Implementation of existing maternal and child nutrition-related interventions could prevent 25% of all child deaths in the 36 countries with the highest burden of undernutrition. Breastfeeding counselling and vitamin A supplementation are currently the nutrition strategies with the greatest potential to cut child deaths. These are the conclusions of Professor Zulfiqar Bhutta, Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan, and Professor Simon Cousens, London School of Hygiene and Tropical Medicine, UK, and colleagues, authors of the third paper in The Lancet's Series on Maternal and Child Undernutrition.
The authors reviewed interventions to promote breastfeeding; strategies to promote complementary feeding, with or without provision of food supplements; micronutrient supplementation; general support strategies for family and community nutrition; and reduction of disease burden, eg. promotion of handwashing strategies to reduce malaria burden during pregnancy. They studied how these factors affected children’s growth patterns and risk of death. In populations with enough food, education about complimentary feeding increased the height-for-age Z score* by 0.25 standard deviations (SDs), while provision of food supplements increased the score by 0.41 SDs in food-insecure populations.
Further, they found that management of severe acute malnutrition (SAM) using WHO guidelines can reduce case-fatalities related to this condition by 55%. However this requires admission to a health facility. Less intensive, community based management of SAM using ready-to-use therapeutic foods also has the potential to reduce mortality substantially and is likely to be easier to implement at high coverage. For pregnant women, supplementation with iron folate increased their blood haemoglobin levels at term by 12g/L, decreasing the risk of death for women who experience haemorrhage, while supplementation with multiple micronutrients reduced the risk of low birthweight at term by 16%. However, the authors note that more research is needed to assess maternal nutrition interventions at sufficient scale. For children, vitamin A supplementation in the neonatal and in late-infancy periods were recommended, as were preventive zinc supplements, iron supplements in non-malaria endemic areas, and universal promotion of iodised salt.
Modelling the effects of these nutrition-related interventions, the authors estimated that, if implemented at high coverage in the 36 countries with the highest burden of undernutrition, they could reduce mortality between birth and 36 months by about 25%, reduce stunting at 36 months by 36%, and reduce the disability-adjusted life-years (DALYs) associated with stunting, severe wasting, intrauterine growth restriction, and micronutrient deficiencies by around 25%.
But the authors add that nutrition strategies on their own are not enough, saying: “Although available interventions can make a clear difference in the short term, elimination of stunting will also require long-term investments to improve education, economic status, and empowerment of women.”
They conclude: “Attention to the continuum of maternal and child undernutrition is essential to attainment of several of the Millennium Development Goals and must be prioritised globally and within countries. Countries with a high prevalence of undernutrition must decide which interventions should be given the highest priority, and ensure their effective implementation at high coverage to achieve the greatest benefit. We have shown that the evidence for benefit from nutrition interventions is convincing. What is needed is the technical expertise and the political will to combat undernutrition in the very countries that need it most.”
Notes to editors: *Height for age Z score is an internationally accepted measure for evaluating stunting or how short a child is in comparison to the normal range. For the series, this has now been estimated using the new WHO growth reference standards based on breastfed children
Professor Simon Cousens, London School of Hygiene and Tropical Medicine, UK, T) +44 (0) 20 7927 2422 E) simon.cousens@lshtm.ac.uk
Professor Zulfiqar Bhutta, Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan T) +92 21 4864782 /+92 300 8236813 E) zulfiqar.bhutta@aku.edu
The paper associated with this release can be viewed at
http://www.eurekalert.org/jrnls/lance/undernutrition3.pdf
Journal
The Lancet