Global Nutrition Targets Research Articles

Multilevel Analysis of Factors Associated with Wasting and Underweight among Children Under-Five Years in Nigeria.

Wasting and underweight reflect poor nutrition, which in children leads to retarded growth. The aim of this study is to determine the factors associated with wasting and underweight among children aged 0–59 months in Nigeria. A sample of 24,529 children aged 0–59 months from the 2013 Nigeria Demographic and Health Survey (NDHS) was used. Multilevel logistic regression analysis that adjusted for cluster and survey weights was used to identify significant factors associated with wasting/severe wasting and underweight/severe underweight. The prevalence of wasting was 18% (95% Confidence Interval (CI): 17.1, 19.7) and severe wasting 9% (95% CI: 7.9, 9.8). The prevalence of underweight was 29% (95% CI: 27.1, 30.5) and severe underweight 12% (95% CI: 10.6, 12.9). Multivariable analysis revealed that the most consistent factors associated with wasting/severe wasting and underweight/severe underweight are: geopolitical zone (North East, North West and North Central), perceived birth size (small and average), sex of child (male), place/mode of delivery (home delivery and non-caesarean) and a contraction of fever in the two weeks prior to the survey. In order to meet the WHO’s global nutrition target for 2025, interventions aimed at improving maternal health and access to health care services for children especially in the northern geopolitical zones of Nigeria are urgently needed.

Reaching the Global Target to Increase Exclusive Breastfeeding: How Much Will It Cost and How Can We Pay for It?

There is an urgent need for global action to increase the rates of exclusive breastfeeding. In 2012, the World Health Assembly (WHA) set a global target to increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% by 2025. However, current investment levels are insufficient to drive the kind of progress that is needed to meet the target. Reaching the global nutrition target of increasing exclusive breastfeeding to 50% will require an average annual investment of $570 million over 10 years in addition to what is currently being spent. This investment is projected to result in an additional 105 million children being exclusively breastfed and at least 520,000 child deaths prevented over the next 10 years. This analysis was part of an investment framework developed by the World Bank, Results for Development Institute, and 1,000 Days to provide policy makers with a roadmap for how to reach four of the six WHA global nutrition targets: decreasing childhood stunting, decreasing childhood wasting, decreasing rates of anemia in women of reproductive age, and increasing exclusive breastfeeding in the first 6 months.

The Persistent Problem of Malnutrition In India

India contributes to about a third of the total number of the under -nourished in the world. Generally, under-nutrition is assessed as under-weight or stunting and/or wasting. The Periodic surveys by the National Nutrition Monitoring Bureau (NNMB) and the National Family Health Survey (NFHS) reveal unacceptably high prevalence of under-weight and stunting among Indian children of 0-59 months of age. About 19% Indian children are born with low birth weight (<2500 g) due to chronic maternal under-nutrition. About a third of the rural adults also have chronic ener gy deficiency (BMI <18.5). Anaemia, as assessed by low haemoglobin, is widespread among the vulnerable segments of population. Calorie inadequacy, with or without protein inadequacy, is the predominant dietary problem and a lar ge majority of individuals consume less than 70% of the recommended dietary allowance of micronutrients. Though the periodic surveys by NNMB and/or NFHS indicate gradual reduction in under-nutrition over time, its prevalence is unacceptably high. However, all the nutrient intakes show a decline over the last four decades. Even if India achieves the WHO Assembly’s first of the six global nutrition targets of 40% reduction by 2025 in the extent of stunted in under-5 children, unacceptably high proportion of one in four children might still be stunted. Nutritional anaemia and sub-clinical vitamin A deficiency are widespread. Deficiencies of other micronutrients like riboflavin, folic acid, vitamin B 12 and vitamin D are also rampant. Among the adults, while there is a gradual reduction in chronic energy deficiency over the four decade follow-up period, there is also a gradual increase in overweight and obesity. Substantial increases in economic growth experienced over the past two decades did not translate into a similar substantial reduction in under -nutrition, perhaps due to unequal economic growth excluding the poor. Nutrition-sensitive interventions and programmes in agriculture, social safety nets, early child development, education, women’s empowerment and access to safe drinking water and sanitation have enormous potential to scale-up and enhance the effectiveness of nutrition-specific interventions.

Nutrition: How will the next 'Decade of Nutrition' be different from the past one?

The global burden of malnutrition (undernutrition, micronutrient deficiencies or obesity) is considerable and associated with risk of excess mortality and long-term adverse outcomes. Concerted action to achieve agreed global nutrition targets is proposed for the next decade, which must be coupled with the political will to address the root causes of malnutrition and implement evidence-based strategies.

The cost of not breastfeeding in Southeast Asia.

Rates of exclusive breastfeeding are slowly increasing, but remain suboptimal globally despite the health and economic benefits. This study estimates the costs of not breastfeeding across seven countries in Southeast Asia and presents a cost-benefit analysis of a modeled comprehensive breastfeeding strategy in Viet Nam, based on a large programme. There have been very few such studies previously for low- and middle-income countries. The estimates used published data on disease prevalence and breastfeeding patterns for the seven countries, supplemented by information on healthcare costs from representative institutions. Modelling of costs of not breastfeeding used estimated effects obtained from systematic reviews and meta-analyses. Modelling of cost-benefit for Viet Nam used programme data on costs combined with effects from a large-scale cluster randomized breastfeeding promotion intervention with controls. This study found that over 12 400 preventable child and maternal deaths per year in the seven countries could be attributed to inadequate breastfeeding. The economic benefits associated with potential improvements in cognition alone, through higher IQ and earnings, total $1.6 billion annually. The loss exceeds 0.5% of Gross National Income in the country with the lowest exclusive breastfeeding rate (Thailand). The potential savings in health care treatment costs ($0.3 billion annually) from reducing the incidence of diarrhoea and pneumonia could help offset the cost of breastfeeding promotion. Based on the data available and authors’ assumptions, investing in a national breastfeeding promotion strategy in Viet Nam could result in preventing 200 child deaths per year and generate monetary benefits of US$2.39 for every US$1, or a 139% return on investment. These encouraging results suggest that there are feasible and affordable opportunities to accelerate progress towards achieving the Global Nutrition Target for exclusive breastfeeding by 2025.

Equate and Conflate: Political Commitment to Hunger and Undernutrition Reduction in Five High-Burden Countries

Summary As political commitment is an essential ingredient for elevating food and nutrition security onto policy agendas, commitment metrics have proliferated. Many conflate government commitment to fight hunger with combating undernutrition. We test the hypothesis that commitment to hunger reduction is empirically different from commitment to reducing undernutrition through expert surveys in five high-burden countries: Bangladesh, Malawi, Nepal, Tanzania, and Zambia. Our findings confirm the hypothesis. We conclude that sensitive commitment metrics are needed to guide government and donor policies and programmatic action. Without, historically inadequate prioritization of non-food aspects of malnutrition may persist to imperil achieving global nutrition targets.

Systematic review of the effects of iodised salt and iodine supplements on prenatal and postnatal growth: study protocol

IntroductionIodine is an essential micronutrient and component of the thyroid hormones. Sufficient ingestion of iodine is necessary for normal growth and development. If iodine requirements are not met, growth can...

The lack of progress in reducing anaemia among women: the inconvenient truth

Most of the 1.62 billion people currently affected by anaemia are women or young children. Since 1995, the global prevalences of anaemia among non-pregnant women, pregnant women and children aged less than 5 years have fallen only slightly: from 33 to 29%, 43 to 38% and 47 to 43%, respectively.1 Although the corresponding prevalences of severe anaemia have shown more substantial declines over the same period –from 1.8 to 1.1%, 2.0 to 0.9% and 3.7 to 1.5%, respectively – the global prevalence of anaemia only fell by 0.2 to 0.3 percentage points per year between 1993 and 2013.2 Anaemia in women – especially among non-pregnant women in central, northern and western Africa, central Asia and the Middle East and among pregnant women in southern Africa and southern Asia – is a particularly persistent problem.1 The global development challenges addressed by the eight Millennium Development Goals included the reduction of child and maternal mortality. Although the aim of Goal 5A was to reduce the maternal mortality ratio – i.e. the number of maternal deaths per 100 000 live births – by 75% by the end of 2015, this ratio has only fallen by 47% over the past two decades.3 The results of a recent meta-analysis indicated a strong causal link between maternal iron-deficiency anaemia and adverse birth outcomes.4 A strong association has been found between moderate to severe anaemia at 28 weeks’ gestation and the severity of intra- and postpartum haemorrhage,5 which cause 23% of maternal deaths.6 Encouragingly, about 50% of the episodes of anaemia that occur in non-pregnant and pregnant women are amenable to correction by iron supplementation.4 However, Goal 5A is not likely to be achieved even in the post-2015 era unless anaemia in women and its underlying causes are addressed more effectively. In 2012, attendees at the Sixty-fifth World Health Assembly endorsed a comprehensive plan for the improvement of maternal, infant and young child nutrition and set six global nutrition targets to be achieved by 2025. These targets included a 50% reduction in the number of women of reproductive age affected by anaemia with respect to the estimated number for 2011. It is hoped that the setting of the latter target will help to stimulate both the scale-up of existing interventions and new concerted, accelerated and sustained multi-level action that, together, will lead to substantial reductions in the global prevalence of anaemia among women. In an analysis of national nutrition policies by the World Health Organization,7 iron supplementation for pregnant or non-pregnant women was found to be the micronutrient supplementation measure that was most often implemented at national scale. Such supplementation can be remarkably successful. In north-western Viet Nam, for example, a comprehensive programme of iron supplementation and deworming among women of reproductive age resulted in a 48% decrease in the prevalence of anaemia among the targeted women within 12 months.8 Much information on the prevalence and consequences of anaemia is available. Anaemia reduction is incorporated in the policy frameworks of many countries and the new global anaemia reduction target should inspire the relevant stakeholders to support the scale-up of effective interventions. Sadly, with fewer than 1000 days now left to reach the target, MDG 5A is unlikely to be achieved on time in every country. We must hope that, between 2011 and 2025, the world has more success in halving the number of women of reproductive age affected by anaemia and that, in 2025, we do not find ourselves wondering how we failed to achieve yet another goal.

Recent achievements of Korosten Inter-Area Medical Diagnostic Center after completion of the Chernobyl Sasakawa Health and Medical Cooperation Project: 1996–2000

Anaemia causes health and economic harms. The prevalence of anaemia in women aged 15–49 years, by pregnancy status, is indicator 2.2.3 of the UN Sustainable Development Goals, and the aim of halving the anaemia prevalence in women of reproductive age by 2030 is an extension of the 2025 global nutrition targets endorsed by the World Health Assembly (WHA). We aimed to estimate the prevalence of anaemia by severity for children aged 6–59 months, non-pregnant women aged 15–49 years, and pregnant women aged 15–49 years in 197 countries and territories and globally for the period 2000–19.For this pooled analysis of population-representative data, we collated 489 data sources on haemoglobin distribution in children and women from 133 countries, including 4·5 million haemoglobin measurements. Our data sources comprised health examination, nutrition, and household surveys, accessed as anonymised individual records or as summary statistics such as mean haemoglobin and anaemia prevalence. We used a Bayesian hierarchical mixture model to estimate haemoglobin distributions in each population and country-year. This model allowed for coherent estimation of mean haemoglobin and prevalence of anaemia by severity.Globally, in 2019, 40% (95% uncertainty interval [UI] 36–44) of children aged 6–59 months were anaemic, compared to 48% (45–51) in 2000. Globally, the prevalence of anaemia in non-pregnant women aged 15–49 years changed little between 2000 and 2019, from 31% (95% UI 28–34) to 30% (27–33), while in pregnant women aged 15–49 years it decreased from 41% (39–43) to 36% (34–39). In 2019, the prevalence of anaemia in children aged 6–59 months exceeded 70% in 11 countries and exceeded 50% in all women aged 15–49 years in ten countries. Globally in all populations and in most countries and regions, the prevalence of mild anaemia changed little, while moderate and severe anaemia declined in most populations and geographical locations, indicating a shift towards mild anaemia.Globally, regionally, and in nearly all countries, progress on anaemia in women aged 15–49 years is insufficient to meet the WHA global nutrition target to halve anaemia prevalence by 2030, and the prevalence of anaemia in children also remains high. A better understanding of the context-specific causes of anaemia and quality implementation of effective multisectoral actions to address these causes are needed.USAID, US Centers for Disease Control and Prevention, and Bill & Melinda Gates Foundation.