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CSU 16/2008: INTERVENTIONS FOR MATERNAL & CHILD UNDERNUTRITION & SURVIVAL

Friday, 18th of April 2008

CSU 16/2008: INTERVENTIONS FOR MATERNAL & CHILD UNDERNUTRITION & SURVIVAL
 
 In this abstract, Bhutta and colleagues review the evidence on
 interventions for nutrition and survival; readers will find important
 points highlighted below in boldface
 
 "[E}xisting 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%."
 
 Full text is available on line to Lancet subscribers.
 
 Good reading.
 
 BD
 
 
 
1: Lancet. 2008 Feb 2;371(9610):417-40.
 What works? Interventions for maternal and child undernutrition and
 survival.
 Bhutta ZA, Ahmed T, Black RE, Cousens S, Dewey K, Giugliani E, Haider
 BA, Kirkwood B, Morris SS, Sachdev HP, Shekar M; Maternal and Child
 Undernutrition Study Group.
 
 
 Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@aku.edup
 
 
 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.
 
 Related Links
 Addressing malnutrition in young children in South Africa.
 Setting the national context for paediatric food-based dietary
 guidelines. [Matern Child Nutr. 2007]
 Vitamin A supplements ameliorate the adverse effect of HIV-1,
 malaria, and diarrheal infections on child growth. [Pediatrics.
 2002]
 Onset and evolution of stunting in infants and children.
 Examples from the Human Nutrition Collaborative Research
 Support Program. Kenya and Egypt studies. [Eur J Clin Nutr.
 1994]
 Perspectives on nutrition needs for the new millennium for
 South Asian regions. [Biomed Environ Sci. 2001]
 [Control of iron deficiency in developing countries] [Sante.
 2002]