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 (MDG1)** and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 and 5)**. These are the conclusions of Dr Denise C. Coitinho, World Health Organization, on temporary secondment to World Food Programme (WFP) to coordinate the inter-agency team on child hunger and undernutrition; and Dr Jennifer Bryce, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA, and colleagues, authors of the fourth paper in The Lancet's Series on Maternal and Child Undernutrition.
The authors say: “Despite isolated successes in specific countries or for interventions – eg, iodised salt and vitamin A supplementation – most countries with high rates of undernutrition are failing to reach undernourished mothers and children with effective interventions supported by appropriate policies.”
They address seven key challenges for addressing undernutrition at national level: getting nutrition on the list of priorities; keeping it there; doing the right things; not doing the wrong things; acting at scale; reaching those in need; data-based decisionmaking and building strategic and operational capacity. The authors say: “Interventions with proven effectiveness that are selected by countries should be rapidly implemented at scale. The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects. Programme efforts, as well as monitoring and assessment, should focus on this segment of the continuum of care.”
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 the real life setting of a particular country, nor to support actions that have not been proven to have a direct effect on undernutrition. The authors say: “In addition to health and nutrition interventions, economic and social policies addressing poverty, trade, and agriculture that have been associated with rapid improvements in nutritional status should be implemented. There is a reservoir of important experience and expertise in individual countries about how to build commitment, develop and monitor nutrition programmes, move toward acting at scale, reform or phase-out ineffective programmes, and other challenges. This resource needs to be formalised, shared, and used as the basis for setting priorities in problem-solving research for nutrition.”
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….the charge to nutrition leaders at country level is to review their existing strategies and programmes to ensure that priority is given to interventions with a proven effect on undernutrition in pregnant women and children younger than two years of age, and then to develop feasible strategies for increasing public demand for these interventions and delivering them at scale.”
Notes to editors: *The 20 countries with a stunting prevalence equal to or higher than 20% in children under the age of five years, that together account for over 80% of the world’s undernourished children, are: Democratic Republic of Congo, Ethiopia, Kenya, Madagascar, Nigeria, South Africa, Sudan, Uganda, Tanzania, Egypt, Yemen, Afghanistan, Bangladesh, India, Burma, Nepal, Pakistan, Indonesia, Philippines, and Vietnam.
**MDG1: Reduce by half the proportion of people living on less than a dollar a day, and reduce by half the proportion of people who suffer from hunger.
MDG4: Reduce by two thirds the mortality rate among children under five
MDG5: Reduce by three quarters the maternal mortality ratio (source: United Nations website)
Dr Denise C. Coitinho, World Health Organization, on temporary secondment to WFP to coordinate the inter-agency team on child hunger and undernutrition T) +39 06 65132245 / +39 340 4732195 E) denise.costacoitinho@wfp.org
Dr Jennifer Bryce, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA T) +1 607 280 4800 E) jbryce@jhsph.edu
The paper associated with this release can be viewed at
http://www.eurekalert.org/jrnls/lance/Undernutrition4.pdf.
Journal
The Lancet