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The impact of "Option B" on HIV transmission from mother to child in Rwanda: An interrupted time series analysis.
PloS One. 2018; 13(2):e0192910.BACKGROUND: Nearly a quarter of a million children have acquired HIV, prompting the implementation of new protocols-Option B and B+-for treating HIV+ pregnant women. While efficacy has been demonstrated in randomized trials, there is limited real-world evidence on the impact of these changes. Using longitudinal, routinely collected data we assessed the impact of the adoption of WHO Option B in Rwanda on mother to infant transmission. METHODS: We used interrupted time series analysis to evaluate the impact of Option B on mother-to-child HIV transmission in Rwanda. Our primary outcome was the proportion of HIV tests in infants with positive results at six weeks of age. We included data for 20 months before and 22 months after the 2010 policy change. RESULTS: Of the 15,830 HIV tests conducted during our study period, 392 tested positive. We found a significant decrease in both the level (-2.08 positive tests per 100 tests conducted, 95% CI: -2.71 to -1.45, p < 0.001) and trend (-0.11 positive tests per 100 tests conducted per month, 95% CI: -0.16 to -0.07, p < 0.001) of test positivity. This represents an estimated 297 fewer children born without HIV in the post-policy period or a 46% reduction in HIV transmission from mother to child. CONCLUSIONS: The adoption of Option B in Rwanda contributed to an immediate decrease in the rate of HIV transmission from mother to child. This suggests other countries may benefit from adopting these WHO guidelines.
Professional care delivery or traditional birth attendants? The impact of the type of care utilized by mothers on under-five mortality of their children.
Tropical Medicine and Health. 2018; 46(1)Background: Because of the high under-five mortality rate, the government in Zambia has adopted the World Health Organization (WHO) policy on child delivery which insists on professional maternal care. However, there are scholars who criticize this policy by arguing that although built on good intentions, the policy to ban traditional birth attendants (TBAs) is out of touch with local reality in Zambia. There is lack of evidence to legitimize either of the two positions, nor how the outcome differs between women with HIV and those without HIV. Thus, the aim of this paper is to investigate the effect of using professional maternal care or TBA care by mothers (during antenatal, delivery, and postnatal) on under-five mortality of their children. We also compare these outcomes between HIV-positive and HIV-negative women. Methods: By relying on data from the 2013-2014 Zambia Demographic Health Survey (ZDHS), we carried out propensity score matching (PSM) to investigate the effect of utilization of professional care or TBA during antenatal, childbirth, and postnatal on under-five mortality. This method allows us to estimate the average treatment effect on the treated (ATT). Results: Our results show that the use of professional care as opposed to TBAs in all three stages of maternal care increases the probability of children surviving beyond 5 years old. Specifically for women with HIV, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.07 percentage points (p.p), 0.71 p.p, and 0.87 p.p respectively. Similarly, for HIV-negative women, professional care usage during antenatal, at birth, and during postnatal periods increases probability of survival by 0.71 p.p, 0.52 p.p, and 0.37 p.p respectively. However, although there is a positive impact when mothers choose professional care over TBAs, the differences at all three points of maternal care are small. Conclusion: Given our findings, showing small differences in under-five child's mortality between utilizers of professional care and utilizers of TBAs, it may be questioned whether the government's intention of completely excluding TBAs (who despite being outlawed are still being used) without replacement by good quality professional care is the right decision. © 2018 The Author(s).
Maternal and Child Nutrition. 2017 Apr; 13(2):1-16.Poor linear growth in children <5 years old, or stunting, is a serious public health problem particularly in Sub-Saharan Africa. In 2013, the World Health Organization (WHO) released a conceptual framework on the Context, Causes and Consequences of Childhood Stunting (the ‘WHO framework’) that identifies specific and general factors associated with stunting. The framework is based upon a global review of data, and we have applied it to a country-level analysis where health and nutrition policies are made and public health and nutrition data are collected. We reviewed the literature related to sub-optimal linear growth, stunting and birth outcomes in Ethiopia as a case study. We found consistent associations between poor linear growth and indicators of birth size, recent illness (e.g. diarrhea and fever), maternal height and education. Other factors listed as causes in the framework such as inflammation, exposure to mycotoxins and inadequate feeding during and after illness have not been examined in Ethiopia, and the existing literature suggests that these are clear data gaps. Some factors associated with poor linear growth in Ethiopia are missing in the framework, such as household characteristics (e.g. exposure to indoor smoke). Examination of the factors included in the WHO framework in a country setting helps identifying data gaps helping to target further data collection and research efforts.
Policy requirements for HIV testing and counselling of infants and young children in health facilities.
Geneva, Switzerland, WHO, 2010.  p.Currently, many opportunities to diagnose HIV infection in infants and children are missed within the health system. These opportunities for diagnosis of HIV arise at facilities providing services for antenatal care, prevention of mother-to-child transmission (PMTCT) of HIV, immunization, nutrition, inpatient admissions and within programmes for other vulnerable children. It is estimated that only 8% of HIV-exposed infants received early virological testing in 2008. Analysis of international cohort data confirms that very few HIV-infected infants are started on antiretroviral therapy, and those who do receive it, are started when they are already very sick, largely due to a delay in HIV testing. The benefits of expanded access to HIV testing and counselling for infants and children are numerous and include the following: early identification of HIV-infected infants and children as a first step to treatment and care; identification of HIV-exposed but uninfected infants, which facilitates follow-up care and prevention measures that will help to ensure that they remain uninfected and healthy; life-planning for parents and/or children who are HIV infected; and increased access to care and antiretroviral therapy for parents. Providing HIV testing for infants and children, however, presents unique challenges for policy-makers, programme managers and health-care providers. To address these challenges, WHO and the United Nations Children’s Fund (UNICEF), in consultation with the Interagency Task Team on Prevention of HIV Infection in Pregnant Women, Mothers and their Children, have prepared this policy brief, which is in line with existing WHO technical recommendations, including guidance on provider-initiated HIV testing and counselling issued by WHO in 2007. The brief aims to outline key issues that should be addressed within national policy guidance to support country programming. It is designed to be used by country programmes and technical working groups as they review and develop policy and practice guidelines relevant to HIV testing for children. For the purposes of this brief, infants and children should be considered to include all children who are 14 years of age or younger. Specific attention should be given to those issues related to children below the age of 10 years. (Excerpt)
World Health and Population. 2008; 10(2):25-39.Our study examines factors influencing demand for contraception for spacing as well as for limiting births in India. Data on socio-economic, demographic and program factors affecting demand for contraception in India are from the National Family Health Survey, 1998--99. The recent document from the National Rural Health Mission has completely ignored the use of contraception in controlling fertility in India. Empirical results of our study suggest giving priority to and focusing attention on supply-side factors such as a regular and sustained supply of quality contraceptive methods to improve accessibility and affordability. Further, strengthening the information, education and communication (IEC) component of the reproductive and child health (RCH) package would allay misapprehensions about the side effects and health risks of contraception. Focusing attention on demand-side factors such as women's empowerment through education, gainful employment and exposure to mass-media would help reduce the unmet demand for family planning. The resulting reduction in fertility would hasten the process of demographic transition and population stabilization in India.
Lancet. 2008 Oct 25; 372(9648):1459.Your Aug 16 Editorial1 emphasises that India is far from its target of reaching Millennium Development Goal 4 on child survival, despite its impressive rate of economic growth compared with the other south Asian nations. You state that India is spending only 3% of its gross domestic product (GDP) on health, which is less than the other countries in the Asia-Pacific region; however, India has actually been spending only 0|9% of its GDP on heath for the past two decades.2 2-3% of GDP is the predicted level of spending by the Indian Government by 2010.2 Although the link between poverty and child mortality is very strong, some countries are better at translating their economic growth into pre venting child deaths. For example, India's gross national income (GNI) per head has in creased by a staggering 82% from US$450 in 2000 to $820 in 2006, yet its child mortality rate only declined by 19% from 94 per 1000 births to 76 per 1000. Over the same period, Bangladesh saw a much smaller 23% in crease in GNI per capita-from $390 in 2000 to $480 in 2006-but its child mortality dropped by 25% from 92 to 69 per 1000 births.3,4 The maternal mortality rate also declined from 440 per 10 000 births in 1997 to 315 in 2001 in Bangladesh.5 All countries, even the poorest, can reduce child mortality if they pursue the right policies and prioritise their poorest families. Good government choices save children's lives but bad ones are a death sentence. (full-text)
Public-private partnerships: Managing contracting arrangements to strengthen the Reproductive and Child Health Programme in India. Lessons and implications from three case studies.
Geneva, Switzerland, World Health Organization [WHO], 2007.  p.Strengthening management capacity and meeting the need for reproductive and child health (RCH) services is a major challenge for the national RCH program of India. Central and state governments are using multiple options to meet this challenge, responding to the complex issues in RCH, which include social, cultural and economic factors and reflect the immense geographical barriers to access for remote and rural population. Other barriers are also being addressed, including lessening financial burdens and creating public-private partnerships to expand access. For example, the National Rural Health Mission was initiated in order to focus on rural populations, although departments of health face a number of challenges in implementing this initiative. In this document, we focus on a key area: the development of management capacity for working with the private sector. We synthesize the lessons learnt from three case studies of public-private partnerships in RCH: two are state initiatives, in Gujarat and Andhra Pradesh, and the third is the national mother nongovernmental organization scheme. The case studies were conducted to determine how management capacity was developed in these three public-private partnerships in service delivery, by examining the structure and process of partnerships, understanding management capacity and competence in various public-private partnerships in RCH, and identifying the means for developing the management capacity of partners. (author's)
Safe, voluntary, informed male circumcision and comprehensive HIV prevention programming. Guidance for decision-makers on human rights, ethical and legal considerations. Pre-publication.
Geneva, Switzerland, UNAIDS, 2008 Mar. 28 p. (UNAIDS/08.19E / JC1552E)Throughout the world, HIV prevalence is generally lower in populations that practise male circumcision than in populations where most men are uncircumcised. This has been observed over the years of the HIV epidemic and has now been confirmed through three randomized controlled trials concluded in 2005-2006. The trials showed that male circumcision reduces by 60% the transmission of HIV from women to circumcised men. The results have led to the conclusion that male circumcision is an effective risk-reduction measure for men, and should be used in addition to other known strategies for the prevention of heterosexually acquired HIV infection in men. (excerpt)
New York, New York, UNICEF, 2007 Dec.  p.Five years after the Special Session, more than 120 countries and territories have prepared reports on their efforts to meet the goals of 'A World Fit for Children' (WFFC). Most have developed these in parallel with reports on the Millennium Development Goals, carrying out two complementary exercises. Reports on the Millennium Development Goals highlight progress in poverty reduction and the principal social indicators, while the World Fit for Children reports go into greater detail on some of the same issues, such as education and child survival. But they also extend their coverage to child protection, which is less easy to track with numerical indicators. The purpose of this document is to assemble some of the information contained in these reports, along with the latest global data - looking at what has been done and what remains to be done. It is therefore organized around the four priority areas identified in A World Fit for Children, discussing each within the overall framework of the Millennium Development Goals. To appreciate the achievements for children over the past two decades, it is also useful to reflect briefly on how their world has changed. Children born in 1989, the year when the Convention on the Rights of the Child was adopted, are now on the brink of adulthood. They have lived through a remarkable period of social, political and economic transformation. (excerpt)
Sulphadoxine / pyrimethamine versus amodiaquine for treating uncomplicated childhood malaria in Gabon: A randomized trial to guide national policy.
Malaria Journal. 2008 Feb 12; 7:31.In Gabon, following the adoption of amodiaquine/artesunate combination (AQ/AS) as first-line treatment of malaria and of sulphadoxine/pyrimethamine (SP) for preventive intermittent treatment of pregnant women, a clinical trial of SP versus AQ was conducted in a sub-urban area. This is the first study carried out in Gabon following the WHO guidelines. A random comparison of the efficacy of AQ (10 mg/kg/day x 3d) and a single dose of SP (25 mg/kg of sulphadoxine/1.25 mg/kg of pyrimethamine) was performed in children under five years of age, with uncomplicated falciparum malaria, using the 28-day WHO therapeutic efficacy test. In addition, molecular genotyping was performed to distinguish recrudescence from reinfection and to determine the frequency of the dhps K540E mutation, as a molecular marker to predict SP-treatment failure. The day-28 PCR-adjusted treatment failures for SP and AQ were 11.6% (8/69; 95% IC: 5.5-22.1) and 28.2% (20/71; 95% CI: 17.7-38.7), respectively This indicated that SP was significantly superior to AQ (P= 0.019) in the treatment of uncomplicated childhood malaria and for preventing recurrent infections. Both treatments were safe and well-tolerated, with no serious adverse reactions recorded. The dhps K540E mutation was not found among the 76 parasite isolates tested. The level of AQ-resistance observed in the present study may compromise efficacy and duration of use of the AQ/AS combination, the new first-line malaria treatment. Gabonese policy-makers need to plan country-wide and close surveillance of AQ/AS efficacy to determine whether, and for how long, these new recommendations for the treatment of uncomplicated malaria remain valid. (author's)
Washington, D.C., Population Reference Bureau [PRB], 2007 Dec.  p.With continuing political turmoil, emergency rule declared, and concerns about how free and fair January elections will be, Pakistan has been under the spotlight recently. But the political arena isn't the only area where challenges persist. Beneath the surface, more problems are brewing in the sixth most populous country in the world. Some of the challenges are fueled by the country's rapidly growing population, which is making increasing demands on social services, especially the health care system. A comparison of population pyramids reflects how Pakistan has grown and how its needs will multiply. Between 1970 and 2000, Pakistan more than doubled in population to 144 million from 60 million. Its population ages 15 to 49 more than tripled to 68 million from 14 million. As the number of people in that age group rose, so did demand for maternal and child health care. And health care needs are likely to grow as the 2025 projection for those ages 15 to 49 rises to 121 million, nearly double the 2000estimate. (excerpt)
Implementing the new recommendations on the clinical management of diarrhoea: guidelines for policy makers and programme managers.
Geneva, Switzerland, WHO, 2006. 34 p.WHO and UNICEF have released revised recommendations aimed at dramatically cutting the number of deaths due to diarrhoea. These new recommendations take into account two significant recent advances: demonstration of the increased efficacy of a new formulation for ORS containing lower concentrations of glucose and salt, and success in using zinc supplementation in addition to rehydration therapy in the management of diarrhoeal diseases. Prevention and treatment of dehydration with ORS and fluid commonly available at home, breastfeeding, continued feeding, selective use of antibiotics, and providing zinc supplementation for 10 to 14 days are the critical therapies that will help us achieve these goals. This manual provides policy makers and programme managers with the information they need to introduce and/or scale up a national decision to introduce the new ORS formulation and zinc supplementation as part of the clinical management of diarrhoeal diseases. (excerpt)
SCN News. 2006; (33):27-29.The rising prevalence of overweight and obesity has become a topical issue worldwide. Children have not been spared this problem as childhood obesity is on the increase, even in developing countries, where infectious disease and malnutrition continue to take their toll on children. Concern about childhood obesity stems from the fact that not only does it predict obesity in adult life but it is also associated with the development of unfavourable health outcomes. For example, type 2 diabetes is increasingly a problem among children. Thus, in tackling overweight and obesity, one must put in place an efficient growth monitoring system that would permit then early detection of growth deviation among young children at risk. (excerpt)
Food and Nutrition Bulletin. 2004; 25 Suppl 1:S5-S14.The rationale for developing a new international growth reference derived principally from a Working Group on infant growth established by the World Health Organization (WHO) in 1990. It recommended an approach that described how children should grow rather than describing how children grow; that an international sampling frame be used to highlight the similarity in early childhood growth among diverse ethnic groups; that modern analytical methods be exploited; and that links among anthropometric assessments and functional outcomes be included to the fullest possible extent. Upgrading international growth references to resemble standards more closely will assist in monitoring and attaining a wide variety of international goals related to health and other aspects of social equity. In addition to providing scientifically robust tools, a new reference based on a global sample of children whose health needs are met will provide a useful advocacy tool to health-care providers and others with interests in promoting child health. (author's)
Food and Nutrition Bulletin. 2003; 24 Suppl 4:S69-S77.The importance of micronutrient deficiencies or "hidden hunger" was clearly emphasized by the inclusion of specific goals on iron, vitamin A, and iodine deficiency at the 1990 World Summit for Children and other major international nutrition conferences. Significant progress has since been made toward eliminating vitamin A and iodine deficiencies, with less progress made toward reducing the burden of iron-deficiency anemia. The role of international agencies, such as the World Health Organization, United Nations Children's Fund, Food and Agricultural Organization, and World Bank in assisting countries to make progress toward the World Summit for Children goals has been very important. International agencies have played a critical role in advocating for and raising awareness of these issues at the international, regional, and national levels among policymakers and the general population. Using a rights-based approach, UNICEF and other agencies have been instrumental in elevating to the highest political level the discussion of every child's right to adequate nutrition. International agencies have also been very supportive at the national level in providing technical guidance for programs, including monitoring and evaluation. These agencies have played a critical role in engaging the cooperation of other partners, including bilateral donors, non-governmental organizations, and the private sector for micronutrient programs. Furthermore, international agencies provide financial and material support for micronutrient programs. In the future, such agencies must continue to be heavily involved in programs to achieve the newly confirmed goals for 2010. The present paper focuses on the role of international agencies in combating micronutrient deficiencies, drawing on the lessons learned over the last decade. The first section of the paper summarizes the progress achieved since 1990, and the second section describes the specific role of international agencies in contributing to that progress. (author's)
New York, New York, UNICEF, 2006 Sep. 33 p.Water is as fundamental to human life as the air we breathe. Yet, ironically, this essence of life can have an injurious impact if its source is not free from pollution and infection -- and the most likely pollutant is human faeces that have not been disposed of and have spread because of a lack of basic sanitation and hygiene. Young children are more vulnerable than any other age group to the ill effects of unsafe water, insufficient quantities of water, poor sanitation and lack of hygiene. Globally, 10.5 million children under the age of five die every year, with most of these deaths occurring in developing countries. Lack of safe water, sanitation and adequate hygiene contribute to the leading killers of children under five, including diarrhoeal diseases, pneumonia, neonatal disorders and undernutrition. This means that Millennium Development Goal 7 -- to ensure environmental sustainability -- and its associated 2015 targets of reducing by half the proportion of people without sustainable access to safe drinking water and basic sanitation are of vital relevance to children. MDG 7 is also crucial in relation to improving nutrition, education and women's status, and success in this field will thus play a major role in determining whether the world meets its MDG targets across the board. (excerpt)
Toolkit to improve private provider contributions to child health: introduction and development of national and district strategies.
Washington, D.C., Academy for Educational Development [AED], Support for Analysis and Research in Africa [SARA], 2005 Jun. 50 p. (USAID Development Experience Clearinghouse DocID / Order No: PN-ADF-758; USAID Contract No. AOT-C-00-99-00237-00)June 2002, the World Bank published a discussion paper titled Working with the Private Sector for Child Health. The paper--developed with technical assistance from the USAID Bureau for Africa, Office of Sustainable Development (AFR/SD) through the Support for Analysis and Research in Africa (SARA) project--lays out a framework for analyzing the contributions of the private sector in child heath. The framework, outlined below, is designed to serve as a basis for assessing the potential of different components of the private sector at country level. The framework identifies the following components of the private sector as being important for child health: Service providers (formal sector, other for-profit, employers, non-governmental organizations [NGOs], private voluntary organizations [PVOs], and traditional healers); Pharmaceutical companies; Pharmacies; Drug vendors and shopkeepers; Food producers; Media channels; Private suppliers of products related to child health, e.g. ITNs; Health insurance companies. (excerpt)
Lancet. 2006 Sep 2; 368(9538):817-819.In 2003, as the Bellagio Study Group on Child Survival, we called on major international public-health organisations and funders to put child survival at the top of their priorities (panel). In January, 2006, the Executive Board of UNICEF approved, in principle, a new joint health and nutrition strategy for 2006-15. The UNICEF strategy is a landmark, signalling a substantial shift from the so-called "boat-adrift" pattern of child survival efforts over the past decade. The strategy can serve as a foundation for renewed, reinvigorated, and successful efforts to achieve the Millennium Development Goals, all of which depend for their achievements on massive and unified efforts in child survival. Three elements of the strategy are courageous, building on evidence rather than politically correct rhetoric. First, the joining of health and nutrition into a unified movement rises above disciplinary infighting to recognise essential synergies--synergies between under-nutrition and infections that account for over half the deaths in children aged younger than 5 years, and potential synergies in prevention and treatment that make simple interventions to improve child nutrition the most cost-effective option for poor governments seeking to achieve the Millennium Development Goals. (excerpt)
Kyiv, Ukraine, UNDP, 2003. 36 p.Ukraine is a young nation on the move. The national response to HIV/AIDS is also gathering pace. It is bringing together fresh coalitions of people, leaders and institutions who want to stop the further spread of this virus and to ensure care for those who are in need. The good news for all is that there are now known ways of preventing the spread of the virus and treatment is increasingly available. The challenge remains immense -- to some overwhelming. The insidious nature of the virus is that it attacks men and women in the prime of their life -- between the ages of 15 and 40. It robs children of their parents, and society of its productive citizens. Limited budgets and ungrounded stigma have severely hampered a scaled-up nationwide response. Positive rhetoric is helpful, but it needs to be matched by personal commitment and concrete actions. With the infusion of new resources, now is the time to remove the log jams and unleash a broad-based national effort to change the current course of the epidemic. As the Secretary General of the United Nations Kofi Annan recently said, "We have come a long way, but not far enough. Clearly, we will have to work harder to ensure that our commitment is matched by the necessary resources and action." (excerpt)
UN Chronicle. 1991 Jun; 28(2): p..The United Nations Children's Fund (UNICEF) has made a "promise to children"--to try to end child deaths and child malnutrition on today's scale by the year 2000. The Fund estimates that a quarter of a million children die every week from common illnesses and one in three in the world are stunted by malnutrition. That broad goal, declared on 30 September 1990 by 71 Presidents and Prime Ministers attending the first World Summit for Children, includes 20 specific targets detailed in the Plan of Action for implementing the World Declaration on the Survival, Protection and Development of Children in the 1990s, adopted at the Summit. Among them are: one-third reduction in under-five death rates; halving maternal mortality rates; halving of severe and moderate malnutrition among the world's under-fives; safe water and sanitation for all families; and measures covering protection for women and girls, nutrition, child health and education. Other goals include making family planning available to all couples and cutting deaths from diarrhoeal diseases--which kill approximately 4 million young children annually--by one half, and pneumonia--which kills another 4 million a year--by one third. (excerpt)
New York, New York, UNICEF, 2005 Apr.  p.The past decade has seen UNICEF take the very best practices from its long and productive history and apply them in the service of today's children who live in a world previously unimagined. A complex world marked by intractable poverty, pervasive political instability, serial conflicts, HIV and AIDS. A world where there are few, if any, single causes, easy solutions or quick fixes. At $1.7 billion in 2004, UNICEF's income almost doubled in 10 years. The money, all voluntary contributions, was invested in programmes that prioritized early childhood, immunization, girls' education, improved protection and HIV and AIDS. Global progress on many fronts has been phenomenal: Mortality rates for children under five have dropped by around 15 per cent since 1990; Deaths from diarrhoea, one of the major killers of children under five, have been cut in half since 1990; Polio, once a deadly killer, is nearly eradicated; Measles deaths dropped by nearly 40 per cent; More children are in school than ever before; National laws and policies to better protect children have been enacted in dozens of countries. And, perhaps most profoundly of all, nearly every country in the world has ratified the Convention on the Rights of the Child. (excerpt)
New York, New York, UNICEF, 2005. 25 p.The world must take urgent account of the specific impact of AIDS on children, or there will be no chance of meeting Millennium Development Goals (MDG) 6 - to halt and begin to reverse the spread of the disease by 2015. Failure to meet the goal on HIV/AIDS will adversely affect the world's chances of progress on the other MDGs. The disease continues to frustrate efforts to reduce extreme poverty and hunger, to provide universal primary education, and to reduce child mortality and improve maternal health. World leaders, from both industrialized and developing countries, have repeatedly made commitments to step up their efforts to fight the spread of HIV/AIDS. They are beginning to increase the political leadership and the resources needed to fight the disease. Significant progress is being made in charting the past and future course of the pandemic, in providing free antiretroviral treatment to those who need it, and in expanding the coverage of prevention services. But children are still missing out. (excerpt)
BMJ. British Medical Journal. 2005 Nov 26; 331(7527):1270.That the call for reassessing health outcomes by Evans et al is limited to a disease model as linked to millennium development goals 4, 5, and 6 alone is surprising. The World Health Organization listed child underweight as the leading risk factor contributing to the global burden of disease; and Pelletier et al have clearly shown that malnutrition underlies over 55% of all mortality in under 5s in developing countries. These results, which indicate that mild to moderate malnutrition is associated with higher mortality and that an epidemiological synergism exists between malnutrition and morbidity, have been substantiated by several other studies. So long as the global community continues to aim to tackle health as a disease model divorced from nutrition, as Evans et al propose, it will continue to fail in achieving the millennium development goals. Malnutrition represents the non-income aspects of poverty and a malnourished population cannot aspire to achieve the health goals without also dealing with nutrition. Furthermore, many nutrition interventions that can be made mainstream through the health sector are among the most cost effective best-buys in development as assessed by the Copenhagen consensus and others. Any future efforts at achieving the millennium development goals must incorporate these nutrition interventions. (excerpt)
Lancet. 2005 Jun 25; 365(9478):2153-2154.10 years from now, in 2015, governments of the world will meet to assess whether we have achieved the Millennium Development Goals (MDGs), the most widely ratified and loudly trumpeted set of development goals ever signed onto by every country in the world. MDG-4 commits the global community to reducing child deaths below age 5 years by three-quarters from a 1990 baseline. 2 years ago, in 2003, the Bellagio Lancet Child Survival Series drew attention to the fact that each year over 10 million children under 5 die in the world, mainly from preventable conditions that rarely kill children in rich countries. This year, a second Lancet series focused on a previously neglected subset of child deaths—the almost 40% of all under-5 deaths that occur in newborn babies. Together, these two series provided the necessary evidence to revitalise efforts to reduce child and newborn deaths and to achieve MDG-4, to which all countries have committed. Both series showed that most child deaths could be prevented with simple low-cost interventions feasible now, yet not reaching poor children. To reach MDG-4, massive increases are required in coverage of essential interventions. (excerpt)