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Category: Malnutrition

Celebrating Progress Towards Leaving No One Behind on World Food Day

Low and middle-income countries are still grappling with the ongoing COVID-19 pandemic, conflict, and weather shocks which continue to impact global food and nutrition security. The World Food Programme estimates that 50 million people in 45 countries are on the edge of famine. On World Food Day 2022, we take stock of the hard-fought progress that has been made to strengthen nutrition during the first 1,000 days, and we renew our commitment to continue the fight. Though work still needs to be done to truly leave no one behind, we applaud the following actions that have been taken by the US government to address food and nutrition insecurity in low and middle-income countries.

United Nations General Assembly Food Security Announcements

US Government Global Food Security Commitments

Multiple events were held at the United Nations General Assembly (UNGA) in New York related to food and nutrition security efforts. President Biden announced $2.9 billion in additional funding to strengthen food security, which included funding for humanitarian assistance and global development assistance. As part of UNGA, the Global Food Security Summit, which was held one year after the UN Food Systems Summit, took place on September 20th and included remarks from Secretary of State Antony Blinken. Secretary Blinken highlighted current actions to address food insecurity, including progress made on the Roadmap for Global Food Security, and called for  more countries to respond to the food insecurity crisis. He mentioned commitments made by the US government, which include $6.1 billion in humanitarian assistance and $2.3 billion in development assistance, and the expansion of Feed the Future. Much of the funding provided by the US government addresses the negative impact on food insecurity throughout the world due to the war in Ukraine.

Commitments to Prevent and Treat Severe Malnutrition

On September 21st, USAID, UNICEF, the Government of Senegal, and the Children’s Investment Fund Foundation co-hosted “The Child Malnutrition Crisis: Pledging to Save Lives.” The event followed the call to action and announcement from United States Agency for International Development (USAID) Administrator Samantha Power in July when the US committed $200 million to scale up access to wasting treatment, including Ready-to-Use-Therapeutic Food (RUTF). During the September event at UNGA, $280 million was announced which included new funding from donors around the world to address severe malnutrition and wasting. Between these events, over $530 million has been committed through public and private sector funds which has the potential to reach the majority of children suffering from wasting with treatment.

Passing the Global Malnutrition Prevention and Treatment Act

In September, the Senate passed the Global Malnutrition Prevention and Treatment Act and it is awaiting President Biden’s signature. The legislation was led by USAID and non-governmental organizations (NGOs) like 1,000 Days of FHI Solutions dedicated to preventing and treating malnutrition. It makes nutrition an even higher priority within the US government by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs and allows USAID administrators to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. 1,000 days is proud to have supported this lifesaving bill!

Advancing the Global Food Security Reauthorization Act of 2022

The House of Representatives passed the Global Food Security Reauthorization Act of 2022 on September 29, 2022. This legislation reauthorizes the Global Food Security Act (GFSA) through 2028 and continues to build upon and strengthen the Feed the Future initiative. It supports agriculture-led economic growth, bolsters small-holder and women-owned farms, and improves maternal and child nutrition, including during the 1,000-day window. GFSA will strengthen local and regional economies and promote resiliency in some of the world’s lowest income countries. This legislation aims to not only improve food and nutrition security, but also national security, and meets the moment to address rates of increased hunger and malnutrition globally.

Moving Progress Forward

Further progress on a global scale is still needed to address the food and nutrition insecurity crises. While we recognize and celebrate the commitments made by donors, the US government, other country governments, and the NGO community, we will continue to advocate for efforts to improve nutrition, particularly during the 1,000-day window. We know the critical role that nutrition plays in a child’s development, and the investments during this time allow communities to prosper. 1,000 Days looks forward to continuing to be a part of efforts to advocate for strong food and nutrition security programs and investments, including evidence-based nutrition interventions.

A Much-Needed Win for Moms and Babies: the Global Malnutrition Prevention and Treatment Act

Photo Credit: USAID

Nutrition plays a foundational role in a child’s development and her country’s ability to prosper. It is why several of the world’s leading economists have called for greater investments in the nutrition and well-being of mothers, babies, and toddlers as a way to create brighter and more prosperous futures for us all.

On September 20, 2022, the Senate passed the Global Malnutrition Prevention and Treatment Act (H.R. 4693) a lifesaving bill that will positively impact tens of millions of women and young children especially in their 1,000-day window, the time between pregnancy and the baby’s second birthday. This is the precious window of opportunity that enables all children to reach their full potential. When children are well nourished, cared for, and protected from disease, violence and toxic stress, they have the best chance at a thriving future. And when children get a strong start, we all benefit.

About the bill

The legislation will support countries in their efforts to prevent the current 2.6 million childhood malnutrition-related deaths worldwide, approximately 150 million children with stunted development, and the 13.6 million children globally under the age of 5 experiencing wasting because they do not have adequate nutrition.

The Global Malnutrition Prevention and Treatment Act, led by the U.S. Agency for International Development (USAID) and non-governmental organizations (NGOs) like 1,000 Days dedicated to preventing and treating malnutrition, makes nutrition an even higher priority by establishing a five-year strategy to institute precise and targeted reforms in U.S. global nutrition programs. It prioritizes investments in high-impact nutrition programs, such as prenatal vitamins, fortifying foods with essential nutrients (like Vitamin D, iron, and iodine), providing young children with vitamin A supplementation, supporting new mothers to breastfeed, and lifesaving treatment for severely malnourished children.

With this bill, the USAID administrators will be able to scale up the prevention and treatment of global malnutrition and coordinate with relevant public and private partners on these efforts. A Nutrition Leadership Council will be established with representatives from relevant inter- and intra-agency offices to coordinate USAID’s efforts and ensure effective use of taxpayer dollars. The USAID administrators will select priority countries to receive prioritized nutrition assistance and develop clear goals for increasing coverage of high-impact, evidence-based nutrition programs. USAID will be required to submit an annual report to Congress on the progress made toward preventing and treating global malnutrition.

“With the passing of this legislation, we believe the effectiveness of these nutrition programs can be significantly increased with greater strategic vision, accountability, integration, and coordination,” said Blythe Thomas, 1,000 Days of FHI Solutions Initiative Director.

The power to change lives

For example, large-scale vitamin A supplementation has played a major role in decreasing Senegal’s under-five mortality rate from 59 to 37 per 1,000 live births in 5 years. In Nepal through the Suaahara II program, USAID increased the rate of exclusive breastfeeding in supported communities from 45% to 71% in 5 years.

This Global Malnutrition Prevention and Treatment Act is an investment in the future of many lives and aims to address malnutrition at the core so that our most vulnerable populations have access to proper nutrition for continued health throughout the lifespan. As Congresswoman Chrissy Houlahan (D-PA) stated “investing in global nutrition translates to lives saved.”

With both the House and Senate passage, we enthusiastically await the legislation being signed into law by President Biden.

1,000 days is proud to have supported this lifesaving bill and will continually engage with USAID and our partners as the act is implemented.

1,000 Days Applauds Bipartisan Introduction of Global Food Security Act

1,000 Days applauds the bipartisan and bicameral introduction of the Global Food Security Act (GFSA), which would primarily reauthorize funding for Feed the Future, a U.S. Government initiative to address the root causes of global hunger and poverty to improve nutrition and food security. The Senate bill (S. 4649) was introduced by Senators Bob Casey (D-PA), Jim Risch (R-ID), Chris Coons (D-DE), and John Boozman (R-AR). The House bill (H.R. 8446) was introduced by Representatives Betty McCollum (D-MN-04), Chris Smith (R-NJ-04), Gregory Meeks (D-NY-05), and Michael McCaul (R-TX-10).

The Global Food Security Act was first enacted in 2016 to reduce hunger and malnutrition, improve resilience in food insecure communities, and support agricultural-led development. GFSA authorized Feed the Future through 2018 and again through 2023. The recently introduced GFSA legislation would reauthorize the program through 2028. To date, Feed the Future has reached over 26 million children with nutrition-specific interventions.

Blythe Thomas, Initiative Director of 1,000 Days welcomes the introduction of GFSA – “We were particularly pleased to see the mention of the 1,000-day window in the House bill language as we know that is a critical period and good nutrition is of the utmost importance. As the bills move through committee, we encourage legislators to focus on the importance of nutrition interventions during the first 1,000 days. We look forward to meeting with Congressional offices and advocating for passage of GSFA during this critical period of global food and nutrition insecurity.”

Maternal and child undernutrition: consequences for adult health and human capital

Published: January 2008 

Publication: The Lancet 

Authors: Prof. Cesar G. Victora, M.D., Prof. Linda Adair, Ph.D., Prof. Caroline Fall, D.M., Pedro C Hallal, Ph.D., Prof. Reynaldo Martorell Ph.D., Prof. Linda Richter Ph.D., Prof. Harshpal Singh Sachdev, M.D., for the Maternal and Child Undernutrition Study Group 

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
    • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
    • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
    • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
    • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • Malnutrition in pregnancy and childhood can cause generational health problems 
  • Undernutrition in pregnant mothers and children was strongly associated with… 
    • Shorter adult height 
    • Less schooling 
    • Reduced economic productivity  
    • Lower offspring birthweight in women (birthweight is positively associated with lung function, the incidence of some cancers; undernutrition could be associated with mental illness) 
  • Lower weight and malnutrition in childhood followed by weight gain after two years of age was found to be risk factors for high glucose concentrations, elevated blood pressure and harmful lipid profiles once adult BMI and height were adjusted for, suggesting that rapid postnatal weight gain, after infancy, is linked to these conditions 

Key Quotes: 

  • “Poor fetal growth or stunting in the first 2 years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased offspring birthweight.” 
  • “Children who are undernourished in the first 2 years of life and who put on weight rapidly later in childhood and in adolescence are at high risk of chronic diseases related to nutrition.” 
  • “We conclude that damage suffered in early life leads to permanent impairment, and might also affect future generations.” 

Read the original article here

Impaired IQ and academic skills in adults who experienced moderate to severe infantile malnutrition: a forty-year study

Published: Nov. 26, 2013

Publication: National Library of Medicine

Authors: Deborah P. Waber, Ph.D., Cyralene P. Bryce, M.D., Jonathan M. Girard, B.A., Miriam Zichlin, B.S., Garrett M. Fitzmaurice, Sc.D., and Janina R. Galler, M.D.

Background

  • Previous studies have indicated that pre- and post-natal malnutrition can result in long term changes to the structure and functionality of the brain, impairing memory and learning in childhood and adolescence
  • There has been less emphasis on researching how malnutrition in the first year of life affects intellectual capacity across the lifespan
  • The “Barbados Nutrition Study” assessed IQ and academic skills in adults in Barbados who were born with a moderate birth rate, but experienced moderate to severe malnutrition in their first year of life
  • Individuals were enrolled in a nutritional health intervention program and monitored until they were at least 12 years of age to ensure they were in good health
  • The control group consisted of healthy individuals from the same neighborhoods and classrooms who did not experience malnourishment in their first year of life

Summary

  • While previously malnourished individuals were able to catch up physically to their healthy peers, their cognitive and behavioral development lagged behind 
  • IQ scores in the intellectual disability range were 9 times more prevalent in the previously malnourished group 
  • Previously malnourished individuals had lower IQs, lower grades in school, and higher rates of attention problems. They also suffered from intellectual disabilities at a higher rate than their healthy peers. 
  • Malnutrition during the first year of life carries risk for significant lifelong functional morbidity.  

Key Facts: 

  • The estimated difference in IQ between the two groups was 15 points when tested as adolescents and 18 points when tested as adults 
  • 26.3 percent of individuals in the previously malnourished group had IQs indicating intellectual disabilities compared to only 3 percent in the control group 

Read the original article here

Long term consequences of early childhood malnutrition

Published: December 2003 

Publication: International Food Policy Research Institution 

Authors: Harold Alderman, John Hoddinott, Bill Kinsey 

Background

  • Researchers studied the preschool nutritional status (measured by height, given age) of children in Zimbabwe who experienced civil unrest and/or a drought before the age of three
  • Civil war and droughts were used as an indicator of malnourishment
  • Nutritional status was then compared to subsequent health and education achievements of these children to show the effects of early-childhood malnutrition on adult outcomes

Summary

  • The study indicates that early childhood malnutrition can lead to continued stunting and lower school achievement in adolescence as compared to peers who experienced no malnutrition or a lesser degree of malnutrition in childhood
  • Children who measured at median height in preschool were more likely to measure at median height by adolescence and have completed an additional 0.7 grades of schooling than students who measured below median height in preschool
  • This study also indicates that improving preschool nutrition can facilitate growth and higher educational achievement in adolescence
  • Because of the negative impact of “shocks” (i.e. war and drought), interventions should focus on mitigating the impact of these shocks.

Read the original article here

Historic Commitment from US Government to Fight Severe Malnutrition

“There are many problems in this world that will take decades to solve sustainably. Ending child deaths from wasting is not one of them. This is something we can do now.” – Will Moore, CEO, Eleanor Crook Foundation at the State of Global Food Security and Nutrition event on July 18.

At the State of Global Food Security and Nutrition event hosted July 18, 2022, by the Center for Strategic and International Studies (CSIS), United States Agency for International Development (USAID) and the Eleanor Crook Foundation (ECF), USAID Administrator Samantha Power announced that the United States will provide UNICEF with an additional $200 million to procure and distribute ready-to-use therapeutic foods (RUTF). The announcement is the most significant commitment that has ever been made to treat wasted children and the largest leap in coverage on record. 

In addition to the $200 million commitment, the Eleanor Crook Foundation, the CRI Foundation and The ELMA Relief Foundation also pledged $50 million to support the effort. Administrator Power announced a goal to match another $250 million from the private sector, high net worth individuals, corporations and other philanthropies with hopes to announce additional funds raised at the U.N. General Assembly in September 2022. 

“Perhaps the most immediate, life saving, humanitarian aid we can provide is assistance to revive severely malnourished children,” said Administrator Power. “Despite the power of (RUTF) in the fight against child wasting, it is drastically underutilized.”

Malnutrition is the greatest threat to child survival worldwide, contributing to more child deaths than AIDS, malaria, and tuberculosis combined. Those who do survive severe malnutrition in early childhood are much more likely than their well nourished peers to suffer from physical and mental stunting that affect future educational attainment, health and earning potential. 

RUTF treatment for six weeks can help nearly 90 percent of children suffering from wasting recover.  According to UNICEF, “Reaching virtually every child in need can be achieved with just US$300 million in additional funding.” The $200 million pledge, coupled with the $50 million pledged today by private philanthropies, could equate to 80% of the way toward the UNICEF goal.

However, RUTF is not the only high-impact nutrition intervention ready to be scaled today. Using a modeling tool developed by the Johns Hopkins Bloomberg School of Public Health, researchers identified four of the most life-saving and cost-effective actions we can take. Known as the Power 4, they include the following: 

  1. Supply all pregnant women with prenatal vitamins;
  2. Support breastfeeding mothers;  
  3. Continue large-scale vitamin A supplementation; and 
  4. Expand coverage of specialized foods (RUTF) for treatment. 

Along with RUTF, the Power 4 have significant potential to reduce child deaths from malnutrition and make up some of the “best buys” in global development. In the United States, just over 1 percent of US global health funding in FY2022 goes to nutrition programming, while AIDS, malaria, and tuberculosis collectively net about 76 percent. It is time to increase global nutrition investments and end the preventable child and maternal deaths malnutrition causes. 

As Administrator Power said today, “No child should die from malnutrition when we have the tools to stop it, it’s that simple.” At 1,000 Days, we agree.

The importance of food systems and the environment for nutrition

Published: 24 November 2020

Publication: The American Journal of Clinical Nutrition

Authors: Jessica Fanzo, Alexandra L Bellows, Marie L Spiker, Andrew L Thorne-Lyman, and Martin W Bloem

Read the original paper here.

Summary 

  • Food systems contribute to and are vulnerable to ongoing climate and environmental changes that threaten their sustainability
  • We’re going to need more research to tell us what food policy changes we should make to ensure everyone has access to nutritious food despite the impacts of climate change.
  • We need to think about this key question: how can both human and planetary health thrive while meeting the demands of a growing human population, and if we can’t have it all, what trade-offs are we willing to live with?

Background

  • Food systems involve the production, processing, packaging, distribution, marketing, purchasing, consumption, and waste of food.
  • By “transforming” (improving) food systems, we could make healthy food more accessible and reduce environmental impact 
  • We need a lot more research to figure out how best to structure this transformation
  • Silos within the field make this research harder

Research Gaps

The impact of climate change on food systems

  • The link between climate and food systems is getting more and more attention, but there are still a lot of gaps in our knowledge. Specifically, we need more research on:
    •  The “missing middle” of the food supply chain (aka anything other than people’s diets and agricultural production) 
    • How climate change will affect non-staple crops (most research to date has only looked at staple crops).
    • How to create context-specific policies (eg. financial incentives, targeted messaging campaigns etc.) that encourage/allow people to eat sustainable diets and how to measure whether these policies are working:

Food systems 

  • Diets. We need more information on:  
    • The best way to measure how sustainable someone’s diet is
    • How people’s diets are changing as incomes rise
    • Healthy, locally appropriate, and sustainable diets are sometimes at odds with one another. How should we prioritize?
      • “One of the shortcomings of the EAT–Lancet Commission report was that it provided a single healthy reference diet for the world, and did not take into account that healthy and sustainable diets may differ in their availability, accessibility, and cost at the global, regional, and individual levels. Even more so, what is considered healthy is not always sustainable, and what is considered a sustainable diet is not always a healthy one.”
  • Food safety. We need more information on:
    • The danger of using pesticides and chemicals, and whether these dangers affect consumer purchases.
    • The danger of plastics (in food packaging, production etc.).
  • Food loss and waste.  We need more information on:
    • How to measure and reduce food waste/loss.

Interesting Stats

  • “Some models suggest that changes in food availability due to climate change, specifically reduced availability of fruit and vegetables, are estimated to result in an additional 529,000 deaths by 2050.”
  • “Globally, agriculture and livestock production utilize ∼40% of arable land account for ∼70% of fresh water withdrawn for human purposes, and are responsible for ∼11% of GHG emissions (although some estimates range from 11% to 24% depending on what is counted).”
  • “​​Food wasted at the retail and consumer levels alone averages 1217 calories, 33 g protein, 6 g fiber, and 286 g Ca per person per day.”

Figure: Link between food systems and the environment

The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries

Published: July 2021

Publication: Nature Food

Authors: Saskia Osendarp, Jonathan Kweku Akuoku , Robert E. Black , Derek Headey, Marie Ruel , Nick Scott , Meera Shekar, Neff Walker, Augustin Flory , Lawrence Haddad, David Laborde , Angela Stegmuller , Milan Thomas  and Rebecca Heidkamp

Read the original paper here.

Summary:

  • COVID-related disruptions to food and health systems mean cases of malnutrition around the world are likely to get worse.
    • People also have less money and therefor are turning to less expensive sources of calories such as starchy staples and eating fewer nutrient-dense foods.
  • The study authors used statistical models to predict what these disruptions would do to malnutrition rates.
  • They calculated “optimistic”, “moderate” and “pessimistic” outcomes.
  • After the paper’s publication, the authors stated the pessimistic outcomes are the most likely.
  • Using the pessimistic model as the authors recommend, they predict that by the end of 2022, COVID-19-related disruptions could result in an additional:
    • 13.6  million wasted children 
    • 3.6 million stunted children 
    • 283,000 additional child deaths
    • 4.8 million maternal anaemia cases
    • 3 million children born to women with a low BMI 
    • US$44.3 billion in future productivity losses due to excess stunting and child mortality.
  • To make up for the demands of the projected undernutrition increases, the authors predict we will need an additional $1.7 billion per year.
  • The report also predicts that ODA for nutrition will be 19% less through 2030 than it would have been without COVID, accompanied by a similar decrease in domestic health budgets.
  • We could save a lot of babies from being born small, preterm or stillbirth by a) switching the prenatal vitamins we give out from iron folic acid (IFA) to multiple micronutrient supplements (MMS) and b) Give balanced energy and protein supplements to malnourished pregnant women.
  • The report argues1 that fewer children would be impacted if we move funding away from providing complementary foods and instead allocate resources toward:
    • Balanced energy protein supplementation
    • Breastfeeding promotion
    • IYCF counseling at 6–23 months of age in food-secure households
    • Wasting treatment
    • Vitamin A supplementation

  • These numbers should make it clear to decision makers that the pandemic is causing levels of undernutrition to rise in LMICs and that we need to urgently increase ODA and domestic funding to address this crisis.

Key Quotes:

  • “The COVID-19 pandemic has created a nutritional crisis in LMICs. Without swift and strategic responses by subnational, national, regional and international actors, COVID-19 will not only reverse years of progress and exacerbate disparities in disease, malnutrition and mortality, but will also jeopardize human capital development and economic growth for the next generation.”
  • “While women of reproductive age and young children are largely spared COVID-19’s direct effects (that is, serious disease and death), our projections demonstrate that, regardless of the scenario, the COVID-19 crisis is expected to have dramatic indirect effects on maternal and child undernutrition and child mortality in the current generation.”
  • “The nutritional impacts of the COVID-19 crisis could have massive, long-term productivity consequences that could extend to future generations. Poor nutrition during early life stunts both physical and cognitive development, affects schooling performance and adult productivity, increases the risks of overweight/obesity and diet-related non-communicable diseases later in life, and triggers the intergenerational transmission of malnutrition.”

1 The article notes that “The optimal results and allocative efficiency gains will vary across countries, depending on demographics, epidemiological factors and baseline intervention coverages, as well as context-specific costs, priority targets, delivery platforms and other constraints.”

Scaling Up Impact on Nutrition: What Will It Take?

Published: 07 July 2015

Publication: Advances in Nutrition

Authors: Stuart Gillespie, Purnima Menon, and Andrew L Kennedy

Read the original paper here.

Summary:

  • Even though scaling is important to the nutrition community, people have different ideas about what the term means. 
  • If we’re going to successfully scale nutrition interventions, we need a clear and consistent definition of what the word means.
  • This paper analyses 36 scaling frameworks (from multiple sectors), and distills these frameworks into nine “critical elements” for successfully scaling nutrition projects:
  1. Have a vision/goal:  From the beginning, it is important that everyone agrees on what the project is trying to achieve and how you will measure success. 
  2. Focus on evidence-based interventions: only scale interventions that have already been tested and that are effective at a smaller scale.  
  3. Context matters.  Make sure that any programs you try to scale take into account all the challenges and opportunities of the surrounding environment (policies, institutions, culture etc.). If there are big barriers, make sure your intervention can work around them or don’t scale it there. 
  4. Drivers for scale up include high-level political support, an engaged nutrition champion to spark support, national and local ownership of the intervention, and performance incentives for individual frontline workers or  whole organizations.
  5. Identify scaling-up strategy, processes, and pathways: Be clear about exactly what you’re trying to scale and how you’re going to do it. These measures can be quantitative (expansion in geographical coverage, budget, or size), functional (increase in types of activities and integration with other programs), political (increases in political power and engagement), and organizational (strengthened organization capacity)
  6. Make sure there is strategic and operational capacity to scale up.  Capacity can be improved through nutrition leadership and training.
  7. Governance:  Recognize that successful scaling means managing trade-offs (for example between demonstrating short-term success and building sustainable systems) and make sure governments at different levels have a coherent way of working together.
  8. Financing:  Not only do you need to have enough money, but that money needs to be reliable and flexible. Interventions also cost different amounts depending where you are, so wherever possible make sure your budget is based on local data and prices.
  9. Monitoring, evaluation, learning, and accountability:  We need a lot more evidence on the impact of and lessons learned from scaling. Make sure to collect and disseminate data as you go.