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Uganda: Early Prevention is Best, Says Child Malnutrition Study
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The Monitor (Kampala)
OPINION
30 April 2008
Posted to the web 29 April 2008
John Mutumba
Preventing infants and young children from becoming undernourished is much more effective than treating children who are already malnourished, according to a new study published in the February 16 issue of leading medical journal, The Lancet.
This study conducted in Haiti found that three indicators of child malnutrition-stunting, underweight and wasting were between four and six percentage points lower among poor communities participating in preventative nutrition programmes rather than recuperative ones.
"These numbers may certainly not appear dramatic to the ordinary person, but the differences between the groups are really substantial, especially considering the challenges of improving childhood nutrition in poor communities," said Marie Ruel, lead author of The Lancet article and director of the Food Consumption and Nutrition Division at the International Food Policy Research Institute (IFPRI).
In lay terms let us compare it to our body temperature, in that at 38 degrees you are perfectly normal yet at 41 degrees you are likely do be dead, a minor deference of three degrees only. The study was conducted by IFPRI and Cornell University in conjunction with World Vision Haiti and the US Agency for International Development.
"Malnutrition must be addressed in the first two years of life, the crucial period for a child's physical and cognitive development," it added. "If nutrition programmes wait until children have already become malnourished, their benefits are significantly diminished," said the Lancet article.
Historically most child nutrition programmes have targeted only underweight children. This seemed to be the desire of the Ministry of Health (MOH) in Uganda and Save the Children's Fund UK to the extent that SCF wrote what many regarded as an inane report criticising the Nutrition and Early Childhood Projects (NECDP) in Uganda, Ethiopia and Bangladesh.
While Uganda closed its project, the projects in Ethiopia and Bangladesh have been extended precisely because results from a study by Colombia University Using data from NECDP had proved the benefits of these three projects.
"This study completely changed the approach to fighting childhood malnutrition," said Lesley Michaud, Maternal and Child Health (MCH) coordinator for World Vision Haiti.
Sadly, these findings had already been realised in Uganda through a longitudinal study carried out by Colombia University whose report is gathering dust in the MOH and Ministry of Finance, Planning and Economic Development. The study goes on to say, "Based on the research findings, many governments, donors and NGOs now target their food security, MCH and nutrition programmes to children under two years of age."
The Haiti study is part of an ongoing focus by The Lancet on maternal and child under- nutrition which underscores the importance of acting early to reduce the consequences of malnutrition.
Of global significance is the realisation that all children, no matter what their race is or where they live, have the same nutritional needs in their first two years of life for proper growth and development which was explained by Purnima Menon, co-author of The Lancet article and IFPRI research fellow, based in New Delhi, India.
This study is particularly relevant to East Africa because these are countries which have both the highest rates of child malnutrition in the world and are home to the greatest number of undernourished children, displaced population, a number of orphans, and are experiencing a devastating HIV/Aids epidemic.
As the causes and consequences of the HIV/Aids epidemic become clearer, so does the realisation of the fundamental importance of food and nutrition in the fight against the combination epidemic. Agriculture is the main source of livelihood for the majority of people globally affected by HIV/Aids, yet agriculture is a sector particularly threatened by the pandemic.
Given implications of reduced labour - and an increasing population mainly of children - the ability of households, particularly the poor to feed themselves is becoming increasingly impossible. Given a rapid rate of attrition of agricultural extension capacity, it's time governments woke up otherwise things will get worse.
These days the emerging stories of strikes and civil unrest due to rising food prices are not uncommon. Is it unreasonable to assume that we in Uganda or East Africa are going to be spared?
The Lancet article states "Both common sense and previous/current scientific research suggest that preventing malnutrition is preferable to treating it, especially because children can suffer irreparable harm from undernourishment during the first two years of life. There is compelling evidence that malnourished children are unproductive as adults.
Nutrition interventions are more effective when targeted as early as possible--and before children reach the age of two years, yet common practice continues to be that nutrition programmes target children up to five years of age, and "once they have become underweight" instead of pregnant women and children below two years of age.
Colombia University and The Institute of Public Health - Makerere University (NECDP Baseline and resurvey) had already recognised this danger in Uganda way back 1995. They circulated the results in the Ministry of Health and the Ministry of Finance, Planning and Economic Development.
Yet it is now we waking up to the fact that substance agriculture is not going to feed us all. This is the time Uganda should tackle the land issue which is critical if she is not going to depend on food aid in the near future.
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The writer holds a Master's degree and a fellowship in Nutrition
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