During 2008 the Lancet has run a fascinating series of articles on malnutrition and deprivation. These are profound contributions to our understanding and knowledge.
There is of course correspondence coming in to the Lancet concerning these articles and reveal the complexities of straight forward and sensible ideas.
Bhutta at al Lancet 2008 vol 371 pp 417-40 wrote about the Intervention for maternal and child undernutrtion and survival.
Amongst the issues raised was the value of vitamin A supplements within 3 days of birth and subsequent survival. Quite separate was the issue of supplementation after 6 months.
Bhutta et al studied all available papers. The problems of interpretation appear to be multiple and include the quality of the studies. Also as pointed out by Sachdev Lancet vol371 p 1746 that there is a risk of ignoring negative or neural results only looking at positive results. As yet unpublished papers are also a problem.
There is no problem about the value of vitamin A supplementation for the 6 months plus infant, the value is real.
For the new born the value is uncertain. This raises the possibility that the newly born can be protected by stores coming directly from their mother in the womb.
There are differences between children in Africa and Asia in the prevalence of kwashiorkor. This affects 2.5% of 1-3 year olds in Malawi in the maize eating communities. These babies are liable to develop metabolic failure, heart failure rather than simple wasting.(Ndekha Lancet vol 371 p 1748 )
The basic problem is one of nutrition and available clean nutritious food.

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Martin Eastwood

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