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34 th Session of the Standing Committee on Nutrition: Working Together Third Session Monday, 26 February. Achieving Freedom from Maternal and Child Undernutrition: An Update on The Lancet Series  . Saul S. Morris London School of Hygiene & Tropical Medicine ( Honorary ). Outline.

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achieving freedom from maternal and child undernutrition an update on the lancet series

34th Session of the Standing Committee on Nutrition:

Working Together

Third Session

Monday, 26 February

Achieving Freedom from Maternal and Child Undernutrition: An Update on The Lancet Series  

Saul S. Morris

London School of Hygiene & Tropical Medicine (Honorary)

outline
Outline
  • Series basics
  • Progress in the three streams of series activity
  • Revised timeline
  • Talk to us!
series objectives
Series objectives
  • Provide evidence of the importance and determinants of maternal and child undernutrition in global health
  • Provide evidence of the effectiveness of nutrition interventions and programs with respect to mortality, morbidity and human potential
  • Place nutrition interventions within a broader context of policies and programs that may affect nutrition and health
series objectives 2
Series objectives - 2
  • Assess the correspondence between existing priorities and funding and opportunities for nutritional interventions to improve health and nutrition
  • Provide recommendations on national/subnational actions with respect to nutritional interventions
  • Provide recommendations for improved institutional arrangements and policies relating to nutrition at global level
of activity
of activity

Streams

Broad engagement of the global nutrition and health communities and interaction with the global food community

Stream 1

Technical reviews, analyses, and writing the series contents

Stream 2

Wide dissemination of and advocacy based on series findings

Stream 3

the maternal and child undernutrition study group
Linda Adair

Tahmeed Ahmad

Lindsay Allen

Zulfiqar Bhutta*

Robert Black**

Martin Bloem

Jennifer Bryce*

Laura Caulfield

Denise Coitinho

Simon Cousens

Ian Darnton-Hill

Mercedes de Onis

Majid Ezzati

Bruce Cogill

Boitshepo Giyose

Pedro Hallal

Betty Kirkwood

Reynaldo Martorell

Saul Morris*

David Pelletier

Per Pinstrup-Anderson

Linda Richter

Juan Rivera

Marie Ruel

Harshpal Sachdev

Meera Shekar

Roger Shrimpton

Ricardo Uauy

Cesar Victora*

The Maternal and Child Undernutrition Study Group

With contributions from many others

who will be acknowledged in the individual papers.

*Writing team leader for one of the series papers; **Series Coordinator and writing team leader.

slide8

Conceptual framework

for the series

Short-term consequences:

Mortality, morbidity, disability

Long-term consequences:

Adult size, intellectual ability, economic productivity, reproductive performance, metabolic and cardiovascular disease

Maternal & child

undernutrition

Inadequate dietary intake

Immediatecauses

Disease

Household food insecurity

Inadequate care

Unhealthy household environment & lack of health services

Underlyingcauses

Income poverty:

employment, self-employment, dwelling, assets, remittances, pensions, transfers, etc.

Lack of capital:

financial, human, physical, social and natural

Basiccauses

Social, economic and political context

Adapted from UNICEF, 1998

terminology
Terminology
  • Undernutrition = stunting, wasting and deficiencies in essential vitamins and minerals
  • Malnutrition = undernutrition or obesity
  • Disability-Adjusted Life Years (DALYs) = a standardised approach to epidemiological assessment that includes estimates of the burden of a disorder in terms of mortality, incidence, average age of onset, duration, and disability severity.
  • Focus countries for the series
    • Stunting prevalence > 20%
    • Rank order by number of stunted children, and begin counting with the country with the greatest number
      • 36 countries that account for 90% of stunted children worldwide

(Papers 1, 3 and coverage in 4)

      • 20 countries accounting for 80% of stunted children worldwide

(Papers 4 & 5)

slide11
Broad engagement of the global nutrition and health communities, and interaction with the global food community

Stream 1

  • Individual papers in the series
    • Contributions from dozens of individuals
      • provision of data
      • analyses
      • technical consultations  
slide12
Broad engagement of the global nutrition and health communities, and interaction with the global food community - 2

Stream 1

  • The series as a whole
    • Consultative meeting, Baltimore, March 2006
    • Announcement at March 2006 SCN meeting
    • Invitation for comment, SCN News (mid-2006)
    • Meeting, UNICEF Innocenti Centre, September 2006
    • Individual and small-group interviews
    • Requests for inputs in series Updates
    • Meeting, Bellagio, November 2006
    • Presentation and discussions today

And in the future

    • Review and comment on draft papers
    • The Lancet peer review process
slide13
Broad engagement of the global nutrition and health communities, and interaction with the global food community - 3

Stream 1

  • Coordination with other nutrition-related events and initiatives
    • The Ending Child Hunger and Undernutrition Initiative
    • The “Hunger and Health” Report under development by the World Food Programme
    • Nutrition partners through presentation at meetings and individual discussions
slide14
Broad engagement of the global nutrition and health communities, and interaction with the global food community - 4

Stream 1

  • Publication of related papers in The Lancet
    • What?
      • Original research
      • Of particular interest:
        • Large-scale effectiveness evaluations
        • New evidence linking undernutrition to relevant actions in sectors other than health
        • Financial/economic costs of acting at scale to address undernutrition
    • When?
      • By 1 May 2007
    • Where?
      • http://ees.elsevier.com/thelancet/
paper 1 maternal and child undernutrition global and regional exposures health consequences
Paper 1:Maternal and child undernutrition: Global and regional exposures & health consequences

Stream 2

  • Systematic literature searches
  • Re-analysis of existing data sets to develop new estimates of:
    • prevalence and overlap of stunting and wasting among children < 5y
    • underweight, stunting and wasting as risk factors for cause-specific deaths due to infectious diseases and disability among children < 5y
    • the prevalence of low birth weight (at term), and its association with neonatal mortality from birth asphyxia and infections
    • risks associated with deficiencies in vitamin A, zinc, iron, iodine and other micronutrients
    • risks associated with suboptimal breastfeeding and complementary feeding
    • global and regional disease burden (deaths and DALYs)
paper 2 maternal and child undernutrition long term consequences for adult health
Paper 2:Maternal and child undernutrition:  long-term consequences for adult health?

Stream 2

  • Systematic literature searches on associations with
    • Human capital (height, schooling, income, etc)
    • Risk factors for chronic disease (blood pressure, glucose, overweight, etc)
    • Chronic diseases (cardiovascular disease, cancer, mental illness, etc)
  • Re-analysis of data sets from 5 long-running cohort studies in Brazil, Guatemala, India, Philippines and South Africa on associations between MCU, human capital and risk factors for chronic diseases
paper 3 global review of nutrition interventions and programs what works
Paper 3:Global review of nutrition interventions and programs: What works?

Stream 2

  • Systematic review of global evidence-base on interventions addressing maternal and child undernutrition
  • More in-depth literature searches by 6 review groups in Karachi, Delhi, Dhaka, Pelotas, Davis and London
  • Outcomes evaluated
    • Growth
    • Micronutrient status & related functional outcomes
    • Mortality
    • Morbidity
    • Birth outcomes
  • Modeled estimates of stunting and DALYs avertable
paper 4 what can be done at national level to reduce maternal and child undernutrition
Paper 4:What can be done at national level to reduce maternal and child undernutrition?

Stream 2

  • Selective literature reviews: policy development and implementation; World Bank projects addressing nutrition; large-scale programs (from paper 3 review)
  • Survey of current nutrition policies and program implementation in: (1) 20 countries with stunting prevalence > 20% and 80% of the stunted children; (2) selected countries not included in (1).
  • Re-analysis of existing data
    • describe types of food eaten by children in the focus countries
    • examine coverage levels in 36 high-burden countries for interventions found important in paper 3 review
  • Focus groups/interviews with policy leaders in developing countries
slide19

Paper 5:Effective international action against undernutrition: Why has it proven so difficult and what can be done to accelerate progress?

Stream 2

  • Systematic reviews
    • all research output related to nutrition in 6-mo period
    • linkages between nutrition outcomes & global change processes
    • media coverage
  • Quantitative analysis of financial flows for nutrition
  • Semi-structured key informant interviews and document review
    • international organizations
    • bilateral donors and foundations
    • universities and international research centers
    • private sector
    • NGOs
  • Problem tree analysis based on program and institutional reviews
slide20

Stream 3

Wide dissemination and advocacy based on series findings

  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
  • Planned launches
    • London (The Lancet)
    • Washington D.C. (GMMB/Gates)
    • In high-undernutrition-burden countries (Gates & partners at country level)
  • Executive summary
    • Format accessible to policy makers
    • Available at time of series publication
  • Series publication as freestanding booklet
slide22

2007

Results from papers 1 & 3

March

Full drafts for internal review

May

Papers submitted

July

Lancet peer reviews

Papers revised & resubmitted

Sep

Publication

Nov

talk to us
Talk to us!
  • Key issues relating to country programs:
    • Who are the key actors (now and potential) at country level?
    • What is the role of nutrition policies and plans?
    • What are practical steps for governments, partners and the private sector to strengthen undernutrition actions at country level?
    • What country-level needs should be met by the international nutrition community?
  • Key issues relating to the international system:
    • How can the UN system be made more effective at country level?
    • How can the SCN increase its focus on results?
    • What kind of partnership could best bring different groups together?
    • How to move towards a more streamlined organizational set-up?
    • How to increase the focus on capacity building?