?Pakistan, Afghanistan, Kenya, Tanzania and Uganda are among the 34 countries around the globe most affected by childhood malnutrition. If just 10 key nutrition interventions are scaled up to 90 per cent coverage in these countries, nearly 15 per cent of all deaths in children under five can be prevented, and at least a fifth of all stunting averted, according to a review paper in The Lancet Maternal and Childhood Nutrition Series 2013.
Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? provides a comprehensive update on the current recommendations to address inadequate nutrition – consisting of stunting, wasting and deficiencies of essential vitamins and minerals – in vulnerable mothers and their children. It is also a follow-up to the recommendations outlined in The Lancet Series on Maternal and Child Undernutrition in 2008.
The authors of the paper include Professor Zulfiqar Bhutta, Founding Director, Centre of Excellence in Women and Child Health, Dr Jai K Das, Senior Instructor, and Ms Arjumand Rizvi, Senior Data Analyst from Aga Khan University.
As part of the review, the authors meticulously searched through all available data on 43 nutrition-related interventions, eventually short-listing down to just 10 core interventions. These include providing folic acid, calcium, and balanced energy protein and micronutrient supplements to pregnant women; promoting breastfeeding and delivering appropriate complementary feeding to infants; providing vitamin A and zinc supplements to children up to the age of five; and using proven treatment strategies to manage moderate and severe malnutrition in children.
In a major step-up to the 2008 review recommendations, the authors also assessed the potential effect of different ways of reaching out to and engaging with poor and difficult-to-access populations.
Community-based promotion and delivery of seven nutrition-specific interventions in three countries, Pakistan, Bangladesh and Ethiopia, showed that the effects of scaling up is greatest in the poorest income groups, reducing not only the overall burden of childhood deaths but also substantially lessening existing disparities in access and mortality
The Pakistan projections revealed that the proportion of deaths averted of children younger than five years would be more than 20 per cent in poorest, 10 per cent in poorer and five per cent in middle income groups as compared to less than five per cent in richer and richest groups.
“The alarming results of Pakistan’s National Nutrition Survey 2011 show that too many children are sick or dying, wasted or stunted in early childhood, in that special window of opportunity between pre-pregnancy and two years of age, when good nutrition is needed for a healthy and productive life,” stressed Professor Bhutta. “The potential benefits to the affected countries in terms of improved productivity and reduced healthcare costs are substantial.”
It is thus important to “scale up integrated packages of health and nutrition interventions,” said Dr Bhutta.
Providing these interventions is estimated to save 900,000 children annually, at an estimated cost of US$9.6 billion. More than half of this cost is accounted for by India and Indonesia, both countries with sufficient financial resources to make a substantial contribution to the cost of stepping up the fight against malnutrition.
The authors estimate that once plausible contributions by affected countries are taken into account, the remaining cost to external donors would be around $3-4 billion — somewhat less than Coca-Cola and McDonalds’ combined annual spend on advertising.
About The Lancet series on Nutrition
In 2008, The Lancet had published its first series on the issue of maternal and child undernutrition. The series called for a focus on nutrition in the first 1000 days of a child’s life for lasting benefits throughout life, and stronger integration and partnerships at regional, national and global levels in all sectors.
With its 2013 edition on the subject, The Lancet has re-evaluated the problems and examined the issue of overweight and obesity for women and children and their consequences in low-income and middle-income countries.
The four papers in the series are Maternal and child undernutrition and overweight in low-income and middle-income countries; Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost; Nutrition-sensitive interventions and programmes: how can they help to accelerate progress in improving maternal and child nutrition; and The politics of reducing malnutrition: building commitment and accelerating progress.