Current strategies for stunting reduction in the light of emerging evidence of complexity
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The document discusses current strategies for reducing stunting in early childhood within the African context, emphasizing the significance of addressing environmental toxins and nutrition security. It highlights the low efficacy of existing interventions and the need for a comprehensive approach integrating health, environmental safety, and nutritional initiatives. The author suggests enhancing collaboration among stakeholders and incorporating new research findings to improve stunting reduction strategies moving forward.
Current strategies for stunting reduction in the light of emerging evidence of complexity
- 1. Current strategies for stunting reduction in the light of emerging evidence of complexity Habiba Hassan-Wassef, MD National Research Center, Cairo, Egypt e-mail: bio_egypt@hotmail.com
- 2. Outline • Growth faltering and stunting in early childhood • Importance of stunting reduction to Africa • Emerging body of knowledge on the causes • The need to look at the big picture of the food and nutrition security system • Adjusting current strategies for stunting reduction to particular conditions of the African context • Examples of programmes for integration of strategies for reduction of the risk of exposure to environmental toxins and bacterial contaminants • Suggestions for the way forward
- 3. Undernutrition and stunting in early childhood • Stunting describes the relation of height to age. A child is stunted when the height for age z-scores (HAZ) are less than -2. • Child stunting rates reflect prolonged nutritional deprivations and are used to monitor changes in nutritional status over time. • Prolonged child undernutrition can lead to irreversible health and developmental consequences such as impaired brain development, vulnerability to infections and increase in mortality rates, reduced educability and productivity in adult life.
- 4. Stunting reduction is key for the realization of Agenda 2063 and the goal of Transforming Africa “Improving the quality of life for the people of Africa” is an objective in the High 5 Agenda for transforming Africa of the African Development Bank
- 5. The quality of Africa’s human capital “The greatest contributor to economic growth is not physical infrastructure, but brain power: what I refer to as “grey matter infrastructure”. Stunted children today lead to stunted economies tomorrow.” Quote taken from speech on nutrition by A. Adesina, President of the African Development Bank.
- 6. Ever growing evidence on causal factors for growth retardation List includes: • Environmental chemicals and contaminants in nature and in the agro-food supply chain • Mutagenic agents present in industrial products in particular those destined for household use • Climate change related chemical exposure to fungal toxins
- 7. Increased vulnerability of children and pregnant mothers to environmental toxins • Vulnerability increases in undernourished children and increases the risk of infections * • Studies indicate possibility of impact on fetal development *“Interventions targeting child undernutrition in developing countries may be undermined by dietary exposure to aflatoxin”, Sinead Watson, Yun Yun Gong & Michael Routledge (2017) Critical Reviews in Food Science and Nutrition, 57:9, 1963-1975.
- 8. Limitations of current Stunting reduction strategies Scaling up of 10 proved nutrition-specific interventions to cover 90% of stunted will reduce stunting by 20% ONLY?? (Lancet 2013)
- 9. Examples of recent researches focusing on identifying causes of growth retardation • Postweaning Exposure to Aflatoxin Results in Impaired Child Growth: A Longitudinal Study in Benin, West Africa, Yunyun Gong, Assomption Hounsa, Sharif Egal, Paul C. Turner, Anne E. Sutcliffe,1 Andrew J. Hall, Kitty Cardwell, and Christopher P. Wild. • How immediate and significant is the outcome of training on diversified diets, hygiene and food safety? An effort to mitigate child undernutrition in rural Malawi, (2018) Anitha Seetha, Takuji W Tsusaka, Timalizge W Munthali, Tinna Manani, Lizzie Kachulu, Nelson Kumwenda, Mike Musoke and Patrick Okori • Comparison of urinary aflatoxin M1 and aflatoxin albumin adducts as biomarkers for assessing aflatoxin exposure in Tanzanian children. Chen, G, Gong, YY, Kimanya, ME et al. (2018), Biomarkers, 23 (2). pp. 131-136.
- 10. Examples of recent researches focusing on identifying causes of growth retardation (Contd.) • Does aflatoxin exposure cause child stunting? Project Spotlight : Mitigating aflatoxin consumption for improving child growth in Eastern Kenya (2015) Kelly jones and Vivian Hoffmann,IFPRI (ongoing research) • “Aflatoxin Impacts on Child Growth”, presentation by Ahmed Kablan, PharmD, PhD. Office of Agricultural Research and Policy Bureau for Food Security (BFS/ARP); USDA/ARS/Office of International Research ProgramTanzania Nutrition GLEE
- 11. The Food Security System A new conceptual Framework Ecker, O. and Breisinger C., IFPRI Discussion Paper 01166 (2012) • The Framework integrates the four pillars of food security into a system approach. • It links complex interactions of factors at the micro and macro levels and shows how shocks and natural disasters, as well as intervents of policy and programme, affect the availability of food, people’s access to it, and the resulting nutritional status of individuals of all ages. • It helps understand the complexity of causal factors underlying child stunting and , in turn guides the design of strategies to address them.
- 13. Hence the importance of adoption of effective coordination and harmonization mechanisms for implementation of a jointly conceived policy and strategy with distribution of roles between the partners and stakeholders as well as the targeted community. (Ref.: NEPAD recommendation describing coordination mechanisms)
- 14. Highlights of the present body of knowledge (1) • Evidence of low efficacy of current stunting reduction strategies is available. • A body of research on the health and nutrition impact of environmental toxins and food (and water) contaminants, referred to as ‘a largely ignored public health problem’ (Wild CP and Gong YY, 2010) continues to be produced. • The dangerous impact on health is recognized by those involved in reducing risk exposure in agricultural products and the food chain (Re. AUC-PACA initiative calling for “Engaging the Health and Nutrition Sectors in Aflatoxin Control in Africa”. • “The Mycotox Charter” for increasing awareness of, and concerted action for, minimizing mycotoxin exposure world wide, published in TOXINS (2018) does not sufficiently focus on health concerns.
- 15. Highlights of the present body of knowledge (2) • Details of routes of exposure, absorption, distribution, metabolism and excretion in humans and animals are becoming known. • Rapid tests for biomarkers continue to be improved for facilitating rapid screening of populations and establishment of surveillance systems. • Control measures are being applied in the food processing industry. • Application of hygiene and food safety control measures to local markets remains wanting
- 16. Proposals to strengthen the health content of ‘The Mycotox Charter’ Some recommendations to increase the health content: • Expansion of text on health in the commitment section. • Addition of texts on helping promote identification of home grown solutions for reducing MT exposure/contamination. • Identification of appropriate strategies/tools for application of public health regulation to local markets in Low and Middle Income Countries. • Addition of texts for spreading mycotoxin literacy and knowledge and advocacy to policy makers and politicians to be added where relevant in the Charter.
- 17. Balancing the various management strategies for environmental toxins and bacterial contaminants is not evident The slow development of the economic cost of erosion of human capital of future generations through inaction does not carry enough weight* against the immediate loss to national economies of loss of trade, market access and of livelihoods Due to contaminated agro-food products destined for export *(Health concerns receive less attention than economic concerns)
- 18. Examples of programs for integration of strategies for management of environmental toxins (2) • Building Africa’s Grey Matter Infrastructure initiative of the AfDB for promoting increased investments in nutrition. • National food and nutrition policy and strategy plans • The Scaling Up Nutrition national plans • Food security and nutrition and sustainable agriculture country plans • Food inspection and control departments of the health sector and of the National Food Safety Agency
- 19. Examples of programs for integration of strategies for management of environmental toxins (2) • Country plans for the UN Decade on Nutrition • Programs promoting sustainable food systems for healthy diets • Programs promoting health, productivity and food security • Programmes addressing the quality and safety of local formulation of complementary foods
- 20. The way forward • The health and economic burden of contamination of food and feed by environmental toxin and bacteria can compromise the achievement of development goals and the aspired acceleration of Africa’s economic growth and needs to be addressed. • Integration of updated stunting reduction strategies in various ongoing and future continental and national debates, discussions, processes, and development plans of concerned sectors can benefit all parties. • Newly identified rapid risk exposure assessment technologies can now be used for establishing a surveillance system in high risk or endemic areas.
- 21. The way forward • All available data needs to be carefully reviewed in preparation for an AUC-PACA meeting of concerned stakeholders to discuss how the current stunting reduction strategies need to be adapted to the particularities of the African context. • There is need to respond to the call for comments and modifications made by the authors of “The Mycotox Charter”. • Production of training modules and training of the health teams in diagnosis, management and control of environmental toxins and contaminants.
- 22. The way forward • Continued evaluation of emerging evidence • More research and networking among the African research centers already engaged in stunting related research • Strengthen the health dimension in the work and activities of of PACA and FARA • Prepare for and organize a multi-stakeholder conference - in collaboration with WHO - to adapt stunting reduction strategies to particularities of the African context
- 23. THANK YOU