Susan Horton

Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost?

Maternal undernutrition contributes to 800,000 neonatal deaths annually through small for gestational age births; stunting, wasting, and micronutrient deficiencies are estimated to underlie nearly 3·1 million child deaths annually. Progress has been made with many interventions implemented at scale and the evidence for effectiveness of nutrition interventions and delivery strategies has grown since The Lancet Series on Maternal and Child Undernutrition in 2008. We did a comprehensive update of interventions to address undernutrition and micronutrient deficiencies in women and children and used standard methods to assess emerging new evidence for delivery platforms. We modelled the effect on lives saved and cost of these interventions in the 34 countries that have 90% of the worlds children with stunted growth. We also examined the effect of various delivery platforms and delivery options using community health workers to engage poor populations and promote behaviour change, access and uptake of interventions. Our analysis suggests the current total of deaths in children younger than 5 years can be reduced by 15% if populations can access ten evidence-based nutrition interventions at 90% coverage. Additionally, access to and uptake of iodised salt can alleviate iodine deficiency and improve health outcomes. Accelerated gains are possible and about a fifth of the existing burden of stunting can be averted using these approaches, if access is improved in this way. The estimated total additional annual cost involved for scaling up access to these ten direct nutrition interventions in the 34 focus countries is Int

Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect

9·6 billion per year. Continued investments in nutrition-specific interventions to avert maternal and child undernutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at greatest risk can make a great difference. If this improved access is linked to nutrition-sensitive approaches--ie, womens empowerment, agriculture, food systems, education, employment, social protection, and safety nets--they can greatly accelerate progress in countries with the highest burden of maternal and child undernutrition and mortality.

Why invest, and what it will take to improve breastfeeding practices?

The importance of breastfeeding in low-income and middle-income countries is well recognised, but less consensus exists about its importance in high-income countries. In low-income and middle-income countries, only 37% of children younger than 6 months of age are exclusively breastfed. With few exceptions, breastfeeding duration is shorter in high-income countries than in those that are resource-poor. Our meta-analyses indicate protection against child infections and malocclusion, increases in intelligence, and probable reductions in overweight and diabetes. We did not find associations with allergic disorders such as asthma or with blood pressure or cholesterol, and we noted an increase in tooth decay with longer periods of breastfeeding. For nursing women, breastfeeding gave protection against breast cancer and it improved birth spacing, and it might also protect against ovarian cancer and type 2 diabetes. The scaling up of breastfeeding to a near universal level could prevent 823,000 annual deaths in children younger than 5 years and 20,000 annual deaths from breast cancer. Recent epidemiological and biological findings from during the past decade expand on the known benefits of breastfeeding for women and children, whether they are rich or poor.

The economics of iron deficiency

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, womens work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US

Birth Order and Child Nutritional Status: Evidence from the Philippines

44·8 billion show the industrys large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about

Scaling up nutrition : what will it cost?

302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Child nutrition and family size in the Philippines

Abstract This paper examines the evidence for a causal relationship between iron deficiency and a variety of functional consequences with economic implications (motor and mental impairment in children and low work productivity in adults). To the extent that we can be confident that iron deficiency does cause a consequence with economic implications, this effect is quantified in economic terms. Illustrative calculations for 10 developing countries suggest that the median value of annual physical productivity losses due to iron deficiency is around

Women and Industrialization in Asia

2.32 per capita, or 0.57% of GDP. Median total losses (physical and cognitive combined) are

Maternal and child nutrition: building momentum for impact

16.78 per capita, 4.05% of GDP. Using a cost of

Costs, affordability, and feasibility of an essential package of cancer control interventions in low-income and middle-income countries: key messages from Disease Control Priorities, 3rd edition

1.33 per case of anemia prevented, from one of the few effectiveness studies of national fortification, allows us to calculate the benefit-cost ratio for long-term iron fortification programs. The median value is 6:1 for the 10 countries examined and rises to 36:1 including the discounted future benefits attributable to cognitive improvements. This paper improves on previous work by including a much more thorough survey of the quantitative magnitudes involved, and by incorporating effects of iron deficiency on cognition. However, more research is needed to verify the accuracy of the assumptions needed for this type of analysis.