The first 1,000 days

We are in a race against time to eliminate the global menace of malnutrition. Malnutrition cripples global economic growth and development. This issue needs to be addressed urgently because future global prosperity and safety are closely linked with our ability to respond effectively to this challenge. Why is this such an urgent issue? Many countries are facing high levels of malnutrition, which consequently leads to changes in the demography of the world. The ratio of the working age to non-working age population is rising and will peak in the next 20 years, and this increase has significantly affected economic growth in many parts of the world. The solution largely lies on the early years of life, when the foundation of human potential is laid, getting the right nutrients at the right time, subsequently preventing malnutrition. Growing up with insufficient macro and micronutrient at different stages of a person’s life can translate into becoming a healthy adult — or not.

What is the right thing to do and what is the right time to act? For that it is important to understand the long lasting effects of malnutrition on individuals and nations as well .The problem of malnutrition in Third World countries is best seen as a ‘syndrome of developmental impairment’, which includes multiple components such as growth failure, delayed motor and behavioural development, diminished immune-competence and increased morbidity and mortality. Malnutrition and starvation have devastating impact on children, adults and on pregnant women. There are severe and far-reaching effects of malnutrition, especially among infants. Long-term malnutrition often cause mental retardation, stunted growth, poor and weak immune system, micronutrient deficiency, GI tract infections, anaemia and inevitably — death. For a country like Pakistan, the statistics in this regard portray a bleak future. According to the Food Assistance Fact Sheet (August 11^th, 2017), 45% of Pakistani children under the age of five are stunted, 32% are underweight and 15% suffer from acute malnutrition.

Most growth retardation occurs early in life. The two periods of highest vulnerability are during intrauterine development and during the shift from dependence on breast milk to addition of other foods to the diet, generally beginning after the first six months of life. In fact, almost all of the growth retardation documented in studies carried out in developing countries has its origin in the first two or three years of life. Once present, growth retardation usually remains for life as growth deficits. The Lancet, which has published a landmark series of papers on Maternal and Child Undernutrition, also strengthens the evidence that a nation’s economic advancement is tied to the first 1,000 days of every child’s life, as stated in one of its articles, “Fetal growth restriction and poor growth early in infancy are now recognised as important determinants of neonatal and infant mortality, stunting and overweight and obesity in older children and adults. Preventive efforts should continue to focus on the 1,000 days.” The right nutrition during this crucial period can have an enormous impact on a child’s ability to grow, learn and develop to his or her full potential.

Dr Atif Habib, assistant professor in the Department of Pediatrics and Child Health at Aga Khan University, delivered this message at the ceremony organised at the launch of National Nutritional Survey 2018, saying that “Poor nutrition in the crucial early years of a child’s life triggers irreversible mental and physical defects that have a lifelong impact on a child’s productivity, immunity against disease and earning capacity as an adult.” When a child is adequately nourished from conception through infancy and the essential energy, protein, fatty acids and micronutrients necessary for physical and mental development are available during this foundational period; this phenomenon establishes the basis for lifetime health. It is now well recognised that the first 1,000 days of life are critical determinants of survival, growth and well-being of the off-springs right through life. What goes right and what goes wrong for fetal and child nutrition during this period has lasting and irreversible consequences for later life.

Governments, NGOs, institutions, agencies and even the food industry should strategise and plan aptly to make use of this window of opportunity (1,000 days) for the prevention and even correction of this enormous menace. Interventions should be taken that are cost-effective and harvest high returns for cognitive development, individual adult earnings and economic growth. Improving nutrition during the first two years of life by using a diet rich in macro and micronutrient can have a positive impact on the future health of an individual. The challenge lies in breaking the cycle of malnutrition. In this regard the WHO has recommended many steps, such as promotion of exclusive breastfeeding during the first six months of life and continued breastfeeding thereafter, food fortification, especially of food available for children between six months to five years of age, educational interventions that include nutrition awareness among children and women with a strong emphasis on feeding nutrient-rich foods (from both animal and plant-based sources), in conjunction with food supplementation in food-insecure populations. In forthcoming articles a detailed review of steps taken and need to be taken by all stakeholders will be highlighted in an effort to emphasise what should be done and what can be done.

Nutrition must be prioritised within the government’s health agenda, and there is a need for reforms in institutional and administrative framework through which nutrition-specific interventions are delivered. Strategies must remain tirelessly dedicated on the time frame of the first 1,000 days of a child’s life and depend on evidence-based interventions to wrestle with the numerous contributing reasons of malnutrition. Targeting the important 1,000-day period is one of the best investments that can be made to improve health, nutrition and economic outcomes in Third World countries like Pakistan.

Published in The Express Tribune, April 24^th, 2018.

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