FACT SHEET

The Importance of Nutrition for Child Survival

Maternal and child undernutrition too few nutrients to sustain growth and development contributes to 3.5 million deaths each year and is responsible for about 11 percent of the total global disease burden.1,2 Millions of children suffer cognitive disability, stunted growth, poorly developed immune systems and other physical impairments because they lack an adequate supply of nutritious food. Poor child health also undermines societal development; improved health is the first step toward enabling children to break out of a cycle of ill-health and poverty that may otherwise continue for generations.3 Yet, millions of childrens lives can be saved or improved through proven cost-effective interventions, including vitamin A and zinc supplementation and counseling on breastfeeding. The first Millennium Development Goal (MDG), established by the international community in 2000, is to halve between 1990 and 2015 the proportion of people who suffer from hunger.4 One measure of hunger (i.e., discomfort from not eating or lack of access to food that sufficiently meets dietary needs) assessed by the MDG is the proportion of underweight children under age 5. Between 1990 and 2005, the proportion of underweight children declined by about 20 percent; the current rate of decline is not sufficient to achieve the MDG target.5 Regionally, countries in East and West Asia, Latin America and the Caribbean have significantly reduced the proportion of underweight children; some countries are on-track to achieve MGD targets. There is less progress in South Asia and sub-Saharan Africa. Percent of Children Underweight and Stunted, by Region1
Region Children Under Age 5 Years 142 million 357 million 57 million Percent Stunted 40.1 31.3 16.1 Percent Underweight 21.9 22.0 4.8 Percent LBW* 14.3 18.3 10.0 Percent IUGRLBW** 8.9 12.4 5.3

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Africa Asia Latin America (Caribbean, South and Central America) *LBW: Low birth weight (<2500 grams); **IUGR-LBW: Intrauterine growth restrictionlow birth weight.

Maternal nutrition, including an abundant and well-balanced diet, is critical for healthy pregnancy and delivery. For the child, lack of adequate nutrition during pregnancy can result in intrauterine growth restriction (i.e., weight at less than 10 percent for gestational age) and/or low birth weight; these conditions put a newborn at risk for other illnesses. Maternal post-pregnancy nutritional status has little impact on the quantity of breast milk for infants, unless maternal undernutrition is severe. However, vitamin and mineral deficiencies in the mothers diet can affect the quality of breast milk, and contribute to newborn micronutrient deficiencies.1 About one-third of children under age 5 living in developing countries an estimated 178 million children have stunted growth.1 Millions of undernourished children are at increased risk of infectious diseases in childhood and chronic diseases in adulthood.6, 7 Intellectual impairment and blindness limit a childs academic achievement. Compared with those who do not experience physical or intellectual deficits, undernourished children are more likely to perform poorly in school and to be less economically productive in later life, as reflected by a 20 percent deficit in income.7 Childhood illness contributes to the impoverishment of families, who incur medical care expenditures they can ill afford and reduced income for other necessities, such as food and education. Interventions to prevent stunting and its long-term after-effects are, in fact, simple and highly cost effective, have long-term benefits on schooling and intelligence tests in adulthood,8 and return up to $3 in additional wages for every $1 invested in improving child nutrition.9

Interventions to meet maternal and child nutritional needs The three main approaches to delivering nutrition interventions are:
Provide supplements to address specific or multiple deficiencies; Diversify diets to increase the quantity and variety of food sources; Fortify commonly used products or foods, including salt, sugar, milk, infant formula and flour or bread. Key interventions for pregnant and lactating women are supplementation with calcium, iron, folic acid, iodine (or use of iodized salt) and balanced energy and protein, including consumption of meat, fish or poultry.10 Important infant interventions include promoting breastfeeding and vitamin A supplements. Critical interventions for children are fortification or supplementation with vitamin A, zinc, iron and iodine (or use of iodized salt), and the use of ready-to-use therapeutic foods.1,10 Vitamin A and zinc deficiencies together are responsible for about 1 million deaths per year supplementing these key micronutrients can reduce deaths and a significant portion of the disease burden. Ready-to-use therapeutic foods, which provide protein, carbohydrates and micronutrients, can be delivered through community-managed programs that achieve high coverage.

Selected Essential Micronutrients1, 2 Calcium: is needed for healthy bones and teeth, and for nerves, muscles and the heart to function properly. Deficiency impairs bone and tooth development and other key functions. Folic acid (vitamin B9): is essential, especially in pregnancy. Lack of folic acid increases the risk of neural tube and other birth defects, and preeclampsia during pregnancy. Iodine: is needed during pregnancy and childhood for proper development. Deficiency can impair motor and mental development in children. Iron: critical for cell growth and differentiation into specific cell types and for oxygen transport to tissues in the body. Maternal anemia causes pregnancy complications. Childhood anemia can reduce cognitive development, immune functioning and strength/energy. Vitamin A: is needed for vision, bone development and cell differentiation into specific cell types. It is critical for a healthy immune system. Deficiency can cause blindness and increased susceptibility to disease and death. Vitamin B12: is essential for nerve and red blood cell development. Deficiency may result in poor cognitive function, anemia/fatigue, mental health problems and failure to thrive (growth disorder in which weight or height are significantly lower than normal). Vitamin D: is critical for bone growth and development, and functions in the immune and neuromuscular systems. Deficiency can result in rickets and other skeletal weaknesses/deformities. Zinc: is essential for a healthy immune system, DNA synthesis and normal growth and development during pregnancy and childhood. Poor growth and development, eye and skin lesions, delayed wound healing, weight loss and death can result from deficiency.

Addressing diseases associated with undernutrition Availability of clean water reduces diarrheal and other water-borne parasitic diseases to which undernourished children are particularly vulnerable.11 In addition, preparation of infant formula or other foods require clean water. De-worming efforts and provision of insecticide-treated bed nets are critical during pregnancy and for children under age 5.
Oral rehydration solution is used to treat dehydration from diarrheal diseases by replacing essential electrolytes lost through diarrhea. The provision of zinc supplements has been found to reduce the severity of diarrhea illness and prevent deaths among children.12 Long-term interventions to reduce poverty and the disease burden will indirectly reduce the prevalence of nutrition-related illness and death, and will improve the health of mothers and children.10
Black RE. 2008. Maternal and child undernutrition: global and regional exposures and health consequences. Lancet 371:243-60. 2 US Natl Library of Med, NIH. Vitamins. MedlinePlus. (accessed May 18, 2008), Available from: http://www.nlm.nih.gov/ 3 Islam M. 2006. The costs of maternal-newborn illness and mortality. Geneva: WHO. Available from: http://www.who.int/reproductive-health/universal_coverage/issue2/index.htm 4 UN Millennium Project. 2005. Halving hunger: it can be done. Available from: http://www.unmillenniumproject.org/documents/HTF-SumVers_FINAL.pdf 5 United Nations. 2007. Millennium Development Goals report. Available from: http://www.un.org/ 6 Victora C. 2008. Maternal and child undernutrition: consequences for adult health and human capital. Lancet 371:340-57. 7 Grantham-McGregor S, et al. 2007. Developmental potential in the first 5 years for children in developing countries. Lancet 369:60-70. 8 Engle PL. 2007. Strategies to avoid the loss of developmental potential in more than 200 million children in the developing world. Lancet 369:229-42. 9 Belli P. 2005. Investing in childrens health. Bulletin of the World Health Organization 83(10):777-84. 10 Bhutta Z, et al. 2008. What works? Interventions for maternal and child undernutrition and survival. Lancet 371:417-40. 11 Heymann DL, editor. Control of communicable diseases manual. 18 ed. Washington, DC: APHA, 2004. 12 Keusch GT, al. e. Diarrheal diseases. In: Jamison D, al. e, editors. Disease control priorities in developing countries. Washington, DC: World Bank, 2006.
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