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.