Community Nutrition Promotion: Challenge & Solution
The Challenge
Proper nutrition is important for a child’s health, learning, and development. Proper nutrition also benefits families and the entire community in the long run. The key periods where a child is most vulnerable is before birth, and during lactation and weaning. Growth and mental problems caused by undernutrition before the age of two are extremely difficult, if not impossible, to reverse.
The Solution
While specific nutrition interventions (like micronutrient supplementation, micronutrient fortification and biofortification) can transform lives and improve the health of entire populations, their obvious limitation is that with each intervention, only a small part of the overall problem is being addressed: Vitamin A supplements solve the specific problem of vitamin A deficiency, iodization of salt solves the specific problem of iodine deficiency, and so forth.
To make further progress, households will need to change their food practices. This means behavioral change, which is considerably more complex than micronutrient supplements or fortification.
A key opportunity to try to encourage these changes comes during pregnancy. Undernutrition in infants is extremely difficult, if not impossible, to reverse. The key messages to impart to pregnant women are about improving diet, breastfeeding, complementary feeding of infants and young children, and identifying inadequate growth and weight gain in babies.
Delivering these messages effectively requires one-on-one discussion, typically with the mother. Weighing the mother-to-be, and weighing and measuring the baby, are important tools with which to frame the educational messages. Such educational sessions can also be used to provide micronutrient supplements and a deworming intervention.
The Research
Sue Horton et al. find that nutrition education is an order of magnitude more expensive than micronutrient supplements and micronutrient fortification, but its cost-effectiveness is on par with many other attractive health investments.
There are three major types of interventions:
Incorporation of nutrition education into existing Child Health Days;
Community nutrition promotion using volunteers;
Nutrition education as part of the lowest tier of the health care system.
The appropriate intervention depends on the level of development of a country and the current level of development of health services. Cost-effectiveness is typically higher when interventions are “packaged” with other interventions and the costs of personnel time are spread over multiple interventions.
Good program design is absolutely essential in community nutrition programs. Immunization, micronutrient fortification and supplementation programs can fail – but this is the exception rather than the rule. However, there are various behavior-change programs that have shown little or even no effect, and are therefore poor investments.
More than 60 countries have at least one Child Health Day. In many nations, this involves providing vitamin A supplements, immunizations and deworming. In nations with less availability of primary health care facilities, this outreach format is likely to be particularly appropriate.
In middle income countries and urban areas, coverage by existing primary health facilities tends to be better. In such cases, it can be cost-effective to add a health facility-based nutrition education program that includes complementary feeding demonstrations, growth monitoring sessions and nutrition messages, and motivation for staff by using an accreditation process combined with training.
Horton et al. estimated the costs and benefits of scaling up community-based nutrition promotion. Reaching 114 million people per year would cost $7 per person per year, at an annual cost of $798 million. The benefits are estimated to be worth around $10,000 million per year.
Where to Find Out More
The Copenhagen Consensus research that this section draws from:
Hunger and Malnutrition: Copenhagen Consensus 2008 Challenge Paper
Sue Horton, H. Alderman, J.A. Rivera
Hunger and Malnutrition Chapter
in Global Crises, Global Solutions, second edition
Edited by Bjorn Lomborg
The Expert Panel's joint explanation for their rankings is available for download here. The Expert Panel's individual rankings and further elaboration can be found in the book, Global Crises, Global Solutions, second edition.