3.1 million children under five die of malnutrition annually


 

Author(s): 
Jyotsna Singh
Issue Date: 
2013-6-10

Study says child mortality linked to maternal undernutrition, obesity

Forty-five per cent of deaths of children below the age of five globally are attributed to malnutrition, says a study published as part of a compendium of research papers from The Lancet. The study looks at maternal and child undernutrition and overweight in low- and middle-income countries (LMICs) and calls for an enabling environment to tackle malnutrition and incorporate specific nutrition goals and actions.

The authors of the paper led by Robert Black, professor, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, performed a comprehensive analysis of the different causes of maternal and childhood malnutrition, including poor breastfeeding practices and deficiencies of vitamins and minerals such as vitamin A, zinc, iron and calcium. They also analysed the consequences of malnutrition, including stunting (low height for age), wasting (low weight for height), and underweight (low weight for age), all of which result in increased risk of death and illness for both pregnant women and children.

Mother’s health matters

image [1]

The research links child mortality to maternal health, with iron deficiency in mothers associated with low birth weight (<2,500g) in babies. Maternal undernutrition also restricts the growth of the baby in the womb and is responsible for a quarter of child deaths. The study finds children born too small–27 per cent in LMICs–are at a substantially higher risk of dying. Maternal short stature and underweight also limit foetal growth and cause 12 per cent of neonatal deaths. Suboptimum breastfeeding too is associated with deaths of more than 800,000 children annually.
 
According to the researchers, India’s biggest problem is the number of young anaemic mothers–55.8 per cent of adolescents aged between 15 and 19 years and 56.7 per cent of women aged between 20 and 24 years were found to be anaemic. In contrast, corresponding values for Guatemala were 21.0 per cent and 20.4 per cent respectively. Eleven per cent of adolescent girls in India were found to be underweight.

“Currently, only 0.4 per cent of aid is spent combating malnutrition despite it being the leading cause of child deaths,” says Ishaprasad Bhagwat, doctor and health manager with non-profit Save the Children, India.

Stunting still high

The global prevalence of stunting has gradually decreased in the past 20 years, but still remains high in absolute numbers. The researchers estimate that stunting affected at least 165 million children worldwide in 2011. In the same year, at least 50 million children were affected by wasting and 100 million children were underweight. Over 90 per cent of these were in Asia and Africa. Africa is the only major region in the world where the number of stunted children has increased in the past decade.

The authors correlate the prevalence of stunting to equality in different countries. Nigeria showed no change in prevalence of stunting from 2003 to 2008, and the degree of inequality, too, remained almost unchanged. Bangladesh demonstrated a decrease in the prevalence of stunting, though inequality levels remained unchanged. Brazil showed a much lower prevalence of stunting. The researchers thus concluded that equality in the country improved because of a substantial decrease in stunting in the poorest populations.

Obesity brings risks

The research demonstrates that obesity is fast becoming a cause for child undernutrition and mortality. The prevalence of maternal overweight has steadily increased since 1980 and exceeds that of underweight in all regions of the world. Obese pregnant women, whose body mass index is more than 30 kg/m2, are four times more likely to develop gestational diabetes and two times more likely to develop pre-eclampsia. During labour and delivery, maternal obesity is associated with maternal death, haemorrhage, caesarean delivery, or infection; and a higher risk of neonatal and infant death, birth trauma, and macrosomic infants. In the post-partum period, obese women are more likely to delay or fail to lactate and have more weight retention than women of normal weight.

The framework of the report is an improvement on the 2008 conceptual framework of the United Nations Children’s Fund (Unicef), which was also prepared under Black’s lead. The new framework shows the dietary, behavioural and health determinants of optimum nutrition, growth and development. It analyses how they are affected by policies related to food security, care giving resources and environmental conditions. Apart from immediate reasons related to maternal and bodily health of a child, the new framework also encompasses “economic and social conditions, national and global contexts, resources, and governance”.

The paper has been published in the Lancet series on maternal and child nutrition 2013 that was released on June 6.  

 


Source URL: http://www.downtoearth.org.in/content/31-million-children-under-five-die-malnutrition-annually

 

Sexual violence: a global awakening, from India #delhigangrape #Vaw


The rape and murder of a 23-year-old female physiotherapy student from Delhi—six men have been arrested for the attack, which took place on Dec 16—has rightly caused outrage and anguish across India. Immediately after her death, following treatment in a hospital in Singapore, Delhi was locked down by police to prevent outbreaks of public protest. Despite these measures, thousands of Indian citizens took part in peaceful vigils to express their anger at the violence inflicted against this young student, as well as the harassment experienced daily by thousands of Indian women.
Prime Minister Manmohan Singh has called for “a constructive course of action”. But there is agreement that India has failed to address a pervasive culture of sexual violence and gender injustice. This political neglect has created a permissive environment where men can rape, beat, and kill a woman with impunity. India is a respected democracy that has delivered phenomenal economic success for its growing middle class. But the country’s inattention to fundamental protections and liberties for its citizens reveals a nation facing a moral turning point. We endorse the campaign by the The Times of India and others to address “the lack of respect for women in our patriarchal society”.
Yet it would be a grievous error to conclude that sexual violence is a predicament confined to India. It is not. Rape and other forms of violence against women and girls are a feature of all societies. In South Africa, for example, as many as a third of men have taken part in acts of rape.
As a first step, sexual violence must be acknowledged as a reality by all of us, and its causes discussed. We must support the creation of safe systems for preventing, reporting, and remedying acts of sexual violence. As advocates for women’s health, health professionals have a special role in defeating rape. It’s time we exercised our voice more strongly. The greatest respect we can give to the memory of the Indian student who died on Dec 29 is by protecting and strengthening the political and social rights of women worldwide.

 

German doctors free to take cash from drug firms #Badnews


 
A recent ruling by Germany‘s Supreme Court has caused a public storm over the ethical conduct of doctors and drug companies in the country. Rob Hyde reports from Hamburg.
Self-employed physicians in Germany accepting up to €10 000 from drug companies in cash, or gifts such as computers, equipment, or holidays, will not face corruption charges.
The Federal Court of Justice, in Karlsruhe, Germany‘s Supreme Court, ruled that drug companies cannot be penalised under current legislation, even when paying German freelance physicians to prescribe their drugs. Similarly these doctors can now officially accept this money without either party facing criminal charges of bribery. The ruling could apply to around 124 000 of 342 000 doctors working in the country, which includes around 121 700 independent physicians working under freelance contracts in Germany’s national health system.
The most recent case in question involved a sales representative of a major German drug firm who, via its benefits programmme, paid cash to a group of national health service doctors. Here each doctor received a 5% commission on each product they prescribed. Though the firm officially said the money was remuneration for delivering academic presentations, these seminars never took place. The sales agent was then charged with commercial bribery by a lower court, and fined.
When the sales representative appealed, the case was referred to the Federal Court of Justice. Here the Grand Criminal Panel reversed the lower court’s ruling and acquitted the accused. It then also ruled that the physicians were neither civil servants, nor representatives of a state institution, and so could not be charged with “bribery of public officials”, as defined in paragraph 332 of the German Penal Code, or under criminal law. The court further decided that the physicians were also neither employees nor representatives of a business operation, and so could not be charged with commercial bribery under paragraph 299.
The court’s decision has been welcomed by a wide range of leading German health organisations. Though declining to comment directly, in a written press statement Birgit Fischer, managing director of the Association of Research-based Pharmaceutical Companies, said the decision meant doctors “…can now continue to see themselves as members of a free profession and are not just categorised as the extended arm of the statutory health insurance funds”.
Speaking to The Lancet, head of the German Medical Association, Frank Ulrich Montgomery, shared the view, saying the court ruling protects the rights of doctors to operate in an independent professional capacity. “Such physicians are not public servants or employed by anyone, so they should be free to perform freelance work for clients in the same way that an architect or lawyer can.”
“Self-employed entrepreneurs are not an organ of health insurance funds and this is a good thing. If they were either civil servants or had been commissioned by the health fund then they would be working for the health fund and so would be subordinate to it. This means they would have to consider the economic interest of this insurance fund before the needs of the patient. A freelancer is free of this economic agenda.”
Much of the German press, however, has reported the recent court verdict in terms of it now officially giving drug companies and doctors the legal right to bribe and be bribed, respectively. Coverage has included headlines such as “Bribery of doctors is completely legal” from the television news channel n-tv. According to Montgomery, the media coverage of the case is part of wider behind-the-scenes agenda to tarnish the reputation of doctors. “We now have a campaign orchestrated by the health insurance funds to make doctors out to be completely corrupt…The Supreme Court did indeed rule that the doctor had not broken criminal law, but that definitely does not give doctors now the right to be bribed by the pharmaceutical industry. Doing this breaches the professional code of the German Medical Association.”
For Ann Marini, spokesperson for the Central Association of Health Insurance Funds, it is not enough for a professional code of conduct to be left to apply the penalties which the legal system is not able to. She said that the Supreme Court has not taken a clear stance on the real issue. “It cannot be that behaviour for one type of doctor is considered by the German Penal Code, to be a crime of bribery, and yet the very same behaviour from a freelance physician is perfectly legal. We would have wished that the court had openly and clearly said that all doctors, of all sorts, can be prosecuted for corruption.”

Fake Drug Plague or Pharmaceutical Industry Attack on Generics?


by Pratap ChatterjeeCorpWatch Blog
June 13th, 2012

Are Africa and South East Asia just suffering from a deluge of fake medicines that is causing disease resistance to rise? Or are they also suffering from a deluge of poorly informed media articles, encouraged by the pharmaceutical industry that wants to make war on generic drugs?

A recent article published in the latest issue of the Lancet Infectious Diseases magazine examines a new study by the U.S. National Institutes of Health noting that a third of malaria drug samples examined from the two regions were found to be fake or substandard.

The magazine says that it is “simplified and neutral” to “use falsified as a synonym for counterfeit, devoid of considerations of intellectual property” and urges the use of tough measures to combat these fake drugs.

Similar articles on “fake” drugs appear regularly in the medical publications like the British Medical Journal as well as major business publications like the Financial Times, which suggest that the black market for fake drugs generated $75 billion in revenues in 2010.

Pfizer, a New York company, is particularly active in the campaign against “fake drugs.” There is good reason for Pfizer to be concerned: Viagra, Pfizer’s brand of sildenafil citrate, is one of the most popularly faked drugs. James Love, the executive director of Knowledge Ecology International, a Washington NGO, notes that “It is quite clear that theoverwhelming majority of counterfeit busts involve Viagra and other erectile dysfunction drugs.”

The data on drug busts is not that surprising given the fact Viagra is an expensive drug in high demand from people who are willing to buy it under the counter or online.

However, such “lifestyle” drugs – as they are often called – are quite different from cancer drugs which are not faked quite as often. Indeed the problem is far more complex: there is a wide range of so-called “fake” drugs such as spurious drugs, counterfeit drugs, falsely labeled drugs (wrong dates, missing ingredients etc.) and poor quality drugs which the Lancet proposes to lump together.

And by introducing the term “devoid of considerations of intellectual property” the Lancet is also including the trade in generic drugs.

It is these generic drugs that pharmaceutical industry lobbyists like the Pharmaceutical Research and Manufacturers of America (PhRMA) and the U.S. Chamber of Commerce, both major lobbyists in the U.S., want the media to attack, says Love.

Here’s where the problem arises: “For political reasons, PhRMA and the Chamber plays up the counterfeit angle quite a bit, to justify a very broad intellectual property right enforcement agenda, by mixing together the counterfeit, falsified, substandard or fake drug categories,” he writes.

Love says that the Lancet suggestion to use “simplified and neutral” language could well lead to problems for buyers in poor countries. He notes that “corporate intellectual property right holders … are lobbying governments for stronger IPR enforcement measures. These lobby groups present dangerous drugs as the core motivating factor for legislation that has little to do with solving the bulk of the substandard and dangerous drug problem, and they also seek to introduce measures the undermine the trade in high quality legitimate generic products.

“One risk is that the various anti-counterfeit drug initiatives will be used to further undermine legal parallel trade in branded drugs. Another is that surveillance of trade in unpatented and unbranded chemicals will be used to further expand monopoly power,” Love adds.

Let’s unpack that a bit. What’s the legal parallel trade in branded drugs? Well, drug manufacturers themselves often sell their drugs cheaper in countries with big public health systems or just because the population is too poor to pay for Western prices. These drugs are sometimes sold back legally to buyers in other countries. Technically this trade could be shut down. (See “Murky Medicines” for an interesting article on how the U.K. buys medicines abroad legally at cheaper prices)

What about unpatented and unbranded chemicals? Are they a good idea? Well, it turns out that even the major drug makers use unpatented and unbranded chemicals all the time. Drugs typically contain one or more active pharmaceutical ingredients (APIs). If these APIs are patented, the patent holder can make a lot of money. But a lot of drugs are made from cheap (and perfectly good) unpatented APIs that even the big companies buy to make their branded drugs.

When countries like Thailand or India allow generic manufacturers to make drugs (either because the license has expired or to deal with an urgent healthcare crisis), these manufacturers turn to the very same API producers. Where it gets complicated is that the API producers are in a tough spot because if they supply the generic manufacturers, the big boys have been known to cut them off. (Bristol-Myers Squibb used this strategy in Thailand to cut off production of the AIDS drug ddI)

Basically what Love is saying is that if we use a hammer to address the issue of drugs, all the problems of generic, spurious, counterfeit, falsified and poor quality drugs look like different kinds of nails, when in fact some of them may not even be nails at all. “If authors systematically see the problem in ways consistent with drug company lobbyists, they are not seeing the whole picture,” he concludes.

Stamp out spurious drugs by all means, check to make sure that expired drugs are not re-labeled, and test batches to make sure that low quality drugs are not slipped into the market, but be careful of stopping the sale of perfectly good generic drugs that can save lives at a dramatically cheaper price by making them illegal.

Global Health and Feminism


One of the symbols of German Women's movement ...

One of the symbols of German Women's movement (from the 1970s) Deutsch: Ein Logo der deutschen Frauenbewegung (aus den 70er Jahren) (Photo credit: Wikipedia)

Feminism might be a taboo word within academic medicine, but it clearly has made an important contribution to global health

By Richard Smith

The Lancet, the leading journal for global health, has mentioned feminism only twice in its 189 years. The BMJBritish Medical Journal– hasn’t mentioned it at all. Does it indicate that feminism has had no impact on global health? All three speakers at a meeting at the London School of Hygiene and Tropical Medicine in January this year, strongly disagreed.

Richard Horton, editor of the Lancet and a man, told us that the Lancet had mentioned feminism only twice, and Tony Delamothe, deputy editor of the BMJ and another man, told me that the BMJ had no entries. I, a third man, didn’t check, but Jane Smith, another deputy editor of the BMJ and a woman, did. She found that theBMJ has had 102 mentions of “feminism” and 302 mentions of “feminist” and the Lancethas 23 mentions mentions of “feminism” but none of “feminist.” Thank God for women.

One reason that the journals might not have mentioned it is because “feminism” is a taboo word within academic medicine, said Richard Horton, editor of the Lancet. Lori Heise, one of the speakers and a senior lecturer at the London School, said how she had to think carefully before “coming out” as a feminist.

Feminism can mean many things, said Andrea Cornwall from Sussex University, but all definitions coalesce around inequalities and inequities. It is a political practice concerned with reducing those inequalities and inequities—and such a programme is central to global health.

Read more here

Calling all doctors to research into vaccine safety


Dear Dr ___,

Namaskar. Yes I do write against vaccines in general and do not support any vaccination program. This is because of my 27 years of study on the subject, something which I doubt any pediatrician and/or other doctors have done. These doctors do not know anything other than that a few children can get local injection site inflammation, suffer high fevers, even seizures and the cases of anaphylaxis, for which they are requested to be ready with an emergency kit but for which they are rarely prepared against.

I would like you to do some research yourself because nothing less will convince you. There are no safety tests done on vaccines and such tests are avoided. We all know what happened to Dr Wakefield who merely did a case study and suggested more research. Instead of welcoming the much needed advice the medical establishment reacted with alacrity and used the most dubious means possible to disgrace this good doctor, cancel his licence and verily deport him from the UK. His case study was also pulled out by the Lancet, an unprecedented event in the history of medicine.

The FDA has very recently conceded that no toxicity tests are done on vaccines because they are perceived to be safe. The only so called safety tests carried out for usually 14 days by the vaccine manufacturers themselves. They test extremely healthy children against a control group that are given another vaccine. Such tests even do not report serious adverse events as they are perceived to be due to other underlying causes, just as you so assiduously point out. This is a universal excuse that should be condemned rather than being entertained as pregnant mothers, infants and children are the most vulnerable populations.

In my 27 years long campaign for justice I have found that people, medical or non medical, do not wake up unless they or their children are affected. After that they sulk for long periods being affected by guilt, depression and utter helplessness. Rarely do they take up the cudgel to fight as they soon realise what they are up against. Both doctors and other people are threatened to keep quiet. Even I too face threats and there has also been an attempt to bribe me into submission. If vaccines are so sacrosanct and safe, why these highly unethical practices?

Regarding your own research I suggest the following;

1. Study the latest developments in the field of immunology
2. Study if vaccines being manufactured follow the recent findings
3. Collect all available medical literature that point out the dangers of the vaccination process
4. Study the incidence of those dangers pointed out in the child population
5. Study ALL the ingredients of vaccines with the help of a qualified toxicologist
6. Study the incidence of those disorders that come up in point no 5 in the child population
7. Study the presently available attempts that compare vaccinated with non vaccinated populations
8. Go through my articles “Vaccines: The Risk Vs Benefit Argument” and “50 Reasons to Protect Infants from Vaccines”
9. Ask the IAP on what basis they recommend the vaccines they do
10. Ask the Govt of India how they recommended the Oral Polio Vaccine, the BCG Vaccine, the Hep-B vaccine, the most recent Pentavalent and why they still continue with the DPT despite all developed countries discontinuing it.
11. Ask them how Bill Gates, a person with no medical qualification, is allowed to dictate our new Draft Vaccine Policy
12. Study how vaccines work, and whether the effect is prophylactic or anaphylactic
13. Question why the Pentagon is currently undertaking vaccine research
14. Question why known eugenicists like Bill Gates are involved with the vaccination process

After doing all these sincerely and with an open mind, study the history and politics of vaccines, not the doctored history that is now available but the real history and politics.

Regarding the measles vaccine, the recent catch up drive that was undertaken on the basis of a report that talked of 7 deaths, and the drive, as reported by scared doctors, killed 6 healthy children. The matter was ignored till certain persons intervened. And then the vaccine was exonerated and the blame put on program errors. Tell me which parent can be consoled with this semantic foul play.

Regarding the article I sent please get in touch with the authors of this study (after doing the above research), gain their confidence with the new knowledge gained in the process, and know for yourself their views on the matter.

You will also be interested to know that I have sensitized the chief functionaries of the IAP, the people who are directly involved with vaccine schedules and policies, and they have no answers for my questions. In fact many members of the IAP covertly support me and supply me required literature. I am in constant touch with highly reputed doctors and medical scientists in India and abroad on this highly controversial issue.

If you so wish I am willing to humbly help you in your research.

With regards,
Jagannath

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