[pronut-hiv] Maternal and child undernutrition: an urgent opportunity

["ProNut-HIV" <pronut-hiv@healthnet.org>]

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 (
http://www.thelancet.com/online/focus/undernutrition ) 

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 
( http://www.thelancet.com/online/focus/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  (
http://www.thelancet.com/online/focus/undernutrition )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.