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  • Both stunting and environmental enteric dysfunction improve

    2019-06-26

    Both stunting and environmental enteric dysfunction improve with radical shifts in environment, such as NU 9056 structure or local economic development. This improvement is reflected to some extent by the smoothing of the seasonality of undernutrition reported by Nabwera and colleagues in these three Gambian villages, which they attributed to general improvements in local wealth, food security, and education. Tackling of the residual burden of stunting will therefore likely need multifaceted, community-based interventions. We agree with the investigators\' prediction that basic water, sanitation, and hygiene improvements will be insufficient to further reduce stunting. Much higher-intensity interventions are required—across multiple generations and in combination with economic development—to overcome this barrier to child survival.
    The Millennium Development Goal era was characterised by concerted efforts to improve child survival. This work continues with the Sustainable Development Goals but targets have also been set for preschool children to participate in organised learning and to meet their developmental milestones. The challenge now is that more than four of ten children in low-income and middle-income countries are at risk of impaired cognitive development. Children with stunted growth and living in extreme poverty do poorly at school, have lower incomes as adults, and contribute to the transmission of poverty across generations. Optimum child development needs health, nutrition, security, safety, loving care, and learning. This nurturing environment should be present from before pregnancy and onwards. Nutrition-specific programmes have important roles in these efforts with potential effects not only on foetal and child survival, health and development, but also on adult non-communicable diseases. In , Prado and coauthors have followed-up the large SUMMIT multiple micronutrient trial in Indonesia and analysed the effect of prenatal multiple micronutrient (MMN) supplementation as well as the associations between other early biomedical and socioenvironmental conditions and children\'s cognition at age 9–12 years. The researchers assessed different aspects of cognitive development: general intellectual ability, declarative memory, procedural memory, executive function, academic achievement, fine motor dexterity, and socioemotional health. The associations were assessed in three different samples from the original pregnancy cohort: a representative sample, a sample of malnourished mothers at recruitment, and a sample of women with anaemia at recruitment. The procedural memory outcome differed between the MMN and the iron and folic acid groups in the random sample, and general intellectual ability in the anaemia sample. These possible effects of prenatal MMN on school age child development were small but a bit more prominent in the anaemia sample. The gathering of evidence of the relative strength of effects for the micronutrients, and of associations with other biomedical and socioenvironmental conditions for development is commendable. Socioenvironmental conditions such as parental education, socioeconomic status, home environment, and maternal depression seemed to be more important determinants than the biological determinants measured.
    The global health community does not spend much time on branding, which perhaps explains why existing classifications for the three largest groups of diseases are both outdated and counterproductive. The first Global Burden of Disease study described infectious diseases, non-communicable diseases (NCDs), and injuries. This grouping reflected a predominantly infectious disease burden in low-income and middle-income countries, which has since tilted towards NCDs. A name that is a longwinded non-definition, and that only tells us what this group of diseases is not, is not befitting of a group of diseases that now constitute the world\'s largest killer. NCDs—which include cancer, diabetes, chronic obstructive pulmonary disease, cardiovascular disease, and mental health conditions—are the leading cause of death worldwide and disproportionately afflict developing countries (unpublished). NCDs will cost the global economy US$47 trillion over the next two decades, and they continue to push millions of people into poverty. Nevertheless, NCDs receive the lowest overseas development assistance per disability-adjusted life-year, and even the most cost-effective NCD interventions are severely underfunded compared with their infectious disease counterparts. What\'s more, NCDs are under-represented in developing countries\' national health plans, undermining progress towards reaching universal health coverage and improvement of human capital. NCDs share all the ideological and social justice issues of HIV but cause 30 times more deaths and receive 17 times less funding.