Family Health Check Up: Nutrition for a Healthy Start to Life

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5/9/2013 4:36:00 PM
This is the third post in the six-part Family Health "Check Up" 2103 series which provides a window into the ways in which we think about our Family Health strategy, at the foundation. Follow @gatesfoundation and @gdarmsta on Twitter to join the conversation.

Here at the Gates Foundation, as the
nutrition team reflects back over 2012 for our strategy review, a couple of notable experiences stand out for us as evidence of progress. In partnership with organizations which work to improve nutrition for children in the poorest countries, we have seen some exciting achievements. Though many challenges remain, these events (and many others over the course of the year) reaffirm our strategic direction to focus our investments on healthy growth, breastfeeding and complementary feeding, and control of selected micronutrient deficiencies.

The first evidence of progress is the increased attention that nutrition is receiving on the global health and development agenda.  Governments and donors alike are beginning to recognize that investing in nutrition makes health as well as economic sense, and many in Asia and Africa are committing to the Scaling up Nutrition movement (SUN) to improve nutrition outcomes.

  In partnership with organizations which work to improve nutrition for children in the poorest countries, we have seen some exciting achievements.

A second notable moment, and further evidence that we’re headed in the right direction, was the release of the Copenhagen Consensus 2012, which ranked investing in a bundled package of nutrition interventions as the number one priority to advance global health and well-being. These interventions include breastfeeding and complementary feeding promotion, provision of micronutrients, food fortification, treatment of severe acute wasting, provision of food supplements in food insecure areas, and treatment of worms and diarrhea.

In an effort to further share the work we’re focused on here at the foundation, below are some of the highlights from 2012:

  • In the area of healthy growth, a UC-Davis led consortium is testing a new product line designed to help prevent under-nutrition among mothers and young children. Small-quantity Lipid-based Nutrient Supplements (LNS) are designed to deliver essential nutrients, including high-quality protein, vitamins, minerals, and essential fatty acids to vulnerable populations that oftentimes have diets that are insufficient in many nutrients critical for prenatal and postnatal physical growth, immune function, neurobehavioral and cognitive development. We are excited about LNS as a possible breakthrough innovation because it is preventative, ready-to-use, has a long shelf-life and can be produced locally. Preliminary results on the impact of LNS in Burkina Faso will become available in a few weeks.  We are eagerly awaiting additional findings from studies in Malawi, Ghana, and Bangladesh and look forward to sharing these over the year ahead. 
  • Alive & Thrive continues to work to improve breastfeeding and infant and young child feeding through interventions delivered at scale. In Bangladesh, exclusive breastfeeding rates have increased by 42% nationally after a 15-year plateau.  Local partner, BRAC, has focused on improving the quality and coverage of frontline worker counseling and generation of awareness and demand at the community level. Midterm data indicate that the program has made progress shifting feeding behaviors, including an increase by 17 percentage points in early initiation of breastfeeding, a 4-fold improvement in age-appropriate complementary feeding practices, and a 3-fold increase in the consumption of iron rich foods.
  • Another part of our nutrition strategy addresses micronutrient deficiencies by establishing effective, scalable delivery models for commercial fortification and biofortification, and demonstrating the health impact of these interventions, particularly for the 1,000 day period from conception to 2 years old. The Global Alliance for Improved Nutrition (GAIN) is involved in this process by supporting the creation of public-private partnerships and innovative business models to develop and deliver fortified food products. GAIN has partnered with governments, local companies and other implementing organizations to support the enactment of legislation mandating staple food fortification in Kenya, Tanzania, and Uganda. Such policy change is an important lever to increase consumption of high quality fortified foods and improve the sustainability of fortification efforts in these countries through government monitoring and regulation.

To stay true to our vision that all children have the nutrition they need for a healthy start to life, we have made a couple of adjustments to our strategy as new evidence advances our own understanding of how to achieve the greatest impact.

  • First, our product development work is zeroing in on new food-based solutions that will improve neurocognitive development as well as physical growth.
  • We have also broadened our focus on the 1,000-day period to include research on preconception nutrition. Because women often do not know that they are pregnant until many weeks into their pregnancies and entering pregnancy in good health is vital, there may be substantial long-term health and cognitive benefits to improving a woman’s nutritional status prior to pregnancy, for example through engaging adolescents.

We recognize that addressing maternal and child malnutrition will take the concerted effort of many sectors—including health, water/sanitation, agriculture, education, and social protection.  We work closely with many partners in these various sectors to improve the nutritional impact of their efforts. 

 We recognize that addressing maternal and child malnutrition will take the concerted effort of many sectors.

Last summer, for example, together with our agriculture team we published a position paper on how to optimize the nutritional impact of our agricultural investments, and there is an unprecedented degree of alignment between the two teams to work together to take forward this agenda. We have also developed a conceptual framework to guide our work in optimizing the pathway from increased agricultural productivity and income generation to improved nutritional status for women and children. Through research trials in several countries we are also exploring the synergistic impact of improving water and sanitation while simultaneously enhancing a child’s nutrient intake.  

Globally, we have made significant progress in 2012 when it comes to understanding more about how to address the nutritional needs of children, and along with our partners we are excited about the prospects for 2013.  We continue to learn, adjust, and grapple with a number of challenges to achieving impact at scale. A major question on our mind is: how do we measure our impact and sustain this momentum into 2015 and beyond? We will continue to ask the hard questions and explore ways to create catalytic change when it comes to improving children's nutritional status in the poorest countries in the world. 

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