<br><span class="gmail_quote">From: <b class="gmail_sendername">Ruggiero, Mrs. Ana Lucia (WDC)</b> <<a href="mailto:ruglucia@paho.org">ruglucia@paho.org</a>><br>crossposted from: <a href="mailto:EQUIDAD@listserv.paho.org">EQUIDAD@listserv.paho.org</a><br>
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<p><font face="Arial" size="2"><span style="FONT-SIZE: 10pt; FONT-FAMILY: Arial">            <b><font color="#333399"><span style="FONT-WEIGHT: bold; COLOR: #333399">The Lancet Series, Maternal and child undernutrition </span></font></b></span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: maroon; FONT-FAMILY: Arial">What works? Interventions for maternal and child undernutrition and survival</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><br></span></font><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 9pt; COLOR: navy; FONT-FAMILY: Arial">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</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="navy" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">The Lancet, Volume 371, Number 9610, 2 February 2008</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><br></span></font><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">Full text available online at: <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616936/fulltext" target="_blank"><font color="navy"><span style="COLOR: navy">http://www.thelancet.com/journals/lancet/article/PIIS0140673607616936/fulltext</span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="1"><span style="FONT-SIZE: 8pt; COLOR: navy; FONT-FAMILY: Arial">[Free subscription required]</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"><br>"…..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.</span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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. </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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. </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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%. </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial">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…."</span></font></p>

<p><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p><font face="Arial" color="navy" size="2"><span style="FONT-SIZE: 10pt; COLOR: navy; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#993300" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #993300; FONT-FAMILY: Arial">Maternal and child undernutrition: consequences for adult health and human capital</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"><br>Cesar G Victora, Linda Adair, Caroline Fall, Pedro C Hallal,  Reynaldo Martorell, Linda Richter, Harshpal Singh Sachdev<br>
Maternal and Child Undernutrition Study Group</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#333399" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">The Lancet, Volume 371, Number 9609, 26 January 2008</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Available online at; <a onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616924/fulltext" target="_blank"><font color="#333399"><span style="COLOR: #333399">http://www.thelancet.com/journals/lancet/article/PIIS0140673607616924/fulltext</span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="maroon" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: maroon; FONT-FAMILY: Arial">Maternal and child undernutrition: global and regional exposures and health consequences</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Robert E Black, Lindsay H Allen,  Zulfiqar A Bhutta, Laura E Caulfield, Mercedes de Onis, Majid Ezzati, Colin Mathers, Juan Rivera<br>
Maternal and Child Undernutrition Study Group</span></font></p>
<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#333399" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">The Lancet,  Volume 371, Number 9608, 19 January 2008</span></font></b></p>

<p style="MARGIN-LEFT: 0.5in"><b><font face="Arial" color="#333399" size="2"><span style="FONT-WEIGHT: bold; FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></b></p>
<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial">Available online at: <a title="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext" onclick="return top.js.OpenExtLink(window,event,this)" href="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext" target="_blank"><font title="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext" color="#333399"><span title="http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext"><span style="COLOR: #333399">http://www.thelancet.com/journals/lancet/article/PIIS0140673607616900/fulltext</span></span></font></a> </span></font></p>

<p style="MARGIN-LEFT: 0.5in"><font face="Arial" color="#333399" size="2"><span style="FONT-SIZE: 10pt; COLOR: #333399; FONT-FAMILY: Arial"> </span></font></p>
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