by rapid weight gain in the 3-5 year age range--increasing the risk of chronic disease later in life. Children who are stunted or underweight at birth are also shown to complete fewer years of schooling and earn less income as adults. Lower income, poor health and reduced access to proper nutrition then impact the health of children born into future generations, establishing a repetitive cycle.

"The Bank's investments in nutrition over the recent years have focused on the crucial window of opportunity between pre-pregnancy to 24 months of age; however, it is clear now that we need even greater investment in this age group," said Joy Phumaphi, Vice President for Human Development of the World Bank, which co-financed some of the work for the Series. "Malnutrition robs youngsters of their human potential, and poor countries of vital economic growth, which is why the Bank will step-up its work in the 36 countries where 90 percent of the world's malnourished children live."

To help address nutrition in this critical age group, the Global Alliance for Improved Nutrition (GAIN) today announced a new initiative to strengthen private sector engagement in the fight against malnutrition in children under 2 years old. GAIN, with support from a USD $38 million grant from the Bill & Melinda Gates Foundation, will provide loans, grants, and technical advice to help develop and distribute low-cost, easy-to-use, nutritious foods.

"Every child deserves a chance at a healthy life, and that chance starts with good nutrition. By bringing companies together with governments and non-profits, we can make nutritious foods accessible and affordable to families in the world's poorest countries," says Jay Naidoo, Chairman of the Board for GAIN.

Researchers estimate that basic nutrition programs could prevent 25 percent of child deaths in the world's poorest countries

The third paper estimates the potential benefits of implementing effective and applicable health and nutrition interventions. Of the 45 reviewed interventions, breastfeeding promotion, appropriate complementary feeding, supplementation with vitamin A and zinc, and appropriate management of severe acute malnutrition showed the most promise for reducing child deaths and future disease burden related to undernutrition. Based on these new analyses, the authors estimate that universal coverage with proven interventions could prevent about one-quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one-third.

"For more than 30 years, USAID has supported programs to prevent malnutrition, stunting, and micronutrient deficiencies," said Dr. Kent R. Hill, Assistant Administrator, Bureau for Global Health, USAID. "Improved nutrition and health for the world's poorest people is not only a moral imperative but also a pragmatic investment for peace, security, and worldwide economic growth."


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