In the closing statement of a magnificent plenary lecture at the Durban International Congress of Nutrition in 2005, Professor Alan A Jackson stated with great emphasis what we all know as a chilling truth: We have failed the children of Africa!
And we have. Under five mortality rates in Western and Central Africa are the highest in the world, according to UNICEF1. In this region, one out five children do not live to see their fifth birthday. Problems are also huge in Eastern and Southern Africa.
Two reviews on child development from the International Child Development Steering Group (ICDSG) have been published this year in the Lancet Reference Walker, Wachs, Gardner, Lozoff, Wasserman and Pollitt2, Reference Grantham-McGregor, Cheung, Cueto, Glewwe, Richter and Strupp3. According to ICDSG, the magnitude of the problem is immense: about 200 million children under 5 years of age are unable to reach their potential in cognitive and psychosocial development. Failing to reach this developmental potential is likely to perpetuate the vicious circles of poverty and low education. The ICDSG points out the following four causes: malnutrition (stunting), deficiency of iron, deficiency of iodine, and lack of stimulation in infancy.
The ICDSGReference Walker, Wachs, Gardner, Lozoff, Wasserman and Pollitt2 reveals the following prevalences among children in developing countries during the first five years of life: stunting 31%, mild-to-severe iodine deficiency 35%, iron-deficiency anaemia 23–33%.
Poverty, armed conflict, crop failure, climate change, displacement and inequity within and between countries obviously do not help. We look forward to the third ICDSG review, pointing out possible strategies for the future. In previous years, the Bellagio Study Group on Child Survival published several ground-breaking papers on child survival and nutrition transitionReference Popkin5, Reference Popkin, Lu and Zhai6, valuable material for all nutrition educators and policy planners. A follow-up meeting is planned for this year.
Measles: good news
The extensive efforts to fight measles are paying off, showing a reduction in measles by 75% in AfricaReference Wolfson, Strebel, Gacic-Dobo, Hoekstra, McFarland and Hersh7. The death toll in Africa due to measles has decreased from roughly 506 000 in 1999 to 126 000 in 2005.
The massive campaign8 included two vaccinations per child, vitamin A supplementation and an integrated general child health campaign including nets for malaria protection, polio vaccines and regular check-ups of the child. It is important to remember that the magnificent results of the campaign certainly stem from the whole campaign rather than the immunisation on its own.
Previous studies indicate that more than half of all deaths from infectious diseases have underlying malnutrition and undernutrition as a contributing factorReference Claeson, Gillespie, Mshinda, Troedsson and Victora4, Reference Pelletier and Frongillo9, Reference Caulfield, de Onis, Blossner and Black10. This is not a competition between vaccination efforts and nutrition interventions; obviously the two are both important for increasing childhood survival. The encouraging results do point to the huge possibilities for achieving an impact when sufficient resources are available and when organisations join forces, as in this case WHO, UNICEF, CDC, the American Red Cross and the United Nations Foundation.
Poverty, education, gender: much to do
A recent paperReference Darnton-Hill, Kennedy, Cogill and Hossain11 points out the role of education of girls and women as extremely important in improving the health as well as nutritional status of children. Coming back to the first theme in this Editorial – we need to remember the implications of undernutrition on cognitive development for the most vulnerable groups and consider how to best support women within the most vulnerable groups as gatekeepers for healthy nutrition. Capacity-building on several levels is needed, accompanied by other efforts.
African universities need to lead the developmentReference Wahlqvist12, Reference Wade13, and the number of African universities is increasing steadily, including those who provide high-level nutrition training. The First Meeting of the African Nutrition Societies is taking place in Morocco in May 200714, hopefully another important step in collaboration and networking over the African continent.
As for the rest of us, not active in Africa, we all need to gather our forces. Strong support should be provided to African universities in their capacity-building efforts, in harmony with the efforts of WHO, UNICEF, the World Food Programme and other international bodies. Running around trying to do things in splendid isolation does not result in progress. African children urgently need our commitment in joint efforts. It is up to all of us to make sure that the development of child health in Africa is reported as dramatically improved at the next International Congress of Nutrition in 2009. In Rome 1992, political leaders from 159 countries and the European Union pledged15 to eliminate famine, starvation and micronutrient deficiencies such as vitamin A and iodine before the end of the decade, and further to substantially reduce starvation, hunger and other micronutrient deficiencies. The world does not need any more broken promises.
