SCN News No 36 - UNSCN

www.unsystem.org/scn FEATURES 17
Nutrition interventions that can accelerate the reduction of maternal and child undernutrition
Robert Black, Johns Hopkins University, lead author from the Lancet Nutrition Series
Introduction
The Maternal and Child Undernutrition Study Group, comprised of leading academics and nutrition experts
from the UK, USA, Asia, and Africa, has been working over the last two years on a series of five papers on
maternal and child undernutrition in developing countries, the Lancet Nutrition Series (Maternal and Child
Undernutrition Study Group 2008). The Series follows a number of earlier important Series from The Lancet,
such as those on child survival and neonatal health, maternal health and child development, which have
shaped policy and action and show the journal’s commitment to global health. The special series on child
survival, for example, brought additional attention to the issues of child survival (The Bellagio Study Group on
Child Survival 2003). While the Lancet Child Survival Series of course paid some attention to nutrition issues
and interventions, such as the importance of promoting breastfeeding and complementary feeding and to
some of the micronutrients, I think those of us who were involved in that series felt that we had not done full
justice to the issues of nutrition and therefore proposed to do more. As we still felt that there was a big gap
with regard to nutrition, we volunteered to the journal to take on this task, with the five papers of the Lancet
Nutrition Series being the combination of that work (Maternal and Child Undernutrition Study Group 2008).
The Series examines evidence-based interventions that, if implemented at scale, could significantly reduce
the effects of maternal and child undernutrition.
The first two papers quantify the prevalence of maternal and child undernutrition and consider the short-term
consequences in terms of deaths and disease burden, as measured by Disability-Adjusted Life Years
(DALYs), and long-term educational and economic effects and associations with adult chronic diseases
bringing in an array of new and important analysis (Black et al 2008; Victoria et al 2008). The third paper
estimates the potential benefits of implementing health and nutrition interventions that current evidence
indicates are effective and applicable in low- and middle-income countries (Bhutta et al 2008). The last two
papers consider the current state of such interventions and how they could be implemented at scale through
actions at national and global levels, what commitments are required at the country level to respond to the
existing challenges and what action is needed from the international nutrition system (Bryce et al 2008;
Morris et al 2008). As Ms Veneman said in her opening speech, the international nutrition system needs to
see more work, coordination and certainly funding, which is justified for the problem of undernutrition
(Veneman 2008).
This paper mainly focuses on the nutrition-related interventions described in paper 3. It also describes some
of the background for these analyses which concern the basis for describing the problem of maternal and
child undernutrition as described in paper 1 and by Mercedes de Onis in this SCN News (de Onis 2008).
Background for the intervention modelling
Undernutrition begins with the mother. In the series, we talk about maternal undernutrition for the mother's
health as well as for foetal development and the application in early childhood. This includes not only the
body size issues in terms of low BMI, but also less visible micronutrient deficiencies that can lead to serious
health problems for the mother and intra-uterine growth restriction (IUGR).
We do in the series look at stunting, wasting, underweight and the related disease burden. While previous work
that we and others have done regarding the nutrition-related burden of disease and intervention effectiveness used
underweight, we decided, as described by de Onis in this issue of SCN News, that it would be much better to look
at stunting and wasting separately, because they do have different programmatic implications. While both stunting
and wasting begin in early childhood, stunting reflects a chronic restriction of linear growth, as indicated by low
height for age, whereas wasting reflects acute weight loss as indicated by a low weight for height. Both conditions
are usually caused by diets that do not provide sufficient nutrients and by high rates of infectious disease.
As described by de Onis, 90% of the 178 million children under five who are stunted in the world live in just
36 countries. These 36 countries were used in the intervention modelling that we did in paper 3 with actual
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