NEW YORK, 17 January 2008 (IRIN) - The first two years in a child's life are crucial in determining its well-being in adulthood, according to a series of five papers launched in The Lancet on 17 January. Maternal and child under-nutrition in the first two years is the underlying cause of 3,5 million deaths a year, 35 percent of disease in young children and a host of longer-term ills, states the report.

The series finds that poor foetal growth or stunting in the first two years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income, and decreased birth weight in offspring.

Moreover, children undernourished in the first two years, who put on weight rapidly later in childhood and in adolescence, are at high risk of chronic diseases related to nutrition, such as high glucose concentrations, hypertension and increased levels of harmful fats in their blood.

Although children at present under study are too young to assess the link between under-nutrition and life expectancy, such an association will probably become apparent in the long term.

"Under-nutrition is the largely preventable cause of over a third – 3,5 million – of all child deaths," said Richard Horton, editor of the British medical journal.

"Stunting, severe wasting and intrauterine growth restriction are among the most important problems. There is a golden interval for intervention: from pregnancy to two years of age. After age two years, under-nutrition will have caused irreversible damage for future development towards adulthood."

Targeted interventions

The series finds that implementation of existing maternal and child nutrition-related interventions, such as breastfeeding counselling and vitamin A supplementation, could prevent 25 percent of all child deaths in the 36 countries with the highest burden of under-nutrition. Non-exclusive breastfeeding in the first six months of life results in 1,4 million deaths and 10 percent of disease burden in children younger than five, while vitamin A and zinc deficiencies were estimated to account for 600,000 and 400,000 deaths, respectively, in 2005.

Effective action against such micronutrient deficiencies in pregnancy and young children, especially those younger than 24 months, could avert much stunting, which is especially difficult to reverse after 36 months.

The series finds that 80 percent of the world's undernourished children live in just 20 countries, across four regions - Africa, Asia, western Pacific and the Middle East - a wake-up call for finance ministries and development agencies to realise that adequate nutrition in early life is essential for human capital formation.

"The central message of this series is that effective nutrition actions exist but have not been implemented at scale and assessed, especially in countries where high proportions of the burden of disease are attributable to under-nutrition," the fourth paper states.

Targeted funding

On the funding issue, the series notes that donor investment in basic nutrition in low- and middle-income countries is estimated at US$250-300 million a year in the first half of this decade.

If all of it were allocated with perfect targeting to the 20 countries accounting for 80 percent of stunted children, each of the roughly 130 million infants younger than two living there could benefit from just over $2 a year – far less than the $5-10 per child that effective large-scale community nutrition programmes are estimated to cost.

Eight core problems that reduce the effectiveness of the international nutrition system are cited: inadequate strategies, limited sticking power of policies, structures that impede collaboration, weak coordination, weak linkages with countries, lack of high-level interest, inadequate human resources and unpredictable and inflexible funding.

"It is time for a paradigm shift aimed at achieving universal access from the start for proven interventions to address maternal and child under-nutrition," states the fourth paper in the series.

But, it cautions, "There are no simple prescriptions to reduce under-nutrition, although achievement of high coverage with four or five of the proven interventions would certainly have a sizeable effect."

As series co-author Robert Black of the Johns Hopkins Bloomberg School of Public Health, Baltimore, told IRIN: "The key message is that maternal and child under-nutrition is a major global health problem but that proven and feasible nutritional interventions could have very large health benefits if fully implemented."

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