Cebu City - “Please! Please not my baby!” She pleaded painfully in horror as soldiers ripped her two year old child from her arms. Squeals, screams, shrieks pierced the streets in what is documented as one of the most horrific, bloodiest periods after the birth of Jesus the Christ. Mothers witnessed how soldiers decapitated babies threw their heads and limbs like abandoned rag dolls. No whimper could be heard as soldiers cut two year olds in a bloody heap. Herod had ordered two year old children killed after learning that a messiah was born and would become King of Humanity and the Prince of Peace.
Then was fulfilled that which was spoken by Jeremiah the prophet that in Rama was there a voice heard, lamentation and weeping and great mourning. The apostle Matthew wrote of Rachel weeping for her children and would not be comforted.
Much like Herod’s time, there is mourning and weeping in present times as 3.5 million of children under the age of five years die of malnutrition. The 2008 Lancet series on Maternal and Child Undernutrition reports that underlying causes of undernutrition has found millions more permanently disabled owing to poor dietary intake in the earliest months of life.
Gone maybe the Herods and ruthless soldiers ripping away babies – still -- that there are children who are undernourished, restricted and stunted of growth, can be tragic and alarming signs of a global malaise. Mostly it is because governments are not committed enough to do something about improving the nutritional status of its populace. And if there are those who are committed, much needs to be seen if nutrition programs translate well from idea to implementation. Such indifference and lack of commitment to reverse or eradicate undernutrition is much like Herod ordering the killing of two year old children.
A global malaise called undernutrition is like the slaughter of babies. It is a symptom of malaise in governance in present times. Undernutrition includes a tragic array of effects like intrauterine growth restriction (IUGR) resulting in low birth weight; underweight or a reflection of low weight-for-age. It is also described as stunting or chronic restriction growth in height indicated by a low height-for-age. And wasting or an acute weight loss indicated by a low weight-for-height and less visible micronutrient deficiencies.
Physicians, nutritionists and researchers trace undernutrition to poor dietary intake during the first two years of life. Poor dietary intake is then blamed to poverty. For governments not as brutal as Herod, there ought to be no undernutrition. At a time of peace and when there are technological inroads in food and agriculture production, there ought to be no reason for undernutrition.
The irony is, increased food production does not always equate to increased nutrition. Based on the 2008 Lancet study, an estimated 13 million children are born each year with IUGR or have low birth weight. Some 112 million are underweight and 178 million children under five years suffer from stunting.
There is substantial evidence linking stunting to poor cognitive development, low school performance and impaired motor skills. When a child at the age of two is stunted, the stunting is irreversible. When the child grows to become an adult, he never gets the chance to reach full intellectual potential and is thus of diminished economic potential.
FIRST 1,000 DAYS
Undernutrition is not an invasive and sin-wrought phenomenon. There is a window of opportunity for preventing undernutrition from conception through 24 months of age. In other words, pregnancy to age 24 months or the first 1,000 days of a child is the critical window of opportunity for the delivery of nutrition interventions. But if proper nutrition interventions are not delivered to children before the age of 24 months, they could suffer irreversible damage into their adult life and to subsequent generations. Hence it is said that undernutrition is an intergenerational disease.
Unlike the ripping and decapitating of Herod’s time, the health consequences of maternal and child undernutrition are measured in deaths, contribution to overall rates of disease and in the number of life years diminished by disease or disability. The Lancet calls it Disability Adjusted Life Years (DALYs). It is the unit of disability-adjusted life years that measures the gap between the current health of a population and an ideal situation where everyone in the population lives into old age in full health.
In getting a big picture of the total loss of health from different causes, DALYs combine years of life lost due to premature death and years of life lived with disabilities into a single indicator.
In present times, stunting, severe wasting and IUGR together are estimated to contribute annually to 2.2 million deaths and 91 million disability-adjusted life years. Together, stunting, severe wasting and IUGR are responsible for seveb percent of the total disease burden for any age group, making these conditions the highest of any risk factor for overall disease burden.
There is a way out of undernutrition. The Lancet suggests effective interventions like breastfeeding counseling, complementary feeding, and vitamin A and zinc complementation to reduce underweight, stunting, deficiencies and deaths. Interventions to reduce iron and iodine deficiencies are important for a child’s cognitive development, educability and economic productivity. But then the problem seems to be if governments are convinced and committed about implementing these interventions and not just the intervention itself.
When Herod had known about a child who would become king, he immediately told the wise men to investigate who that child would be. Indeed the wise men knew exactly where to find him by way of calculating the appearance of the stars and evidence from prophecy. Herod also gave strict instructions that the wise men would have to come back. They never did and in a fit of anger, ordered the two year old children killed.
The Lancet series has given a roadmap of interventions at addressing undernutrition. Unless governments faithfully follow these roadmaps, any initiative to address undernutrition is decapitated, slaughtered, thrown to a bloody heap. Once again there will be lamentation, great weeping and mourning just as it was in Herod's time. -Ruth G. Mercado
