Triple Burden Of Disease Research Articles

Equity in Health and the New Normal: The Philippine Universal Health Care Law

The Philippine Universal Health Care (UHC) Law, consistent with the WHO’s Primary Health Care (PHC) Declaration (1978, 2008 and 2018) strives to achieve Equity in Health and Health for all Filipinos by ensuring universal access to health care within a New Normal that ensures inclusive growth. While the series of PHC declarations address gross health inequities among nations; our UHC Law addresses health inequities within our nation. Fifty per cent of Filipinos, who die, continue to die without health professional attendance. Our health outcomes are improving but lag behind those of our ASEAN neighbors. We continue to face what the Department of Health (DOH) describes as the triple burden of disease. Our health inequities persist within a socio-economic context of non-inclusive growth. To address these inequities in health, we need to work for a new normal that would ensure inclusive growth. In health, we need to implement the UHC law based on the philosophy and principles of PHC. There have been initial advances in the implementation of UHC. To accelerate it further, the UHC SG recommended the prioritization of the establishment of an interoperable, real time national health information system to guide governance, human resource for health (HRH) production, deployment and distribution, the provision of medicines and technology, and health financing. In addition to health systems reform, we need to shock and awe the Filipino people with a comprehensive primary care benefit package that can be actually utilized by the poor, generate popular support for UHC, and have significant impact on decreasing Out-of-Pocket health expenditures. To achieve Health for All Filipinos and Equity in Health, we need to ensure universal access to quality health care (UHC) within a new normal that leads to inclusive growth.

Level of Adequate Knowledge of Non-communicable Diseases and Associated Factors Among Adult Residents of North Shewa Zone, Oromia Region, Ethiopia: A Mixed-Method Approach.

BackgroundNon-communicable diseases (NCDs) are currently the leading cause of morbidity and mortality, posing significant challenges to global healthcare systems. Particularly, the prevalence of NCDs is rising in Ethiopia, resulting in a triple burden of diseases on the health system that disproportionately affects all age groups. Hence, this study aims to determine the level of adequate knowledge of NCDs and associated factors among adult residents of the North Shewa zone, Oromia region, Ethiopia.MethodsA community-based cross-sectional study with a concurrent mixed-method approach was conducted from April 1, 2021 to May 30, 2021 among 846 residents using the multistage sampling technique. Interviewer administered questionnaire was used to collect quantitative data and a guiding checklist was used to collect qualitative data. Bivariable and multivariable logistic regressions were fitted to compute the association between explanatory variables and knowledge of NCDs. Adjusted odds ratios at 95% confidence interval with a p-value < 0.05 were used to decree statistical significance in multivariable analysis. Also, a thematic framework analysis was used for qualitative data analysis.ResultsA total of 823 subjects have participated in this study making a response rate of 97.3%. The level of adequate knowledge was 33.9% (95%CI: 30.67, 37.13). Higher-income, receiving information from health professionals, owning a TV, having a family member with NCD(s), and marital status were factors significantly associated with adequate knowledge of NCDs.ConclusionThis study reveals a high level of inadequate knowledge of NCDs despite its foundational ability in tackling the burden of NCDs. As a result, broadening a wider and more comprehensive health promotion strategy for the prevention of triple burden of NCDs would benefit the population. Additionally, special efforts are needed both at the practice and policy levels targeting the disadvantaged groups, such as low-income people, those who do not receive information from health professionals, those who do not own a television, and those who are widowed/divorced, who were found to have less knowledge of NCDs.

Climate change, natural calamities and the triple burden of disease

Climate change, natural calamities and the triple burden of disease

The efficacy of public health initiatives in decreasing disease prevalence: A multidisciplinary approach

Health promotion is a crucial component of public health, particularly in the context of the global "triple burden of disease," which includes the ongoing challenge of persistent communicable diseases, the management of emerging infections, and the control of the notable rise in non-communicable chronic diseases. Globalization, urbanization, technological advancements, and improved travel accessibility have facilitated progress but have also presented intricate challenges to public health, including sedentary lifestyles, unhealthy dietary practices, and heightened susceptibility to environmental health risks. The increase in unhealthy behaviors, including tobacco use, poor dietary choices, and physical inactivity, underscores the importance of health awareness in disease prevention. Public health functions at various levels to enhance community health by employing education, awareness, and behavioral change initiatives that utilize psychological theories to analyze the determinants of health-related decision-making. Campaign effectiveness is typically assessed through pre- and post-intervention comparisons to evaluate impact, particularly for initiatives aimed at behavioral changes, including smoking cessation, healthy eating, and disease prevention. Policymakers, non-governmental organizations, and international agencies, such as the United Nations and WHO, endorse health campaigns addressing issues from obesity prevention to tobacco use reduction.

Rotavirus A infection in children under five years old with a double health problem: undernutrition and diarrhoea \u2013 a cross-sectional study in four provinces of Mozambique

BackgroundMozambique has a high burden of group A rotavirus (RVA) infection and chronic undernutrition. This study aimed to determine the frequency and potential risk factors for RVA infection in undernourished children under 5 years old with diarrhoea in Mozambique.MethodsThe analysis was conducted using data from March 2015 to December 2017, regarding children under 5 years old with at least one type of undernutrition. Anthropometric measures were used to calculate indices of weight-for-age, weight-for-height and height-for-age through the Z-Scores. RVA results were extracted from the National Diarrhoea Surveillance database. Descriptive statistics, chi-square test was used for qualitative variables and organized in contingency tables and 95% Confidence Intervals (CI) were considered for the calculation of RVA infection proportion and in the multiple logistic regression models to estimate the adjusted odds ratios (AOR).ResultsOf the 842 undernourished children included in the analysis, 27.2% (95% CI: 24.3–30.3%) were positive for RVA. The rate of RVA infection was 42.7% (95% CI: 38.0–47.5%) in the pre-vaccine period, with great reduction to 12.2% (95% CI: 9.4–15.6%) in the post-vaccine period. Most of the RVA undernourished children had severe wasting (33.3%) and severe stunting (32.0%). The risk of infection was significantly high in children from 0 to 11 months (p-value < 0.001) when compared to the age group of 24–59 months. A higher proportion of RVA infection was detected in households with five or more members (p-value = 0.029). Similar proportions of RVA were observed in children fed only by breast milk (34.9%) and breast milk with formula (35.6%). A higher proportion of undernourished HIV-positive children co-infected with RVA (7.4%) was observed.ConclusionsThe frequency of RVA infection in undernourished children declined following the introduction of the vaccine in Mozambique. Beyond the temporal variation, Maputo province, age and crowded households were also associated to RVA infection. A high proportion of RVA infection was observed in children with severe wasting and a triple burden of disease: undernutrition, RVA and HIV, highlighting the need to conduct follow-up studies to understand the long-term impact of these conditions on children’s development.

A Collaborative Edge-Cloud Internet of Things Based Framework for Securing the Indian Healthcare System

: Today, 73 years after the independence and twenty years after the turn of the century, “Health for All” which should have been accomplished by now, remains a far-fetched and an elusive dream. Instead, the people of India are bequeathed a triple burden of disease: sustaining the weight of transmittable infections, expanding burden of nontransferable illnesses, and a healthcare system not efficient enough to handle them both. At present, India is home to one-third of the poor population around the world. After a high population growth rate, unregulated and inefficient healthcare is the major cause for this abjection and poverty. The global position of India vis-à-vis the health indicators like Infant Mortality Rate (IMR), Crude Birth Rate (CBR), Crude Death Rate (CDR) and life expectancy is shocking, shameful and on a downward trend. The objective of this paper was to identify the major issues in the Indian healthcare system and offer Internet of Things (IoT) based solutions. The underdevelopment of health and health services in India is brought about by the same determinants that cause underdevelopment in the first place. This paper discusses these causes and major issues responsible for the dilapidated state of Indian healthcare and offers IoT based solutions for dealing with each of these issues. Moreover, a collaborative edge/cloud IoT based framework has been proposed for remedying the Indian healthcare. : The presented solutions could be used for making healthcare and thereby, health, a reality for all.

The rising complexity and burden of multimorbidity in a middle-income country.

The limited knowledge on aetiology, epidemiology and risk factors for multimorbidity especially evident from low and middle-income countries curtail the development and implementation of sustainable healthcare models. Sri Lanka, boasting for one of South Asia's most efficient public health systems that is accessible free-of-charge by the citizens is presently transitioning from lower-middle to upper-middle-income tier. Faced with the triple burden of disease, it is imperative for Sri Lanka to incorporate an integrated model to manage multimorbidity. A descriptive cross-sectional study was carried out in medical clinics of a tertiary care hospital and a University primary care department. Data were extracted on to a form from the clinical records of patients over the age of 20 years with at least one non-communicable disease (NCD) and analysed. Multimorbidity was present among 64.1% of patients (n = 1600). Nearly 44.44% of the patients aged 20-35 years have a minimum of two disorders, and by the time they reach 50 years, nearly 64% of the patients have two or more non-communicable diseases. Nearly 7% of those aged over 65 years were diagnosed with four or more disorders. A fourth of the sample was affected by co-morbid diabetes mellitus and hypertension, whereas the combinations of coronary heart disease with hypertension and diabetes mellitus were also found to be significantly prevalent. A salient revelation of the binomial logistic regression analysis was that the number of disorders was positively correlated to the presence of mental disorders 7.25 (95% CI = 5.82-8.68). Multimorbidity is highly prevalent among this population and seemingly has a detrimental effect on the psychological wellbeing of those affected. Therefore, the need for horizontal integration of all primary to tertiary care disciplines, including mental health, to manage multimorbidity by policymakers is emphasized as a priority task.

Prevalence of catastrophic health expenditure and its associated factors, due to out-of-pocket health care expenses among households with and without chronic illness in Bangalore, India: a longitudinal study.

SummaryBackgroundIndia, one of the economic powerhouses of the world, is lacking in health development.Moreover, it is facing ‘Triple burden of disease’. Indians have one of highest proportion of out-of-pocket (OOP) health expenses. Salient reasons are poor quality public health care, costly private care and lack of health insurance. This has led to catastrophic health expenditure (CHE). Another contributor to this CHE is the chronic illness, which require long-term follow-up. It is estimated that catastrophic health expenditure impoverishes 3.3% of Indians every year. This study was undertaken with an aim to estimate the prevalence of catastrophic health expenditure and its associated factors.MethodsA longitudinal study with one-year follow-up period was conducted among 350 households of an urban area in Bangalore city. Simple random sampling method was used to select the study sample. Data collection done using pre-tested, semi-structured questionnaire by interview method.ResultsChronic illness mean health expenditure was 1155.67 INR (56.09% of the direct cost was spent on drugs). In acute illness, mean health expenditure was 567.45 INR (59.54% of the direct cost was spent on drugs). Fourty eight (14.86%) of the households experienced CHE in the one year Statistically significant association was found between socio-economic status and catastrophic health expenditure. Eighty-five 42% of the households who experienced CHE had a member with chronic illness in it.ConclusionReducing the financial burden of high health care expenses is possible by improving the government health care system, free quality regular supply of medications to chronic disease patients and to improve the beneficiaries under insurance schemes.

The triple burden of disease, destitution, and debt: Small business-women’s voices about health challenges after becoming debt-ridden

More than 115 million women across the world are borrowers of microfinance loans. However, there is concern that women from poor backgrounds who take loans may suffer from multiple challenges of physical and mental health burdens. In this qualitative study we aimed to identify the types of health challenges faced by active women borrowers of microfinance loans. Open ended questions were asked from 442 women across seven cities and four provinces of Pakistan. Categories were developed through the content analysis approach using NVIVO. We have been able to identify thirteen different health challenges faced by poor women borrowers under two broad headings of “environmental factors” and “healthcare delivery system.” We recommend the introduction and expansion of different health and social development services by microfinance provider’s to support the health needs of poor women clients. Women also need support from the Government of Pakistan in improving access to education, health coverage, and formal sector work opportunities. Our study implies increased health policy support for disadvantaged women borrowers of microfinance across the world.

Achieving a Responsive Philippine Health Research Agenda: An Analysis of Research Outputs and Underlying Factors

Introduction. Priority setting in the context of health research is important for developing countries as it assists policymakers and researchers in effectively and efficiently targeting research topics with the greatest benefit for public health. In the local setting, the Philippine National Unified Health Research Agenda (NUHRA) was formulated to prioritize health research topics that address the health needs of the population alongside the health sector’s goal for universal health care. This paper attempts to understand the alignment of the health research outputs by the Philippine Council for Health Research and Development (PCHRD) in addressing the priority health needs of the country.&#x0D; Methods. Review of secondary data and key informant interviews was done. Using a thematic analysis approach, we extracted secondary data from the 2006 to 2017 PCHRD Annual Reports to identify the completed PCHRDfunded health research projects. Excluded in scoping of secondary data were the zonal and other unpublished or not readily available online reports.&#x0D; Results. Results show that most research outputs address NUHRA priorities on health technology development and on the health needs on all life stages and triple burden of diseases under the Philippine Health Agenda. However, for research outputs to improve health outcomes, efforts must first be focused on health systems strengthening and the utilization of existing research information.&#x0D; Conclusion. Gaps and challenges in the previous NUHRAs suggest that even as researches are aligned to the agenda, they do not necessarily address the health needs of the Philippines.

Association between the Human Development Index and Millennium Development Goals 6 Indicators in Sub-Saharan Africa from 2000 to 2014: Implications for the New Sustainable Development Goals

It is important to assess whether regional progress toward achieving the millennium development goals (MDGs) has contributed to human development and whether this has had an effect on the triple burden of disease in the continent. This analysis investigates the association between the human development index (HDI) and co-occurrence of HIV/AIDS, tuberculosis (TB), and malaria as measured by MDG 6 indicators in 35 selected sub-Saharan African countries from 2000 to 2014. The analysis used secondary data from the United Nations Development Programme data repository for HDI and disease data from WHO Global Health observatory data repository. Generalized Linear Regression Models were used to analyze relationships between HDI and MDG 6 indicators. HDI was observed to improve from 2001 to 2014, and this varied across the selected sub-regions. There was a significant positive relationship between HDI and HIV prevalence in East Africa (β = 0.048 [95% CI: 0.040–0.056], p < 0.001) and Southern Africa (β = 0.032 [95% CI: 0.002–0.062], p = 0.034). A significant positive relationship was observed with TB incidence (β = 0.009 [95% CI: 0.003–0.015], p = 0.002) and a significant negative relationship was observed with malaria incidence (β = -0.020 (95% CI: -0.029 to -0.010, p < 0.001) in East Africa. Observed improvements in HDI from the year 2000 to 2014 did not translate into commensurate progress in MDG 6 goals.

166 A Triple Burden of Disease Revealed by Pilot Prospective Registry in a Major East Africa Accident and Emergency Department

166 A Triple Burden of Disease Revealed by Pilot Prospective Registry in a Major East Africa Accident and Emergency Department

Epidemiological Status in Selected States of India: Causes of Death Analysis

Epidemiological Status in Selected States of India: Causes of Death AnalysisAbstract Number:1768 Rahul Koli* Rahul Koli* IIPS,India, India, E-mail Address: [email protected] Search for more papers by this author AbstractEpidemiological Status in selected states of India: Causes of death analysis Name of author: Rahul Koli1 PhD Scholar,IIPS,Mumbai,India. India has experienced important improvements in its health situation in recent decades, but the health gap between different community and within state is still a significant problem. India now finds itself in the half way of third stage of epidemiological transition model, as the country is definitely struggling with a triple health burden.Objectives To understand and explore the differential in epidemiological status among selected states of India To assess the sex differentials in leading causes of death in selected states Methodology The data has been taken from ‘Medical certification of causes of Death’ for five states i.e. Andhra Pradesh, Karnataka, Maharashtra, Manipur and Delhi. The present study classifies the different causes of death clubbed taking into consideration the nature of cause of death in three broad groups – communicable diseases, non- communicable diseases and other causes of death. The age group is taken as ,<1,1-4,5-14,15-24,25- 34,35-44,45-54,55-64,65-69,70+. Result andConclusion The states like Karnataka, Andhra Pradesh, and Delhi are having more than 50 years of life expectancy, decrease in IMR value and communicable disease, which can be a possible indication that these states are in the halfway of third stage of epidemiological transition, which was given by Omran in 1971. But the states like Maharashtra and Manipur the situation is quite different compared to other states, in these two states life expectancy is higher with lower IMR and deaths due to non-communicable disease is more than 60% but in recent years there is possibility of re-emergence of infectious and parasitic disease made a huge contribution to the increase of communicable deaths. All states are under double burden of disease of communicable and non- communicable, while Delhi is under triple burden of disease.

How health economic evaluation (HEE) contributes to decision-making in public health care: the case of Brazil

The universal access to a health care system for the Brazilian population was established in 1990. Brazil is a country with no tradition in the production and use of health economic evaluation (HEE) to guide decision making in the public health system. It is only within the last two decades that HEEs using a microeconomic approach have appeared in the academic field. On a national level, HEE and Health Technology Assessment (HTA), in a wider sense, were first taken into account in 2003. Two policies deserve to be mentioned - (i) the regulation of medicines in the Brazilian market, and (ii) science, technology and innovation policy. The latter required the fostering of applied research to encourage the application of methods which employ systematic reviews and economic analyses of cost-effectiveness to guide the incorporation of technologies in the Brazilian health care system. The Ministry of Health has initiated the process of incorporating these new technologies on a federal level during the last ten years. In spite of the improvement of HEE methods at Brazilian universities and research institutes, these technologies have not yet reached the governmental bodies. In Brazil, the main challenge lies in the production, interpretation and application of HEE to all technologies within the access scheme(s), and there is limited capacity building. Setting priorities can be the solution for Brazil to be able to perform HEE for relevant technologies within the access scheme(s) while the universal coverage system struggles with a triple burden of disease.

Health of Indigenous Circumpolar Populations

Indigenous circumpolar populations have experienced profound transitions in lifeways over the past half-century as a result of economic development. Although there have been positive aspects of this social transformation, most circumpolar groups today have a triple burden of disease, with a modestly elevated infectious disease level, an elevated and increasing burden of chronic conditions such as obesity and cardiovascular disease, and high rates of mental health–related challenges. The health of contemporary circumpolar populations is not easily characterized because of dramatic regional differences that stem from socioeconomic disparities among nonindigenous groups, individual population histories, lifestyle factors, environmental pollution, and underlying biological variation. Overall health and well-being range from excellent among the Sami of Sweden and Norway to extremely poor among marginalized native populations in northern Russia. Circumpolar groups today are not only threatened by continued regional economic development and pollution, but also uniquely vulnerable to global climate change.

Are intestinal parasites fuelling the rise in dual burden households in Venezuela?

In developing countries undergoing rapid economic development, the number of dual burden households (i.e. co-existing overweight/obesity and stunting) is increasing. While intestinal parasites are prevalent in these countries, their contribution to dual burden households has so far been neglected. We studied the association between intestinal parasite infection and belonging to a dual burden household in a rural community of Venezuela. We examined 225 individuals. A dual burden household was defined as a household with at least one overweight/obese adult (BMI > 25) and at least one stunted child (height -for-age z score <-2). Intestinal parasite (Giardia lamblia and geohelminth) infection was determined by faecal smears. In this community, 47.3% of the individuals were infected with intestinal parasites. Among adults, 65.2% were overweight/obese and 13.8% of the children were stunted. More than one in four households (26.8%) were dual burden households. Being infected with G. lamblia & geohelminths was significantly associated with being in a dual burden household (OR = 4.75, 95% CI: 1.01-22.20, n = 188), indicating a triple burden of disease in this community in Venezuela. While the relationship between intestinal parasite infection and stunting has been well established, these results indicate a need to further explore the association of intestinal parasite infection with dual burden households.

Public health in India: Issues and Challenges

Health is determined not only by medical care but also by determinants outside the medical sector. Public health approach is to deal with all these determinants of health which requires multi sectoral collaboration and inter-disciplinary coordination. Although there have been major improvements in public health since 1950s, India is passing through demographic and environmental transition which is adding to burden of diseases. There is triple burden of diseases, viz. communicable, non-communicable and emerging infectious diseases. This high burden of disease, disability and death can only be addressed through an effective public health system. However, the growth of public health in India has been very slow due to low public expenditure on health, very few public health institutes in India and inadequate national standards for public health education. Recent years have seen efforts towards strengthening public health in India in the form of launch of NRHM, upgradation of health care infrastructure as per IPHS, initiation of more public health courses in some medical colleges and public health institutions and strengthening of public health functional capacity of states and districts under IDSP.

Children's environmental health—from knowledge to action

WHO estimates that up to 25% of the global burden of disease is due to preventable environmental exposures. Children are especially vulnerable because they receive a higher dose than adults, with more extreme consequences. The unborn child's health can also be affected, because the environment can influence gene expression and organogenesis. The burden of disease is unevenly distributed, with greatest exposure to children in developing and low-income countries. While children in such countries still have to cope with traditional threats, including lack of access to safe water, poor sanitation and hygiene, and infectious diseases, they suffer from emerging environmental exposures that threaten their health, such as the effects of rapid globalisation, an upsurge in urbanisation, transboundary chemical transport, and unsustainable consumption. All of these threats contribute to environmental degradation. 1 Suk WA Ruchirawat KM Balakrishnan K et al. Environmental threats to children's health in southeast Asia and the western Pacific. Environ Health Perspect. 2003; 111: 1340-1347 Crossref PubMed Scopus (60) Google Scholar Along with poverty and undernutrition, children in developing countries are faced with a triple burden of disease.

Prevalence of obesity, physical inactivity and undernutrition, a triple burden of diseases during transition in a developing economy. The Five City Study Group.

Objective and design — The objective of the study was to find out the prevalence of overweight, obesity, undernutrition and physical activity status in the urban populations of India. Cross-sectional surveys were conducted in 6-12 urban streets in each of five cities in five different regions of India using a common study protocol and criteria of diagnosis.Subjects and methods — A total of 6940 subjects (3433 women and 3507 men) aged 25 years and above were randomly selected from the cities of Moradabad (n = 2002), Trivandrum (n = 1602), Calcutta (n = 900), Nagpur (n = 894) and Bombay (n = 1542). Evaluation and validation were performed by a physician and dietitian-administered questionnaire at Moradabad. After pooling of data, all subjects were divided into various age groups for men and women. Obesity (body mass index = 30 ≥ kg/m2) and overweight (BMI ≥ 25-29.9 kg/m2 and > 23 kg/m2) as well as waist-hip ratio (> 0.85 in women and > 0.88 in men, central obesity) were calculated and physical activity status assessed by a validated questionnaire.Results — The overall prevalence of obesity was 6.8% (7.8 vs. 6.2%, P < 0.05) and overweight 33.5% (35.0 vs. 32.0%, P < 0.05) among women and men, respectively.The highest prevalence of obesity (7.8%) and overweight (36.9%) was found among subjects aged 35 to 44 years in both sexes. The prevalence of obesity was significantly (P < 0.05) greater in Trivandrum (8.5%), Calcutta (7.1%) and Bombay (8.3%) compared to Moradabad (6.2%) among women and in Trivandrum (7.4%) and Bombay (7.2%), compared to Nagpur (5.0%) among men.There was a significant decreasing trend in obesity (P < 0.05) and overweight (P < 0.05) with increasing age above 35-44 years in both sexes.The overall prevalence of subjects > 23 kg/m2 was 50.8% and central obesity 52.6%.The overall prevalence of sedentary behaviour was 59.3% among women and 58.5% among men. Both sedentary behaviour and mild activity showed a significant increasing trend in women after the age of 35-44 years. In men, such a trend was observed above the age of 45 years. Sedentary behaviour was significantly (P < 0.05) greater in Trivandrum, Calcutta, and Bombay compared to Nagpur. Sedentary behaviour was significantly (P < 0.001) associated with obesity in both sexes, compared to non-obese men and women. The overall prevalence of undernutrition was 5.5% (n = 380) which was significantly more common in Moradabad, north and Nagpur, central India compared to other cities.Conclusions — Obesity, overweight and central obesity and sedentary behaviour coexist with undernutrition, and have become a public health problem in all the five cities of India.The prevalence of obesity and sedentary behaviour was significantly greater in Trivandrum, Calcutta and Bombay compared to Moradabad and Nagpur. Sedentary behaviour was significantly associated with obesity compared to non-obese subjects in both sexes, which may be due to greater economic development in metro cities.

Large-scale interventions and programmes addressing nutrition-related chronic diseases and obesity: examples from 14 countries.

Developing countries are clearly facing a double burden of disease. The prevalences of overweight and obesity are rising among adults simultaneously with high rates of undernutrition among children 1‐7 . Consequently, nutrition-related chronic diseases, such as cardiovascular disease and diabetes, are emerging as concerns in developing countries 8 . These concerns are combined with the continued need to address undernutrition and infectious disease. Overweight and obesity are increasing in Chile among low-income groups and poor communities 9 . There is a triple burden of disease in South Africa, described by Vorster 10 . These are poverty-related infectious diseases, including HIV/AIDS, violence-related injuries and an increase in lifestyle-related non-communicable diseases. The burden of obesity and cardiovascular disease in the more developed regions of Brazil is also emerging among the poor 11 . As nutrition-related chronic diseases become more prevalent, limited resources will be further strained by the simultaneous cost of addressing infectious disease and undernutrition, while treating nutrition-related chronic diseases. Early prevention is essential in order to prevent the epidemic. As Reddy 8 states in this supplement, prevention is a necessary, cost-effective means of avoiding the high social, biological and economic costs of a treatment-based approach to nutrition-related chronic diseases. Thus, as a part of this meeting, we considered programmes in developing countries that have sought to intervene early to prevent obesity and nutrition-related chronic diseases.