[pronut-hiv] Needless Death from Undernutrition

["George Carter" <fiar@verizon.net>]

http://www.voanews.com/english/Science/2008-01-18-voa20.cfm
Undernutrition Causes Needless Deaths in Poor Countries
By Rosanne Skirble
Washington, DC
22 January 2008
	
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.

Breastfeeding for the first six months of life gives infants a  
healthy start on life
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.

Damage suffered early in life leads to permanent impairment
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."

178 million children under five suffer from stunting
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 British journal The Lancet launches its undernutrition series at  
the Woodrow Wilson International Center for Scholars in Washington
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.