Saul Sutkover Morris

Every parent aspires to provide a nutritious diet for their children, but many struggle to realize this ambition. The authoring agencies of the 2020 State of Food Security and Nutrition in the World report ¹ estimated that one-quarter of the world’s population of > 1.5 billion people cannot afford even the cheapest possible nutrient-adequate diet that meets, according to the report, “all known requirements for essential nutrients.” According to the report, this diet is unaffordable for 53% of the population of sub-Saharan Africa, and 18% of the population of southern Asia, regions that, together, are home to 52% of the world’s children ² and a concentration of 86% of people living in extreme poverty worldwide. ³

Identifying dietary nutrient gaps and interpreting their public health significance are essential for improving poor diets and reducing malnutrition. Evidence indicative of the burden of nutrient deficiencies and inadequate nutrient intake or availability exists in many countries yet is often misinterpreted or underused in decision-making. Clear guidance is lacking on how to synthesize and interpret the relevant evidence, which comes in many forms. To fill this methodological gap, an approach called Comprehensive Nutrient Gap Assessment was created to enable use of existing evidence to assess the public health significance of nutrient gaps and identify evidence gaps. Comprehensive Nutrient Gap Assessment requires ≥ 2 experts in nutritional assessment but does not require primary data collection or secondary quantitative data analysis. It can be implemented relatively quickly with low costs, for specific countries and subnational regions, and updated on the basis of new data with minimal effort. The findings from a Comprehensive Nutrient Gap Assessment are easily interpretable by nontechnical decision makers yet include clear justification for technical audiences.

Despite considerable global efforts to reduce growth faltering in early childhood, rates of stunting remain high in many regions of the world. Current interventions primarily target nutrition-specific risk factors, but these have proven insufficient. The objective of this study was to synthesize the evidence on the relationship between active tobacco use during pregnancy and growth outcomes in children under five years of age. In this systematic review and meta-analysis, six online databases were searched to identify studies published from January 1, 1980, through October 31, 2016, examining the association between active tobacco use during pregnancy and small-for-gestational age (SGA), length/height, and/or head circumference. Ecological studies were not included. A meta-analysis was conducted, and subgroup analyses were carried out to explore the effect of tobacco dosage. Among 13,189 studies identified, 210 were eligible for inclusion in the systematic review, and 124 in the meta-analysis. Active tobacco use during pregnancy was associated with significantly higher rates of SGA (pooled adjusted odds ratio [AORs] = 1.95; 95% confidence interval [CI]: 1.76, 2.16), shorter length (pooled weighted mean difference [WMD] = 0.43; 95% CI: 0.41, 0.44), and smaller head circumference (pooled WMD = 0.27; 95% CI: 0.25, 0.29) at birth. In addition, a dose-response effect was evident for all growth outcomes. Tobacco use during pregnancy may represent a major preventable cause of impaired child growth and development.

Eggs are a highly nutritious food but have been shown to be infrequently consumed in many low‐income countries, especially by women and children. We collate country‐level data on egg production, availability, consumption, prices, industry structure, and contextual trends and use these to estimate current patterns and likely future outcomes under four alternative scenarios. These scenarios are as follows: incremental change based on expected economic growth and urbanisation (the base scenario); enhanced productivity of independent small producers; aggregated production in egg hubs; and the accelerated spread of large‐scale intensive production. All scenarios are modelled out to 2030 using a mix of regression and deterministic models. We find that children's consumption of eggs is highly correlated with national availability, and both are a function of egg prices. Eggs are unavailable, expensive, and infrequently consumed by children in much of South Asia and sub‐Saharan Africa. The base scenario results in modest increases in production in low‐income regions. Focusing efforts on independent small producers can only boost rural consumption in a handful of countries where poultry ownership is unusually high and would be expensive and logistically challenging to scale. Aggregation of production, with minimum flock sizes of 5,000 layers per farm, is a more promising pathway to increasing availability in rural areas. To meet the needs of urban populations, large‐scale intensive production is needed. Intensive production brings down prices significantly, allowing many more poor households to access and consume eggs. Recent experience in countries such as Thailand confirms that this is both feasible and impactful.

Acute lower respiratory illness (ALRI) is a major global cause of morbidity and mortality among children under 5. Antibiotic treatment for ALRI is inexpensive and decreases case fatality, but care-seeking patterns and appropriate treatment vary widely across countries. This study sought to examine patterns of appropriate treatment and estimate the burden of cases of untreated ALRI in high mortality countries.

Achievement of Millennium Development Goal (MDG) 4 for child survival requires acceleration of gains in newborn survival, and current trends in improving maternal health will also fall short of reaching MDG 5 without more strategic actions. We present a Maternal Newborn and Child Health (MNCH) strategy for accelerating progress on MDGs 4 and 5, sustaining the gains beyond 2015, and further bringing down maternal and child mortality by two thirds by 2030.