A thousand splendid days

2011-06-03 00:00

THE first 1 000 days of a child's life — from conception until the age of two — largely determine what kind of a future that child will have.

This is according to international researchers and children's rights activists who are lobbying for governments to intervene in this critical time for children if they want an active, intelligent and productive future workforce.

Inadequate food during this time, both for the pregnant mother and her baby, can have a permanent effect on the child's cognitive development.

Undernutrition can cause "brain damage, impair the baby's motor movement and impact of its exploratory behaviour", according to the Maternal and Child Undernutrition Study Group, an international group of researchers.

"Poor foetal growth or stunting during the first two years of life leads to irreversible damage, including shorter adult height, lower attained schooling, reduced adult income and decreased offspring birth weight," according to the group in a series on nutrition that was published in The Lancet in 2008.

The Lancet series, which concluded that "the international nutrition system is broken…[and] leadership is absent", spurred governments and aid agencies to refocusing on nutrition as the basis of good health.

International donors such as the Gates Foundation, the World Bank, children's organisations and bilateral aid agencies from countries such as Canada, Britain and France have committed themselves to supporting nutritional interventions, including the fortification of basic foods with vitamins and nutrients.

The Global Alliance for Improved Nutrition (Gain) supports public-private partnerships to improve the diets of poor communities.

Gain's chairperson, ex-trade unionist Jay Naidoo, says that South Africa's focus on matric results is way too late for the many children who have either dropped out of school or are failing because of the effects of early undernutrition.

"One clear reason so many kids fail in matric is the effect of early undernutrition on their mental and physical development later in life," says Naidoo.

"The critical window of nutrition opportunity is the first 1 000 days from conception to two years. Missing this period is the most damaging for the mental and physical development of children."

Naidoo says the government should be "encouraging mothers to attend antenatal and postnatal clinics with a transport allowance and a food basket or vouchers and education on nutrition".

Gain also advocates six months' exclusive breast-feeding for all babies and is strongly in favour of school feeding schemes.

"School feeding is crucial for attendance in school and for increasing nutrition. This is often the only meal children from poverty-stricken homes have in the day," said Naidoo, lashing out at provinces that have allowed the schemes to collapse.

"South Africa really has to get its priorities right. Children matter because they are our most precious future resource."

Research is only just unravelling the many long-term effects of undernutrition thanks to long-term studies that have followed large groups of children from birth to adulthood.

Paradoxically, there is also a link bet­ween underweight babies and obese children and adults.

Mothers who have not had enough nutrition during pregnancy usually give birth to underweight babies with less "lean mass" (such as muscle) and more fat than normal-weight babies.

If these babies put on weight in later childhood or adulthood, they are more likely to put on fat not lean mass.

Put these children in homes where the diet is "energy-dense food" (usually processed food with few nutrients, such as mielie meal), and exercise is not encouraged, and they are "predisposed to excess weight gain and body-fat accumulation", according to Dr Benjamin Caballero, from the Centre for Human Nutrition at the Johns Hopkins Bloomberg School of Public Health in the United States.

Undernourished babies ballooning into obese adults is becoming common in developing countries (including South Africa) where "high prevalence of low birth weight is now combined with an urban, sedentary lifestyle and increased access to low-cost, energy-dense foods," says Caballero.

Overweight and obese people are at risk of heart disease, high blood pressure and diabetes.

There is even some evidence that people whose mothers were malnourished during the middle phase of their pregnancy have double the rate of schizophrenia.

Undernutrition is largely preventable, according to the 1 000 Days alliance.

"Evidence shows that investment in a package of proven interventions focusing on supporting healthy growth, optimal early feeding and breast-feeding, and a reduction in micronutrient deficiencies, can lead to exceptionally high health and development returns," says the alliance.

"Improvement in child and maternal nutrition is an affordable investment, and probably the best investment in development a country can make," Werner Schultink, chief of nutrition for the United Nation Children's Fund (Unicef), told a Harvard Global Health Institute symposium recently. — Health-e News.

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