Maternal and childhood malnutrition 1

The Lancet has embarked on an immensely important series on Maternal and Childhood under nutrition s
BlackRL et al 2008, Maternal and child undernutrition: global and regional exposures and health consequence. The Lancet vol 371, 243-260.
There are also important leaders in the same edition
Morbidity and mortality in families in Iraq p177
Maternal health and child undernutrition: an urgent opportunity R Horton p 179
The challenge of hunger J Sheeran p 180
Nutrition interventions need improved operational capacity Heikens et al p 181

Maternal and child undernutrition is highly prevalent in low-income and middle-income countries, resulting in substantial increases in mortality and overall disease burden. In this paper, new analyses are presented to estimate the effects of the risks related to measures of undernutrition, as well as to suboptimum breastfeeding practices on mortality and disease
They discussed their findings as
Maternal short stature and low body mass index in pregnancy and lactation. Maternal short stature is a risk factor for mother and baby in the delivery as the pelvis is small.
Childhood underweight, stunting and wasting.
The authors estimate that stunting, severe wasting, and intrauterine growth restriction together were responsible for 2 2 million deaths and 21% of disability-adjusted life-years (DALYs) for children younger than 5 years. Deficiencies of vitamin A and zinc were estimated to be responsible for 0 6 million and 0 4 million deaths, respectively, and a combined 9% of global childhood DALYs. Iron and iodine deficiencies resulted in few child deaths, and combined were responsible for about 0 2% of global childhood DALYs. Iron deficiency as a risk factor for maternal mortality added 115000 deaths and 0 4% of global total DALYs. Suboptimum breastfeeding was estimated to be responsible for 1 – 4 million child deaths and 44 million DALYs (10% of DALYs in children younger than 5 years). In an analysis that accounted for co-exposure of these nutrition-related factors, they were together responsible for about 35% of child deaths and 11% of the total global disease burden. The high mortality and disease burden resulting from these nutrition-related factors make a compelling case for the urgent implementation of interventions to reduce their occurrence or ameliorate their consequences.
Maternal and child undernutrition is the underlying cause of 3-5 million deaths, 35% of the disease burden inchildren younger than 5 years and 11% of total global DALYs
The number of global deaths and DALYs in children less than 5 years old attributed to stunting, severe wasting,and intrauterine growth restriction constitutes the largest percentage of any risk factor in this age group
Vitamin A and zinc deficiencies have by far the largest remaining disease burden among the micronutrientsconsidered
Iodine and iron deficiencies have small disease burdens, partly because of intervention programmes, but sustained effort is needed to further reduce their burden
Sub optimum breastfeeding, especially non-exclusive breastfeeding in the first 6 months of life, results in
1-4 million deaths and 10% of disease burden in children younger than 5 years
Maternal short stature and iron deficiency anaemia increase the risk of death of the mother at delivery accounting for at least 20% of maternal mortality

Martin Eastwood
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