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Global Agencies Launch New Research in Viet Nam Highlighting Pregnancy and the First 24 Months as Critical Window for Reducing Maternal & Child Undernutrition

11% of All Global Disease Burden Attributable to Maternal and Child Undernutrition, According to New Research Published in The Lancet

Hanoi, Viet Nam – Government, international agencies and non-government organization (NGO) health and nutrition leaders met today to launch a landmark series of research papers on maternal and child undernutrition published in the leading international medical journal The Lancet.  The officials and other health experts gathered at a morning launch and afternoon briefing in the city to discuss the specific global child and maternal nutrition issues and the specific challenges facing Viet Nam in the years ahead.

The Lancet’s Series on Maternal and Child Undernutrition, funded in part by the Bill & Melinda Gates Foundation, draws international attention to the critical role of early nutrition in the health and development of children and the economic growth of nations.  Viet Nam, one of only seven countries around the world where the significant Lancet papers are being launched, was chosen because of the strides the country has made in improving nutrition and its commitment to reducing stunting among the population.

Top government leaders from the Ministry of Health, the National Institute of Nutrition and other government ministries joined representatives from the Asian Development Bank, Save the Children, UNICEF, the United Nations Standing Committee on Nutrition and the World Health Organization as well as Lancet author Dr. Jennifer Bryce of Johns Hopkins Bloomberg School of Public Health, to launch the series in Viet Nam.
  
The five-part series reviews and analyzes the effectiveness and potential impact of nutrition-related interventions and policy options in developing countries and includes recommended actions to accelerate efforts to improve maternal and child undernutrition. The series follows a number of earlier important series from The Lancet, such as those on Child Survival and Neonatal Health that have shaped policy and action in countries across the globe.

“The launch of this significant series in Viet Nam provides an opportunity for us to draw national attention to this important issue, and highlight what can be done to accelerate actions to improve maternal and child undernutrition in the country,” said Viet Nam’s Vice Minister of Health, Dr. Tran Chi Liem.

Undernutrition includes a wide array of effects including intrauterine growth restriction (IUGR) resulting in low birth-weight; stunting, a chronic restriction of growth in height indicated by a low height-for-age; wasting, an acute weight loss indicated by a low weight-for-height; and less visible micronutrient deficiencies. Undernutrition is caused by a poor dietary intake that does not provide sufficient nutrients and by common infectious diseases, such as diarrhea and instestinal parasites. These conditions are most significant in the first two years of life, highlighting the importance of nutrition in pregnancy and the window of opportunity for preventing undernutrition from conception through 24 months of age. 

“More than 3.5 million mothers and children under five die unnecessarily each year in poor countries due to the underlying cause of undernutrition, and millions more are permanently disabled by the physical and mental effects of a poor dietary intake in the earliest months of life,” said series author, Dr. Jennifer Bryce of Johns Hopkins Bloomberg School of Public Health. “This series provides a new evidence base for expanded nutrition-related programs and interventions, which if implemented at scale would prevent many of these deaths and disabilities.”

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.

The research found that 178 million children under five suffer from stunting, the vast majority in sub-Saharan Africa and South-central Asia. Of these, 160 million (90%) live in just 36 countries (including Viet Nam), representing almost half (46%) of the 348 million children in those countries. An estimated 55 million children are wasted, of whom 19 million children are affected by severe acute malnutrition (SAM).  While the prevalence of wasting and incidence of severe acute malnutrition has declined markedly in Viet Nam in the past 15-20 years, the prevalence of stunting remains high and is a major child nutrition challenge for Viet Nam as it strives to become a middle-income country.

Stunting, severe wasting and intrauterine growth restriction (IUGR) together are estimated contribute annually to 2.2 million deaths and 91 million disability-adjusted life years (DALYs), 21% of the total for all causes for children less than 5 years old. Together, stunting, severe wasting and IUGR are responsible for 7% of the total disease burden for any age group, the highest of any risk factor for overall global disease burden. Among micronutrient deficiencies, vitamin A and zinc are the greatest contributors to disease burden because of their direct effects on child health. Sub-optimal breastfeeding increases the risk of poor nutrient intake and illness and was estimated to be responsible for 1.4 million child deaths and 44 million DALYs (10% of all DALYs in children less than 5 years old). Together these risk factors were responsible for more than one-third—about 35%—of under-five child deaths and 11% of the global total disease burden. 

Conditions such as stunting, severe wasting and IUGR in the first two years of life cause irreparable harm by impeding physical growth and—if followed by rapid weight gain in the 3-5 year age range—increasing the risk of chronic disease later in life. Children who are stunted or born with IUGR are also shown to complete fewer years of schooling and earn less income as adults, hindering their cognitive growth and economic potential. Lower income, poor health and reduced access to proper nutrition then continue to impact the health of children born into future generations, establishing a repetitive cycle.

“While we have made improvements in health among Vietnamese, especially nutrition status,” said Viet Nam’s Minister of Health, Dr. Tran Chi Liem, “there is still much work to be done in the areas of maternal and child undernutrition”

The third paper estimates the potential benefits of implementing effective and applicable health and nutrition interventions. Of the 45 reviewed interventions, breastfeeding promotion, appropriate complementary feeding, supplementation with vitamin A and zinc, and appropriate management of severe acute malnutrition showed the most promise for reducing child deaths and future disease burden related to undernutrition. Based on these new analyses, the authors estimate universal coverage with the full package of proven interventions at observed levels of program of effectiveness could prevent about one-quarter of child deaths under 36 months of age and reduce the prevalence of stunting at 36 months by about one-third, averting some 60 million DALYs. 
The final two papers consider the current state of interventions and how they could be implemented at scale through actions at national and global levels. The fourth paper in the Series reports on an assessment of actions addressing undernutrition in the 20 highest undernutrition-burden countries. The paper charges nutrition leaders at country level to review their existing strategies and programs to ensure that priority is given to interventions with demonstrated impact on undernutrition among pregnant women and children less than two years of age, and then to develop feasible strategies for increasing public demand for these interventions and delivering them at scale. 

The final paper offers recommendations for how international aid organizations can be more effective in supporting national nutrition efforts, noting that the international nutrition system requires significant reform in order to be effective.

“In Viet Nam, we have the opportunity to make remarkable progress in child health and nutrition.  Improvements in nutrition status among mothers and children would have the greatest potential for reducing child deaths and future disease burden related to undernutrition," said Dr. Nguyen Cong Khan, Director of the National Institute of Nutrition.

The launch of The Lancet series marks one of several events hosted by the Viet Nam government to draw attention to the issue of nutrition. In March, Viet Nam will host the 35th Session of the United Nations Standing Committee on Nutrition, where health and nutrition experts from across the globe will discuss ways to accelerate the reduction of maternal and child undernutrition, and where Viet Nam will discuss its own plan to reduce stunting.

A panel of leading international public health experts announced the research findings at events in Washington, D.C. and London. The full articles plus accompanying materials are also available for download free of charge at www.globalnutritionseries.org and at www.thelancet.com.
 
About the Series
In addition to Vietnam, launches will be held in Ethiopia, Peru, India and West Africa over the next several weeks to raise awareness and generate greater support for nutrition initiatives at the country level. Many international health and development agencies including UNICEF, USAID, the World Bank, and the World Health Organization contributed to the production of the series, which includes contributions from leading academics and nutrition experts from the UK, USA, Asia, and Africa.

The Bill & Melinda Gates Foundation provided financial support for the preparation of the series, the Wellcome Trust provided support for paper 2 analyses, the World Bank provided support for some of the background papers, and the UNICEF Innocenti Research Centre and the Rockefeller Foundation Bellagio Conference Center provided meeting support. The Lancet is the world’s leading independent general medical journal with international focus on all aspects of human health.

 

 

 
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