The Lancet Series on Maternal and Child Undernutrition Progress
Research snapshot1
Thirteen years after the first Lancet Series on Maternal and Child Undernutrition, the latest series on Maternal and Child Undernutrition Progress revisits the global agenda for tackling undernutrition. It explores key advancements made on stunting, wasting and micronutrient deficiencies and lays out an ‘agenda for action’ to accelerate progress towards global nutrition goals. The series serves as an important milestone and a key moment to reinvigorate the nutrition agenda in 2021 as part of the Nutrition for Growth Year of Action.
The first paper, by Victora et al, reviews progress on undernutrition in 50 low- and middle-income countries using data from 2000 to 2015. It found that the prevalence of childhood stunting has fallen (from 32.5% in 2000 to 21.9% in 2017) but progress on wasting and low birthweight (LBW) has been slow. New evidence has shown that 4.7% of children are affected by both wasting and stunting, a condition associated with a 4.8 times increase in mortality and that both wasting and stunting can exist at birth and peak in the first six months of life.
Among women of reproductive age, the prevalence of low body-mass index has reduced but the prevalence of short stature remains high. Data on micronutrient status is limited, particularly for women, but evidence has shown improvements in vitamin A status. The prevalence of zinc deficiency and anaemia remain high. The paper further highlights the role of social inequalities in undernutrition and that the modest improvements made since 2000 may be offset by the COVID-19 pandemic. (Victora et al, 2021)
The second paper, by Keats et al, explores updated evidence on interventions to address maternal and child malnutrition, examining both direct and indirect interventions and offering a revised framework for nutrition actions. The evidence collected supports the continued effectiveness of all the interventions outlined in the 2013 Lancet Series. Evidence has strengthened for the effectiveness of antenatal multiple micronutrient supplementation in reducing the risks of stillbirths, LBW and babies born small-for-gestational age and there is emerging evidence for preventative small-quantity lipid-based nutrient supplementation (SQ-LNS) for reducing childhood stunting, wasting and underweight. However, evidence gaps remain on how to tackle malnutrition in school age children and adolescents. Overall, greater efforts are needed to improve intervention coverage. (Keats et al, 2021)
The third paper, by Heidkamp et al, outlines steps that must be taken if the 2025 World Health Assembly targets and the 2030 Sustainable Development Goals are to be met. It reaffirms the importance of multi-sector actions and the emphasis on the first 1,000 days. The paper highlights several direct nutrition interventions that are ready for scaling up in health systems. However, it stresses the need for well-resourced nutrition data and information systems to inform approaches. The authors also note the need for more evidence on cost-effectiveness to allow governments to plan sufficiently for implementation and scale-up. The paper concludes with a call to action for nutrition stakeholders to unite around common priorities to tackle the so-called ‘unfinished undernutrition agenda’. (Heidkamp et al, 2021)
In an accompanying commentary to the Lancet Series, Shekar et al explore progress in light of the COVID-19 pandemic and call for renewed efforts to support countries to prioritise interventions to be delivered at scale. (Shekar et al, 2021).
1https://www.thelancet.com/series/maternal-child-undernutrition-progress
References
Heidkamp, R A et al (2021) "Mobilising evidence, data, and resources to achieve global maternal and child undernutrition targets and the Sustainable Development Goals: an agenda for action." The Lancet 397(10282): 1400-1418.
Keats, E et al (2021) "Effective interventions to address maternal and child malnutrition: an update of the evidence." The Lancet Child & Adolescent Health 5(5): 367-384.
Shekar, M et al (2021) "Maternal and child undernutrition: progress hinges on supporting women and more implementation research." The Lancet 397(10282): 1329-1331.
Victora, C G et al (2021) "Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda." The Lancet 397(10282): 1388-1399.