KARACHI, July 14: Vitamin A supplement has been found to reduce the incidence of diarrhoea and measles in children between six and 59 months, besides decreasing all-cause mortality by 28 per cent in the same age group, says a recently published study.
It also points out that early skin-to-skin contact (kangaroo care) in preterm neonates or premature babies is associated with 40pc reduction in the risk of mortality, a 58pc reduction in hospital-acquired infections or sepsis and a 77pc reduction in hypothermia (abnormally low blood pressure).
The study has been presented early this month in The Lancet Series on maternal and childhood malnutrition. It introduces 10 evidence-based nutrition interventions that according to the study can reduce the current total deaths in children younger than five years by 15pc if they are scaled up to 90pc coverage in populations at risk.
The analysis has been achieved after the researchers modelled effect on the lives saved and cost of these interventions to address under-nutrition in the 34 countries that have 90pc of the worlds’ children with stunted growth.“Among them is Pakistan where these interventions would benefit at least 10 million children and prevent almost 123,000 deaths per year,” said Dr Prof Zulfiqar Bhutta, founding director of the Centre of Excellence in Women and Child Health, Aga Khan University, and the lead author of the study.
Referring to the country’s National Nutrition Survey 2011, he said that too many children were sick or dying, wasted or stunted in early childhood. “In that special window of opportunity between pre-pregnancy and two years of age, when good nutrition is needed for a healthy and productive life, the potential benefits to the affected countries in terms of improved productivity and reduced healthcare costs are substantial.”
The 10 interventions identified in the paper include providing folic acid, calcium, and balanced energy protein and micronutrient supplements to pregnant women; promoting breastfeeding and delivering appropriate complementary feeding to infants; providing vitamin A and zinc supplements to children up to the age of five; and using proven treatment strategies to manage moderate and severe malnutrition in children.
According to the paper, maternal malnutrition contributes to 800,000 neonatal deaths annually; stunting, wasting and micronutrient deficiencies are estimated to underlie nearly 3.1 million child mortality annually.
Accelerated gains are, however, possible, it says, and about one fifth of the existing burden of stunting can be averted using these approaches, if access is improved.
Systematic reviews done under the study find that breastfeeding initiation within 24 hours of birth is associated with 44pc to 45pc reduction in all-cause and infection-related neonatal mortality and is thought to mainly operate through the effects of exclusive breastfeeding.
It also shows that intermittent iron supplement given to children younger than two years reduces the risk of anaemia by 49pc and iron deficiency by 76pc.
The findings also suggested that this supplement could be a viable public health intervention in settings in which daily supplementation had not been implemented or was not feasible.
The study’s findings show that preventive zinc supplementation reduces the incidence of diarrhoea by 13pc and pneumonia by 19pc
with a non-significant 9pc reduction in all-cause mortality.
A review of five trials of periconceptional (relating to the period from before conception to early pregnancy) folic acid supplementation suggests a 72pc reduction in risk of development of neural tube defects and a 68pc reduction in risk of recurrence if compared with no intervention.
Folic acid supplementation during pregnancy, according to the study, improves mean birth weight, with a 79pc reduction in the incidence of megaloblastic (characterised by many large immature and dysfunctional red blood cells) anaemia.
Calcium supplement during pregnancy reduces the incidence of gestational hypertension by 35pc, pre-eclampsia (high blood pressure during pregnancy) by 55pc and preterm births by 24pc.
“Continued investments in nutrition-specific interventions to avert maternal and child under nutrition and micronutrient deficiencies through community engagement and delivery strategies that can reach poor segments of the population at the greatest risk can make a great difference.
“If this improved access is linked to nutrition-sensitive approaches, that is, women’s empowerment, agriculture, food systems, education, employment, social protection and safety nets — they can greatly accelerate progress in countries with the highest burden of maternal and child under nutrition and mortality,” the study says.
The study also highlights that major factors directly affecting pregnancy outcomes is also the young age at the first pregnancy and repeated pregnancies at young age. Adolescent pregnancy, it says, is associated with a 50pc increased risk of stillbirths and neonatal deaths and increased risk of preterm birth, low birth weight and asphyxia (lack of oxygen in the body that often causes death).
Kangaroo care, it explains, denotes early skin-to-skin contact between mother and baby at birth or soon thereafter, plus early and continued breastfeeding, parental support, and early discharge from hospital.—Faiza Ilyas