Global targets and nutrition interventions to counter malnutrition

Growing Child 8

Malnutrition is a global issue in many low and middle income countries, with adolescent and pregnant women and young children being among the most vulnerable groups. In 2014, the decision-making body of World Health Organization (WHO) -World Health Assembly- formulated the ‘Global targets 2025.1 At the same time, a science-based intervention framework was developed and published by the leading Lancet Nutrition Interventions Review Group.2 This framework promotes a systematical life stage approach and prioritises interventions, to reach the WHO targets in the most effective way.

According to experts, a diversified approach on treatment or prevention of malnutrition in different life stages is important to reach the ‘Global targets 2025’ of the World Health Organization (WHO) and further improve maternal, infant and young child nutrition after the 2015 deadline of the Millennium Goals.

Adolescent and pregnant women as well as young children are most vulnerable to malnutrition and therefore deserve special attention in interventions.

The Lancet series on maternal and child nutrition (2013), models ten nutrition-specific interventions across the lifecycle to address undernutrition and micronutrient deficiencies in women of reproductive age, pregnant women, neonates, infants and children.

Global WHO targets for 2025

The WHO, which acts primarily as a norm and policy priority setting organization, formulated six essential global health targets related to improved maternal, infant and young child nutrition by 2025, see table 1.1  Worldwide there are many organizations committed to combat malnutrition, such as the United Nations affiliated World Food Programme and UNICEF, local governments and many humanitarian organisations. All organisations involved should ideally prioritize their actions on meeting these WHO targets.

 

Table 1: WHO Global targets 20251

1.      40% reduction in the number of children under 5 who are stunted.
2.      50% reduction of anaemia in women of reproductive age.
3.      30% reduction in low birth weight.
4.      No increase in childhood overweight.
5.      Increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%.
6.      Reduce and maintain childhood wasting to less than 5%.

 

Integrated and diversified approach to interventions

Interventions that target malnutrition can target nutritional and non-nutritional factors. Many causes of malnutrition are directly related to a person’s dietary pattern, and thus nutrient intake. In addition there are many factors indirectly related to malnutrition.3,4 For instance, health-related issues such as maternal and child care, or accessibility to good health services.

A number of interventions and strategies exist to prevent and treat malnutrition. They include nutrition-specific interventions, focusing on the provision of actual foods and nutrients, as well as nutrition-sensitive interventions, improving purchasing power and access to nutritious food. Additional indirectly health related interventions (sanitary, water, education, agriculture etc.) are also important to reach sustainable change. The WHO as well as the Lancet Series on Maternal and Child Nutrition call for giving higher priority to nutrition programmes, but also underline the importance of a diversified approach: where actions target nutritional as well as non-nutritional causes in different life stages (see figure 1).3,4 In figure 1, the Lancet series modelled ten priority nutrition interventions (bold), as well as other nutrition- and non-specific nutrition interventions, together with the target age groups.4

Figure 1: Conceptual framework4

Effective nutrition interventions

In the 2013 Lancet nutrition report, nutrition interventions with most impact per life stage were scientifically reviewed. To be able to determine the effect of nutrition specific interventions, 34 countries were selected that globally account for 90% of children with stunted growth. In table 2, the potential effect on child survival is calculated when the ten nutrition interventions are clustered in four packages and scaled up from their level in 2011 to 90% coverage.4

Table 2: Effect of packages of nutrition interventions at 90% coverage4

Optimum maternal nutrition during pregnancy

  • Maternal multiple micronutrient supplements to all
  • Calcium supplementation to mothers at risk of low intake**
  • Maternal balanced energy protein supplements as needed
  • Universal salt iodisation**
102.000

(49.000 – 146.000)

Infant and young child feeding

  • Promotion of early and exclusive breastfeeding for 6 months and continued breastfeeding for up to 24 months
  • Appropriate complementary feeding education in food secure populations and additional complementary food supplements in food insecure populations
221.000

(135.000 – 293.000)

Micronutrient supplementation in children at risk

  • Vitamin A supplementation between 6 and 59 months age
  • Preventive zinc supplements between 12 and 59 months of age
145.000

(30.000 – 216.000)

Management of acute malnutrition

  • Management of moderate acute malnutrition
  • Management of severe acute malnutrition
453.000

(285.000 – 482.000)

Data are number of lives saved (95% CI). *Effect of each of package when all four packages are scaled up at once. **Intervention has effect on maternal or child morbidity, but no direct effect on lives saved.

Scaling up these nutrition-specific interventions should, according to the authors, help to prevent maternal and child malnutrition in the countries at highest risk, thereby bringing the post-2015 development goals a step closer. The WHO and Lancet group also see a role for public-private partnerships in decreasing malnutrition. Especially technical and scientific collaboration (e.g. staple-food fortification) can contribute to a successful approach.2

References

  1. World Health Organization. Global targets 2025. 2014 [cited 2014 15 May]; Available from: http://www.who.int.
  2. The Lancet Nutrition Interventions Review Group, Executive Summary of The Lancet Maternal and Child Nutrition Series. 2013.
  3. World Health Organization Essential Nutrition Actions. Improving maternal, newborn, infant and young child health and nutrition. 2013.
  4. Zulfiqar A Bhutta, et al., Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? The Lancet, 2013. 382(9890): p. 452 – 477.