By Clayton Ajello, Global Network for Neglected Tropical Diseases.
This blog was originally posted on Impatient Optimists.
For 22-year-old Claribel, making ends meet is a challenge. She and her family live in a remote, marginalized community in the Dominican Republic with little access to health services and clean water – conditions which place Claribel’s family at risk for contracting neglected tropical diseases (NTDs) such as intestinal worms. Claribel’s three children, Altagracia (6), Wardin (3) and Nismael (2), eat arroz con habichuelas (rice and beans) for nearly every meal, and they rarely have access to essential protein and vegetables.
While Claribel’s children are eating enough calories, they still suffer from undernutrition because their diets are deficient in the essential vitamins and minerals necessary for proper physical and mental development. At the same time, they are also suffering from intestinal worms – also referred to as soil transmitted helminths (STH) – which cause, aggravate and intensify the loss of nutrients, especially vitamin A and iron.
Plagued by both undernutrition and NTDs, the children have low energy and sometimes cry for no apparent reason. Intestinal worm infections place these children at greater risk for vitamin A deficiency (VAD) because the worms prevent their bodies from absorbing what little vitamin A they have in their diets.
Unfortunately, Claribel’s story reflects a global problem. Millions of children across Latin America and the Caribbean, Asia and Africa suffer from deficiencies in Vitamin A, iron and other critical nutrients that their bodies need to grow and fight illness in addition to NTD infections. The combined effects are devastating, resulting in impaired growth, decreased cognitive function, anemia and even death.
This is why organizations like Global Network for Neglected Tropical Diseases, pharmaceutical companies and many other global partners are working together to address intestinal worms and undernutrition. This partnership, called the STH Coalition, is helping children across the world reach their full potential through a multi-sectoral approach, leveraging delivery platforms and expertise from the health, education, nutrition and water and sanitation community.
Delivering deworming treatments with Vitamin A supplements and other nutrition interventions has shown promising health outcomes, including reduced anemia, lower child mortality, improved child growth and development and overall improved nutrition. In the long-term, this integrated approach can reduce school absenteeism and improve worker productivity.
Just one dose of vitamin A, twice a year, can reduce mortality rates by up to 24 percent.
For at-risk children from six months to five-years-old, just one dose of vitamin A, twice a year, can reduce mortality rates by up to 24 percent. Moreover, for children 12 months of age or older, simultaneous administration of a single dose of a deworming treatment, like albendazole, kills worms living in a child’s system.
For Claribel’s children, Altagracia, Wardin and Nismael, the benefits of this integrated approach are clear. Thanks to the support of Vitamin Angels and global partners, the children received both vitamin A and albendazole. Lately, they have been more energetic and Claribel is grateful for the change she is seeing in her children. Inspired by her desire to see her children succeed, Claribel is now taking classes to receive her high school diploma and dreams that her children will one day find a good job doing something that makes them happy.
Claribel is now taking classes to receive her high school diploma and dreams that her children will one day find a good job doing something that makes them happy.
The international development community has the opportunity to act now in order to foster future success stories. By focusing new energy toward eliminating the policy, program and resource gaps that hinder existing efforts to end both intestinal worms and undernutrition, global partners can accelerate impact. Simply put, the development community should embrace a coordinated, integrated response to address both problems. Given the strong momentum behind the fight to end NTDs and the growing unified movement to end undernutrition, now is a propitious time to identify synergies in policies, leverage delivery platforms and foster greater collaboration across sectors to deliver high-impact health and nutrition solutions to families like Claribel’s.
Together with a wide range of experts and advocates from the neglected tropical disease (NTD), nutrition and broader development community, the Global Network for Neglected Tropical Diseases is excited to launch a new policy brief.
Toward a Healthy Future: Working Together to End Neglected Tropical Diseases & Malnutrition – examines the relationship between NTDs and malnutrition, and the actions needed to address both of these challenges. The evidence linking intestinal worm infections and schistosomiasis underscore the importance of tackling these two problems together:
- NTDs and malnutrition are geographically linked: all of the 34 countries carrying the highest levels of malnutrition are also endemic for NTDs. In fact, ten of these countries make up 90 percent of the global NTD burden.
- Poor nutrition increases susceptibility to parasitic disease infections, while NTDs, like intestinal worms and schistosomiasis, are underlying causes of stunting, wasting and micronutrient deficiencies.
- Poor access to water, sanitation and poor hygiene practices are well-known contributing factors to the spread of NTDs
Encouraging work is being done to address these issues. A number of multilateral organizations, governments, NGOs and endemic countries are already implementing programs that deliver treatments for intestinal worms and schistosomiasis alongside other nutrition and health interventions, effectively leveraging policies and delivery strategies. United to Combat NTDs: Delivering on Promises and Driving Progress report showed that in 2013, nearly 1.35 billion NTD treatments were donated and over 70 countries developed national NTD plans.
While these are important steps in the right direction, a funding gap stands in the way of ensuring that these treatments reach the people who need them. To reduce malnutrition and control and eliminate NTDs, the global health community must build upon this work and scale up deworming alongside nutrition interventions, such as Vitamin A and iron supplementation.
The Global Network’s policy brief calls for international policymakers and advocates to:
- Recognize the impacts of NTDs and malnutrition and the clear benefits of addressing these issues in tandem.
- Expand access to routine deworming treatments for all populations at risk, including pre-school- and school-aged children, women of childbearing age and pregnant women through existing treatments and delivery platforms.
- Include deworming as a strategy to improve health and nutrition for mothers and children
- Ensure sustainability by simultaneously investing in water, sanitation and hygiene (WASH) and other social determinants of health.
- Increase resources and link policies that facilitate joint programming and partnerships
- Mobilize greater political and financial support for NTDs and malnutrition during international and regional fora.
We hope you’ll read the policy brief Twitter chat on Wednesday, October 22 at 2:00PM EDT using the hashtag #NTDsNutrition.
By Scott E. Bleggi, Sr. International Policy Analyst, Bread for the World Institute
Scott Bleggi is a senior international policy analyst Bread for the World Institute. Bread for the World Institute provides policy analysis on hunger and strategies to end it. The Institute educates opinion leaders, policy makers, and the public about hunger in the United States and abroad.
Controlling neglected tropical diseases (NTDs) is an important part of improving nutrition, and vice versa. Diseases such as schistosomiasis and intestinal worms result in stunting, wasting and micronutrient deficiencies, and poor nutrition increases susceptibility to NTD infection. Cross-sector collaboration – between the health, nutrition, NTDs and WASH communities – is crucial to achieving nutrition and NTD control and elimination targets.
Nutrition is a foundational element in human development, and a growing body of evidence shows that it is a vital link across international development sectors. Although nutrition was once solely the domain of public health professionals, development assistance practitioners in agriculture, education, gender, and water/sanitation/hygiene (WASH) are realizing that their successful project outcomes can have a direct and positive effect on nutrition.
Does a value-chain project in horticulture or livestock production improve nutrition? What about efforts to keep girls in school an extra year or two before they assume family and village responsibilities? Does improved hand-washing and food preparation hygiene improve nutrition? The answer to all these questions is a resounding yes!
The number of people in the world affected by at least one of the 17 NTDs listed by WHO is approaching 1.5 billion, and we know now that NTDs can damage a person’s nutritional status at any point in life. Worse, contracting an NTD can cause infection and other problems that cancel out or even reverse efforts to improve nutrition.
As nutrition started to be at the core of development assistance across sectors, it was clear that a comprehensive strategy to coordinate efforts was necessary. In May 2014, USAID announced its Nutrition Strategy. Bread for the World Institute participated in its development, along with other members of the nutrition stakeholder community (advocacy and operational partners of USAID).
The nutrition strategy recognizes the essential role of nutrition in human development (especially during the “1,000 Days” period from pregnancy to age 2). Moreover, the strategy acknowledges that high rates of chronic malnutrition can cause significant losses in a nation’s GDP and impose other economic costs. The USAID strategy also lays the foundation for the development of a comprehensive Global Nutrition Coordination Plan among all U.S. government offices.
The strategy treats nutrition as “multi-sectoral” meaning that effective nutrition interventions can be made not only in health programming, but also in agriculture, education, and WASH projects. The most important direct nutrition interventions include 11 “essential nutrition actions” Lancet Maternal and Child Nutrition series. Indirect nutrition actions are nutrition-sensitive activities that target the underlying causes of undernutrition, and direct interventions can be complemented by indirect nutrition actions for maximum impact. In fact, combining direct and indirect actions by “bundling” projects that include both has been found to be the most effective development investment a country can make.
USAID is committed to the Feed the Future of reducing stunting by 20 percent in five years in regions where this initiative has programs.
Companion legislative bills have been introduced in the Senate and the House that would authorize Feed the Future as the government’s primary program for global food and nutrition security. Despite recent improvements reported by FAO, there are still 805 million chronically undernourished people in the world. With legislation, we can solidify U.S. leadership in fighting hunger and malnutrition, build and improve upon vital work that has been done, and leverage a government approach across all sectors and programs to meet specific goals for progress against global hunger and malnutrition.
By: Jordan Teague, Program Associate at WASH Advocates
My niece turned two years old on Sunday. It was a joyful occasion, celebrating that she can now speak in full sentences, gives full-blown hugs and started pre-school in the fall. The entire family gathered this weekend with presents, cake and a birthday outing to a fire truck parade. During the festivities, it occurred to me that my niece is now past the first 1,000 days of her life, the most critical time with regard to her nutrition. We are fortunate that because we live in the United States, we have not had to worry about undernutrition or the illnesses related to that condition, but what if she had been born somewhere else?
In many places around the world, undernutrition is not the only worry that families have for their small children and themselves. Over economic growth.
A lack of safe drinking water, adequate sanitation and proper water, sanitation and hygiene (WASH) contributes to both NTDs and undernutrition. Safe WASH is inhibit nutrient absorption and lead to stunting and undernutrition. Improved WASH allows for the absorption and use of vital nutrients and calories, leading to improved nutrition and health.
Given the myriad of linkages between WASH, NTDs and nutrition, joint policies and programming have significant potential to scale up the impact of the individual efforts. For example, in 2013 Dubai Cares launched an integrated Home Grown School Feeding Program that includes elements of all three sectors. This program includes in-school meals prepared from local foods and commodities in addition to deworming treatment and provision of WASH interventions in the schools. This program shows how different stakeholders can collectively use their diverse expertise to make a larger impact on the health of a community.
WASH interventions support the sustainability of progress made through NTD and nutrition programs on reducing disease and improving health. Real and sustainable impacts can be achieved when investments in NTDs and nutrition go hand-in-hand with efforts to provide WASH.
Jordan Teague is the Program Associate at WASH Advocates, where she focuses on sustainability within the WASH sector and the integration of WASH with other development efforts such as nutrition, NTDs and education.