Focus Area: Nutrition
and Micronutrients
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| Photo: Melissa May |
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Statement of the Problem
Maternal and childhood undernutrition resulting from protein, energy and micronutrient deficiencies constitutes a leading composite health disparity between the developing and the developed world. Basic nutritional indicators reveal the prevalence of low weight, due to wasting and stunting malnutrition, to be four to 25-fold higher among mothers and preschool children in developing countries. Micronutrient deficiencies, largely unknown to higher income countries, plague hundreds of millions of people in lower income countries, most severely affecting young children and women of reproductive age.
Childhood and maternal undernutrition, conventionally attributed to protein-energy malnutrition, poses the highest burden of disease with respect of disability-adjusted life years, with deficiencies of vitamin A, zinc, iron and iodine being major contributors to loss of healthy life. According to WHO, childhood malnutrition (assessed by low weight for age) is associated with 50% or more of the 10.5 million child deaths that occur in the developing world each year. Concurrent, preventable micronutrient deficiencies may, however, account for a substantial proportion of mortality due to poor nutrition.
In Southern Asia and sub-Saharan Africa, for example, vitamin A deficiency likely accounts for ~ 30% of early child mortality. Zinc deficiency may account for 25% to 35% of childhood diarrhea and pneumonia-related morbidity, which may explain substantial mortality risk associated with undernutrition. Impaired immune function is a likely primary mechanism by which malnutrition increases morbidity. Frequent and severe infection further compromises host nutrient status by impairing intake and absorption, sequestering nutrient availability, and increasing utilization and excretion, resulting in a "synergy" that, for undernourished children, can increase risk of death.
Deficiencies of micronutrients, such as iodine and iron, at critical life stages can also impair child development and, if widely prevalent and persistent, can compromise individual and societal achievement. Nutritional vulnerability extends beyond early childhood to adolescence and the reproductive years at which ages maternal deficiencies of iron, vitamin A, zinc and iodine and others may impair maternal, fetal and infant health and survival. It is clear that any overall strategy to achieve gains in survival and public health in the third world must address the vast burden of key, preventable nutritional deficiencies. The GRA, building on a history of strategic research carried out under previous cooperative agreements with JHU and its partners, has an opportunity to influence, shape and make substantial contributions to the global micronutrient intervention agenda.
HaRP Approach
The Health Research Program (HaRP) seeks to improve nutrition in children by:
- Conducting research on the use of zinc and other micronutrients to treat and prevent disease
- Fostering innovation in successful breastfeeding counseling
- Research and consensus building within the scientific and programmatic community to reduce low birth weight
- Increasing the quality of complementary feeding practices in at-risk population
- Promoting the use of child's nutritional status in the re-estimation of the Global Burden of Disease
Related Links
- Diarrhea Treatment Guidelines - Not Yet Field Tested [PDF, 282KB]
Guidance on how to implement the new WHO/UNICEF recommendations for the use of ORS and zinc supplementation in the clinical management of diarrhea. The guidelines presented in this document are generic; that is, they will be most effective when modified to support the particular strategy being used to introduce the new recommendations in each country.
- Diarrhea Guidelines for New Diarrhea
Treatment Protocols
for Community-Based Healthcare Workers - Not Yet Field Tested [PDF, 116KB]
A generic guide to help community-based healthcare workers improve diarrhea management. The new tools described
in this guide will help to prepare community-based healthcare workers to better help mothers treat
a child with diarrhea. In addition this guide will help them to
know when to refer children with more severe diarrhea and
dehydration.
- Report to Congress: Health-Related Research and Development Activities at USAID - May 2006 [PDF, 881MB] (requires Adobe Reader)
The U.S. Congress requested that USAID provide a report describing its role in the research, development, and application cycle and its efforts to coordinate research and development activities with other agencies. With this report USAID provides a proactive strategy for using research funds and a plan for stimulating the development and introduction of key products to address diseases affecting the developing world and countries in transition.
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