Maternal and child undernutrition: Effective action at national level. The Lancet, 371(9611), 510-526

Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA.
The Lancet (Impact Factor: 45.22). 03/2008; 371(9611):510-26. DOI: 10.1016/S0140-6736(07)61694-8
Source: PubMed


80% of the world's undernourished children live in just 20 countries. Intensified nutrition action in these countries can lead to achievement of the first Millennium Development Goal (MDG) and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 and 5). Despite isolated successes in specific countries or for interventions--eg, iodised salt and vitamin A supplementation--most countries with high rates of undernutrition are failing to reach undernourished mothers and children with effective interventions supported by appropriate policies. This paper reports on an assessment of actions addressing undernutrition in the countries with the highest burden of undernutrition, drawing on systematic reviews and best-practice reports. Seven key challenges for addressing undernutrition at national level are defined and reported on: getting nutrition on the list of priorities, and keeping it there; doing the right things; not doing the wrong things; acting at scale; reaching those in need; data-based decisionmaking; and building strategic and operational capacity. Interventions with proven effectiveness that are selected by countries should be rapidly implemented at scale. The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects. Programme efforts, as well as monitoring and assessment, should focus on this segment of the continuum of care. Nutrition resources should not be used to support actions unlikely to be effective in the context of country or local realities. Nutrition resources should not be used to support actions that have not been proven to have a direct effect on undernutrition, such as stand-alone growth monitoring or school feeding programmes. In addition to health and nutrition interventions, economic and social policies addressing poverty, trade, and agriculture that have been associated with rapid improvements in nutritional status should be implemented. There is a reservoir of important experience and expertise in individual countries about how to build commitment, develop and monitor nutrition programmes, move toward acting at scale, reform or phase-out ineffective programmes, and other challenges. This resource needs to be formalised, shared, and used as the basis for setting priorities in problem-solving research for nutrition.

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Available from: David L Pelletier, Oct 01, 2015
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    • "Two of the papers involved the development of recommendations for how countries could move the nutrition agenda forward [paper 4 (Bryce et al., 2008)] and how the international nutrition system could overcome its governance challenges [paper 5 (Morris et al., 2008]. Paper 4 was written by three engaged academics (including myself) and two senior nutrition staff from UN agencies (Bryce et al., 2008 "
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    ABSTRACT: Biological anthropologists within academia and in other sectors are increasingly engaged in a variety of problem-oriented research and in the design, implementation, or evaluation of policies and programs, domestically and abroad. Such work can have distinctive requirements in terms of disciplinary background, professional orientation, and professional development. This article explores these issues through the author's autobiographical account of a career in food and nutrition policy from within an academic nutrition department.. The article is guided by an analytical framework that compares eight projects in terms of their mode of knowledge production, academic impact, public impacts, and personal rewards. The projects range from village-based surveys in Samoa and Malawi to food security planning in upstate New York communities, US policies on genetically engineered (GE) foods, and participant-observer research on nutrition policy development in low-income countries. The cumulative experience reveals the importance of a commitment to problem-solving, a transdisciplinary orientation, intellectual and methodological dexterity, ongoing engagement with policy actors and openness to emergent research questions, new research settings, and nontraditional funding sources. Am. J. Hum. Biol., 2014. © 2014 Wiley Periodicals, Inc.
    American Journal of Human Biology 01/2015; 27(1). DOI:10.1002/ajhb.22523 · 1.70 Impact Factor
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    • "In facing this pattern of underinvestment, the food and nutrition community has increasingly come to agree that building political commitment is essential to furthering food and nutrition security on government agendas (Heaver 2005; Bryce et al. 2008; Natalicchio et al. 2009; Mejía-Acosta 2011; Pelletier et al. 2011; Gillespie et al. 2013). Despite this agreement, the concept of political commitment for food and nutrition is rarely adequately defined or empirically measured (Fox et al. 2011; Goldberg et al. 2012). "
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    ABSTRACT: Lack of political commitment has been identified as a primary reason for the low priority that food and nutrition interventions receive from national governments relative to the high disease burden caused by malnutrition. Researchers have identified a number of factors that contribute to food and nutrition's 'low-priority cycle' on national policy agendas, but few tools exist to rapidly measure political commitment and identify opportunities to advance food and nutrition on the policy agenda. This article presents a theory-based rapid assessment approach to gauging countries' level of political commitment to food and nutrition security and identifying opportunities to advance food and nutrition on the policy agenda. The rapid assessment tool was piloted among food and nutrition policymakers and planners in 10 low- and middle-income countries in April to June 2013. Food and nutrition commitment and policy opportunity scores were calculated for each country and strategies to advance food and nutrition on policy agendas were designed for each country. The article finds that, in a majority of countries, political leaders had verbally and symbolically committed to addressing food and nutrition, but adequate financial resources were not allocated to implement specific programmes. In addition, whereas the low cohesion of the policy community has been viewed a major underlying cause of the low-priority status of food and nutrition, the analysis finds that policy community cohesion and having a well thought-out policy alternative were present in most countries. This tool may be useful to policymakers and planners providing information that can be used to benchmark and/or evaluate advocacy efforts to advance reforms in the food and nutrition sector; furthermore, the results can help identify specific strategies that can be employed to move the food and nutrition agenda forward. This tool complements others that have been recently developed to measure national commitment to advancing food and nutrition security.
    Health Policy and Planning 06/2014; 30(5). DOI:10.1093/heapol/czu035 · 3.47 Impact Factor
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    • "The Millennium Development Goals (MDGs) one and four which intend to eradicate extreme poverty and hunger and reduce child mortality respectively by two-thirds by the year 2015 were set to aid in the reduction of the malnutrition burden [8]. Also, there have been various interventions such as exclusive breastfeeding and micronutrient supplementation to reduce child malnutrition in developing countries [9]. "
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    ABSTRACT: Background Stunting, is a linear growth retardation, which results from inadequate intake of food over a long period of time that may be worsened by chronic illness. Over a long period of time, inadequate nutrition or its effects could result in stunting. This paper examines the correlates of stunting among children in Ghana using data from the 2008 Ghana Demographic and Health Survey (GDHS). Methods The paper uses data from the children recode file of the 2008 Demographic and Health Survey (DHS), a nationally representative cross sectional survey conducted in Ghana. A total of 2379 children under five years who had valid anthropometric data were used for the study. Data on the stunting of children were collected by measuring the height of all children under six years of age. A measuring board produced by Shorr Productions was used to obtain the height of the children. Children under 2 years of age were measured lying down on the board while those above 2 years were measured standing. In the DHS data, a z-score is given for the child’s height relative to the age. Both bi-variate and multi-variate statistics are used to examine the correlates of stunting. Results Stunting was common among males than females. Age of child was a significant determinant of stunting with the highest odd of stunting been among children aged 36–47 months. Region was significantly related to stunting. Children from the Eastern Region were more likely to be stunted than children from the Western Region which is the reference group (OR = 1.7 at p < 0.05). Number of children in household was significantly related to stunting. Children in households with 5–8 children were 1.3 times more likely to be stunted compared to those with 1–4 children (p < .05). Mother’s age was a significant predictor of stunting with children whose mothers were aged 35–44 years being more likely to be stunted. Conclusion Culturally appropriate interventions and policies should be put in place to minimise the effects of the distal, proximal and intermediate factors on stunting among under 5 children in Ghana.
    BMC Public Health 05/2014; 14(1):504. DOI:10.1186/1471-2458-14-504 · 2.26 Impact Factor
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