PHA-Exch> Maternal and child undernutrition: an urgent opportunity: Lancet

[Claudio Schuftan]

    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-3.5million-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?
-------------- next part --------------
An HTML attachment was scrubbed...
URL: <http://phm.phmovement.org/pipermail/phm-exchange-phmovement.org/attachments/20080118/f860942a/attachment-0001.html>