Mothers participating in the USAID ACCESO program in Santa Maria, La Paz, Honduras are being taught how to prepare more nutritious food for their undernourished children by incorporating the vegetables they grow in their gardens into their traditional rice and tortilla diet. Here a young child eats a spoonful of visibly nutritious rice, as his older sister looks on. Photo is from Michelle Los Banos-Jardina, USUN Rome.
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Evidence has been mounting to support the hypothesis that maternal undernutrition, as well as in-utero infant and young child undernutrition, are correlated with the risk of developing nutrition related non-communicable diseases (N-RNCDs) later in life. Since 2012, the Strengthening Partnerships, Results, Innovations around Nutrition Globally (SPRING) Project has been mining this evidence base for information that can help program planners and policy makers better conceptualize what this correlation could mean in practical terms for maternal and child nutrition interventions.
SPRING has completed several activities that contribute to this effort. As a first step, we conducted descriptive analyses of secondary data in selected regions and countries to explore where future N-RNCD risks may lie, and to identify how undernutrition programs may need to be tailored to reduce health problems as children and adolescents reach adulthood. Currently SPRING has ten country profiles across Africa and Southeast Asia, and two regional profiles that summarize trends across countries for these two regions.
Based on these descriptive analyses for our selected countries, we found that most nutritionally at-risk countries had several sub-populations with overlapping nutritional burdens (where both under- and over-nutrition were present at the same time within the same household or same individual). While one would expect this to consistently happen in the wealthier, more educated households, this pattern was not uniform across countries, and several countries such as Zambia and Malawi, the less wealthy, rural, and the less educated also saw significant overlap.
While sub-national analyses could not be conducted for pre-NCD and N-RNCD conditions, in the regional profiles we were able to examine trends and prevalence across nations. According to the World Health Organization (WHO) type II diabetes mellitus (diabetes) and cardiovascular disease (CVD), along with cancer and other NCDs, account for around one-quarter to one-third of all deaths in SSE Asia (calculated from WHO 2011) and around one-third of all deaths in Africa (calculated from WHO 2011). The data that have been estimated for prevalence of diabetes, show that while growth of diabetes in SSE Asian countries has not been remarkable, it does in fact have one of the highest average prevalence rates of diabetes among adult women, only recently overtaken by the Americas region in 2007. While Africa overall does not have a particularly high rate of diabetes, there has been a steady increase over the ten most recent years of data. The range of diabetes prevalence is quite wide for this region, with the lowest figure being 5.9% in Burundi, and the highest being 14.7% in Cape Verde (2008 estimates). Southern Africa seems to have the highest sub-region burden, with Swaziland and Lesotho both coming in at around 12%. For comparison, the United States had an average prevalence for adult women of 9.1% that year.
The regional profiles also discuss the national trends in calorie availability and child nutritional status, to highlight where future risk may be building. For copies of the regional and country briefs, and to learn more about SPRING, please go visit their website. SPRING will be adding new country profiles as needed, so check back for additional countries.
The country and regional profiles are a useful first step in operationalizing research into usable information for program planning and policy advocacy. As a second step, SPRING completed the first phase of a cost effectiveness simulation model looking at the short and long term effects of undernutrition interventions that are conducted in the first 1,000 days. The goal is to produce a more inclusive understanding of the relative value of nutrition interventions by extending the time frame for estimating benefits, specifically in terms of quantifying the ‘value added’ by their impact on early life genetic programming and any resulting later life course N-RNCD risk. For more information on our simulation model, please see our activities.
Going forward, SPRING will actively work with USAID to identify innovative applications of these resources to country programs. Via improved planning, advocacy, and targeting, this information can contribute to reducing the impacts of NCDs via better nutrition across the globe.
This blog is part of a new interview blog series called “Behind the Scenes.” It includes interviews with USAID leaders, program implementers, Mission Directors, and development issue experts who help fulfill USAID’s mission. They are a casual behind-the-scenes look into USAID’s daily effort to deliver economic, development and humanitarian assistance around the world — and the results we’ve seen.
In this issue, we interview Dr. Ariel Pablos-Méndez, Assistant Administrator for Global Health, about the key role nutrition has in global health.
Tell us about nutrition and how programs fit into the effort to end preventable child death?
It is a very exciting time for nutrition with the global community coming together to commit to halting a leading killer of children: undernutrition. This week also marks the one year anniversary of the Child Survival Call to Action when the United States joined UNICEF and the governments of Ethiopia and India, in a bold pledge to catalyze action towards ending preventable child deaths within a generation. What emerged from the Call to Action was a rejuvenated global movement for child survival under the banner of ‘Committing to Child Survival: A Promise Renewed.’ Since then, 174 governments have renewed their promise to children by pledging to redouble efforts on child survival. Obviously, good nutrition is very closely linked to the Call to Action and the A Promise Renewed movement. We will continue to work with our partners to build on the progress made since the launch of the call to action, strengthen efforts to scale up evidence-based nutrition interventions during the first 1,000 days, and cultivate new leaders and nutrition champions to help us achieve our goals.
Why is The Lancet series important?
The Lancet Series on Maternal and Child Nutrition re-focuses the global community on the critical importance of proper nutrition in preventing child and maternal deaths and in preventing later complications from non-communicable diseases and in ensuring that children have the best start in life. The Series also provides strong evidence that improving nutrition is one of the best ways to achieve lasting progress in development. One of the most sobering statistics from this ground-breaking series is that more than 45% of deaths in children under 5 years of age are attributable to nutrition disorders, resulting in more than 3 million deaths annually.
It has been five years since the 2008 Lancet nutrition series, which galvanized the global community around evidence-based interventions for the prevention of needless suffering and death among children. The 2008 series brought focus to the crucial and strategic importance of good nutrition to the first 1,000 days between pregnancy and the second birthday. We agree with the authors of the Lancet series that “now is our crucial window of opportunity to scale up nutrition.” Indeed, we must work together to seize this opportunity to create the future we want.
How is the U.S. prioritizing nutrition?
The U.S. is providing global leadership, mobilizing our resources with a keen focus on results, and helping accelerate partnerships needed to achieve impact. From the creation of his Feed the Future initiative to launching the New Alliance for Food Security and Nutrition, President Obama has championed food security and nutrition. Nutrition is the defining link between Feed the Future and the Global Health Initiative. Addressing undernutrition is critical to meeting our shared goal of ending preventable child and maternal deaths.
To demonstrate this commitment, we have coordinated and packaged, for the first time, the significant USG effort behind global nutrition: $1 billion for nutrition-specific interventions and nearly $9 billion for nutrition-sensitive activities over fiscal years 2012-2014. Also, USAID will develop a comprehensive nutrition strategy, informed by robust USG interagency input and learning. Supported by USAID’s Bureaus for Global Health and Food Security, Administrator Shah will personally serve as the focal point for coordinating nutrition programs.
What is new or different in your approach?
The U.S. is continuing to advance nutrition through a modern approach and new model of development that emphasizes innovation, technology, and a focus on the private sector and civil society organizations as key partners to ensure long-term success because we know we cannot do this alone. By leveraging the resources and expertise of a diverse constellation of actors — from the private sector to research universities — we can leapfrog traditional development barriers and create solutions that will encourage countries to create their own development plans to achieve their own national nutrition goals. In support of the Scaling Up Nutrition (SUN) Movement and the 1,000 Days partnership, USG has made a new commitment to track “nutrition-sensitive” and “nutrition-specific” investments so that we provide consistent, accurate and meaningful reporting on programs.
Where must we do better?
We must crowd in local resources. Host country-led investment in nutrition is absolutely critical. But beating hunger and undernutrition takes leadership and collective action, not just resources. Countries themselves must take ownership and accountability in the fight and local civil society has a critical role in ensuring sustained commitment and investment at a country-level. It is also vital for donor partners to better coordinate our work. The strength of cooperation is crucial in the changing development landscape. Ultimately, coordination brings programmatic synergies, economies of scale, reduced duplication of effort, shared risk, and streamlined reporting. Importantly, in the current global health architecture, coordination among us can help us achieve better impact in complex systems.
Follow Dr. Ariel Pablos-Méndez on Twitter (@ampablos).
This originally appeared on the Feed the Future Blog.
When I was pregnant with my sons, I paid close attention to my diet. I cut out caffeine and the occasional alcoholic drink. I ate more spinach when my body needed more iron.
I continued to make adjustments to my diet when I breastfed my boys for the first several months of their lives. I thought about the food I put in my body for the health of my babies and for me.
I knew the importance of nutrition in those early stages of childhood, even before my kids were born. What I didn’t realize is that if a child isn’t given the proper nutrition in the first 1,000 days of life, from pregnancy to age 2, his growth could be stunted and his performance in school could be affected.
To think that pregnant women and children are lucky to even have a daily meal, let alone a nutritious one, never even crossed my mind when I was pregnant.
I was lucky to have the means to eat a healthy diet and access to the food my body needed.
I’m much more aware of what it means to be food insecure these days. My nonprofit work in Maine has opened my eyes to child poverty that I didn’t know existed in my own back yard. Nearly 1 in 4 children in Maine are food insecure.
I’ve written blog posts on food insecurity, hunger and global nutrition. Honestly, I wasn’t sure how my audience would react to such subjects. Hearing about 165 million malnourished children in the world isn’t exactly uplifting.
But I always try to show the good that can come out of such knowledge, whether it’s a local restaurant giving a meal to needy families for every meal sold or employees tending a garden to stock a food pantry. Telling the stories of those who are helping to solve these problems inspires action in others.
On a global level, there is much to be done. An initiative like the U.S. Government’s Feed the Future, led by USAID, is leading the way by showing how nutrition, poverty and food insecurity are all related.
Rather than taking a one-size-fits-all approach, Feed the Future is addressing undernutrition through country-owned programs. They are looking at agricultural development and addressing the most at-risk population, women and children. The investment in food security is seen as an investment in our own economy. I am elated to see that almost 12 million children under 5 have been reached by Feed the Future nutrition programs.
It’s encouraging to see our world leaders take on global malnutrition.
Together, we can keep them accountable.
About the author: Jennifer Barbour is a copywriter, blogger, aspiring author and new media consultant. She aims to inspire, to entertain and to make you think. Her passions are writing, philanthropy, her awesome family and bacon, though not necessarily in that order. You can find out more at anotherjennifer.com.
Gaz Mohamed Mohamed Hussein Al Masarah comes from Masrah, a small village on the Nile about 40 kilometers (25 miles) north of the governorate capital of Asyut, Upper Egypt. She is 25-years-old and delighted to be included in a group of 20 young women selected by the SMART Project (Community-based Initiatives for a Better Life, funded by USAID) to work as Community Health Workers (CHWs) in their own communities. This class of 20 future CHWs is part of a total cadre of 1,200 women who have been trained.
The SMART project—a USAID-funded MCHIP project that focuses on improving maternal and neonatal health and nutrition—works through community development associations in Upper and Lower Egypt to train physicians and CHWs to improve newborn care, nutrition, and the use of modern family planning methods. Providers and CHWs are trained to focus on the nutritional habits of pregnant and lactating women, implement perinatal practices (such as intensive care for preterm or low birth weight babies), and encourage exclusive breastfeeding for six months.
During a break in the training on infant nutrition, Gaz recounts how, as one of six children, her family was never able to afford to send her to school. Her older sister married young and her brothers attended primary school, but Gaz was kept at home to help her mother. However, when she was 10-years-old, a relative started a literacy class in the village, and persuaded Gaz’s father to allow her to attend.
Gaz laughs when she tells how happy she was to carry her books around like the other students she had seen. She worked hard at the literacy classes and was soon able to join Year 5 in Primary School. She finished with good results and, with the support of her father, went on to secondary school, where at graduation her marks were good enough for her to have entered the faculty of agriculture, education, or commerce. However, her father did not want her to move into Asyut to continue her studies.
Not wanting to stay in the house all day, Gaz began to look for something she could do in her village. At the beginning of 2012, she was nominated by a local community development association to participate in the SMART training course for CHWs. The Smart Project selects CHWs in every community in the targeted governorates to visit pregnant and breastfeeding women in order to disseminate messages about healthy nutritional habits and infant care. Gaz’s best friend from school, Manal, was also nominated, and they were very excited to join the training together.
Gaz excitedly shares her knowledge from the training. She says she has learned about the benefits of breastfeeding and is convinced it will help mothers who traditionally start feeding their children different drinks and soup after only 40 days. She speaks confidently and enthusiastically about her new role in the community, saying how happy she is to be able to help her neighbors and friends in the village. Thankfully, her father has also accepted the idea that his daughter is working.
Gaz’s mother is proud of her daughter, too, especially for choosing to help other women. As the first woman in the family to have received an education and worked outside the home, Gaz contributes some of her monthly salary toward the family food bill. The rest she is saving for her marriage expenses. Although she is engaged, she is in no hurry to marry and insists she will continue working after she marries. She recognizes that the knowledge she has gained during the CHW training will be very useful for her when she has children of her own.
And reflecting back on her childhood desire to go to school, Gaz says she never would have imagined that she would one day have the information and confidence to go into women’s homes to discuss health and nutrition issues. “I just wanted to be educated like my brothers,” she says. “And that gave me the chance to be working and helping people. I wish that all the girls in Masrah could have an education. With education we could chase the ghost of malnutrition from Asyut!”
Learn more about USAID’s work on improving nutrition.
In communities across Malawi, men and women like Eliza are attending facilitated discussions using interactive toolkits developed by BRIDGE II and implemented by local partners. BRIDGE II is a five-year HIV prevention project, supported by USAID, through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). As it winds down, data is being collected on the extent of the project’s reach and how it is impacting the knowledge, attitude and behavioral practices of individuals and communities. But how do we go beyond the numbers and document those successful approaches and tools and share the value of interpersonal communication and education as key to changing people’s beliefs and practices?
BRIDGE II aims to reduce new HIV infections through eliminating barriers to individual action and shifting social norms. It addresses key risk factors for HIV in Malawi such as having more than one sexual partner at a time, lack of condom use, and alcohol abuse. Gender norms and inequities often lie beneath these risky behaviors, and BRIDGE II openly addresses these issues. A multi-sectoral project with a strong community focus, BRIDGE works directly through creative multi-media campaigns, transformative and participatory toolkits (like the Hope Kit, PDF), interactive radio programs, service referral and linkages, and community theater. BRIDGE also builds local capacity by providing support to community and faith-based networks to strengthen their HIV prevention programs. The goal is lasting, positive change that not only prevents new HIV infections, but also strengthens the ability of Malawi’s communities to care for and protect themselves.
Through concerted effort by dedicated staff and an engaged network of partners, these approaches and tools are showing promising signs of change, particularly in the lives of women like Eliza who have been empowered to make healthier lifestyle choices for themselves and their families. Men and women understand their HIV risk and are gaining the information, skills and motivation they need to prevent infection. People are utilizing HIV-related services and adopting safer sexual practices and couples are openly communicating about their relationship in a way they never have before. They are getting tested for HIV and keeping love within their homes. Systems and institutions are strengthened to take the lead in HIV prevention through greater coordination and thought leadership.
The tools created within BRIDGE II will soon be made available to a wider audience as a comprehensive online kit via K4Health. This toolkit can be used by others to facilitate open communication about behavior change to curb HIV. Click here for more information on BRIDGE II and please check back at the end of the year to find more information on the e-Toolkit!
In this Feed the Future video, narrator Matt Damon discusses efforts to turn the tide against global hunger and increase agricultural production around the world. The video was shown at the “Feed the Future: Partnering With Civil Society” event on September 27, 2012.
This morning, during a global nutrition-focused event co-hosted by Bread for the World Institute and Concern Worldwide, USAID announced its ongoing commitment to work with the U.S. Government’s leadership to reduce undernutrition around the world. The event followed the Nutrition for Growth event in London. During his trip and on behalf of the U.S. Government, Administrator Shah signed the Global Nutrition for Growth Compact which commits donors and private partners to scale up nutrition programs specifically targeted to reduce undernutrition in women and children.
Also last week, Administrator Rajiv Shah and Tjada McKenna, deputy coordinator for Feed the Future, participated in a Google+ Hangout on the role of nutrition in child survival and food security nutrition with representatives from the ONE Campaign, GAIN and 1,000 Days, as well as Candice Kumai, who is a chef, food writer, Iron Chef Judge and nutrition champion for Future Fortified.
Learn more about USAID’s work on improving nutrition.
Most people have never heard of stunting. It’s one of the least reported, least recognized, least understood issues facing humanity, yet tackling it should be seen as an opportunity both for personal health and national development.
Stunting, caused by chronic undernutrition in children, does not only affect a person’s growth or height. The damage that undernutrition causes to a brain’s cognitive capacity is permanent. It cannot be reversed.
As UNICEF documented in its 2013 report, ‘Improving Child Nutrition: The achievable imperative for global progress’, chronic undernutrition scars the lives of some 165 million children around the world. Undernutrition contributes to half of all child deaths and around one fifth of maternal deaths.
Stunting traps people into a lifelong cycle of poor nutrition, illness, poverty and inequity. Children’s poorer school performance results in future income reductions of up to 22 per cent on average. As adults, they are also at increased risk of obesity, diabetes and cardiovascular disease.
Despite the challenges, we can and must win the battle against stunting and other forms of undernutrition – and investing in the first 1,000 days of a child’s life shapes the future of nations.
Experts have consistently confirmed that taking action on undernutrition is the single most important, cost-effective means of advancing human well-being. This would accelerate the achievement of the Millennium Development Goals, would save lives and should be a top global priority.
We know what works and what needs to be done to radically reduce stunting and undernutrition: from micronutrient and vitamin supplements to awareness raising, promoting exclusive breastfeeding and treating severe and acute malnutrition. Efforts should also be linked to improving access to education and safe water, promoting hygiene, preventing and treating diseases, and strengthening social safety nets.
Over the past 20 years alone, the number of stunted children under the age of five in the world has fallen by 88 million – from 40 to 26 per cent, or a one-third reduction.
However, a brand new Lancet series on nutrition from 6 June 2013 shows that progress is not fast enough. What is needed now is strong, global commitment and leadership to accelerate efforts.
UNICEF is a proud partner in the major global initiative called the Scaling Up Nutrition (SUN) movement, which is bringing much needed focus and investment for nutrition in a number of countries. Through the SUN country network, government focal points from each of the 40 countries involved share experiences, seek advice and provide each other with assistance, analyses of progress and lessons learned.
Broader efforts to address child survival are also galvanizing partnerships. Governments including those of Ethiopia, India and the U.S. have thrown their weight behind the A Promise Renewed movement, which – with supported by UNICEF – is uniting governments, civil society, faith based leaders and private sector around the clear and compelling goal: to end preventable child deaths and give every last child the best possible start in life.
No child, no mother, no country should ever have to suffer the injustice of a lack of nutrition in the 21st century. We cannot stand by and allow a child to be condemned to a life of deprivation – especially when we know how to prevent it.
For updates on what the United States is doing to improve nutrition, follow the hashtags #Nutrition4Growth and #GHmatters on Twitter.