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HEALTH: Most Malnourished Children Aided Too Late

Abra Pollock

WASHINGTON, Feb 21 2008 (IPS) - Prevention may be the best medicine of all when it comes to tackling childhood malnutrition, according to a study published this week in the leading medical journal The Lancet.

Using research based on nutritional assistance programmes in Haiti that are run by World Vision, a Christian humanitarian organisation, experts found that preventative programmes offered to children of all health levels had a noticeably greater impact on reducing the prevalence of malnutrition, as compared with "recuperative" programmes that only treated children who are already moderately malnourished.

"The findings from Haiti are of global significance because all children, no matter where they live, have the same nutritional needs in their first two years of life for proper growth and development," said Purnima Menon, co-author of The Lancet article and a New Delhi-based research fellow for the International Food Research and Policy Institute (IFPRI), which co-sponsored the study along with several other groups.

According to the Global Alliance for Improved Nutrition, vitamin and mineral deficiencies each year cause one million children to die before the age of five and 100,000 infants to be born with preventable physical defects.

Other recent studies at several U.S. universities link poor nutrition and the stress of poverty among infants and toddlers with impairment in the brain&#39s development, including deficiencies in memory and language abilities, reported the Financial Times this week.

However, throughout the past two decades, most development agencies have focused their efforts on recuperative programmes, said Marie Ruel, the study&#39s lead author and the director of IFPRI&#39s Food Consumption and Nutrition division.

Agencies have been wary to fund preventative programmes because this "umbrella" model treats all children of a certain age range within a community, without a sense of which of them would otherwise become malnourished, she explained.

In addition, evidence demonstrating why aid should be invested in preventative programmes has been scant – until now.

Aside from investing in preventative programmes, authors of the study underscore the importance of delivering nutritional assistance to younger children.

Most recuperative nutrition programmes serve underweight children up until the age of five. Yet, "biologically, we have shown that after two years of age – or maybe three – you can feed children and they will not recuperate, certainly in terms of height," Ruel said. "After three, interventions have been shown not to benefit children."

Although Haiti was the site of the study, its findings could have ramifications for several other developing regions, experts agree.

"The study is particularly relevant for South Asia, which has both the highest rates of malnutrition in the world and is home to the greatest number of undernourished children," Menon said.

According to IFPRI, in India approximately 47 percent of children are underweight, and nutritional deficiencies affecting young children also remain notably high in the rural areas of Central America and the Andean region.

Not only is it critical for these regions to address malnutrition from a health perspective, but better early childhood nutrition can also result in economic benefits later in life, said a separate IFPRI said published in January 2008.

The 35-year study based in Guatemala found that giving children a high-energy, high-protein supplement called atole during their first two years of life significantly boosted their earnings later on in life.

"This research demonstrates that early childhood nutrition is not only crucial for the physical growth of children, but is also a wise, long-term economic investment," said Renaldo Martorell, a professor of International Nutrition at Emory University who was one of the researchers who conducted the original study in Guatemala. "Just as we need to invest in infrastructure, we need to invest in children."

For now, development agencies and private voluntary organisations (PVOs) such as World Vision seem to be taking some notice of the most recent study&#39s results.

World Vision, which is world&#39s largest aid distributor for the United Nations&#39 World Food Programme, has already contacted IFPRI about implementing the preventative model in Ethiopia and parts of Latin America, Ruel said.

And an e-mail noting the recent study&#39s results was circulated by the staff of the World Food Programme, as well as the U.S. Agency for International Development (USAID), to all of their country officers in the field.

"Now [these agencies] see that World Vision was able to implement this programme," Ruel said. "In Haiti, all the [PVOs] have now switched without asking any more questions."

According to Lesly Michaud, maternal and child health coordinator for World Vision-Haiti, "This study completely changed our approach to fighting childhood malnutrition."

Armed with evidence that points to the increased impact and effectiveness of this changed approach, experts now hope to convince funders that when it comes to childhood malnutrition, it is crucial to take a preventative approach to treat the disease and not the symptoms.

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