Nutrition interventions could prevent a quarter of child deaths in poor communities

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Public release date: 16-Jan-2008

http://www.eurekalert.org/pub_releases/2008-01/l-nic011108.php

Contact: Professor Simon Cousens

simon.cousens@...

44-2

Lancet

Nutrition interventions could prevent a quarter of child deaths in poor

communities

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.”

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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@...

Professor Zulfiqar Bhutta, Department of Pediatrics and Child Health,

Aga Khan University, Karachi, Pakistan T) +92 21 4864782 /+92 300

8236813 E) zulfiqar.bhutta@...

The paper associated with this release can be viewed at

http://www.eurekalert.org/jrnls/lance/undernutrition3.pdf

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