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Month: December 2020

Big News! First-ever Dietary Guidelines for Moms and Babies Released Today

Today the U.S. Departments of Agriculture (USDA) and Health and Human Services (HHS) released the Dietary Guidelines for Americans, 2020-2025. Updated every five years, the Dietary Guidelines provide science-based advice on what to eat and drink to promote health, help reduce risk of chronic disease, and meet nutrient needs. 

For the first time ever, this newest edition of the guidelines provides advice by life stage, including specific recommendations for infants, toddlers, and pregnant and lactating women in the first 1,000 days. 

The Dietary Guidelines, 2020-2025 encourages everyone to “make every bite count” by choosing foods that are full of nutrients. This includes a variety of fruits, vegetables, grains, dairy or dairy alternatives, and protein foods. It also includes the following key recommendations for moms and babies in the first 1,000 days:

At 1,000 Days, we know that nutrition is critical to the health and well-being of moms and babies. The first 1,000 days are a time of tremendous potential and enormous vulnerability. The nourishment moms and babies receive during this time has a profound impact on a child’s ability to grow, learn, and thrive. The new guidance provides parents and caregivers with the evidence-based information they need to give their children the best chance to lead healthy, prosperous lives that are free of preventable chronic disease. The recommendations will also inform federal nutrition programs that reach young children and their families, as well as serve as an important reference point for physicians, nutrition counselors, and early childcare providers.

We are also pleased to see the Dietary Guidelines discuss systems, policy, and environmental changes that are needed to ensure all families can meet their breastfeeding goals and access healthy diets. The Dietary Guidelines calls for removing barriers such as limited access to (paid) family leave policies and inadequate breastfeeding support at home or at work. It also highlights the importance of WIC, SNAP, and other government programs that provide crucial supports for families dealing with food insecurity.  

We applaud USDA and HHS for their efforts leading up to the release of this landmark document at the end of a year marked by a global pandemic. 1,000 Days looks forward to working with USDA and HHS to communicate the Dietary Guidelines, 2020-2025 to diverse audiences of parents, caregivers, and professionals and to ensure that future editions of the guidelines continue to build upon the important foundation released today.

For more information about the Dietary Guidelines, 2020-2025, visit DietaryGuidelines.gov and MyPlate.gov.  

 

Disparate Impacts of COVID-19 Through the 1,000-Day Lens

It has been a year like no other, but we at 1,000 Days believe hope is on the horizon. In the United States, mask-wearing is becoming the norm and COVID-19 vaccination campaigns have begun among health care workers and at nursing homes and long-term care facilities. Congress passed an urgently-needed coronavirus relief package, and the incoming Administration will seek further investments in our nation’s families in the new year. We have hope.

Yet, families across America continue to struggle – and some are harder hit than others. 

This month the Centers for Disease Control and Prevention (CDC) released a new resource about racial and ethnic health disparities related to the COVID-19 pandemic. The resource examines how underlying health and social inequities put many racial and ethnic minority groups at increased risk of getting sick, having more severe illness, and dying from COVID-19. Social determinants of health, which are conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes – as well as the chronic stress that comes from racism – contribute to these disparities. Additionally, the CDC resource explains how COVID-19 mitigation strategies, such as stay-home orders and business closures, can have unintended consequences that put some populations at risk. Minority groups are experiencing higher rates of job loss, food insecurity, housing instability, and disruptions in preventive healthcare services. 

The pandemic has been especially difficult for women, including those in the 1,000-day window. In November, the CDC confirmed that pregnant women are at increased risk of developing serious illness or dying as a result of COVID-19 – and research in Philadelphia shows that Black and Hispanic pregnant women are five times as likely as white and Asian women to have been exposed to the virus. Working women are also bearing the brunt of the current economic crisis. It’s a perfect storm: on the one hand, the crisis has affected industries that employ more women than men (restaurants and other retail establishments, hospitality, and health care), and on the other hand, shuttered daycares and schools make it difficult to keep working. In fact, of the 1.1 million people who dropped out of the labor force in September, 80% were women. Women are on the frontlines of the pandemic, and too many are not receiving the support they need to thrive. 

This is why 1,000 Days has been fighting – and will continue to fight – for policies and programs that allow all women, children, and families to be healthy and thrive. This includes access to paid leave provisions to care for themselves and their loved ones as the number of coronavirus cases continues to spike. Families must also have access to quality and affordable healthcare and the support of nutrition programs like WIC and SNAP. 

The CDC states: “To stop the spread of COVID-19, we need to ensure resources are equitably available for everyone to maintain physical and mental health.” We stand ready with our community to fight for the opportunities that provide all people a chance to live a healthy life and especially build toward a more equitable society in which every family can have a safe and healthy first 1,000 days and beyond.

Statement on the Coronavirus Relief Bill

1,000 Days was pleased to see the coronavirus relief bill signed into law Sunday night, providing critical support to our nation’s families and avoiding a government shutdown.

As the leading nonprofit organization working to ensure women and children in the U.S. and around the world have the healthiest first 1,000 days, we know that families are struggling as the COVID-19 pandemic drags on.

Provisions such as enhanced unemployment benefits, direct cash payments, and augmented SNAP benefits will help families stay afloat and avoid food insecurity during this difficult time.

However, this relief package does not extend the paid leave mandate first established in the March Families First Coronavirus Response Act. Without guaranteed paid sick and family leave, workers who become ill or who cannot work due to childcare needs will be left without options as coronavirus cases continue to rise. Paid leave is a public health imperative now more than ever, and families need guaranteed access to be healthy and thrive.

The 1,000 days between a woman’s pregnancy and her child’s second birthday set the foundation for all those that follow, and healthy moms and babies are the foundation of a healthy society.

As we look ahead to a new year and a new administration, we remain focused on advocating for the policies, systems and environmental changes that will:

  • Strengthen and improve federal nutrition programs for all moms and babies who need them;
  • Secure federal paid family and medical leave, enhancing millions of lives;
  • Provide all moms and their young children access to quality, comprehensive health care;
  • Create the environments for all moms to meet their breastfeeding goals; and
  • Invest in the nutrition and well-being of mothers, infants and young children around the world, to curb severe malnutrition and avoid preventable child deaths.

Blythe Thomas
Initiative Director
1,000 Days, an Initiative of FHI Solutions

The Latest Evidence on the Simplified Protocols for Wasting

Background

  • Traditionally, children who had wasting (also called acute malnutrition) were treated in hospitals.
  • Hospital stays were inefficient, expensive, and forced caregivers to leave behind work and other responsibilities.
  • This inefficiency meant very few kids received treatment, which increased the risk of illness and death from malnutrition.
  • Starting in the early 2000s, international aid organizations and national health systems began treating wasted kids at home using packaged, nutrient-dense food called Ready-to-use Therapeutic Food (RUTF). These programs are called Community-Based Management of Acute Malnutrition (CMAM).
  • CMAM programs are more cost-effective than hospitalization and allow more children to get the treatment they need, but the program quality varies and we still aren’t reaching nearly enough children.
    • Inefficiencies in the CMAM model include an arbitrary cutoff between moderate and severe cases which often leads to fragmented treatment, difficulty in reaching Health Facilities on a weekly basis to receive treatment, etc.
  • Today, less than 25% of even severely wasted children receive the treatment they need.

Finding new and better ways to treat wasted children

  • Researchers have recently started looking for new ways to simplify and improve CMAM programs so that they can reach and save more kids.
  • Most ideas for “simplified CMAM protocols” include:
    • Treating all wasted kids with the same product (integrated protocol). In the past, organizations gave different therapeutic foods to kids who were more severely malnourished (SAM) compared to kids who were only moderately malnourished (MAM). New research is showing that it is not only possible to treat all malnourished kids with the same product, but that this can cut down on treatment costs by making supply chains more efficient.
    • Training and empowering parents to screen their own children for wasting at home for malnutrition rather than leaving screening up to healthcare workers who see kids a lot less often.
    • Changing to an easier way to screen for malnutrition (mid upper arm circumference or MUAC) that relies less on fancy equipment which is expensive and harder to use, transport, and maintain (such as the scale and height board needed to measure weight-for-height z score, another way of diagnosing wasting).
    • Simplifying the dosage of therapeutic food so that it is easier for low-literacy parents and healthcare workers to administer.
    • Reducing the amount of therapeutic food prescribed. New research is showing that children might need less therapeutic food to recover than they have traditionally been given. Safely reducing doses can help each shipment of therapeutic food go further and reach more children.

Recent Studies/Evidence supporting Simplified CMAM protocols

  • The Optimising treatment for acute Malnutrition (OptiMA) proof of concept study in Burkina Faso trained mothers to use a simpler way to screen their children for malnutrition and treated all kids – regardless of how malnourished they were – with the same product at a gradually reduced dose. The recovery rate for even the most severely malnourished children was 86.3% – higher than the global standard for successful recovery (greater than 75%.)
  • A recent systematic review found that caregivers can effectively detect severe malnutrition in their kids. On average, caregivers noticed that their children were malnourished earlier and more often than health workers did, which meant children were able to get treatment sooner.
  • A randomized controlled trial in Sierra Leone found that treating all malnourished kids with the same product and using the simpler way of screening for malnutrition an integrated protocol had higher coverage and a higher recovery rate compared to a standard protocol
  • The Combined Protocol for Acute Malnutrition Study (ComPAS) tested how treating all malnourished kids with the same product (a combined protocol for MAM and SAM) compared to the traditional way of treating kids. The study found no difference in recovery rate. The combined protocol was cheaper and just as effective.

Main takeaways

  • There are a number of ways to simplify the way kids are treated for severe malnutrition.
  • This simplification could potentially allow more kids to access high-quality programs which would, in turn, save more lives.
  • A number of studies have shown that simplified protocols have a number of benefits compared to standard treatment protocols, including equivalent or better recovery rates, higher coverage, and lower cost per child treated.
    • Simplified protocol programs:
      • Are more efficient in terms of logistics and supply chain systems
      • Have cheaper administrative costs
      • Reduce the time and equipment required by health workers.
    • Research is still limited and a number of trials are ongoing. More research is needed on how to implement simplified treatment programs at scale and to understand issues around coverage, cost, and supply in different contexts.

References

  1. Briend, A., Collins, S. Therapeutic nutrition for children with severe acute malnutrition: Summary of African experience. Indian Pediatr 47, 655–659 (2010).
  2. Lenters L, Wazny K, Bhutta ZA. Management of Severe and Moderate Acute Malnutrition in Children. In: Black RE, Laxminarayan R, Temmerman M, et al., editors. Reproductive, Maternal, Newborn, and Child Health: Disease Control Priorities, Third Edition (Volume 2). Washington (DC): The International Bank for Reconstruction and Development / The World Bank; 2016 Apr 5. Chapter 11. Available from: https://www.ncbi.nlm.nih.gov/books/NBK361900/ doi: 10.1596/978-1-4648-0348-2_ch11

Launch of a Nutrition for Growth Year of Action

As 2020 nears a close, 1,000 Days celebrates the more than USD$3 billion pledged to fight global malnutrition at the the launch of the Nutrition for Growth (N4G) Year of Action, hosted by the Governments of Canada and Bangladesh in partnership with the Government of Japan. The COVID-19 pandemic has brought the world many, and often interlinked, challenges to face, but we must remain steadfast on the overlooked crisis of malnutrition. Malnutrition continues to be a major obstacle to achieving economic prosperity, is responsible for 45% of under-five child deaths, and can have devasting consequences on a child’s growth and brain development.

The N4G Year of Action launch, which took place December 14, offered an opportunity to highlight the importance of good nutrition, particularly in the first 1,000 days, as the world recovers and rebuilds from COVID-19’s devastating impacts on global malnutrition rates. Early action takers took to the stage to announce bold and inspiring nutrition commitments critical to saving and improving the lives of children, women, and communities. We must sustain and grow this political will as we embark into 2021 and the Year of Action for nutrition.

COVID-19 has already threatened a decade of progress we have achieved in protecting the health and wellbeing of babies and mothers worldwide. The Standing Together for Nutrition Consortium presented new evidence at the event warning that without immediate action, COVID-19 has the potential to cause 9.3 million children to be wasted and 2.6 million children to be stunted. These tragic consequences are entirely preventable through cost-effective nutrition programming such as providing Vitamin A supplementation and ensuring access to proper breastfeeding counseling.

Overall, the kick-off mobilized more than USD$3 billion in commitments from a range of government, donor, multi-lateral, and civil society stakeholders. The Government of Canada committed CAD$520 million of new money for nutrition-specific investments – especially for women and girls; Pakistan re-affirmed its commitment made in November of 350 billion rupees (USD$2.18 billion) over the next five years to address malnutrition and stunting; UNICEF pledged to mobilize an additional USD$800 million in 2021 to accelerate global efforts for the prevention, early detection and treatment of child wasting; and World Vision International committed USD$500 million of private funding to reach more than 1 million women and children by 2025 to prevent malnutrition. This is only a snapshot of the announcements – check out the full details here.

These combined efforts must inspire governments and donors to follow suit with even more ambitious financial and policy investments of their own. The USD$3 billion represents only a fraction of what is needed to bring us back on track to achieve the Sustainable Development Goal 2 of ending hunger and malnutrition by 2030, as well as the World Health Assembly global nutrition targets by 2025. New financial estimates highlight that in order to mitigate impacts of COVID-19 on malnutrition, the world will need an additional USD$1.2 billion per year on top of the USD$7 billion per year called for by the Global Nutrition Investment Framework.

The Government of Japan, host of the 2021 N4G Summit in December, launched their updated Vision and Roadmap for the N4G Year of Action at the kick-off event. This vision calls on all stakeholders to step up to the challenge of ending malnutrition in all its forms and opens the door for leaders to make their ambitious commitments on nutrition throughout major global events next year.

With new funding and greater political will, we can achieve sustainable progress in ending malnutrition in all its forms by 2030. 1,000 Days is committed to work in partnership with all stakeholders to make 2021 THE year of action for nutrition to make this goal a reality.

Statement on Coronavirus Relief Package

1,000 Days is heartened to see progress toward a bipartisan coronavirus relief package. As the leading nonprofit working to ensure that moms and babies have the healthiest first 1,000 Days, we know that families in the U.S. and around the world have been hard-hit by the pandemic. COVID-19 has further entrenched racial, economic and health inequality, leaving more families food insecure and without access to the quality healthcare they need to stay healthy and safe. What we need most is a robust emergency package to ensure USAID can administer vital nutrition and anti-hunger programs. Families must have access to emergency paid sick days and paid leave provisions to care for themselves and their loved ones as the number of coronavirus cases continues to spike. Low- and moderate-income families must have access to quality and affordable healthcare. And vital nutrition programs like WIC and SNAP must have increased funding and flexibility. The 1,000 days between a woman’s pregnancy and her child’s second birthday set the foundation for all those that follow, and healthy moms and babies are the foundation of a healthy society. We do not have time to wait.

Blythe Thomas
Initiative Director
1,000 Days, an initiative of FHI Solutions