Up to half of all children presenting to nutrition rehabilitation units (NRUs) in Malawi are infected with HIV. This study aimed to identify features suggestive of HIV in children with severe acute malnutrition (SAM). All 1,024 children admitted to the Blantyre NRU between July 2006 and March 2007 had demographic, anthropometric and clinical characteristics documented on admission. HIV status was known for 904 children, with 445 (43%) seropositive and 459 (45%) seronegative. Associations were found for the following signs: chronic ear discharge, lymphadenopathy, clubbing, marasmus, hepato-splenomegally and oral candida. Any one of these signs was present in 74% of the HIV seropositive and 38% of HIV-uninfected children. HIV-infected children were more stunted, wasted and anaemic than uninfected children. In conclusion, features commonly associated with HIV were often present in uninfected children with SAM, and HIV could neither be diagnosed nor excluded using these. The study recommends HIV testing be offered to all children with SAM where HIV is prevalent.
Poverty and health
Rotavirus gastroenteritis is a major health problem among Malawian children. Studies spanning 20 years have described the importance, epidemiology and viral characteristics of rotavirus infections in the country. Despite a wide diversity of circulating rotavirus strains causing severe disease in young infants, a clinical trial of a human rotavirus vaccine clearly demonstrated the potential for rotavirus vaccination to greatly reduce the morbidity and mortality due to rotavirus diarrhoea in Malawi. This new enteric vaccine initiative represents a major opportunity to improve the health and survival of Malawian children.
More than 178 million children are currently suffering from chronic malnutrition, which contributes to a third of all child deaths globally. According to this report, a total of £150 would give a hungry child the right kind of food and support to stop them from dying from malnutrition and protect their brains and bodies from being permanently damaged by hunger. Half of the world’s hungry children live in just eight countries: Afghanistan, Bangladesh, the Democratic Republic of Congo (DRC), Ethiopia, India, Kenya, Sudan and Vietnam. The Hungry for Change report reveals that it would cost £5.25 billion a year to combat child hunger in these countries and dramatically reduce the number of children who are stunted or malnourished.
Eight nutrition studies from rural Malawi are discussed in this paper. Their aims were various, for example, to describe typical growth pattern of children, analyse occurrence and determinants of undernutrition and evaluate a community-based nutritional intervention for malnourished children in rural Malawi; to determine the timing of growth faltering among under three-year-old children; to characterise the timing and predictors of malnutrition; and to compare the effect of maize and soy flour with that of ready-to-use food in the home treatment of moderately malnourished children. Some of the findings of the studies included: growth of children under three years old followed an age-dependent seasonal pattern; intrauterine period and the first six months of life are critical for the development of stunting, whereas the subsequent year is more critical for the development of underweight and wasting; supplementation with 25 to 75 g/day of highly fortified spread (FS) is feasible and may promote growth and alleviate anaemia among moderately malnourished infants; and one-year-long complementary feeding with FS does not have a significantly larger effect than micronutrient-fortified maize–soy flour on mean weight gain in all infants, but it is likely to boost linear growth in the most disadvantaged individuals and, hence, decrease the incidence of severe stunting. In a poor food-security setting, underweight infants and children receiving supplementary feeding for twelve weeks with ready-to-use FS or maize–soy flour porridge show similar recovery from moderate wasting and underweight. Neither intervention, if limited to twelve-week duration, appears to have significant impact on the process of linear growth or stunting.
The epicentre of the child health emergency is sub-Saharan Africa and South Asia but, without a concerted and sustained effort in their countries, there’s little prospect of Millennium Development Goal 4 being met at a global level. The causes of this emergency vary according to the local context, and will require tailored responses by governments, donors and international institutions. Examples of good leadership exist in countries like Liberia, where President Ellen Johnson Sirleaf has used the peace dividend to triple health spending, withdraw user charges and focus on the prevention of malaria. The first tier of healthcare for children is the household level, and beyond that the immediate community. Yet relatively little attention is paid by most governments to low-cost and easy-to-deliver measures that can be taken at this level, which can have a decisive impact on child health, from hand washing and breastfeeding to early identification of pneumonia. World Vision estimates that a comprehensive package of family and community care alone could prevent 2.5 million child deaths each year. What’s needed is a redefinition of health systems to incorporate family- and community-level care, in tandem with a fundamental rebalancing of public spending placing much greater emphasis on prevention. Safe water and sanitation and basic hygiene are necessary to achieve this aim – the World Health Organization estimates that they could together save US$7 billion in health care costs each year.
Asthma has been a public health issue since the 1960s. Factors associated with asthma are environmental and genetic. This study is based on a random sample of 742 students aged 13–14 attending various schools at Polokwane, in the province of Limpopo in South Africa. Survey logistic regression and multi-level analyses were used for data analysis. The study identifies three key determinants of asthma at the district, school and individual levels. The study shows that persistent cough, exposure to smoke at the household level and lack of access to flush toilets at the household level are key predictors of asthma in children. Variability at the level of districts accounts for 46% of total variance. Variability at the level of schools accounts for 33% of total variance.
Donors have spent very little on nutrition – barely 1.7% of development and emergency food aid between 2004 and 2007 actually addressed malnutrition, says this report. The analysis suggests that donors should maximise the value of funding by ceasing in-kind donations and provide cash instead, allowing aid agencies to source cheaper or more appropriate food in the region or beneficiary country. However, donor countries in the European Union (EU) and Canada, which had recently moved to provide cash, were not spending enough on nutrition. Malnutrition should in recent years have benefited both from the global renewed interest in the problem, and from the emergence of a broad consensus within the nutrition community enabling the scale up of activities in high-burden countries. Yet the analysis finds that funding has remained more or less flat, stuck at roughly the same level since 2000–2004. A tiny percentage (1.7%) of the interventions reported as ‘development food aid-food security’ and ‘emergency food aid’ in the OECD database actually address nutrition. The authors argue that if interventions such as these are to be considered as a means to address malnutrition, then food security and food assistance projects (namely food transfer, cash or voucher programmes) must be targeted more precisely on nutrition as a main objective and be designed accordingly.
Humanity has made enormous progress in the past 50 years toward eliminating hunger and malnutrition. Some five billion people – more than 80% of the world's population – have enough food to live healthy, productive lives. Agricultural development has contributed significantly to these gains, while also fostering economic growth and poverty reduction in some of the world's poorest countries. This book examines how policies, programmes and investments in pro-poor agricultural development have helped to substantially reduce hunger across Africa, Asia and Latin America. The 20 success stories presented here provide both lessons and inspiration for continued efforts to eradicate hunger and malnutrition among the one billion people still facing this scourge.
Dismal global figures hide the fact that the number of hungry people has been declining in 31 countries during the fifteen-year period from 1991 to 2005. This paper analyses four examples of countries that are on track to achieve 2015 food security targets: Armenia, Brazil, Nigeria and Vietnam. Based on these examples, it argues that success in the battle to halve hunger will usually be characterised by: creation of an enabling environment for economic growth and human wellbeing; outreach to the most vulnerable and investment in the rural poor; protection of gains; and planning for a sustainable future. Several developing countries have succeeded in transforming their agriculture sectors, turning them into important sources of growth and export earnings, and thus increasing their contribution to poverty and hunger reduction. The paper studies examples of countries that have transformed their sectors, concluding that supporting smallholder farmers is one of the best ways to fight hunger and poverty. It is estimated that 85% of the farms in the world measure less than two hectares, and that smallholder farmers and their families represent two billion people, or one-third of the world’s population.
In 2009, students from more than 90 countries tackled the intersection of poverty and climate change. For the past two years, the Global Debates have focused on several climate change issues - water rights, carbon emissions, action plans, obligation of developed nations and more. However, these issues relate also to the impact that global warming has on international development and our ability to end extreme poverty. These facts are a part of the growing evidence that students will bring to Global Debate activities this year, through writing blogs on the UN’s response to climate change and poverty, and collaborating with elected leaders on the importance of a comprehensive climate treaty in Copenhagen.