Water and Nutrition: Harmonizing actions for the United Nations Decade of Action on Nutrition and the United Nations Water Action Decade

Progress for both SDG 2 and SDG 6 has been unsatisfactory, with several indicators worsening over time, including an increase in the number of undernourished, overweight and obese people, as well as rapid increases in the number of people at risk of severe water shortages. This lack of progress is exacerbated by climate change and growing regional and global inequities in food and water security, including access to good quality diets, leading to increased violation of the human rights to water and food. Reversing these trends will require a much greater effort on the part of water, food security, and nutrition communities, including stronger performances by the United Nations Decade of Action on Nutrition and the United Nations International Decade for Action on Water for Sustainable Development. To date, increased collaboration by these two landmark initiatives is lacking, as neither work program has systematically explored linkages or possibilities for joint interventions. Collaboration is especially imperative given the fundamental challenges that characterize the promotion of one priority over another. Without coordination across the water, food security, and nutrition communities, actions toward achieving SDG2 on zero hunger may contribute to further degradation of the world’s water resources and as such, further derail achievement of the UN Decade of Action on Water and SDG 6 on water and sanitation. Conversely, actions to enhance SDG 6 may well reduce progress on the UN Decade of Action on Nutrition and SDG 2. This paper reviews these challenges as part of a broader analysis of the complex web of pathways that link water, food security and nutrition outcomes. Climate change and the growing demand for water resources are also considered, given their central role in shaping future water and nutrition security. The main conclusions are presented as three recommendations focused on potential avenues to deal with the complexity of the water-nutrition nexus, and to optimize outcomes

Impact of the shift from NCHS growth reference to WHO(2006) growth standards in a therapeutic feeding programme in Niger.

OBJECTIVES: To describe the implementation of the WHO(2006) growth standards in a therapeutic feeding programme. METHODS: Using programme monitoring data from 21,769 children 6-59 months admitted to the Médecins Sans Frontières therapeutic feeding programme during 2007, we compared characteristics at admission, type of care and outcomes for children admitted before and after the shift to the WHO(2006) standards. Admission criteria were bipedal oedema, MUAC <110 mm, or weight-for-height (WFH) of <-70% of the median (NCHS) before mid-May 2007, and WFH <-3 z score (WHO(2006)) after mid-May 2007. RESULTS: Children admitted with the WHO(2006) standards were more likely to be younger, with a higher proportion of males, and less malnourished (mean WFH -3.6 z score vs. mean WFH -4.6 z score). They were less likely to require hospitalization or intensive care (28.4%vs. 77%; 12.8%vs. 36.5%) and more likely to be treated exclusively on an outpatient basis (71.6%vs. 23%). Finally, they experienced better outcomes (cure rate: 89%vs. 71.7%, death rate: 2.7%vs. 6.4%, default rate: 6.7%vs. 12.3%). CONCLUSIONS: In this programme, the WHO(2006) standards identify a larger number of malnourished children at an earlier stage of disease facilitating their treatment success

The Political Economy of India's Malnutrition Puzzle

Child malnutrition in India is shockingly high and is falling unusually slowly in a period of large gains in aggregate prosperity. Yet technical solutions to malnutrition are known. This article suggests the disjunction is a consequence of institutional features of India, in which rent?creation and rent?sharing in an unequal society are central. Economic reforms partially altered relations between the state and business, helping spur growth, but growth is much weaker in rural areas and poorer states. And service delivery remains enmeshed in patronage and populism. This is acutely misaligned with required action on malnutrition that involves provision of complementary public goods, by different agencies, with a key role for front?line workers. Systemic institutional change is going to be a long haul; in the meantime, public action needs to be designed around existing political and organisational realities. Otherwise increased nutrition?related spending will be like pushing on a string

Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh

BACKGROUND: Household food insecurity and under-nutrition remain critically important in developing countries struggling to emerge from the scourge of poverty, where historically, improvements in economic conditions have benefited only certain privileged groups, causing growing inequality in health and healthcare among the population. METHODS: Utilizing information from 5,977 children aged 0-59 months included in the 2004 Bangladesh Demographic and Health Survey , this study examined the relationship between household wealth inequality and chronic childhood under-nutrition. A child is defined as being chronically undernourished or whose growth rate is adversely stunted, if his or her z-score of height-for-age is more than two standard deviations below the median of international reference. Household wealth status is measured by an established index based on household ownership of durable assets. This study utilized multivariate logistic regressions to estimate the effect of household wealth status on adverse childhood growth rate. RESULTS: The results indicate that children in the poorest 20% of households are more than three time as likely to suffer from adverse growth rate stunting as children from the wealthiest 20% of households (OR=3.6; 95% CI: 3.0, 4.3). The effect of household wealth status remain significantly large when the analysis was adjusted for a child's multiple birth status, age, gender, antenatal care, delivery assistance, birth order, and duration that the child was breastfed; mother's age at childbirth, nutritional status, education; household access to safe drinking water, arsenic in drinking water, access to a hygienic toilet facility, cooking fuel cleanliness, residence, and geographic location (OR=2.4; 95% CI: 1.8, 3.2). CONCLUSION: This study concludes that household wealth inequality is strongly associated with childhood adverse growth rate stunting. Reducing poverty and making services more available and accessible to the poor are essential to improving overall childhood health and nutritional status in Bangladesh