TY - JOUR
T1 - Maternal and child undernutrition
T2 - effective action at national level
AU - Bryce, Jennifer
AU - Coitinho, Denise
AU - Darnton-Hill, Ian
AU - Pelletier, David
AU - Pinstrup-Andersen, Per
N1 - Funding Information:
Funding for the preparation of this Series was provided by the Bill & Melinda Gates Foundation. Meetings were hosted by the UNICEF Innocenti Research Centre and the Rockefeller Foundation Bellagio Conference Centre. The sponsors had no role in the analysis and interpretation of the evidence nor in writing the report and the decision to submit for publication. We thank Barbara Ewing for administrative assistance with the Series. We would like to acknowledge the assistance of UNICEF and WHO colleagues who, with their government colleagues, provided information about the current status of nutrition policies and actions in the 20 countries with the highest burden of undernutrition. The WHO Nutrition Regional Advisors Funke Bogunjoko, Kunal Bagchi, and Tommaso Cavalli-Sforza were particularly helpful. We also benefited from the many people who contributed to collection and analysis of qualitative data on the nutrition policy process at country level, including Menno Muldersibanda, Todd Benson, Renee Hill, Tien Ngo, Francesca Decker, other members of the World-Bank supported Mainstreaming Nutrition Initiative, and all those that contributed an interview. David Parker of the UNICEF Innocenti Research Centre provided both technical inputs and an intellectual safe haven in the early stages of developing this paper. Staff of the Food and Agriculture Organization assisted us in presenting a poster at the meeting of the UN Standing Committee on Nutrition in Rome, and worked with Tahmeed Ahmed of the International Centre for Diarrhoeal Disease Control, Bangladesh and the Mainstreaming Nutrition Initiative to organise the focus group with national nutrition leaders at that meeting. We are grateful to Andrés Bortrán, Dilberth Codero-Valdivia, D Hot, and Mary Shawa for participating in the focus group and sharing their experience and insights. Julia Krasevec (UNICEF) reviewed the information provided by country assessment teams for completeness and accuracy, developed the databases, and prepared summary tables for the first round of data collection. Zinta Weise Prinzo, Chantal Gegout, and Chizuru Nishida (WHO) assisted in the re-contacting of countries in June, 2007. Martin Bloem (World Food Program), Bruce Cogill (UNICEF), Boitshepo D Giyose (NEPAD), Katharine Kreis (Bill & Melinda Gates Foundation), Marie T Ruel (IFPRI), Meera Shekar (World Bank), Roger Shrimpton (UN Standing Committee on Nutrition), Cesar G Victora (Federal University of Pelotas) reviewed the paper and provided inputs on organisation and content during a Bellagio workshop in November, 2007. Francis Davidson (USAID) reviewed the first draft and had substantial input in reshaping paper. Saul S Morris (London School of Hygiene and Tropical Medicine) and Roger Shrimpton (Standing Committee on Nutrition) made important contributions to panel 5 . Figure 1 was prepared by Christa Fischer Walker (Johns Hopkins University).
Copyright:
Copyright 2021 Elsevier B.V., All rights reserved.
PY - 2008
Y1 - 2008
N2 - 80% of the world's undernourished children live in just 20 countries. Intensified nutrition action in these countries can lead to achievement of the first Millennium Development Goal (MDG) and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 and 5). Despite isolated successes in specific countries or for interventions-eg, iodised salt and vitamin A supplementation-most countries with high rates of undernutrition are failing to reach undernourished mothers and children with effective interventions supported by appropriate policies. This paper reports on an assessment of actions addressing undernutrition in the countries with the highest burden of undernutrition, drawing on systematic reviews and best-practice reports. Seven key challenges for addressing undernutrition at national level are defined and reported on: getting nutrition on the list of priorities, and keeping it there; doing the right things; not doing the wrong things; acting at scale; reaching those in need; data-based decisionmaking; and building strategic and operational capacity. Interventions with proven effectiveness that are selected by countries should be rapidly implemented at scale. The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects. Programme efforts, as well as monitoring and assessment, should focus on this segment of the continuum of care. Nutrition resources should not be used to support actions unlikely to be effective in the context of country or local realities. Nutrition resources should not be used to support actions that have not been proven to have a direct effect on undernutrition, such as stand-alone growth monitoring or school feeding programmes. In addition to health and nutrition interventions, economic and social policies addressing poverty, trade, and agriculture that have been associated with rapid improvements in nutritional status should be implemented. There is a reservoir of important experience and expertise in individual countries about how to build commitment, develop and monitor nutrition programmes, move toward acting at scale, reform or phase-out ineffective programmes, and other challenges. This resource needs to be formalised, shared, and used as the basis for setting priorities in problem-solving research for nutrition.
AB - 80% of the world's undernourished children live in just 20 countries. Intensified nutrition action in these countries can lead to achievement of the first Millennium Development Goal (MDG) and greatly increase the chances of achieving goals for child and maternal mortality (MDGs 4 and 5). Despite isolated successes in specific countries or for interventions-eg, iodised salt and vitamin A supplementation-most countries with high rates of undernutrition are failing to reach undernourished mothers and children with effective interventions supported by appropriate policies. This paper reports on an assessment of actions addressing undernutrition in the countries with the highest burden of undernutrition, drawing on systematic reviews and best-practice reports. Seven key challenges for addressing undernutrition at national level are defined and reported on: getting nutrition on the list of priorities, and keeping it there; doing the right things; not doing the wrong things; acting at scale; reaching those in need; data-based decisionmaking; and building strategic and operational capacity. Interventions with proven effectiveness that are selected by countries should be rapidly implemented at scale. The period from pregnancy to 24 months of age is a crucial window of opportunity for reducing undernutrition and its adverse effects. Programme efforts, as well as monitoring and assessment, should focus on this segment of the continuum of care. Nutrition resources should not be used to support actions unlikely to be effective in the context of country or local realities. Nutrition resources should not be used to support actions that have not been proven to have a direct effect on undernutrition, such as stand-alone growth monitoring or school feeding programmes. In addition to health and nutrition interventions, economic and social policies addressing poverty, trade, and agriculture that have been associated with rapid improvements in nutritional status should be implemented. There is a reservoir of important experience and expertise in individual countries about how to build commitment, develop and monitor nutrition programmes, move toward acting at scale, reform or phase-out ineffective programmes, and other challenges. This resource needs to be formalised, shared, and used as the basis for setting priorities in problem-solving research for nutrition.
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U2 - 10.1016/S0140-6736(07)61694-8
DO - 10.1016/S0140-6736(07)61694-8
M3 - Review article
C2 - 18206224
AN - SCOPUS:38349018816
VL - 371
SP - 510
EP - 526
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9611
ER -