evidence-based blog of Filippo Dibari

Posts Tagged ‘chronic malnutrition’

European Commission (ECHO) on Nutrition

In Under-nutrition on February 16, 2015 at 4:35 pm


Why is this essential?

Undernutrition is the phsyical outcome of food insecurity and repeated infectious diseases.  It is responsible for 45% of all deaths of children under five, amounting to 3.1 million preventable child deaths every year. It also causes irreversible impairment of growth and cognitive development for hundreds of millions more children. Around 70% of all undernourished children live in South Asia. Globally, some 52 million children under five suffer from acute undernutrition (wasting syndrome and kwashiorkor) – an extreme form of undernutrition, which results in high mortality risk and vulnerability to diseases.

A crisis situation can significantly increase the prevalence of, and risks associated with, undernutrition, potentially leading to a surge in morbidity and mortality. Infants, young children, pregnant and lactating women and elderly people are especially vulnerable although other groups may also require assistance. The nutritional status is usually the result of more than one factor, therefore requiring a multi-sectoral response, in a joint humanitarian and development approach and resilience building.


How are we helping?

The EU has almost doubled its funds allocated to nutrition programmes since 2006,  representing 165 million euros in 2013. In-house nutrition expertise has also been reinforced in the past 6 years: regional thematic experts in 3 Regional Support Offices, a dedicated global expert, a Nutrition Working Group, all reflecting the increasing attention of DG ECHO to the nutrition agenda.

The adoption of an EU policy on nutrition in March 2013 also demonstrates the increasing commitment of the EU towards nutrition. The Staff Working Document, developed by the European Commission’s Humanitarian Aid and Civil Protection department (ECHO),  provides clear strategic priorities on the EU response to undernutrition in emergencies, as follows:

  • treatment of moderate and severe acute undernutrition;
  • tackling the immediate causes of undernutrition through nutrition, health, water and sanitation and food assistance interventions;
  • addressing micronutrient deficiencies.

The priorities are translated into concrete policies, such as: providing access to safe drinking water and sanitation facilities for families and communities; free access to healthcare for children and pregnant and lactating mothers; treatment of moderate and severe acute malnutrition through a community-based approach; organising information sessions on appropriate diet and feeding practices; and supporting households in restoring their livelihoods after a disaster.

ECHO is also working closely with EuropeAid to ensure joint humanitarian and development programming and particularly to ensure coherence and complementary.

Influencing Behaviour Change for Better Child Nutrition in Ghana

In Under-nutrition on September 28, 2014 at 8:50 am

from Schools & Health web site

A new behavioural change communication (BCC) campaign is currently underway in Ghana to encourage schoolchildren to eat nutritious meals and to take on good hygiene habits.

As part of the campaign, representatives from 13 NGOs in Ghana were recently trained by Imperial College London’s Partnership for Child Development​ (PCD) to deliver good nutrition and hygiene messages across 395 communities in Ghana – targeting community events, churches, mosques and other locations.

During the training PCD outlined how materials such as t-shirts and posters should be used by campaign volunteers in communities to encourage nutritious eating habits, diet diversification and good health and hygiene of schoolchildren and their families.

By taking a Training of Trainers (ToTs) approach the lessons learnt by the NGO representatives are to be taught to community based volunteers who will spread nutrition messages to a vast audience across the 395 communities.

The workshops also looked at furthering the campaign through media engagement and how NGOs should report back on campaign outcomes for enhanced learning on what works and what areas are in need of strengthening, so that good nutrition and hygiene messages can be promoted in the best way possible.

Next Steps

In addition to targeting the community, PCD is also carrying out the BCC campaign at the school level where selected teachers will be trained and equipped with influencing manuals and wall charts. Educational jingles are also to be aired on selected radio stations throughout the project’s districts.
The BCC campaign feeds into Ghana’s Home Grown School Feeding ​(HGSF) programme which sees that food for school meals is procured from local smallholder farmers – enabling children to be better able to learn in schools and farmers to be secured of a livelihood.

Click here​ to read more about Ghana’s HGSF programme.

Lipid-Based Nutrient Supplements Do Not Affect the Risk of Malaria or Respiratory Morbidity in 6- to 18-Month-Old Malawian Children in a Randomized Controlled Trial

In Under-nutrition on September 28, 2014 at 7:03 am

by Charles Mangani, Per Ashorn, Kenneth Maleta, John Phuka,Chrissie Thakwalakwa,Kathryn Dewey, Mark Manary, Taneli Puumalainen, and Yin Bun Cheung

from J. Nutr. November 1, 2014



Background: There is evidence to support the use of lipid-based nutrient supplements (LNSs) to promote child growth and development in low-income countries, but there is also a concern regarding the safety of using iron-fortified products in malaria-endemic areas.

Objective: The objective of this study was to test the hypothesis that 6- to 18-mo-old rural Malawian children receiving iron-containing (6 mg/d) LNSs would not have excess morbidity compared with infants receiving no supplementation.

Methods: A randomized controlled trial allocated 840 children to receive daily supplementation with 54 g/d LNS with milk protein base (milk-LNS), 54 g/d LNS with soy protein base (soy-LNS), 71 g/d corn-soy blend (CSB), or no supplementation from 6 to 18 mo of age. Morbidity was compared using a non-inferiority margin set at 20% excess morbidity in supplemented groups compared with the nonsupplemented group.

Results: Baseline characteristics were similar across groups. The proportion of days with febrile illness between 6 and 18 mo was 4.9%, and there were no differences between the groups: 4.9% (95% CI: 4.3, 5.5%), 4.5% (95% CI: 3.9, 5.1%), 4.7% (95% CI: 4.1, 5.3%), and 5.5% (95% CI: 4.7–6.3%) in the milk-LNS, soy-LNS, CSB, and control groups, respectively. The proportion of days with respiratory problems and diarrhea between 6 and 18 mo also did not differ between groups. Compared with controls, the incident rate ratio (95% CI) for clinical malaria was 0.80 (0.59, 1.09), 0.77 (0.56, 1.06), and 0.79 (0.58, 1.08) in milk-LNS, soy-LNS, and CSB, respectively, with 95% CIs confirming non-inferiority. The incidence of febrile episodes, diarrhea, respiratory problems or admission to hospital, prevalence of malaria parasitemia throughout the follow-up, and mean change in hemoglobin concentration from baseline were also similar between the groups.

Conclusions: Daily supplementation with 54 g of milk-based or soy protein–based LNS or 71 g of CSB did not result in increases in malaria or respiratory morbidity in children in a malaria-endemic setting. However, we could not conclude whether LNSs did or did not increase diarrheal morbidity. This trial was registered at clinicaltrials.gov as NCT00524446.

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Critical windows for nutritional interventions against stunting

In Under-nutrition on April 13, 2013 at 7:01 am

by Andrew M Prentice, Kate A Ward, Gail R Goldberg, Landing M Jarjou, Sophie E Moore, Anthony J Fulford, and Ann Prentice

Am J Clin Nutr May 2013



An analysis of early growth patterns in children from 54 resource-poor countries in Africa and Southeast Asia shows a rapid falloff in the height-for-age z score during the first 2 y of life and no recovery until ≥5 y of age. This finding has focused attention on the period −9 to 24 mo as a window of opportunity for interventions against stunting and has garnered considerable political backing for investment targeted at the first 1000 d. These important initiatives should not be undermined, but the objective of this study was to counteract the growing impression that interventions outside of this period cannot be effective. We illustrate our arguments using longitudinal data from the Consortium of Health Oriented Research in Transitioning collaboration (Brazil, Guatemala, India, Philippines, and South Africa) and our own cross-sectional and longitudinal growth data from rural Gambia. We show that substantial height catch-up occurs between 24 mo and midchildhood and again between midchildhood and adulthood, even in the absence of any interventions. Longitudinal growth data from rural Gambia also illustrate that an extended pubertal growth phase allows very considerable height recovery, especially in girls during adolescence. In light of the critical importance of maternal stature to her children’s health, our arguments are a reminder of the importance of the more comprehensive UNICEF/Sub-Committee on Nutrition Through the Life-Cycle approach. In particular, we argue that adolescence represents an additional window of opportunity during which substantial life cycle and intergenerational effects can be accrued. The regulation of such growth is complex and may be affected by nutritional interventions imposed many years previously.

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Lipid-based, ready-to-use foods to fight undernutrition: the state of the art (UCDAVIS)

In Under-nutrition on October 16, 2012 at 8:10 am

Lipid-Based Nutrient Supplements: How Can They Combat Child Malnutrition?

Kathryn G. Dewey, Mary Arimond

PLOS Medicine  September 18, 2012

This paper (download entirely) is particularly relevant for anybody interested in the current knowledge achievements and gaps about management of undernutrition with lipid-based, ready-to-use foods.

The same paper offers also an updated list of references on this topic.

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