Under-nutrition in Pregnancy and Infancy
I received an e-mail this morning from the Lancet Journal concerning the concern for proper nutrition in pregnant women and infants to the age of 2 years old. They state that “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.” Amazingly, this is a concern for more than the medical doctors, but when they show concern, maybe it is REALLY time to start listening.
However, I think that they have missed the mark with statements like “When one considers specific actions to improve maternal and child survival, one is drawn to particular interventions-vaccination, oral rehydration therapy, and the treatment of infection and haemorrhage.” The key is first; education on what is proper nutrition for women already in this state of their life, or who are planning on procreation. (Yes, this affects men too) Second; there needs to be education on the proper stages of nutritional development from birth to at least 2 years of age. I suggest that we should understand the stages of proper nutrition well past 2, even into adulthood. There must be a push for breastfeeding and a greater understanding or processed and refined foods.
And finally I am almost offended at the statement which ends the article. “Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are fragmentary. New governance arrange-ments 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?” It is not that there is no leadership in this area, but that those leaders are not recognized. There are plenty of individuals and groups who are supporting proper nutrition. The groups are Mid-Wives,
Here is the full article:
The Launch of The Lancet’s Series on Maternal and Child Undernutrition – today The Lancet’s Editor Dr Richard Horton and a team of international experts launch this series, and the text of Dr Horton’s comment which opens the Series can be found below.
Maternal and child undernutrition: an urgent opportunity
Nutrition is a desperately neglected aspect of maternal, newborn, and child health. The reasons for this neglect are understandable but not justifiable. When one considers specific actions to improve maternal and child survival, one is drawn to particular interventions-vaccination, oral rehydration therapy, and the treatment of infection and haemorrhage. In recent years, this portfolio of responses has broadened to embrace the health system-human resources, financing, and stewardship. Somehow, nutrition has slipped through the gap.
And yet we know that nutrition is a major risk factor for disease *. What public-health experts and policymakers have not done is to gather the evi-dence about the importance of maternal and child nutrition, catalogue the long-term effects of under-nutrition on development and health, identify proven interventions to reduce undernutrition, and call for national and international action to improve nutri-tion for mothers and children. The five-part Series on maternal and child undernutrition , launched this week by The Lancet, aims to fill this gap in global public health and policy action.
The key messages of the Series, which has been written by an independent team of public-health scientists led by Robert Black, Zulfiqar Bhutta, Jennifer Bryce, Saul Morris, and Cesar Victora, are critically important for all those concerned with the health and wellbeing of women and children. Under-nutrition is the largely preventable cause of over a third-3.5 million-of all child deaths. Stunting, severe 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.
Incredibly, four-fifths of undernourished children live in just 20 countries across four region-Africa, Asia, western Pacific, and the middle East. These are the priority nations for action. In terms of under-5 mortality rates, the most immediate needs are for Afghanistan, Democratic Republic of Congo, Nigeria, Ethiopia, Uganda, Tanzania, Madagascar, Kenya, Yemen, and Burma. In order of population size, and excluding the countries with highest mortality rates, the ranking is different: India, Indonesia, Pakistan, Bangladesh, Vietnam, Philippines, Egypt, South Africa, Sudan, and Nepal.
As this Series shows so clearly, there are proven effective interventions to reduce stunting and micro-nutrient deficiencies. According to strict criteria around admissible evidence, breastfeeding counselling, vitamin A supplementation, and zinc fortification have the greatest benefits. Attention to maternal nutrition through adequate dietary intake in pregnancy and supplementation with iron, folic acid, and possibly other micronutrients and calcium are likely to provide value. But these interventions need additional programmatic experience about how to achieve full coverage.
There is no magic technological bullet to solve the problem of undernutrition. Long-term investments in the role of women as full and equal citizens-through education, economic, social, and political empowerment-will be the only way to deliver sustainable improvements in maternal and child nutrition, and in the health of women and children more generally.
The compelling logic of this scientific evidence is that governments need national plans to scale-up nutrition interventions, systems to monitor and evaluate those plans, and laws and policies to enhance the rights and status of women and children. Although complex and fraught with political disagreement, none of these solutions are separable from global treaties and negotiations over trade, agriculture, and poverty reduction. This latest Lancet Series concludes, not surprisingly perhaps, that the international nutrition system is broken. Leadership is absent, resources are too few, capacity is fragile, and emergency response systems are fragmentary. New governance arrange-ments 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?
Richard Horton
The Lancet, London NW1 7BY, UK
* Lopez AD, Mathers CD, Ezzati M, Jamison DT, Murray CJL. Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data. Lancet 2006; 367: 1747-57.
