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Friday 26th May, 2006
In an article published in The Lancet,
Rainer Gross, PhD, UNICEF's chief of nutrition
discusses five facts about world hunger.
Boston, Mass.--While public attention gravitates towards
conflict and natural disaster, many people in countries less
affected by such events struggle with some of the same nutrition
problems as those in crisis.
In a "Viewpoint" published in The Lancet, Rainer Gross, PhD,
UNICEF's chief of nutrition, and Patrick Webb, PhD, dean for
academic affairs at the Friedman School of Nutrition Science and
Policy at Tufts University, discuss five facts about world
hunger, children and wasting, a condition that represents severe
Wasting is defined by a low weight-to-height ratio; it is
visible in the form of skeletally thin children usually found in
the middle of a famine. The authors note that a public health
disaster is generally declared if more than 15% of the children
in a country suffer from wasting. Gross and Webb analyzed
countries with the highest child mortality rates and child
wasting rates. Based on their assessment of the data, the
authors present five surprising facts about severe children
malnutrition and argue that such conditions must be resolved in
non-emergency settings to prevent future public health crises.
First, contrary to popular belief, Africa does not have the
most children suffering from wasting. "Although in the past 10
years, every subregion of Africa saw a rise in both the number
of wasted children under the age of five and in the overall rate
of wasting, about 78% of the world's 5.5 million wasted children
live in India, Pakistan, and Bangladesh; nearly two thirds of
those in India alone," says Webb.
Secondly, the absence of conflict, such as political
instability, does not prevent or resolve wasting in children.
When the authors compared countries without recent conflict to
countries that have recently emerged from periods of conflict or
remain continually unstable, they found that, "?stability,
economic growth, and even political transparency are not in
themselves sufficient factors to overcome the persistence of
wasting in marginalized vulnerable groups." Wasting is a complex
condition that is not simply caused by conflict or famine alone.
Gross and Webb conclude that "effective, targeted actions are
needed as part of the development agenda."
Third, HIV does not appear yet to contribute substantially
and directly to severe wasting in children, although the authors
state that "as the pandemic progresses, high HIV/AIDS rates will
contribute to worsening nutrition, both from the direct effects
of the disease and from an indirect impact on household food
security and childcare. Without dual action against wasting and
HIV/AIDS, the deadly synergy of these two factors is likely to
grow in coming years."
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Fourth, political and economic growth do not always
automatically improve child nutrition. According to the authors,
"wealth creation at a national level does not preclude the
persistence of wasting on a large scale." For example, the
United Arab Emirates, a wealthy country, has a wasting rate of
14%. "Similarly," state the authors, "both India and Brazil have
shown remarkable rates of economic growth without proportional
gains in the nutritional status of poorer people in their
Finally, Gross and Webb state that the development agenda
must tackle child wasting in order to make a lasting impact on
human well- being. "The problem of wasting needs to be addressed
wherever it is identified, not just in emergencies," says Webb.
"Wasting in emergencies represents the tip of the iceberg,"
write the authors.
"Ironically, the international community has become much more
adept at saving the lives of wasted children in the context of
catastrophes than in the context of typical development," state
The authors give several examples of development that will
reduce the chronic undernutrition that results in wasting of
children. These include improving nutrition in pregnant and
lactating women to prevent low-birthweight babies, effective
protection against infectious disease, improved water and
sanitation systems, promotion of breastfeeding during an
infant's first six months, enhanced health and nutrition
information for parents, and micronutrient supplementation.
"The wasted child cannot wait," conclude the authors.
"Millions of children need immediate, life-saving attention
coupled with coordinated longer-term investments that will help
prevent repetitions of nutrition and health insults as they grow
into adulthood. The world cannot afford to waste another decade
talking about global targets, waiting for the macro-effects of
economic and political development to reach children ignored by
the development process."
Patrick Webb served as chief of nutrition for the United
Nations World Food Programme until August 2005. Previously, he
was a member of the Steering Committee of the United Nations
Standing Committee on Nutrition and of the Millennium Project
Task Force on Hunger. Webb serves as a member of the board of
the International Nutrition Foundation and is focal point for
academic outreach for the World Food Programme. Webb was also
the chair of a World Health Organization expert advisory panel
on household food and nutrition security.