PHA-Exch> What works? Interventions for maternal and child undernutrition and survival

[Claudio Schuftan]

From: Ruggiero, Mrs. Ana Lucia (WDC) <ruglucia at paho.org>
crossposted from: EQUIDAD at listserv.paho.org

             *The Lancet Series, Maternal and child undernutrition *



*What works? Interventions for maternal and child undernutrition and
survival*


Zulfiqar A Bhutta,  Tahmeed Ahmed,    Robert E Black,   Simon Cousens
Kathryn Dewey, Elsa Giugliani,   Batool A Haider ,  Betty Kirkwood,   Saul S
Morris,  HPS Sachdev   and   Meera Shekar,   for the Maternal and Child
Undernutrition Study Group

*The Lancet, Volume 371, Number 9610, 2 February 2008*


Full text available online at:
http://www.thelancet.com/journals/lancet/article/PIIS0140673607616936/fulltext

[Free subscription required]


"…..We reviewed interventions that affect maternal and child undernutrition
and nutrition-related  outcomes. These interventions included promotion of
breastfeeding; strategies to promote complementary feeding, with or without
provision of food supplements; micronutrient interventions; general
supportive strategies to improve family and community nutrition; and
reduction of disease burden (promotion of handwashing and strategies to
reduce the burden of malaria in pregnancy). We showed that although
strategies for breastfeeding promotion have a large effect on survival,
their effect on stunting is small.



In populations with sufficient food, education about complementary feeding
increased height-for-age Z score by 0•25 (95% CI 0•01–0•49), whereas
provision of food supplements (with or without education) in populations
with insufficient food increased the height-for-age Z score by 0•41
(0•05–0•76). Management of severe acute malnutrition according to WHO
guidelines reduced the case-fatality rate by 55% (risk ratio 0•45,
0•32–0•62), and recent studies suggest that newer commodities, such as
ready-to-use therapeutic foods, can be used to manage severe acute
malnutrition in community settings.



Effective micronutrient interventions for pregnant women included
supplementation with iron folate (which increased haemoglobin at term by 12
g/L, 2•93–21•07) and micronutrients (which reduced the risk of low
birthweight at term by 16% (relative risk 0•84, 0•74–0•95). Recommended
micronutrient interventions for children included strategies for
supplementation of vitamin A (in the neonatal period and late infancy),
preventive zinc supplements, iron supplements for children in areas where
malaria is not endemic, and universal promotion of iodised salt.



We used a cohort model to assess the potential effect of these interventions
on mothers and children in the 36 countries that have 90% of children with
stunted linear growth. The model showed that existing interventions that
were designed to improve nutrition and prevent related disease could reduce
stunting at 36 months by 36%; mortality between birth and 36 months by about
25%; and disability-adjusted life-years associated with stunting, severe
wasting, intrauterine growth restriction, and micronutrient deficiencies by
about 25%.

To eliminate stunting in the longer term, these interventions should be
supplemented by improvements in the underlying determinants of
undernutrition, such as poverty, poor education, disease burden, and lack of
women's empowerment…."





*Maternal and child undernutrition: consequences for adult health and human
capital*


Cesar G Victora, Linda Adair, Caroline Fall, Pedro C Hallal,  Reynaldo
Martorell, Linda Richter, Harshpal Singh Sachdev
Maternal and Child Undernutrition Study Group

*The Lancet, Volume 371, Number 9609, 26 January 2008*



Available online at;
http://www.thelancet.com/journals/lancet/article/PIIS0140673607616924/fulltext





*Maternal and child undernutrition: global and regional exposures and health
consequences*



Robert E Black, Lindsay H Allen,  Zulfiqar A Bhutta, Laura E Caulfield,
Mercedes de Onis, Majid Ezzati, Colin Mathers, Juan Rivera
Maternal and Child Undernutrition Study Group

*The Lancet,  Volume 371, Number 9608, 19 January 2008*

* *

Available online at:
http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext
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