Invest in Nutrition

Eden, a young boy of 3 years old, was just diagnosed with speech delay. This is one more illness that is affecting him. He also suffers from immune deficiency and deafness. All are related to his first year of life when he has faced severe chronic malnutrition. He looks normal, but the consequences are detrimental; this lack of food (hunger), at a critical moment in his early life, will hamper his ability to learn and hinder opportunities later in life.

This disturbing story may be the intolerable reality of children living in India or Ethiopia; but in fact, this story happens next door to us in America. Eden is one among other protagonists of a provoking documentary launched last month – A Place at the Table.

This documentary is thought-provoking mainly because it shows us that obesity and hunger are neighbours, our neighbours. Access to affordable nutritious foods in a world of plenty seems an unacceptable challenge for too many. In fact, this is increasingly the reality for many children living in both the developing and developed world, mainly because hunger and obesity are globally interconnected. We cannot pretend that it is not visible; it is in fact in our backyard. The burden of malnutrition is one major challenge in the context of the post-MDGs if we really want to achieve sustainable human development for every child in the world.

It is true that we have made significant progress over the past 50 years in the sector of population health. Life expectancies for men and women have increased. A greater proportion of deaths are taking place among people older than 70 years. The burdens of HIV and malaria are falling. Far fewer children younger than five years are dying. But this encouraging picture is being challenged by old and new threats. Africa remains the most afflicted continent, where maternal, newborn, and child mortality, along with a broad array of vaccine-preventable and other communicable diseases, are still urgent concerns. Malnutrition and stunting continue to be a long-term damaging stigma for children in Africa and South East Asia, with an estimated 75% of the world’s 165 million stunted children living there.

The link to extreme poverty is incontestable – as children in the poorest communities are more than twice as likely to be stunted, particularly in rural areas where as many as one third of children are affected.

On the other hand, more young and middle-aged adults in low and middle-income countries are suffering from obesity and diet-related non-communicable diseases (diabetes, hypertension, stoke and cardiovascular disease…). These diseases are driven primarily by phenotypic predisposition and high consumption of ultra-processed foods. With increasing urbanization and shifts in diet and lifestyle, the result could be an escalating epidemic of such conditions in many low- and middle-income countries. This would create new economic and social challenges, especially among vulnerable groups.

Fighting stunting is the emerging battle in the context of optimal human development. It is the irreversible impact of not receiving enough nutrient dense foods within the first 1000 days of life, from pregnancy to a child’s second birthday. But stunting is more than a problem of stature; this lack of nutritious food also impacts the overall physical (organ as well as immune cell function) and cognitive development, and determines the susceptibility to obesity and food-related non communicable diseases later in life.

During the first 1000 days, nutritional requirements to support rapid growth and development are very high, and the baby is totally dependent on others for nutrition, care and social interactions. For example, the first year of life is a time of astonishing change during which babies in normal conditions, on average, grow 55% in length, triple their birth weights and increase head circumference by 40%. Between 1 and 2 years age, an average child grows about 12 cm in length and gains about 3.5 kg in weight. During these crucial days as well as during fetal life, the body is putting together the fundamental human machinery (similar to hardware and software for computer). This process is done over a very short period of time and requires specific nutrients like vitamin A, iron, folic acid, zinc but also protein, long-chain polyunsaturated fatty acids and choline. The immune-system and brain-synapse development are particularly vulnerable. As a result, any disturbance of this frantic activity leaves a terrible mark. Smaller than their non-stunted peers, stunted children are more susceptible to sickness. In school, they often fall behind in class. They enter adulthood more likely to become overweight and more prone to non-communicable diseases. When they start work, they often earn less than their non-stunted co-workers. The drama of this situation is the fact that an undernourished mother is more likely to give birth to a stunted child, perpetuating a vicious cycle of high prevalence of premature death (an estimated 60-80% of neonatal deaths occur among low birth weight babies), undernutrition and poverty.

It is imperative to focus on the first 1000 days of a child’s life as the crucial window of opportunity for change. It is during this time that proper nutrition has the greatest impact on a child’s health and potential future wellbeing and opportunities. A recent publication in Lancet has reinforced this idea, and has showed that attaining optimal growth before 24 months of age is desirable; becoming stunted but then gaining weight disproportionately after 24 months is likely to increase the risk of becoming overweight and developing other health problems. UNICEF’s latest publication “Improving Child Nutrition: The achievable imperative for global progress” is closing the loop. It shows that there are proven low cost solutions for reducing stunting and other forms of undernutrition. These simple and proven nutrition activities need to be integrated together. They include improving women’s nutrition, early and exclusive breastfeeding, providing additional vitamins and minerals as well as giving appropriate nutrient dense foods, especially in pregnancy and the first two years of a child’s life.

Investing in children’s and women’s nutrition is not only the right thing to do from a human right point of view; it is also a cost-effective investment. It can increase a country’s gross domestic product (GDP) by at least 2-3% annually. Every US$1 spent on nutrition activities to reduce stunting will have a return on investment of US$30. This integrated nutritional strategy as proposed by UNICEF and other international stakeholders is the locomotive that can accelerate economic growth and pull millions of people out of poverty.

Let’s work all together to be sure that every children around the world has a place at the table. This is our responsibility!

This article was publish in the Ottawa Citizen last week. This is the link:

http://blogs.ottawacitizen.com/2013/04/26/francoise-briet-invest-in-nutrition/

Don’t bring me the food that western people love!

Over the past few months, I was busy writing articles for different magazines and newspapers.

This is one of them: Don’t bring me the food that western people love!

OCIC article

This is part of a series of articles on food in the context of global development.

All the articles are really interesting. It will give you a different perspective on some key issues. But not only this, there is more. 

This is the link:

http://content.yudu.com/A24lyd/iAMVol4/resources/index.htm?referrerUrl=http%3A%2F%2Focic.on.ca%2Fiam

Hope you will enjoy the voyage…  

Understanding the different dimensions of malnutrition (undernutrition) to maximize human capital development (Part 2: the facts)

This is it!

We are moving to the next blog and we will start by defining briefly the different dimensions of malnutrition (undernutrition) using an interactive approach (maps, figures and facts). It will be a long journey, but I think an interesting learning path not only for you, the people who are reading this blog but also for me and CKi. Let’s start …

1st_Alfredo_Sabat_cartoon2006

(http://timpanogos.wordpress.com/2006/12/22/ranan-lurie-cartoon-competition/)

What is malnutrition?

I won’t give you an academic definition of what is malnutrition. A simple way to understand the concept is the fact that:

Hunger = Undernutrition = Malnutrition

 

Malnutrition = undernutrition or overnutrition

Malnutrition = not enough diversified foods in quantity and/or quality

 

To be healthy (not malnourished): you need to eat well….Your body needs to digest the food and absorb the nutrients released during the digestion process appropriately… Finally, the cells in your body need to use effectively the absorbed nutrients to build tissue, provide energy and/or regulate various organ and cell functions

 

Environmental issues like disease, stress… can affect the overall mechanism and exacerbate the degree of malnutrition

 

Complicate…. No!

 

Tackling the problem of malnutrition demands an integrated approach

 

 Undernitrition – where are we in 2013?

Undernutrition affects millions of people each year all over the world, although the main concentration of cases is found in Sub-Saharan Africa and Asia (see figure below).

figure 1

870 million people are undernourished in the world today. That means one in eight people do not get enough food to be healthy and lead an active life.

Hunger and malnutrition are in fact the number one risk to the health worldwide — greater than AIDS, malaria and tuberculosis combined. It is recognized as the underlying cause of nearly a third of deaths from all diseases in children in pre-school years. In fact, maternal and child undernutrition account for 11 % of the global burden of disease.

The different types of undernutrition:

figure 2

(UNICEF information)

There are two main types of undernutrition as shown in the figure above: growth failure and micronutrient deficiency(see figure below). Each form of undernutrition depends on what nutrients are missing in the diet, for how long and at what age. They include:

1)      Growth failure:

  • Severe and moderate forms of acute malnutrition (leading to wasting) are indicated by a low weight-for-height or presence of bilateral oedemas. This occurs as a result of recent rapid weight loss, or a failure to gain weight within a reasonably short period of time. Wasting occurs more frequently with infants and young children, often during the stages where complementary foods are being introduced to their diets (6 to 24 months), and when children are typically more susceptible to infectious diseases. Acute malnutrition can result from food shortages, a recent bout of illness, inappropriate child care or feeding practices or a combination of these factors.

According to Action Against Hunger, It is estimated that around 41 million children globally have moderate acute malnutrition (MAM). Most children with MAM live in southern Asia and sub-Saharan Africa. Furthermore, it is suggested that there are potentially 20 million children suffering from severe acute malnutrition (SAM) every year, and an estimated 0.5 million to 2 million children with SAM die each year, depending on the type of reporting mechanism.

Sixty percent of all the wasted children (both moderate and severe) in the world live in ten countries (see table below); India being the more affected with ~25 million children suffering of moderate and/or severe acute malnutrition.

figure 3

(UNICEF information)

  • Stunting or chronic undernutrition, resulting in growth retardation, is indicated by a low height for-age. The causes and etiology of stunting include nutrition, infection and mother-infant interaction. Stunting is a cumulative process that can begin in utero and continue until the age of 3 years after birth, compromising the growth of a child. The consequences of becoming and remaining stunted are increased risk of morbidity, mortality, delays in motor and mental development, and decreased work capacity.

Stunting is estimated by the UNICEF to affect 800 million people worldwide. 195 million children under 5 years of ages are stunted. The prevalence of stunting is highest in Africa (40%), and the largest number of stunted children is in Asia (112 million), mostly in South-central Asia (India). Ninety per cent of the overall global burden of child stunting is attributable to 36 countries (see figure below).

WHO-Child-Stunting-map-e1280356202549

(HUMANOSPHERE information)

  • Underweight is a composite measure of both acute and chronic malnutrition, indicated by a low weight-for-age.

figure 6

In 2011, an estimated 17%, or 99 million children under five years of age in developing countries were underweight. As shown in the figure above, underweight is most common in South-central Asia (30%), followed by Western, Eastern, and Middle Africa (22%, 19% and 17%, respectively) and South-Eastern Asia (17%). The situation is better in Eastern and Western Asia, Northern Africa and Latin America and the Caribbean, where less than 10% of children were underweight.

What is well known is the fact that:

1)  Children in the poorest households are twice as likely to be underweight as those in the least poor households.

2) Children living in rural areas are more likely to be underweight than those living in urban areas.

The proportion of children under five years old in developing countries who were underweight has declined by 11 percentage points between 1990 and 2011, from 28% to 17% (see figure below). During this period of time, good progress has been made in Western Asia (reduction from 14% to 5%), Eastern Asia (reduction from 15% to 3%), Caribbean (reduction from 9% to 4%), Central America (reduction from 11% to 4%) and South America (reduction from 6% to 3%). In South-eastern Asia, underweight has declined but remains high at 17%. In contrast, underweight continues to be very high in South-central Asia (30%). This combined with large population, means that most underweight children live in South-central Asia (56 million in 2011). Actually, India has the second higher % of children aged <5 years that are underweighed (43.5%). Finally, as shown in the figure below, progress is still insufficient in Africa. One interesting point is the fact that we don’t know yet if rising food prices and the current economic crisis have affected the latest trends in some populations, it is too early to draw firm conclusions.

figure 7 

2)      The micronutrient deficiency:

Micronutrient deficiencies occur when the body does not have sufficient amounts of vitamins or minerals due to insufficient dietary intake and/or insufficient absorption and/or suboptimal utilization of the vitamins or minerals by the body. One out of 3 people (2 billion people) worldwide are affected by vitamin and mineral deficiencies, according to the WHO.

Three, perhaps the most important in terms of health consequences for poor people in developing countries, are:

  • An estimated 250 million preschool children are vitamin A deficient. An estimated 250,000 to 500 000 vitamin A-deficient children become blind every year, half of them dying within 12 months of losing their sight. Moreover, in vitamin A deficient areas, it is likely that a substantial proportion of pregnant women is vitamin A deficient.
  • Iron deficiency is a principal cause of anemia. Two billion people—over 30% of the world’s population—are anemic. For children, health consequences include premature birth, low birth weight, infections, and elevated risk of death. For pregnant women, anemia contributes to 20% of all maternal deaths.

In many countries, more than half of all women of reproductive age are anemic (see figure below).

anemia-prevalence

  • Iodine deficiency disorders (IDD) put at risk children´s mental health– often their very lives. Serious iodine deficiency during pregnancy may result in stillbirths, abortions and congenital abnormalities such as cretinism, a grave, irreversible form of mental retardation that affects people living in iodine-deficient areas of Africa and Asia. IDD affects over 740 million people, 13% of the world’s population. Fifty million people have some degree of mental impairment caused by IDD.

The figure below shows the areas at high risk of micronutrient deficiency for iron, vitamin A and iodine in the developing world. What is interesting to note is the fact that micronutrient deficiency affects a larger range of low and middle-income countries, more than the problem of underweight and/or stunting (see figure above). Globally, the problem is enormous and needs a special attention.

y7352e32

The two new dimensions of undernutrition:

Improving the health of mothers, newborns and children and reducing the number of preventable deaths are top priorities for many stakeholders working in both the developed and developing worlds. Improving child and maternal health is also an important strategy in the long term because it relates to the fetal origin of adult disease like hypertension, obesity, diabetes and cardiovascular disease. In this new context where we are moving from saving life to improving human development and preventing adult disease, two important dimensions of undernutrition need to be discussed independently. They are:

  • Maternal undernutrition, resulting in poor nutritional status of the mother during preconception, pregnancy and post-natal stages, is indicated by a low Body Mass Index (BMI) and micronutrient deficiencies.

In nowadays, the prevalence of low body mass index (BMI <18.5 kg m-2) among women 15–49 years of age may be as high as 26.5% in Sub-Saharan Africa, 35% in South/Southeast Asia, 15.5% in Caribbean and 4% in Latin America. As shown in the figure below, India is again among the countries with the higher level of underweight women (> 20%). It is important to keep in mind that maternal short stature and low body mass index independently have adverse effects on pregnancy outcomes.

figure 4

(http://openi.nlm.nih.gov/detailedresult.php?img=3182195_pone.0025120.g001&req=4)

It was really difficult to find a visual representation of the worldwide prevalence of underweight among women aged 20-49 years old. The map above shows both the prevalence of underweight and overweight in 57 low to middle income countries. What is quite interesting is the fact thatthe prevalence of overweight in young women residing in both urban and rural areas is higher than those in underweight women, especially in countries at higher levels of socioeconomic development. The best examples are Brazil and South Africa (the worse situation), the exception is India.

  • Low birth weight (LBW) of newborn infants is defined as weighing less than 2,500 g at birth irrespective of gestational age (WHO). More common in developing than developed countries, a birth weight below 2,500 g contributes to a range of poor health outcomes like low fetal and neonatal mortality and morbidity, inhibited growth and cognitive development, and chronic diseases later in life. Birth weight is affected to a great extent by the mother’s own fetal growth and her diet from birth to pregnancy, and thus, her body composition at conception.

 More than 20 million infants worldwide, representing 15.5 %of all births are born with low birth weight, 95.6 % of them in developing countries. The level of low birth weight in developing countries (16.5 %) is more than double the level in developed regions (7 %).

figure 5

Half of all low birth weight babies are born in South-central Asia, where 27 % of all infants weigh less than 2,500 g at birth. Low birth weight levels in sub-Saharan Africa are around 15 %. Central and South America have, on average, much lower rates (10 %), while in the Caribbean the level is almost as high as in sub-Saharan Africa (14%). About 10 % of births in Oceania are low birth weight births. Interestingly, almost 70 % of all low birth weight births occur in Asia; mainly in India, which is also the country with the high prevalence of stunting.

To summarize:

Undernutrition is a major issue, the numbers talk by themselves:

  • 2 billion people worldwide are micronutrient deficient
  • 870 million undernourished people in the world
  • 800 million people worldwide are stunted
  • Asia and the Pacific have the largest share of the world’s hungry people (563 million)
  • 195 million children under 5 are stunted
  • 99 million children under 5 worldwide are underweight
  • 61 million children suffered from acute malnutrition, including 20 million suffering from severe acute malnutrition
  • 20 million children are born with restricted intrauterine growth or prematurely
  • Every year at least 3.5 million of children under 5 die from malnutrition-related causes
  • Women make up a little over half of the world’s population, but they account for over 60% of the world’s hungry
  • 468 million women aged 15 to 49 years (30% of all women) are anemic, at least half because of iron deficiency

Tackling the issue of undernutrition in the word will need significant progress in India because:

  • 230 million people go hungry daily (~1/3 of the worldwide undernourished people)
  • An estimated 40% of the world’s severely malnourished children under 5 live in India
  • 60 million children are underweight
  • 48 % children under 5 are stunted
  • Half of the country’s children are chronically malnourished and 80 % are anemic
  • 30 % of children are born with low birth weight
  • Child malnutrition is responsible for 22 % of the country’s burden of disease
  • At least half of infant deaths are related to malnutrition, often associated with infectious disease
  • More than 90 % of adolescent girls and 50 % of women are anemic

References:

http://www.fao.org/docrep/016/i3027e/i3027e.pdf

 http://www.unicef.org/nutrition/training/2.3/2.html

 http://ccafs.cgiar.org/bigfacts/undernourishment/

 http://jn.nutrition.org/content/129/2/529.full.pdf

 http://blogs.scientificamerican.com/observations/2011/12/08/stunted-growth-from-common-causes-threatens-childrens-later-achievement/

 http://www.childinfo.org/files/low_birthweight_from_EY.pdf

 http://gamapserver.who.int/gho/interactive_charts/mdg1/atlas.html

 http://www.who.int/gho/mdg/poverty_hunger/underweight_text/en/index.html

 http://www.actionagainsthunger.org/impact/nutrition

 http://web.worldbank.org/WBSITE/EXTERNAL/COUNTRIES/SOUTHASIAEXT/0,,contentMDK:20916955~pagePK:146736~piPK:146830~theSitePK:223547,00.html

 http://www.cini.org.uk/childmalutrition.pdf

 http://www.unicef.org/infobycountry/india_statistics.html

 http://apps.who.int/gb/ebwha/pdf_files/WHA65/A65_12-en.pdf

 https://www.wfp.org/hunger/stats

 http://articles.timesofindia.indiatimes.com/2012-01-15/india/30629637_1_anganwadi-workers-ghi-number-of-hungry-people

 

Understanding the different dimensions of malnutrition to maximize human capital development (Part I: Introduction)

Malnutrition (over (bad) and undernutrition) is a global issue not only in the developed world but also in the developing countries. Its outcome is catastrophic in both cases. A simple act … feeding ourselves and our children appropriately seems to be not so easy. Why? There are many reasons that I won’t discuss today in this blog. In fact, I would like to focus on the different dimensions of malnutrition (hunger and undernutrition) and its consequences in the context of international development, mainly because it is currently the “on fire” issue that needs to be addressed. For a lot of stakeholders including us, nutrition and food security represent the cornerstone for progress on other development fronts such as employment, education, the environment and health and in achieving a quality future for humankind.

111-2k4so1b

Over the past five years, the fight against undernutrition and hunger is finally receiving the attention that it deserves:

  • Through the publication in the Lancet of a series of papers related to child and maternal undernutrition in 2008, which drew together evidence on key problems and proven solutions in nutrition (the next series will be launched in May 2013),
  • Followed by a number of initiatives, among other the endorsement of the ‘Scaling Up Nutrition’ Framework (SUN) by various stakeholders (2009). The SUN Framework calls for the implementation and scaling up of two complementary approaches. The first one is direct effective nutrition-specific interventions, focusing on pregnant women and children under two with short-term direct interventions such as the promotion of good nutritional practices, micronutrients, and complementary feeding. The second is a broader multi-sectoral nutrition-sensitive approach that tackles the determinants of undernutrition by promoting agriculture and food security, access to and consumption of nutritious foods, improving social protection, care practices and ensuring access to health care,
  • To the recent Rome meeting consultation on post-2015 development agenda co-led by the Food & Agriculture Organization (FAO) and the World Food Program (WFP) that calls for food security and nutrition to be the central element in future development efforts not just for developing countries but for the global community as a whole.

Although the prevalence of malnutrition in developing countries is decreasing, it is still a major problem for many children. Understanding the problem and consequently formulating intervention programs at the local and national levels is a motion in progress but it still remains a complex and difficult issue.

The first reason being that the process of malnutrition expresses itself in different forms and with variable consequences.

A second reason making malnutrition a complex problem is that the primary causes – the interaction between insufficient food supply (quantity and quality) and the frequent recurrence of infectious diseases – are determined by a multitude of factors of different natures. This complexity – of its expressions, effects, and causality – makes it difficult to get a global vision and understanding of the problem.  

As we are moving in a new era where tackling the problem of malnutrition (hunger, undernutrition and bad nutrition) could be one major focus in the post-2015 development agenda, it is important to better understand the pathophysiology of malnutrition and the factors that influence the growth process in preschool age to help to better direct actions.

During the next few weeks, we will try to answer these questions:

What are the different dimensions of malnutrition (i.e. hunger and undernutrition), the causes, the consequences, and the proposed strategies/solutions to make undernutrition “the world’s number one solvable problem”?

We will focus more specifically on stunting (a not so well known complex aspect of malnutrition with long term impact), micronutrient deficiencies (one of the most cost effective solutions to tackle some specific consequences of malnutrition), the long-term consequences of undernutrition in the context of child and maternal health, the importance of protein intake for human capital development. Finally, we will try to summarize the most appropriate strategy that would use a combination of direct effective nutrition-specific interventions and a broader multi-sectoral nutrition-sensitive approach that tackles the determinants of undernutrition.

Time to move to the next blog….

Save the child …. Give breast milk!*

The World Breastfeeding Week is celebrated every year (August 1st to 7th) in more than 170 countries to encourage breastfeeding and improve the health of babies around the world. It commemorates the Innocenti Declaration made by WHO and UNICEF policy-makers in August 1990 to protect, promote and support breastfeeding (http://www.unicef.org/programme/breastfeeding/innocenti.htm).

As we all know, the first two years of a child’s life are particularly important, as optimal nutrition during this period will lead to reduced morbidity and mortality, to reduced risk of chronic diseases and to overall better development. Indeed, infant and young child feeding is one key area (or the cornerstone) to improve child survival and promote healthy growth and development.

The situation

Malnutrition is responsible, directly or indirectly for about 33% of deaths among children under five. Well above two thirds of these deaths, often associated with inappropriate feeding practices, occur during the first year of life. In fact, despite compelling evidence that exclusive breastfeeding prevents diseases like diarrhea and pneumonia that kill millions of children every year, global rates of breastfeeding have remained relatively stagnant in the developing world, growing from 32% in 1995 to 39% in 2010 (see map below to get an idea of the level of exclusive breastfeeding per country).

In reality, breastfeeding rates in the developing world have been declining until recently. This decline has been attributed to changing socioeconomic factors and the perception that infant formula is superior to breast milk. To give you a concrete example and according to UNICEF Pacific Representative, Dr. Isiye Ndombi: “In the Pacific, breastfeeding rates dropped for a number of reasons, either because mothers were being integrated into the workforce, were not supported by their spouses or were not making informed decisions about the long-term benefits breastfeeding would bring to their children. Exclusive breastfeeding (i.e breastfeeding from birth to six months) are about 40% in Fiji, Tuvalu and Vanuatu, and 31% in the Republic of Marshall Islands.”

“It’s a global trend”, says Elisbeth Sterken, national director of INFACT Canada, a non-profit agency concerned with issues around breastfeeding (http://www.infactcanada.ca/). The impact of bottle-feeding infants is different culture to culture but the long-term impact would be the same – a high incidence of obesity and metabolic diseases. Why?

For example, “in Western cultures, bottle-fed babies begin life with nutritional deficiencies that may lead to health and obesity issues later in life”, she said.

In fact, it was a real surprise to read in a book entitled “Let them eat junk” that baby formula can contain 60% more sugars than regular milk. In fact, a bottle-fed baby consumes 30,000 more calories over its first eight months than a breast-fed one. That’s the calories equivalent of 120 average chocolate bars. Given how early our tastes are formed, it is not surprising that “several research studies have shown correlations between bottle-feeding and subsequent obesity. And the problem continues in baby foods, against efforts to limits the high level of added sugars.

Is it possible to advocate for an improvement of the nutritious value of baby formula and change the current trend?

The task seems tricky. Lobbying power from food companies is huge! The battle is unequal, something similar to the idea developed by Jean de la Fontaine in one of his poems. What union can there be between a clay pot and an iron pot? Because when they collide against each other, the clay pot will be broken.

Just one example to demonstrate this unequal battle: the Thai introduced a proposal to reduce the levels of sugars in baby foods from the existing maximum of 30% to 10%, as part of the global fight against obesity. The proposal was blocked by the US and the EU, where the world’s largest sugar corporations have their home offices. This is one among other examples of the lobbying power of the sugar companies.

And what happens in the developing countries?

In developing countries the impact is more dramatic”, Sterken said. An estimated 1.5 million formula-fed babies die each year because families in developing countries can’t afford the formula and dilute it, use contaminated water to mix it, can’t properly sterilize bottles, or supplement with sugared tea, thereby depriving their children of nutrition, and introducing deadly bacteria into their food.

Another important problem is related to the high level of urbanization in sub-Saharan Africa.

Slums in sub-Saharan Africa are expanding at a fast rate, and the majority of urban residents now live in slum settlements. And in fact, urban poor settlements or slums present unique challenges with regards to child health and survival.  The slums are characterized by poor environmental sanitation and livelihood conditions. Contrary to the long-held belief that urban residents are advantaged with regards to health outcomes, urban slum dwellers tend to have very poor health indicators. Then it is not a surprise to observe thaturban mothers are less likely than rural ones to breastfeed -and more likely to wean their children early if they do begin. Low rates of breastfeeding may be attributed in part to cultural practices, access to and utilization of health care facilities, a lack of knowledge about the importance of the practice, but more importantly to the reality that poor women in urban settings who work outside the home are often unable to breastfeed.

This is an important point, how can we help women who work in developing countries to act sppropriately?  It is a necessity for them to be able to breastfeed because it is good for their babies but they also need to economically survive. A dilema!

Does malnutrition affect the quality of mother’s milk?

The 2008 Lancet Nutrition Series highlighted the remarkable fact that a non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child. Breast milk meets a baby’s complete nutritional requirements and is one of the best values among investments in child survival as the primary cost is the mother’s nutrition. In this context and knowing the high incidence of food insecurity in the developing countries, it seems important to ask if malnutrition (or poor nutrition) can affect the quality of mother’s milk and compromise the potential benefit of breastfeeding where it is most needed, i.e. the developing countries.

In fact, a review of the literature showed that mild or moderate malnutrition rarely affects the amount or quality of breast milk that a woman produces. The mother’s dietary intake will not generally increase how much breast milk she can produce in a day. Her nutritional status before and during pregnancy are important for milk content, but generally this has only of marginal impact since her body will ensure that the breast milk receives the available vitamins and minerals. If her diet remains inadequate for a long time, the milk may contain fewer vitamins and fats as her own body stores are used up. However, her breast milk continues to be nourishing for her child, and provides anti-infective factors that help to protect the child against infections. No breast milk substitute contains these protective factors.

The response at the micro and macro levels

It’s hard to believe that something as natural, healthy and cost-free as breastfeeding needs to be promoted by health and nutrition specialists. But as World Breastfeeding Week began on Aug. 1, breastfeeding specialists want to draw attention to the many benefits of breastfeeding to mother and baby and curb the trend toward bottle-feeding infants with commercially prepared formula.

In 2002, the WHO and UNICEF have developed a Global Strategy for Infant and Young Child Feeding (http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/), which recommends that infants start breastfeeding within one hour of life, are exclusively breastfed for six months, with timely introduction of adequate, safe and properly fed complementary foods while continuing breastfeeding for up to two years of age or beyond.

Moreover, the WHO and the United Nations Children’s Fund jointly developed a code for marketing infant formula to curb aggressive marketing campaigns, especially in developing countries (http://www.who.int/nutrition/publications/code_english.pdf). However, its impact over the past 30 years has been limited because of a series of alleged violations and boycotts.

What do we need to do to reinforce exclusive breastfeeding globally?

An international governance is needed to step in and replace the voluntary marketing code. It will help to address and correct unethical marketing that could be put in place by makers of breastmilk substitutes.

It is also necessary to develop national policies that support maternity leave, not only in developed, but also in developing countries.

And finally, it is important to work at the community level. One of the strategies could be to train low-income mothers as breastfeeding counselors and assist communities in forming mother-to-mother support groups (something similar to Saving Help Group). This strategy will increase the understanding of the risks of not breastfeeding and finally, it will reinforce the practice of exclusive breastfeeding among mothers.

In fact, if the exclusive breastfeeding rate was increased significantly, as much as 13% of all deaths of children younger than 5 years could be prevented that could represent around 1 million children under five in the developing world each year. Moreover, the promotion of breastfeeding could avert 21.9 million disability adjusted life years (8.6%).

What do we mean by exclusive breastfeeding?

“Exclusive breastfeeding” is defined as giving no other food or drink – not even water – except breast milk. It does, however, allow the infant to receive oral rehydration salts (ORS), drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the healthy growth and development of infants; and it’s also an integral part of the reproductive process with important implications for the health of mothers.

Then, what are the benefits? Just a recap….

Exclusive breastfeeding for six months has many benefits for the infant and the mother, says the WHO. “Chief among these is protection against gastro-intestinal infections which is observed not only in developing but also in industrialized countries. Early initiation of breastfeeding, within one hour of birth, protects the newborn from acquiring infections and reduces newborn mortality. Finally, the risk of mortality due to diarrhea and other infections can increase in infants who are either partially breastfed or not breastfed at all.”

Breast milk is also an important source of energy and nutrients in children 6 to 23 months of age. It can provide one half or more of a child’s energy needs between 6 and 12 months of age, and one third of energy needs between 12 and 24 months. Breast milk is also a critical source of energy and nutrients during illness and reduces mortality among children who are malnourished.

Adults who were breastfed as babies often have lower blood pressure and lower cholesterol, as well as lower rates of overweight, obesity and type-2 diabetes.

Breastfeeding also contributes to the health and well-being of mothers. It reduces the risk of ovarian and breast cancer and helps space pregnancies — exclusive breastfeeding of babies under six months has a hormonal effect which often induces a lack of menstruation. This is a natural (though not fail-safe) method of birth control known as the Lactation Amenorrhea Method.

Moreover and from a sustainable point of view, exclusive breastfeeding contributes both directly and indirectly to sustainable development. Evidence has clearly shown that exclusive breastfeeding for the first six months of a baby’s life not only improves their future growth and educational achievement, but also significantly reduces national health costs and helps prevent chronic malnutrition. Breastfeeding helps to prevent a number of diseases in childhood and later in life. It offers protection from infections, allergies and adult-life chronic conditions like hypertension, diabetes, obesity, cardiovascular diseases and cancer that rob the national budgets of millions of dollars.

Breastfeeding needs to be valued as a benefit which is not only good for babies, mothers, and families, but also as a saving for governments in the long run.

* The theme for this year’s celebration is “Understanding the past, planning the future: Celebrating 10 years of WHO/UNICEF’s Global strategy for Infant and Young Child Feeding”. It has the slogan “Save the Child, Give breast milk”.

Resources:

http://allafrica.com/stories/201208060231.html http://allafrica.com/stories/201207051232.html

http://www.scoop.co.nz/stories/GE1208/S00003/make-breastfeeding-easier-for-mothers-says-unicef.htm

http://www.guelphmercury.com/news/local/article/771868–world-breastfeeding-week-aims-to-promote-benefits-curb-bottle-trends

http://www.unicef.org/nutrition/index_emergencies.html http://helid.digicollection.org/en/d/Js8230e/1.3.1.html

http://www.biomedcentral.com/1471-2458/11/396/

http://www.nbcchicago.com/investigations/series/target-5/target-5-sugar-baby-formula-139339308.html

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812877/

http://www.nutraingredients.com/Industry/Infant-formula-marketing-code-has-failed-says-expert

Book: Let them eat junk, how capitalism creates hunger and obesity – Robert Albritton

Developing World Has Less Than 5 Percent Chance of Meeting UN Child Hunger Target

A new study published in The Lancet suggests that developing countries as a whole have a less than 5% chance of meeting the UN’s Millennium Development Goal (MDG) target for the reduction of child malnutrition by 2015(http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60647-3/fulltext#article_upsell). The Article analyses trends in the weight and height (two simple indicators that can permit to define if the malnutrition is chronic or acute) of more than 7•7 million children worldwide between 1985 and 2011 in 141 countries. They also looked how levels are likely to change if current trends continue.  It is the first large-scale study to provide a detailed examination of trends in children’s weight and growth in all developing countries.

Why this study is important?

The phenomenon of hunger does not only weigh on the individual, it also imposes a crushing economic burden on the developing world as economists estimate that every child whose physical and mental development is stunted by hunger and malnutrition stands to lose 5-10 percent in lifetime earnings. Moreover, the first two years of a child’s life are particularly important, as optimal nutrition during this period will lead to reduced morbidity and mortality, to reduced risk of chronic diseases and to overall better development. In fact, optimal breastfeeding and complementary feeding practices are so critical that they can save the lives of 1.5 million children under five every year.

Progresses are made …..

Professor Majid Ezzati, from the School of Public Health at Imperial College London, UK, and the article’s senior author, said: “Our analysis shows that the developing world as a whole has made considerable progress towards reducing child malnutrition, but there are still far too many children who don’t receive sufficient nutritious foods or who lose nutrients due to repeated sickness. Severe challenges lie ahead.”

To summarize the key results

• 61 of these 141 countries have likely a 50—100% chance to achieve the target – particularly in some parts of Asia and Latin America.

• The prevalence of moderate-and-severe stunting (insufficient growth in height for their age) declined from 47•2% to 29•9% and underweight from 30•1% to 19•4% between 1985 and 2011 in developing countries as a whole.

• In 2011, over 300 million children were mildly to severely stunted and over 250 million mildly to severely underweight, with 17 countries – mainly in sub-Saharan Africa and Oceania – seemingly undergoing no improvement in the number of children who are underweight or restricted in growth.

• Undernutrition worsened in sub-Saharan Africa from 1985 until the late 1990s, when height and weight scores began to improve. The deterioration may have been due to economic shocks, structural adjustment, and trade policy reforms in the region in the 1980s and 1990s. In Ivory Coast and Niger, nutritional status was measurably worse in 2011 than it had been in 1985.

• South Asia, the region with the worst nutritional status in 1985, has improved considerably, but undernutrition is still a major issue. About one half of the world’s underweight children live in South Asia, mostly in India.

• China has undergone the largest improvement in children’s height over the last 25 years, with Latin America and the Caribbean region also experiencing significant improvements in this area. The authors suggest that, in many of these countries, the improvements seen are down to overall improvements in the populations’ nutrition, rather than specific interventions targeting children at high risk.

• Some countries in Latin America, such as Chile, now have almost no undernutrition. The proportion of underweight children almost halved per decade in Brazil.

What’s next?

The statistics presented in this article suggest that in most countries, the improvements are due to population-wide improvements in nutrition, rather than interventions targeting high-risk children.

Moreover, according to Professor Ezzati, “There is evidence that child nutrition is best improved through equitable economic growth, investment in policies that help smallholder farmers and increase agricultural productivity, and primary care and food programs targeted at the poor. We mustn’t allow the global economic crisis and rising food prices to cause inequalities to increase, or cut back on investments in nutrition and healthcare.”

To continue in the same direction – strategies that can contribute to the improvement of the overall nutritional status of children:

In a book entitled “Just Give the Money to the Poor, The Development Revolution from the Global South”, the authors showed through a specific example that equitable economic growth at the community level permits  a population-wide nutritional improvement, among other social and economic improvements.  

In  this book, the authors discussed a new strategy – direct cash transfers (CTs). These are regular payments by the state directly to poor people, similar to welfare in developed countries.  The authors showed that this strategy can have a significant social and economic impact. CTs are affordable and the recipients use the money well and do not waste it. As a result, cash grants are an efficient way to directly reduce current poverty, and they have the potential to prevent future poverty by facilitating economic growth and promoting human development.

Something that perhaps you don’t know! And we didn’t know before reading this book.

45 countries in the Global South now give CTs to more than 110 million families. Every program is different, from universal child benefits in Mongolia to pensions in Africa to family grants in Latin America. Some grants are tiny – only $3 a month – whereas others give families more than $100 a month; some cover more than one-third of the population, and others aim only for the very poorest. The size of public spending varies from 0.1% of GDP to 4%, although most programs fall in the range of 0.4% to 1.5%.

What are the outputs/outcomes of this kind of program?

  • Social protection and security for the young, old, disabled
  • Development and economic growth – CTs give poor people the security they need to invest in higher risk/return options like new crops, or migrating in search of work
  • Breaking intergenerational poverty by ensuring children are better nourished and educated than their parents
  • Rights and equity – reducing income inequality and promoting the status of women

To give you a concrete example on how this strategy can impact the life of people

The villagers of Otjivero village (a very destitute rural community) in Namibia have received each month the equivalent of 15 US$ as part of a pilot study to evaluate the socio-economic impact of direct cash transfer.

One of the first and immediate results was the creation of a whole range of economic activities in this small village.

After two years, the program team that managed this pilot study was able to report:

• A decrease of the number of people living below the poverty line from 76 to 37%

• Less than 10% of the children were malnourished – before the experiment, almost half of children were malnourished

• 90% have finished their education – before, they were only 60%

• And crime has dropped

This pilot study has also shown that CT has an impact not only on production but also on demand. In Africa, the purchasing power is usually centered in a few centers, forcing people to leave the countryside to cities, where slums eventually spread. The CT allows rural to grow, it creates local markets and allows people to be self-sufficient.

When you know that you will recieve each month some cash to support your family, this brings some sort of financial security. This kind of initiative helps to ensure that the basic needs for the family are covered but also helps to invest in the future. It creates the first step to equitable economic growth.

Something to meditate! 

Sources:

http://www.redorbit.com/news/health/1112650992/developing-world-has-less-than-5-percent-chance-of-meeting-un-child-hunger-target/

http://www.exchangemagazine.com/morningpost/2012/week27/Thursday/12070507.htm

http://www.oxfamblogs.org/fp2p/?p=2547

http://www.courrierinternational.com/article/2010/04/29/les-miracles-du-revenu-minimum-garanti

Hunger and Obesity Are Food Security Issues ….

…. Or we can also define them as the visible outcomes of the failure of our global Food Security System…

The U.N. says nearly a billion people go to bed hungry every night. At the same time, hundreds of millions of others are obese. To solve those twin crises, we will need to know who is wielding the power over food and marketing.

Raj Patel (http://rajpatel.org/), author of Stuffed and Starved: The Hidden Battle for the World Food System (http://rajpatel.org/2009/10/27/stuffed-and-starved/) says hunger and obesity are not just a matter of eating too little or too much. It has to do with what people are eating and the systems and institutions driving consumption.
To summarize his analysis and to add some of our thoughts:

There’s growing investment in agriculture around the world to feed an expected population of 9 billion by 2050. But as emerging economies grow in Africa and Asia, consumers in those regions are switching to a more Western diet. It’s a diet many blame for obesity, as well as diabetes and cardiovascular disease. However, many others say that people have a choice as to what to eat. They don’t have to buy foods rich in fat, salt and sugar.

And are we really having the choice?

Patel said that’s no.

“When you look at the amount of money that is spent promoting food, the ratio of good food to junk food marketing is about 1 to 500. In other words, for every dollar that’s spent promoting fresh fruits and vegetables 500 is spent promoting junk food,” he said.

And this discrepancy means so much to us with the London Olympic Games that is approaching. All the big food companies are partners of this major event…. Sport is associated with junk food and not with healthy food or healthy eating behaviors.

Again for this Olympic Games, we won’t see an encouragement for healthy nutrition and how this combination – sport and good nutrition - can have a dramatic impact on health. So important for the future of children… Unbelievable!

The battle seems to be lost in advance…

Just a handful of corporations control much of the global food market. It raises the question of what’s considered normal eating?
It is true. “You have kids growing up who think it is normal to be drinking 32 ounces of soda, basically sugar and empty calories. Children who are disconnected from where their food comes from and who are being raised in some very unhealthy eating habits.” Patel said.

Evidence can clearly be found in the United States as well as in some emerging countries like Mexico, India and South Africa.

For example:

• “One in three children who were born in the year 2000 will develop type 2 diabetes. And if we’re talking about children of people of color then that’s near a one in two children will develop type 2 diabetes,”

• “India is a country that’s suffering [from] an epidemic of hunger at the same time as an epidemic of the kinds of disease that used to only happen in rich economies”.

And this is an interesting question …… what can we consider as normal eating?

Is it the same everywhere in the world or do we have major differences based on food tradition, culinary culture as well as genetic background? Can we have a universal approach to this concept?

And finally, if we take the example of Canada, country where CKi is located – what is the legitimacy of having one unique food guidance policy in a country where there are so much different ethnic groups? Recent studies have shown a dramatic level of metabolic diseases in the new immigrant population in Canada. These are some of the questions we ask and we try to answer.

In fact, modern diets are often very different from what our ancestors ate and a lot of people around the world are currently eating. Diversity in food, respect of the tradition around food as well as the culinary culture are keen and we need to value them.

There is hope for better nutrition.

“There’s an amazing kind of rebirth of the food movement in the United States and around the world of people who are excited to be reconnecting with growing their own food, with eating locally and sustainably and organically. And that’s a fight that’s well worth talking about as well, because it’s a way of reducing some of the problems associated with diabetes – the diseases of the modern food system,” he said.

Personally, I was amazed to find a local organization in Port-au-Prince – Buy Local Haiti (Kore Pwodiksyon Lokal – http://www.youtube.com/watch?v=npvx4F9JZyo) that advocates for good food and educates people to eat well based on their culture and tradition and this, despite the socio-economic difficulties in Haiti.

I met these people and I learnt a lot about the importance of the food movement, dignity and human rights, more importantly in countries like Haiti overwhelmed by American rice. In fact before 1970s, Haitian people ate rice only one time/week (mostly on Sunday); nowadays and as a result of the cheap American rice availability, it became the unique daily dish.

Buy Local Haiti has made a video showing a weekly menu based on Haitian culture and tradition. This weekly menu contains only one-time meal with rice. This was a great success on the Haitian TV….. People had water in their mouth!  It reminded them their childhood. They saw that it is possible to eat differently.

Consumers and communities around the world are realizing they have a health and economic crisis on their hands linked to diet. Patel says they’re taking action by defining their own food and agriculture policies. Haiti is also part of this movement! There is hope for a better future….

Source: http://www.voanews.com/content/decapua-food-power-27jun12/1253203.html

To read more about Raj Patel: http://www.theglobeandmail.com/news/world/who-says-raj-patel-is-the-messiah/article566168/

http://www.guardian.co.uk/books/2007/sep/15/healthmindandbody.health

African child mortality – The best story in development

Africa is experiencing some of the biggest falls in child mortality ever seen, anywhere

Sixteen out of the 20 African countries whom have had detailed surveys of living conditions since 2005 reported decreases in their child-mortality rates (this rate is the number of deaths of children under five per 1,000 live births). Twelve had falls of over 4.4% a year, which is the rate of decline that is needed to meet the millennium development goal (MDG) of cutting by two-thirds the child-mortality rate between 1990 and 2015 (see chart). Three countries—Senegal, Rwanda and Kenya—have seen falls of more than 8% a year, almost twice the MDG rate and enough to halve child mortality in about a decade. These three now have the same level of child mortality as India, one of the most successful economies in the world during the past decade.

Image

The decline in African child mortality is speeding up. In most countries it is now falling about twice as fast as during the early 2000s and 1990s. More striking, the average fall is faster than it was in China in the early 1980s, when child mortality was declining around 3% a year, admittedly from a lower base.

The only recent fall comparable to the largest of those in Africa occurred in Vietnam between 1985-90 and 1990-95, when child mortality fell by 37%—and even that was slower than in Senegal and Rwanda. Rwanda’s child-mortality rate have halved between 2005-06 and 2010-11. Senegal has cut its rate from 121 to 72 in five years (2005-10). It took India a quarter of century to make that reduction. The top rates

of decline in African child mortality are the fastest seen in the world for at least 30 years.

One important observation is the fact that the falls have happened in countries large and small, Muslim and Christian, and in every corner of the continent. The three biggest successes are in east, west and central Africa. The success stories come from Africa’s two most populous countries, Nigeria and Ethiopia, and from tiddlers such as Benin (population: 9 millions).

Why this decline?

You might expect that countries that reduced their birth rates the most would also have cut child mortality comparably. This is because such countries have moved furthest along the demographic transition from poor, high-fertility status to richer, low-fertility status. But it turns out that is only partly true. Senegal, Ethiopia and Ghana all have majorly reduced fertility and child mortality. But Kenya and Uganda also did well on child deaths, though their fertility declines have stalled recently. So it cannot all be just about lower birth rates. Liberia, where fertility remains high, did poorly on child mortality—but so did low-fertility places such as Namibia and Lesotho. The link between mortality and broader demographic change seems weak.

What makes a bigger difference? It is some combination of broad economic growth and specific public-health policies, notably the increase in the use of insecticide-treated bed nets (ITNs) which discourage mosquitoes, which cause malaria.

Ethiopia, Ghana, Rwanda and Uganda have been among Africa’s star economic performers recently, with annual GDP growth averaging over 6.5% in 2005-10. At the other end of the scale, Zimbabwe saw its GDP fall and mortality rise. This seems intuitively right. An increase in national income should reduce mortality not just because it is usually associated with lower poverty and better nutrition but also because growth can be a proxy for other good things: more sensible economic policies; more democratic, accountable governments; and a greater commitment to improving people’s living standards.

But growth offers no guarantees. Liberia, with high-mortality rates, actually saw an impressive GDP increases whereas Senegal, whose record in child mortality is second to none, had a rather anemic growth rate by recent African standards (3.8% a year, half that of Rwanda). “The miracle of low mortality” has taken place in different circumstances suggests there can be no single cause. To look for other explanations, therefore, we can look at Kenya in more detail*.

And good riddance

Kenya is a test case. It has cut the rate of infant mortality (deaths of children under one year old) by more than any other country. It has had healthy economic growth (4.8% a year in 2005-10) and a functioning democracy, albeit after horrendous post-election violence in 2008. Moreover, it increased the use of treated bed nets from 8% of all households in 2003 to 60% in 2008. As a result, half the overall drop in Kenya’s infant mortality can be explained by the huge rise in the use of ITNs in areas where malaria is endemic.

Bed nets are often taken as classic examples of the benefits of aid, since in the past they were pioneered by foreign charities. Consistent with the view that aid is vital, Jeffrey Sachs, an American economist, recently claimed that a big drop in child mortality in his Millennium Villages project (a group of African villages that his Earth Institute of Columbia University, New York, is helping) is the result of large increases in aid to villagers. In fact, argues Mr Demombynes, a World Bank representative, the mortality decline in these villages was no better than in the countries as a whole.

The broad moral of the story is that the different sources of aid does not seem to be the decisive factor in cutting child mortality. No single thing was. But better policies, better government, new technology and other benefits are starting to bear fruit. “This will be startling news for anyone who still thinks Africa is mired in unending poverty and death,” says Mr Clemens of the Centre for Global Development. But “that Africa is slipping quickly away.”

Based on an article published in the economist: http://www.economist.com/node/21555571

Hunger eradication essential to achieve sustainable development – UN Food Agency

Sustainable development will not be achieved unless hunger and malnutrition are eradicated, stated by the United Nations food agency in a recent report.

One of the great flaws in current food systems is that despite significant progress in development and food production hundreds of millions of people are hungry because they lack the means to produce or purchase the food they need for a healthy and productive life.

“We cannot call development sustainable while this situation persists, while nearly one out of every seven men, women and children are left behind, victims of undernourishment,” said the Director-General of the Food and Agriculture Organization (FAO), José Graziano da Silva, in a news release.

In the report – entitled Towards the future we want: end hunger and make the transition to sustainable agricultural and food systems – was prepared for the UN Sustainable Development Conference (Rio+20), which will be held in Brazil next month.  The FAO stresses the need to address the flaws in the current food system so that hundreds of millions of people in developing countries have the means to produce or purchase the food they need for their own consumption and income.

“The quest for food security can be the common thread that links the different challenges we face and helps build a sustainable future,” Mr.Graziano da Silva said. “At the Rio Summit we have the golden opportunity to explore the convergence between the agendas of food security and sustainability to ensure that happens.”

The key points in this report are:

  • To establish and protect rights to resources, incorporate incentives for sustainable consumption and production into food systems, promote fair and well-functioning agricultural and food markets, and invest public resources in public goods, especially innovation and infrastructure, among other measures.
  • To help farmers who operate 500 million small farms in developing countries and whose resources are limited due to insufficient access to food and nutrition.
  • The need to change consumption patterns in the developed world to reduce food waste. FAO estimates that global food losses and waste amount to 1.3 billion tons per year, which represents roughly one-third of the world food production for human consumption.
  • To be able to feed the expected global population of nine billion people in 2050, an improved governance of the food and agricultural system is required.

“Unless purposeful action is taken, the increase in food production of 60 per cent needed to meet effective demand will still leave over 300 million people behind who are expected to suffer from chronic hunger in 2050 because they will remain without the means to access food,” FAO noted.

To read more on this issue, go to:

http://www.un.org/apps/news/story.asp?NewsID=42119&Cr=sustainable+development&Cr1

http://www.egovmonitor.com/node/50781

http://www.thisdaylive.com/articles/development-impossible-without-hunger-eradication/117305/

Early Childhood Programs Help Children Thrive and Learn More in Rural Africa

Universal education has long been regarded as the cornerstone for development. However, not many people are aware that early childhood programs are perhaps most important for children in low-income countries across Africa to give them the tools to improve their future. (http://www.un.org/millenniumgoals/education.shtml)

Many children in developing countries are not able to develop to their full potential because of serious deficits in health, nutrition, and proper cognitive and non-cognitive stimulation. The effects of the delayed development in the early years can be deleterious and long lasting, reinforcing the cycle of poverty.

Over the past decade, countries in Sub-Saharan Africa have made progress in expanding primary education. In Mozambique, net primary school enrollment rates increased from 45% in 1998 to 95.5% by 2010 (The World Bank, 2011). Despite these gains, children frequently experience delayed entry to school and present severe developmental delays, especially in poor rural communities. According to Grantham-McGregor et al (2007), 61% of children in Sub-Saharan Africa fail to meet their development potential because of poverty. Inadequate health and nutrition, cultural practices that limit communication between parents and children, and home environments with few books, toys, and other learning opportunities may all contribute towards inadequate physical and cognitive growth. This particularly important in the early periods of physical and mental development. As a result, children arrive at school ill-prepared for a new learning and social environment.

Moreover, low levels of child development are associated with lower levels of school participation and performance, higher rates of criminality, increased reliance on the health care system, and lower future attainment. To address this situation, a number of Early Childhood Development (ECD) interventions have been proposed, including nutrition programs, parenting programs, and pre-school.

The World Bank study is the first such evaluation of ECD programs in Africa, where entrenched poverty means that 61 % of children under the age of five years do not grow and learn to their full potential.  This randomized study shows that children going to preschool are much more likely to show interest in mathematics and writing, recognize shapes, and show respect for other children. Preschool can benefit the whole family: parents of enrolled children are 26% more likely to work, while some older siblings are able to go to school themselves. Small investments ($2.50 a month per child) have a very powerful long term impact!

To see the full evaluation go to:

http://siteresources.worldbank.org/INTAFRICA/Resources/The_Promise_of_Preschool_in_Africa_ECD_REPORT.pdf