This issue of Poverty in Focus reviews the Millennium Development Goals (MDGs) to date and asks what can be done to accelerate MDG progress in the years 2010–2015 and beyond. There have been numerous calls for a new development narrative/paradigm from developing countries, international civil society organisations and development agencies. The contributing authors believe this changing context will affect the debate on the MDGs, past and future, in ways that perhaps only now are starting to become clear. They also believe that impact of the current financial crisis is likely to continue to frame debates over the next five years, and will be critical in determining the economic and social environment. Economic uncertainty in donor countries is also leading to declining public support for aid budgets. They predict the coming period is likely to be much less certain as developing countries, especially in sub-Saharan Africa, face several interconnected crises to which climate change is central, and which will change the context for achieving the MDGs.
Poverty and health
Even if, in terms of income, there are still today a higher number of poor people in the countryside than in Kenya’s cities, poor urban-dwellers face an alarming (and growing) range of vulnerabilities. Oxfam GB Kenya’s report highlights the mutually reinforcing dimensions of vulnerability in Nairobi’s slums. It launched a new Urban Programme Strategy in 2009 that aims to build on the organisation’s strategic comparative advantages, bringing its experience elsewhere into the urban sector in Kenya. These advantages include: coordinating partnerships with key stakeholders, bringing Oxfam GB’s experience in peace and conflict transformation in other parts of rural Kenya into the urban arena; capitalising on its international status in terms of resource mobilisation; and utilising its expertise on water, sanitation and food security to support local organisations in delivering basic urban services. The strategy will be implemented on a phased basis over a fifteen-year period, and will focus on three strategic priority areas: urban governance, sustainable livelihoods, and disaster preparedness and risk reduction.
In order to ameliorate poverty among tuberculosis (TB) sufferers, a few initiatives to support patients with TB have been made in KwaZulu-Natal, South Africa, including free treatment at government hospitals and clinics, and nutritional supplementation and social grants. Although these programmes have been functioning for a number of years, they have never been formally assessed in terms of the costs involved, the effects on the target populations, and the responses of patients. A recent study in Brazil (Belo et al, 2006) investigated a range of support strategies for patients with TB that included material and financial assistance, improved health services support and better administrative organisation – from the patient's perspective. Such a study has not been undertaken in South Africa, however, and given the large amount of money spent on support to TB patients, this is necessary to better inform such programmes.
This study examined child disability screening and its association with nutrition and early learning in countries with low and middle incomes. Cross-sectional data for the percentage of children screening positive for or at risk of disability were obtained for 191,199 children aged 2–9 years old in 18 countries. Screening results were descriptively analysed according to social, demographic, nutritional, early-learning and schooling variables. A median 23% of children aged 2–9 years old screened positive for disability. For children aged 2–4, screening positive for disability was significantly more likely in children who were not breastfed and who did not receive vitamin A supplements. Children aged 6–9 who did not attend school screened positive for disability more often than did children attending school. These results draw attention to the need for improved global capacity to assess and provide services for children at risk of disability. Further research on childhood disabilities is needed in countries with low and middle incomes to understand and address the role of nutritional deficiencies and restricted access to learning opportunities.
In a statement, the Commonwealth Association of Paediatric Gastroenterology and Nutrition (CAPGAN) calls for maternal, neonatal and child health to be more closely linked to improve child survival from HIV, diarrhoea and malnutrition. Colleges of Health Sciences, Nursing and Medicine should become important backbones of maternal and child health systems, through education and implementation research, and through training and retaining of their staff in HIV, diarrhoea and malnutrition in the widest sense. The statement presents that leadership, collaboration and country-capacity support, development of evidence-based guidelines and systems must be stimulated, to ensure coverage and monitoring of equity and progress in achieving Millennium Development Goals 4 and 5.
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.
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.