giovanna

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So far giovanna has created 21 blog entries.
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    Stunting in Nepal: looking back, looking ahead

    Madhu Dixit Devkota, Ramesh Kant Adhikari and Senendra Raj Upreti

    Nepal has made impressive gains in health and nutrition despite being in a state of political, economic and demographic transition. According to the Nepal Demographic Health Surveys, stunting in Nepal has fallen from 57% in 2001 to 41% in 2011, an annual decline of 1.7 percentage points. A 3.9% annual reduction is, however, required to achieve the global target of 40% fewer stunted children by 2025. The Multiple Indicator Cluster Survey conducted in 2014 by the Central Bureau of Statistics and UNICEF indicated a further reduction in the proportion of stunted children to 37.4%.
    The recently drafted Sustainable Development Goal for Nepal, 2016–2030 has outlined a daunting challenge of reducing stunting in children under 5 years of age to 1% by 2030 for the long-term health, wellbeing, human capital development and national economic growth.

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Stunting in Nepal: looking back, looking ahead

Stunting in Nepal: looking back, looking ahead Madhu Dixit Devkota, Ramesh Kant Adhikari and Senendra Raj Upreti Nepal has made impressive gains in health and nutrition despite being in a state of political, economic and demographic transition. According to the Nepal Demographic Health Surveys, stunting in Nepal has fallen from 57% in [...]

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    Stop stunting: Pakistan perspective on how this could be realized

    Jai K. Das, Abdul Baseer Khan Achakzai and Zulfiqar A. Bhutta

    Globally, nearly half of all under-five deaths annually (3 million deaths) are attributable to undernutrition, as malnutrition is associated with increased risk of morbidity and infections, which leads to mortality (Liu et al. 2015). In 2011, at least 165 million children worldwide were stunted, and 52 million were wasted, with higher prevalence in south Asia and sub- Saharan Africa. Malnutrition is not confined to children but is also rampant among women of reproductive age. This maternal malnutrition contributes to fetal growth restriction, which leads to low birthweight and increases risk of childhood infections and mortality. Children exposed to these risks early in life have a higher risk of growth faltering and stunting, which can cause long-term irreversible and detrimental cognitive, motor and health impairments (Black et al. 2013). Most of the irreversible damage due to malnutrition occurs during gestation and in the first 24 months of life, hence underscores the importance of intervening in this period. …

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Stop stunting: Pakistan perspective on how this could be realized

Stop stunting: Pakistan perspective on how this could be realized Jai K. Das, Abdul Baseer Khan Achakzai and Zulfiqar A. Bhutta Globally, nearly half of all under-five deaths annually (3 million deaths) are attributable to undernutrition, as malnutrition is associated with increased risk of morbidity and infections, which leads to mortality (Liu [...]

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    Reducing stunting in India: what investments are needed?

    Rasmi Avula, Neha Raykar, Purnima Menon and Ramanan Laxminarayan

    India has among the highest rates of child malnutrition rates in the world, but these rates have been declining rapidly during the past decade. Between 2006 and 2014, stunting rates for children under five in India have declined from 48 to 38% (Global Nutrition Report, 2014). Despite this progress, child undernutrition rates in India are among the highest in the world, with nearly one-half of all children under 3 years of age being either underweight or stunted. India is still home to over 40 million stunted children and 17 million wasted children (Global Nutrition Report, 2014). In addition, the rates of decline have been highly variable across India’s states. Some states, including Arunachal Pradesh, Mizoram and Delhi, had large rates of reduction in stunting, but overall levels of undernutrition remained high because of high baseline rates. Meanwhile, in Uttar Pradesh, Jammu and Kashmir, Manipur and Jharkhand the situation has not changed significantly (Raykar et al., 2015). Similar variability is observed in the prevalence of anaemia rates as well, which range from 38% in Goa to 78% in Bihar (IIPS & Macro International, International Institute for Population Sciences (IIPS) and Macro International, 2007). …

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Reducing stunting in India: what investments are needed?

Reducing stunting in India: what investments are needed? Rasmi Avula, Neha Raykar, Purnima Menon and Ramanan Laxminarayan India has among the highest rates of child malnutrition rates in the world, but these rates have been declining rapidly during the past decade. Between 2006 and 2014, stunting rates for children under five in [...]

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    Reducing stunting in Bhutan: an achievable national goal

    Laigden Dzed and KinleyWangmo

    The kingdom of Bhutan is a tiny country, landlocked between the two Asian giants of India and China, and has a population of about 762 864 (Bhutan at a glance 2014). Despite the very small size, the country has made remarkable progress towards modern development since initiating planned development in the 1960s. Bhutan has also experienced rapid progress in many of the key determinants of nutrition and health. The life expectancy of the Bhutanese has been increasing steadily over the years, currently standing at 68 years (Statistical Yearbook of Bhutan 2014). The country’s infant mortality rate has declined to 30 per 1000 live births down from 90 per 1000 in 1990 (National Health Survey (NHS) 2012). The 2010 Multiple Indicator Survey showed the prevalence of stunting in children under 5 years to be 33.5%, indicating a 24% decline from 1986 levels (Bhutan Multiple Indicator Survey). …

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Reducing stunting in Bhutan: an achievable national goal

Reducing stunting in Bhutan: an achievable national goal Laigden Dzed and KinleyWangmo The kingdom of Bhutan is a tiny country, landlocked between the two Asian giants of India and China, and has a population of about 762 864 (Bhutan at a glance 2014). Despite the very small size, the country has made [...]

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    Imperatives for reducing child stunting in Bangladesh

    Tahmeed Ahmed, Muttaquina Hossain, Mustafa Mahfuz, Nuzhat Choudhury and Shamim Ahmed

    Although there has been a decline in rates of child stunting in Bangladesh, more than one-third of underfive children still suffer from impaired linear growth. Results of the demographic health surveys since 2004 show that the rate of stunting decreased by only 1.5 percentage points per year (NIPORT, Mitra and Associates & ICF International, 2015). This is not anticipated, given the impressive results the country has demonstrated in reducing infant and maternal mortality over the past two decades (NIPORT, MEASURE Evaluation, and ICDDR,B 2012). Stunting seems to be pervasive throughout the country and is very high in children in slum settlements. Poverty and lack of education are associated with stunting in Bangladesh as elsewhere; however, 21% children from households belonging to the richest wealth quintiles are also stunted. About one-third of children of literate mothers also suffer from stunting. Therefore, the aetiology of stunting is still not clear, although data from Bangladesh suggest that factors associated with the condition include poor maternal nutrition, low birthweight (LBW), severe food insecurity, inappropriate complementary feeding, poverty, illiteracy, poor sanitation, and hygiene practices (Ahmed et al, 2012; Psaki et al., 2014). There is increasing evidence that environmental enteropathy, a condition where the small intestinal mucosa is colonized and damaged by pathogenic bacteria, is one cause of malabsorption of nutrients and stunting. This happens when hygiene and sanitation practices are poor and young children are chronically exposed to bacteria in the environment. …

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Imperatives for reducing child stunting in Bangladesh

Imperatives for reducing child stunting in Bangladesh Tahmeed Ahmed, Muttaquina Hossain, Mustafa Mahfuz, Nuzhat Choudhury and Shamim Ahmed Although there has been a decline in rates of child stunting in Bangladesh, more than one-third of underfive children still suffer from impaired linear growth. Results of the demographic health surveys since 2004 show [...]

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    Stop stunting: situation and way forward to improve maternal, child and adolescent nutrition in Afghanistan

    Ariel Higgins-Steele, Piyali Mustaphi, Sherin Varkey, Humayoun Ludin,
    Najibullah Safi and Zulfiqar A. Bhutta

    While Afghanistan has made progress in improving the nutritional status of children and women, rates of under-nutrition, stunting and wasting remain among the highest in the world, requiring attention to address immediate and underlying causes (Varkey et al. 2015). Given potential human, societal and economic gains from investment in nutrition (Branca et al. 2015) reducing the dual burden of acute and chronic undernutrition must figure among social sector and development priorities for the country.

    Comparisons of two national nutrition surveys in Afghanistan (2004 and 2013) show gradual improvements in the nutritional status of women and children, and yet, the rates of undernutrition continue to be too high. According to a National Nutrition Survey in Afghanistan in 2004, the prevalence of chronic malnutrition (stunted linear growth or low height-for-age) among children aged 6 to 59months was 60.5%; in the same age group, the prevalence of acute malnutrition (wasting) was 8.7% (Afghanistan Ministry of Public

    Health, National Nutrition Survey 2004). The 2013 survey showed malnutrition rates among children 0 to 59months of age with stunting at 40.9%, severe stunting at 20.9%, and moderate stunting at 20% Afghanistan Ministry of Public Health, National Nutrition Survey 2013).

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Stop stunting: situation and way forward to improve maternal, child and adolescent nutrition in Afghanistan

Stop stunting: situation and way forward to improve maternal, child and adolescent nutrition in Afghanistan Ariel Higgins-Steele, Piyali Mustaphi, Sherin Varkey, Humayoun Ludin, Najibullah Safi and Zulfiqar A. Bhutta While Afghanistan has made progress in improving the nutritional status of children and women, rates of under-nutrition, stunting and wasting remain among the [...]

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    Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy

    S V Subramanian, Iván Mejía-Guevara and Aditi Krishna

    Stunting and chronic undernutrition among children in South Asia remain a major unresolved global health issue. There are compelling intrinsic and moral reasons to ensure that children attain their optimal growth potential facilitated via promotion of healthy living conditions. Investments in efforts to ensure that children’s growth is not faltered also have substantial instrumental benefits in terms of cognitive and economic development. Using the case of India, we critique three prevailing approaches to reducing undernutrition among children: an over-reliance on macroeconomic growth as a potent policy instrument, a disproportionate focus on interpreting undernutrition as a demand-side problem and an over-reliance on unintegrated single-factorial (one at a time) approaches to policy and research. Using existing evidence, we develop a case for support-led policy approach with a focus on integrated and structural factors to addressing the problem of undernutrition among children in India.

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Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy

Rethinking policy perspectives on childhood stunting: time to formulate a structural and multifactorial strategy S V Subramanian, Iván Mejía-Guevara and Aditi Krishna Stunting and chronic undernutrition among children in South Asia remain a major unresolved global health issue. There are compelling intrinsic and moral reasons to ensure that children attain their optimal [...]

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    Drivers of nutritional change in four south Asian countries: a dynamic observational analysis

    Derek Headey, John Hoddinott and Seollee Park

    This paper quantifies the factors explaining long-term improvements in child height for age z-scores in Bangladesh (1996/1997–2011), India (1992/1993–2005/2006), Nepal (1997–2011) and Pakistan (1991–2013). We apply the same statistical techniques to data from a common data source from which we have extracted a set of common explanatory variables that capture ‘nutrition-sensitive’ factors. Three are particularly important in explaining height for age z-score changes over these timeframes: improvements in material well-being; increases in female education; and improvements in sanitation. These factors have comparable associations across all four countries.

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Drivers of nutritional change in four South Asian countries: a dynamic observational analysis

Drivers of nutritional change in four south Asian countries: a dynamic observational analysis Derek Headey, John Hoddinott and Seollee Park This paper quantifies the factors explaining long-term improvements in child height for age z-scores in Bangladesh (1996/1997–2011), India (1992/1993–2005/2006), Nepal (1997–2011) and Pakistan (1991–2013). We apply the same statistical techniques to data [...]

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    Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation

    William Joe, Ramaprasad Rajaram and S. V. Subramanian

    Empirical evidence suggests that macroeconomic growth in India is not correlated with any substantial reductions in the prevalence of child undernutrition over time. This study investigates the two commonly hypothesized pathways through which macroeconomic growth is expected to reduce child undernutrition: (1) an increase in public developmental expenditure and (2) a reduction in aggregate income-poverty levels. For the anthropometric data on children, we draw on the data from two cross-sectional waves of National Family Health Survey conducted in 1992– 1993 and 2005–2006, while the data for per capita net state domestic product and per capita public spending on developmental expenditure and headcount ratio of poverty were obtained from the Reserve Bank of India and the Government of India expert committee reports. We find that between 1992–1993 and 2005–2006, state-level macroeconomic growth was not associated with any substantial increases in public development expenditure or substantial reductions in poverty at the aggregate level. Furthermore, the association between changes in public development expenditure or aggregate poverty and changes in undernutrition was small. In summary, it appears that the inability of macroeconomic growth to translate into reductions in child undernutrition in India is likely a consequence of the macroeconomic growth not translating into substantial investments in development expenditure that could matter for children’s nutritional status and neither did it substantially improve incomes of the poor, a group where undernutrition is also the highest. The findings here build a case to advocate a ‘support-led’ strategy for reducing undernutrition rather than simply relying on a ‘growth-mediated’ strategy.

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Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation

Understanding the null-to-small association between increased macroeconomic growth and reducing child undernutrition in India: role of development expenditures and poverty alleviation William Joe, Ramaprasad Rajaram and S. V. Subramanian Empirical evidence suggests that macroeconomic growth in India is not correlated with any substantial reductions in the prevalence of child undernutrition over time. [...]

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    The costs of stunting in South Asia and the benefits of public investments in nutrition

    Meera Shekar, Julia Dayton Eberwein and Jakub Kakietek

    South Asia is home to the largest number of stunted children worldwide: 65 million or 37% of all South Asian children under 5 were stunted in 2014. The costs to society as a result of stunting during childhood are high and include increased mortality, increased morbidity (in childhood and later as adults), decreased cognitive ability, poor educational outcomes, lost earnings and losses to national economic productivity. Conversely, investing in nutrition provides many benefits for poverty reduction and economic growth. This article draws from analyses conducted in four sub-Saharan countries to demonstrate that investments in nutrition can also be very cost-effective in South Asian countries. Specifically, the analyses demonstrate that scaling up a set of 10 critical nutrition-specific interventions is highly cost-effective when considered as a package. Most of the interventions are also very cost-effective when considered individually. By modelling cost-effectiveness of different scale-up scenarios, the analysis offers insights into ways in which the impact of investing in nutrition interventions can be maximized under budget constraints. Rigorous estimations of the costs and benefits of nutrition investments, similar to those reported here for sub-Saharan countries, are an important next step for all South Asian countries in order to drive political commitment and action and to enhance allocative efficiency of nutrition resources.

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The costs of stunting in South Asia and the benefits of public investments in nutrition

The costs of stunting in South Asia and the benefits of public investments in nutrition Meera Shekar, Julia Dayton Eberwein and Jakub Kakietek South Asia is home to the largest number of stunted children worldwide: 65 million or 37% of all South Asian children under 5 were stunted in 2014. The costs [...]