In combat with malnutrition

The recent evidence-based report by The Lancet has awakened the Ethiopian government for immediate action and intervention against one of the world’s biggest killers – malnutrition, as in February the country launched the first ever National Nutrition Strategy (NNS).
Founded in 1823, the journal is acclaimed to be the world’s leading independent medical journal with its coverage international in focus and extending to all aspects of human health.
In 2003, The Lancet published a series of five articles on child survival to act as an urgent call for reform in this neglected area of global public health and the series led to responses on international and national levels to reduce deaths among children younger than 5 years of age.
And in 2005, a series was developed to address the major gap in information about deaths in the four weeks of life – the neonatal period. These articles resulted in increased investment and renewed programmatic commitment by international agencies and national governments of the world.
According to The Lancet’s latest report on maternal and child undernutrition, evidence shows that malnutrition accounts for more than 3.5 million child deaths every year worldwide.
In Ethiopia, malnutrition is the greatest underlying cause of childhood mortality and related to almost 53% of all deaths among children under the age of five. This means 374 child deaths every day and the loss of 144 billion birr (15 billion USD) due to the economic consequences of stunting, and iodine and iron deficiencies, if the situation remains unchanged until 2015, according to The Lancet.
Dr. Robert E. Black, M.P.H., lead author, The Lancet, is Chairman of Edgar Berman Professor of International Health and Director of the Department of International Health and institute of international programs at Johns Hopkins University, USA. On a recent three day visit to Ethiopia, Capital’s Abiy Demilew shared a moment with him in an exclusive interview.

Capital: What are the latest developments in The Lancet after 2003?
Dr. Robert E. Black: The medical journal The Lancet has had a number of series that relate to the health problems of middle and low income countries. In 2003 we had a subsequent series on child survival, maternal health, child development and reproductive health, and seemed time to have a series of focus on maternal and child under-nutrition. So we took on that task and we spent about two years trying to look at all of the evidence accumulated globally to see how big was the problem, what interventions and programs would work and then; how could they be best implemented both at the national level and with the support of international agencies.

Capital: As you may recall, Ethiopia launched its National Nutrition Strategy in February this year. What are the expectations so far?
Dr. Robert E. Black: I think the National Nutrition Strategy Ethiopia implemented is very much consistent with what we have recommended as far as global experience and global literature is concerned.
The strategy is multisectoral and it has a substantial involvement of community level workers who are delivering service. It is focused in different age groups and as well as particular vulnerable groups such as individuals living with HIV/AIDS. So this targeting by age and focusing on specific interventions that we have proven are successful and can be implemented at low cost are very important, and cost effective strategies improve health.

Capital: How can countries like Ethiopia deal with nutrition issues while they still are faced by problems like food shortages?
Dr. Robert E. Black: Ethiopia like many other countries does have problems like food shortages and natural emergencies. And these have to be dealt with in a special response. But over the long term, the multisectoral approaches that this strategy tries to put in place will include agriculture, food production, the attention to food and nutrition security and households and improving health services; all of these things will contribute to the nutritional condition of the population in the long term.
Of course, one has to respond for emergency situations but I think the long term approaches will ultimately benefit the Ethiopian population.

Capital: What are the social impacts of malnutrition?
Dr. Robert E. Black: We know that malnutrition in early childhood has lifetime consequences, including smaller babies and shorter children, less intellectual ability in school performance and also are less productive in economic terms. Adults who have been stunted at early childhood have substantially reduced earning potentials as adults. So these all impact in the economy as well.

Capital: Malnutrition is referred to as the extension of poverty. Is it better to cure the symptom rather than killing the source itself?
Dr. Robert E. Black: Absolutely no question, malnutrition and under-nutrition are the consequences of both poverty and inequity. So even if a country is not in poverty, there are population groups of disadvantaged and the poor. So that undermining problem needs to be addressed. I think addressing those economic issues would be a long term solution and a high priority for a country like Ethiopia.
But we also know that nutrition strategy programs can work even in the face of poverty. Not to say we should maintain poverty but we may be able to make more rapid improvements, substantial changes to the health of the population if we implement the right programs for improving nutrition, as we work to pull people out of poverty.

Capital: As we are talking now, people are dying every minute unable to find the least of their basic needs. How fair is this world?
Dr. Robert E. Black: That’s a most difficult question. But it is well recognized nationally and internationally that, these things are unacceptable. Access to food and education are both basic human rights. But while we have a universal agreement on that, the action is not strong. So the ability of countries to provide food, education and enough health care is really still compromised by the lack of financial means to do that. The answer for these has to come in some degree from the country itself by allocating its resources in the right way but in some cases, also from international assistance in assuring extra fundings are targeted for the right purposes.