Tag Archives: Maternal health

The Lancet series 2013: What is new and how it affects the nutrition world

This blog post is by RESULTS Nutrition Advocacy Officer, Kat Pittore.

maternal-child-nutrition_Lancet 2013 Last week the second Lancet series on maternal and child undernutrition was released, adding new evidence, and providing new analysis on the impact of various nutrition interventions. As a nutritionist, I had been eagerly awaiting the launch for months, waiting for the newest evidence to be released. What does this mean for the nutrition community? What new evidence has been generated and how can it be used to inform our work? What other evidence is needed?

The first Lancet series on maternal and child undernutrition was published in 2008 and provided, for the first time, a synthesis of the scientific evidence on nutrition interventions. One of the difficulties with public health research is that there are thousands of studies available on very specific topics with different groups of the population, for example one study will compare the effect of providing iron to pregnant women in India, another will look at the effects of providing pregnant women in Tanzania with iron and folic acid supplements. The outcomes that studies look at will also be different, even studies measuring similar outcomes, for example, when looking at the effects in stunting (a child being too short for  age) some studies will look at how much a child’s growth has improved whereas some will only look at the number of children who move from stunted to non-stunted. In such a confusing landscape, it is difficult even for a nutritionist like myself to be able to decided what interventions are the most effective and what we need to be advocating for.

The first Lancet series on maternal and undernutrition took all the available studies on key issues including:  most effective nutrition interventions, countries and regions with the highest burden of undernutrition, the long term consequences of undernutrition for adult health and why progress on ending undernutrition has been so slow. It brought all the studies together to create a scientific consensus on what needs to be done.

The 2008 series identified that undernutrition was responsible for 2.2 million deaths in children under 5 each year, or 35% of all under 5 deaths. It also identified 13 key interventions, especially counseling on optimal breastfeeding practices and supplementation or fortification with vitamin A and zinc that could  effectively be scaled up to reduce undernutirtion. Critically it identified the need to focus on the first 1000 days, from conception to age 2, in which nutrition interventions have the greatest impact. This “window of opportunity” became critical for both programming and advocacy efforts.

The first series was a critical first step, and provided necessary consensus in the nutrition community to raise the issue of undernutrition and be able to show tangible benefits to investing in certain interventions, as well as the consequences of failing to act. However, much has changed in the last 5 years and the new series that came out last week uses new data to look at how we can effectively tackle undernutrition in a changing landscape.

The first paper in the 2013 series examines the consequences  of undernutrition, critically that 3.1 million child deaths, or 45% of all under 5 deaths each year, are caused by undernutriton. This number is significantly higher than the number  given in the 2008 series. This is because overall the number of under 5 deaths has decreased, however, nutrition has not been invested in as much as needed, meaning that a greater percentage of a smaller number of deaths are caused by undernutrition. Another change from the earlier series is the inclusion of the growing problem of maternal and child overweight and obesity, which can cause complications during pregnancy and childbirth. Child undernutrition and stunting can also be risk factors for later poor heath – undernourished children are more susceptible to  illness and chronic diseases such as diabetes and heart disease later in life.

The second paper seeks to quantify not just the interventions that are needed, but how much the cost.  It looks at how much it would cost to implement ten specific nutrition  interventions if they were “implemented at scale” which means that at least 90% if the population has access to a service. It was estimated that if we are able to scale up the 10 highly effective interventions in 34 key countries (the ones with most of the undernourished children) we could prevent at least 20% of stunting and 61% of severe wasting (wasting is when a child is too thin for their height and is at a high risk of dying). They estimated that this would cost $9.6 billion per year, of which$ 3-4 billion per year would be need from donors, with the rest coming from countries affected by undernutrition.

The third paper adds significant new data to the nutrition literature, seeking to explore the impact of “nutrition sensitive” programmes.  These are programmes which impact  nutrition status, but are not directly related to nutrition. The paper focuses on 4 areas of nutrition sensitive policies: agriculture, social safety nets, early child development and schooling. These areas were chosen specifically because of the possibility of having a large impact on nutrition as well as the possibility for the programmes to be effectively scaled up.

Overall, the review found that while nutrition sensitive policies have great potential to impact nutritional outcomes, they currently are not being targeted effectively as they could be to reach very young children. Nor do they always improve women’s empowerment. These two weaknesses means the proven impact is not as positive as would be desired.  A key point said by one of the  researchers at the launch is- “lack of evidence of impact does not constitute evidence of lack of impact” Put another way this means that because we do not yet have enough evidence to demonstrate nutrition sensitive policies are effective, it does not mean that they have no impact, only that more research is necessary.

The final paper  emphasises that nutrition is not a non-political issues, and that high level political commitment is necessary to ensure that commitments made are implemented. Some key issues identified in the paper include the need for economic growth, but how economic growth alone is not enough to reduce undernutrition. Another important point is the need to create an enabling environment by increasing political will. The paper also looked at some more contentious issues such as what the role of the private sector should be, and how to ensure that the private sector operates in a responsible way, especially given its troubled past history with marketing of breast-milk substitutes.

The new series comes at a key point in time, increasing evidence for action in the same week that 24 countries and 66 other organizations came together to pledge money and resources towards ending undernutrition. The new evidence strengthens the argument for the need to invest in nutrition now, and provides us with evidence on tangible ways to do so.

The views and opinions expressed are those of the author and do not necessarily reflect the views of RESULTS 

GAVI takes first steps to introduce vaccines against cervical cancer and rubella

Responding to demand from developing countries, the GAVI Alliance has taken the first steps towards the introduction of Human papillomavirus (HPV) and rubella vaccines in developing countries, it was announced today.

If a sustainable price with manufacturers can be agreed, and countries can demonstrate their ability to deliver the vaccines, up to two million women and girls in nine countries could be protected from cervical cancer by 2015.

The GAVI Board also agreed to fund vaccines against the rubella virus, which threatens pregnancies and child health. The plan is to reach 588 million children by 2015.

“These two initiatives have huge potential impact for women and families in the developing world,” said Seth Berkley, CEO of GAVI. “The HPV vaccine is critical to women and girls in poorer countries because they usually do not have access to screening to prevent cervical cancer and treatment taken for granted in richer nations. Today, we have taken deliberate first steps to correct this inequity,” he added.

Highly transmissible, HPV causes approximately 275,000 cervical cancer deaths each year, of which 88% occur in developing countries. Experts say this figure could increase to 430,000 by 2030 if action is not taken. Safe and effective HPV vaccines may prevent 70% of cervical cancer cases. HPV also causes other more rare cancers in both men and women.

Addressing the GAVI Board on 15 November at an event organised by the Bangladeshi Health Ministry, UN Secretary-General Ban Ki-moon encouraged the Alliance, other global health partners and the pharmaceutical industry to “deliver the promise of a future free from the threat of cervical cancer to millions of young women thanks to the HPV vaccine.”

“Investing in their health and their future is the best investment we can make,” Mr Ban added, a year after he launched his Every Women Every Child strategy which GAVI pledged to support with vaccines including HPV and rubella.

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AIDS treatment is great value for money but funding to be cut

In a recent study published last week and covered by the Guardian, academics calculated that it will cost $14.2 billion to keep 3.5 million people living with HIV/AIDS alive on antiretroviral drugs.  While this may seem like a lot, the authors argue that in addition to the health benefits gained, this investment would increase economic productivity and the gains have the potential to significantly offset the costs. The study demonstrates that AIDS treatment is, in fact, good value for money.

Providing antiretroviral treatment to HIV/AIDS patients allows them to continue living a health life. Parents living with HIV are able to raise their children and go to work, enabling them to provide for their families. In addition, providing treatment to PLWHA delays end-of-life medical care which could amount to $34 billion in savings. Tuberculosis and other infections afflict those with HIV at the end of life, so funding treatment options is vital to delay these extra medical costs.

However, although investing in HIV/AIDS treatment not only saves lives and results in economic benefits, the UK Government is cutting back on bilateral aid for HIV/AIDS in developing countries by almost a third over the next four years, according to recent figures published on DFID’s Global Development website. Funding will drop by nearly 85% in Asia and 17% in Africa, despite a 92% rise in Britain’s bilateral aid for global health. It is looking likely that the UK will rely on investments from the Global Fund to Fight AIDS, TB and Malaria to make up for any shortfall.

DFID is currently prioritising reproductive, maternal and newborn health. But arguably, cutting funding to AIDS, TB and malaria will have a detrimental effect to the achievements of these health areas and undermine the progress of the MDGs. Not only do women’s social roles make them more susceptible to developing TB, but pregnant women living with HIV and TB face far higher risks of maternal mortality. TB is the third leading cause of death among women and when combined with HIV, with an often fatal result. RESULTS UK and the International HIV/AIDS Alliance have both expressed their concerns to the Guardian, where the full article can be read.

Huge progress on education is possible: will we do it?

Hometime in Kibera, Kenya. Photo by Shortie66Education is the best poverty-fighter; it has been calculated that if all students in low-income countries left school with just basic reading skills, 171 million people could be lifted out of poverty – which would represent a 12% cut in global poverty.

In November the Education for All Fast Track Initiative (shortly to be renamed the ‘Global Partnership for Education’) is holding a pledging conference where they will call on donor nations to provide additional resources for education in low-income countries. The FTI is asking donors to provide $2.5 billion for their Global Fund for Education, and they recently released details of what they are hoping to achieve in the FTI replenishment case for investment. Through the replenishment the FTI want to pay for:

  • Enrolling an additional 25 million children in school, which will mean halving the population of out of school children in all FTI countries;
  • Increasing primary school completion rates by 7.5%;
  • Reducing the number of children in grade 3 who cannot read by 50% in 20 countries;
  • Providing 50 million new textbooks; and
  • Increasing the numbers of teachers by providing in-service training to 600,000 new teachers.

The really exciting thing is the knock-on effects that this investment would have. Already we have seen the enrolment and completion rates for girls shooting up in FTI countries. Educating women has proven the best tool in the fight against child and maternal mortality over recent decades. As well as reducing overall poverty, through the new investment the FTI will save the lives of 350,000 children and 14,000 women every year.

At the beginning of August RESULTS launched a campaign to build support for the FTI replenishment. If you haven’t already, you can learn more and take action here.

Photo by Shortie66

The Global Fund is ‘Making a Difference’

On May 19th, the Global Fund to Fight AIDS, TB and Malaria released their new results report, impressively illustrating how the Global Fund has saved 6.5 million lives over the past eight years.

Between 2002 and the end of 2010 the Global Fund has approved US$ 21.7 billion for grants in 150 countries. The funded programmes provided lifesaving antiretroviral therapy to 3 million people, detected and treated 7.7 million cases of tuberculosis, and distributed 160 million insecticide-treated nets.
Executive Director of the Fund, Professor Michel Kazatchkine, said: Continue reading

News from the February GAVI Action

For those of you following RESULTS’ work on securing support for the GAVI Alliance, you will remember our February action was to write to MEPs to ask them to support the funding drive that will be taking place in June for this vital initiative.

Every year, more than 8.1 million children around the world die from preventable diseases such as pneumonia, diarrhoea, malaria, HIV and measles, and millions more suffer serious illness and permanent disability. With only 4 years left until 2015, and the 4th Millennium Development Goal on reducing child mortality by two thirds fast approaching, we need to be working as an international community to support vaccinations- one of the best methods we have to save children’s lives on a global scale.

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Birth should not equal death

In light of the Lancet medical journal’s special series published today estimating that 2.6 million stillbirths occurred worldwide in 2009, we thought it would be a good opportunity to highlight maternal and newborn health by re-visiting a video shown to us by White Ribbon Alliance presenter James Cox during our national conference last weekend. As part of James’ presentation, he showed us the following film reminding us that giving birth remains one of the most dangerous things a woman can do, particularly in the developing world:

As the Lancet points out, every day more than 7,200 babies are stillborn, and unlike maternal mortality and wider child death rates, the number of stillbirths is showing little reduction. Continue reading

Kick-starting the week leading up to World TB Day!

As many of you most likely already know, World TB Day will be happening this Thursday! In run-up to World TB Day, here are some news items highlighting why TB is such an important issue and why we need further advocacy to mobilise resources to fight TB – the leading cause of death among curable infectious diseases.

Increasing rates of drug resistant TB are undermining inroads made against TB

Last week, the scientific journal The Lancet published an article written by Dr Alimuddin Zumla and Dr Stephen D Lawn on ‘Increasing Drug Resistance Threatens Gains of World TB Programmes; Smoking and Diabetes are also Fuelling the Global TB Epidemic; Even Modern Drugs for Rheumatoid Arthritis Trigger TB’. The authors say:

“Increasing rates of drug resistant TB in eastern Europe, Asia, and sub-Saharan Africa now threaten to undermine the gains made by worldwide tuberculosis control programmes.”

Drug resistant TB is on the rise and is a threat to everyone. Drug resistance can Continue reading

What do the government aid reviews mean for TB?

Following on from our post earlier in the week looking at what the multilateral and bilateral aid reviews mean for access to education, we have also investigated what the reviews mean for the UK’s contribution to global tuberculosis (TB) control.

Unfortunately, TB does not figure at all prominently in the aid reviews, but this is not surprising due to the disease not being identified as a priority within the Department for International Development (DFID) business plan for 2011 – 2015. In the summary document which covers the results of the two reviews, DFID commit to:

Support global efforts to halve tuberculosis deaths by 2015. We will fund research and development into more effective treatment and vaccines to combat tuberculosis. Continue reading

Celebrating International Women’s Day: 100 years of progress, so much more to do

Women TB advocates Joyce Kamwana and Mamta Jacob meet RESULTS volunteers in October 2010

Today, the world celebrates the 100th Anniversary of International Women’s Day.  So much progress has been made on gender equality in the last century, from the expansion of universal suffrage to social and legal reforms promoting equal rights, and from improvements in reproductive health and more girls in education to progress against gender-based violence.

But despite this, gender inequality still features across the world and in multiple walks of life.  In many countries across the world – particularly but not exclusively poorer countries – women are often deprived of basic rights such as education and health.  Continue reading