As the world counts down to the 2025 World Health Assembly nutrition targets and the 2030 Sustainable Development Goals, millions of women, children, and adolescents worldwide remain undernourished (underweight, stunted, and deficient in micronutrients), despite evidence on effective interventions and increasing political commitment to, and financial investment in, nutrition. The COVID-19 pandemic has crippled health systems, exacerbated household food insecurity, and reversed economic growth, which together could set back improvements in undernutrition across low-income and middle-income countries. This paper highlights how the evidence base for nutrition, health, food systems, social protection, and water, sanitation, and hygiene interventions has evolved since the 2013 Lancet Series on maternal and child nutrition and identifies the priority actions needed to regain and accelerate progress within the next decade. Policies and interventions targeting the first 1000 days of life, including some newly identified since 2013, require renewed commitment, implementation research, and increased funding from both domestic and global actors. A new body of evidence from national and state-level success stories in stunting reduction reinforces the crucial importance of multisectoral actions to address the underlying determinants of undernutrition and identifies key features of enabling political environments. To support these actions, well-resourced nutrition data and information systems are essential. The paper concludes with a call to action for the 2021 Nutrition for Growth Summit to unite global and national nutrition stakeholders around common priorities to tackle a large, unfinished undernutrition agenda—now amplified by the COVID-19 crisis. ; PR ; IFPRI3; ISI; CRP4; 2 Promoting Healthy Diets and Nutrition for all; POSHAN; Transform Nutrition West Africa ; PHND; SAR; A4NH ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
With increasing urbanization, the percentage of women participating in the labor force and the percentage of households headed by single mothers have increased. Reliable and affordable child-care alternatives are thus becoming increasingly important in urban areas. The Hogares Comunitarios Program (HCP) was established in Guatemala City in 1991 as a direct response to the increasing need of poor urban dwellers for substitute childcare. This government-sponsored pilot program was designed as a strategy to alleviate poverty by providing working parents with low-cost, high-quality childcare within their community. ; PR ; IFPRI1; Gender ; FCND
High urbanization rates in Latin America are accompanied by an increase in women's participation in the labor force and the number of households headed by single mothers. Reliable and affordable childcare alternatives are thus becoming increasingly important in urban areas. The Hogares Comunitarios Program (HCP), established in Guatemala City in 1991, was a direct response to the increasing need of poor urban dwellers for substitute childcare. This government-sponsored pilot program was designed as a strategy to alleviate poverty by providing working parents with low-cost, quality childcare within their community. This paper presents preliminary findings from an evaluation of the HCP carried out in 1998 in urban slums of Guatemala City. The evaluation included both an operations (or process) evaluation and an impact evaluation. Key findings of the operations evaluation are summarized, and preliminary findings of the impact evaluation on children's dietary intakes are presented. Aspects related to the targeting, coverage, and cost of the program are also discussed, and the patterns of childcare use by nonbeneficiary households and their costs are described."" ; Non-PR ; IFPRI1; MP14; Theme 12 ; FCND
The economic crisis and food and health system disruptions related to the COVID-19 pandemic threaten to exacerbate undernutrition in low- and middle-income countries (LMICs). We developed pessimistic, moderate and optimistic scenarios for 2020–2022 and used three modelling tools (MIRAGRODEP, the Lives Saved Tool and Optima Nutrition) to estimate the impacts of pandemic-induced disruptions on child stunting, wasting and mortality, maternal anaemia and children born to women with a low body mass index (BMI) in 118 LMICs. We estimated the cost of six nutrition interventions to mitigate excess stunting and child mortality due to the pandemic and to maximize alive and non-stunted children, and used the human capital approach to estimate future productivity losses. By 2022, COVID-19-related disruptions could result in an additional 9.3 million wasted children and 2.6 million stunted children, 168,000 additional child deaths, 2.1 million maternal anaemia cases, 2.1 million children born to women with a low BMI and US$29.7 billion in future productivity losses due to excess stunting and child mortality. An additional US$1.2 billion per year will be needed to mitigate these effects by scaling up nutrition interventions. Governments and donors must maintain nutrition as a priority, continue to support resilient systems and ensure the efficient use of new and existing resources. ; PR ; IFPRI3; CRP4; 2 Promoting Healthy Diets and Nutrition for all; G Cross-cutting gender theme; Advancing Research on Nutrition and Agriculture (ARENA); Ceres2030 ; DSGD; MTID; PHND; A4NH ; CGIAR Research Programs on Agriculture for Nutrition and Health (A4NH)
Governments, donors and others must step up to protect current and future generations from the devastating effects of malnutrition, as well as to prevent acute food insecurity. ; PR ; IFPRI3; ISI; 2 Promoting Healthy Diets and Nutrition for all ; DSGD; MTID; PHND
Malnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition ...
Malnutrition in all its forms has risen on global and national agendas in recent years because of the recognition of its magnitude and its consequences for a wide range of human, social, and economic outcomes. Although the WHO, national governments, and other organizations have endorsed targets and identified appropriate policies, programs, and interventions, a major challenge lies in implementing these with the scale and quality needed to achieve population impact. This paper presents an approach to implementation science in nutrition (ISN) that builds upon concepts developed in other policy domains and addresses critical gaps in linking knowledge to effective action. ISN is defined here as an interdisciplinary body of theory, knowledge, frameworks, tools, and approaches whose purpose is to strengthen implementation quality and impact. It includes a wide range of methods and approaches to identify and address implementation bottlenecks; means to identify, evaluate, and scale up implementation innovations; and strategies to enhance the utilization of existing knowledge, tools, and frameworks based on the evolving science of implementation. The ISN framework recognizes that quality implementation requires alignment across 5 domains: the intervention, policy, or innovation being implemented; the implementing organization(s); the enabling environment of policies and stakeholders; the individuals, households, and communities of interest; and the strategies and decision processes used at various stages of the implementation process. The success of aligning these domains through implementation research requires a culture of inquiry, evaluation, learning, and response among program implementers; an action-oriented mission among the research partners; continuity of funding for implementation research; and resolving inherent tensions between program implementation and research. The Society for Implementation Science in Nutrition is a recently established membership society to advance the science and practice of nutrition implementation at various scales and in varied contexts. ; IFPRI3; CRP4; 1 Fostering Climate-Resilient and Sustainable Food Supply; 2 Promoting Healthy Diets and Nutrition for all ; PHND; A4NH ; PR ; CGIAR Research Program on Agriculture for Nutrition and Health (A4NH)
As the world approaches the 2015 deadline for achieving the Millennium Development Goals (MDGs) – which include a goal of reducing the proportion of hungry people by half – the 2010 Global Hunger Index (GHI) offers a useful and multidimensional overview of global hunger. The 2010 GHI shows some improvement over the 1990 GHI, falling by almost one-quarter. Nonetheless, the index for hunger in the world remains at a level characterized as "serious." The result is unsurprising given that the overall number of hungry people surpassed 1 billion in 2009, even though it decreased to 925 million in 2010, according to the Food and Agriculture Organization of the United Nations. The highest regional GHI scores are for South Asia and Sub-Saharan Africa, but South Asia has made much more progress since 1990. In South Asia, the low nutritional, educational, and social status of women is among the major factors that contribute to a high prevalence of underweight in children under five. In contrast, in Sub-Saharan Africa, low government effectiveness, conflict, political instability, and high rates of HIV and AIDS are among the major factors that lead to high child mortality and a high proportion of people who cannot meet their calorie requirements. Some countries achieved significant absolute progress in improving their GHI. Between the 1990 GHI and the 2010 GHI, Angola, Ethiopia, Ghana, Mozambique, Nicaragua, and Vietnam saw the largest improvements. Twenty-nine countries still have levels of hunger that are "extremely alarming" or "alarming." The countries with "extremely alarming" 2010 GHI scores – Burundi, Chad, the Democratic Republic of Congo, and Eritrea – are in Sub-Saharan Africa. Most of the countries with "alarming" GHI scores are in Sub-Saharan Africa and South Asia. The largest deterioration in GHI scores was seen in the Democratic Republic of Congo, largely because of conflict and political instability. Economic performance and hunger are inversely correlated. Countries with high levels of gross national income (GNI) per capita, an important measure of economic performance, tend to have low 2010 GHI scores, and countries with low levels of GNI per capita tend to have high GHI scores. These relationships do not always hold, however. Conflict, disease, inequality, poor governance, and gender discrimination are factors that can push a country's level of hunger higher than what would be expected based on its income. In contrast, pro-poor economic growth, strong agricultural performance, and increasing gender equity can reduce hunger below what would be expected based on income. The high prevalence of child undernutrition is a major contributor to persistent hunger. Globally, the biggest contributor to the world GHI score is child underweight. Although the percentage of underweight in children under the age of five is only one of three elements in the GHI, it accounts for nearly half of the world GHI score. Child undernutrition is not spread evenly across the globe, but instead is concentrated in a few countries and regions. More than 90 percent of the world's stunted children (children whose height is low for their age) live in Africa and Asia, where rates of stunting are 40 percent and 36 percent respectively. To improve their GHI scores, countries need to accelerate progress in reducing child undernutrition. Recent evidence shows that the window of opportunity for improving child nutrition spans the period from -9 to +24 months (that is, the 1,000 days between conception and a child's second birthday). This is the period when children are in greatest need of adequate amounts of nutritious food, preventive and curative health care, and age-appropriate care practices for healthy development and when interventions are most likely to prevent undernutrition from setting in. After age two, the effects of undernutrition are largely irreversible. To reduce child undernutrition, governments should invest in effective nutrition interventions targeted to mothers and children during the window of opportunity. These interventions should focus on improving maternal nutrition during pregnancy and lactation, promoting sound breastfeeding and complementary feeding practices, providing essential micronutrients, and adopting salt iodization, while also ensuring appropriate immunization. Achieving high coverage of these interventions could have a rapid impact on improving early childhood nutrition. Governments should also adopt policies that deal more broadly with the underlying causes of undernutrition such as food insecurity, lack of access to health services, and poor caring and feeding practices, which are exacerbated by poverty and gender inequity. Poverty-reduction strategies focused on reducing inequities are therefore part of the solution for improving early childhood nutrition, as are policies specifically aimed at improving the health, nutrition, and social status of girls and women ; PR ; IFPRI1; GRP24 ; DGO; PHND; COM
A cinq ans de la date butoir fixée pour atteindre les Objectifs du millénaire pour le développement (OMD), parmi lesquels celui de réduire de moitié la proportion de la population qui souffre de la faim, le rapport « L'indice de la faim dans le monde 2010 », en anglais « 2010 Global Hunger Index (GHI)», offre une vision utile et pluridimensionnelle de la faim dans le monde. Ce rapport fait état de quelques améliorations entre 1990 et 2010, avec une diminution du GHI de près d'un quart pendant cette période. Toutefois, cet indice demeure à un niveau élevé correspondant à une situation « grave » En effet, le seuil historique du milliard de personnes souffrant de la faim a été franchi en 2009. L'Asie du sud et l'Afrique sub-saharienne sont les régions qui présentent les indices les plus élevés bien que l'Asie du sud ait réalisé des progrès notables depuis 1990. Dans cette région, le faible statut social des femmes ainsi que leur accès limité à une nourriture suffisante et à l'éducation constituent les principaux facteurs responsables de la forte prévalence de la malnutrition chez les enfants de moins de 5 ans. En Afrique sub-saharienne, les politiques gouvernementales peu efficaces, les conflits, l'instabilité politique et le fort taux de prévalence du VIH/SIDA sont à l'origine du taux de mortalité infantile élevé et de la sous-alimentation d'une large partie de la population. Certains pays ont accompli de réels progrès en matière de lutte contre la faim. Ainsi, entre 1990 et 2010, l'Angola, l'Ethiopie, le Ghana, le Mozambique, le Nicaragua et le Vietnam ont connu une amélioration significative de leur GHI. Vingt-neuf pays continuent d'afficher des niveaux de faim « extrêmement alarmants » ou « alarmants ». Les pays à GHI « extrêmement alarmant », à savoir le Burundi, le Tchad, la République Démocratique du Congo et l'Erythrée, se situent tous en Afrique subsaharienne. La plupart des pays ayant un indice « alarmant » se trouvent également dans cette région et en Asie du sud. La République Démocratique du Congo a subi la plus grande détérioration de son indice, en grande partie due à la guerre et à l'instabilité politique. Il existe une corrélation inverse entre la performance économique et la faim. Les pays à haut revenu national brut (RNB) par habitant, indicateur qui permet de mesurer la richesse d'un pays, ont tendance à présenter un GHI bas. Au contraire, les pays à bas RNB par habitant ont tendance à présenter un GHI élevé. Cependant, ce lien ne se vérifie pas systématiquement. Les conflits, les maladies, les inégalités, la mauvaise gouvernance et les discriminations liées au genre peuvent entraîner des niveaux de faim supérieurs à ceux calculés en fonction du RNB du pays. Par contre, une croissance économique favorable aux pauvres, un secteur agricole performant et une plus grande égalité entre les hommes et les femmes peuvent faire reculer la faim au-delà des prévisions basées sur le revenu du pays. La persistance de la faim dans le monde s'illustre particulièrement par la forte prévalence de la malnutrition infantile. En effet, la prévalence de l'insuffisance pondérale chez les enfants de moins de cinq ans, un des trois indicateurs pris en compte dans le calcul du GHI, représente à elle seule environ la moitié de l'indice GHI mondial. La répartition géographique de la malnutrition infantile n'est pas homogène, celle-ci se concentre dans quelques pays et régions. Plus de 90% des enfants qui présentent un retard de croissance vivent en Afrique et en Asie. 40% des enfants vivant en Afrique souffrent d'un retard de croissance; en Asie, ils sont 36%. Les pays doivent redoubler d'efforts pour réduire la sous-nutrition infantile. Des études récentes ont montré que les 1000 jours qui s'écoulent entre la conception et le deuxième anniversaire de l'enfant représentent une fenêtre d'opportunité pour améliorer l'état nutritionnel et de développement des nourrissons et des jeunes enfants. C'est pendant cette période cruciale pour leur croissance que les enfants ont le plus besoin d'une alimentation adéquate, riche en nutriments et de soins prophylactiques et curatifs adaptés. C'est également pendant cette période que les interventions visant à prévenir la sous-nutrition affichent les meilleurs résultats. Après le deuxième anniversaire de l'enfant, les séquelles de la sous-nutrition sont pratiquement irréversibles. Les gouvernements devraient investir dans des interventions nutritionnelles destinées aux mères et à leurs enfants pendant cette fenêtre d'opportunité afin de combattre la sous-nutrition infantile. Ces interventions devraient se concentrer sur l'amélioration de l'état nutritionnel des femmes durant la grossesse et l'allaitement, la promotion de l'allaitement maternel exclusif, l'introduction opportune d'une alimentation complémentaire, adéquate et riche en micronutriments essentiels, l'utilisation de sel iodé et enfin la mise en place de campagnes de vaccination. Il est possible d'améliorer significativement l'état nutritionnel des jeunes enfants en garantissant au plus grand nombre l'accès à ce type de programmes. De manière générale, les gouvernements devraient également adopter des politiques visant à combattre les causes sous-jacentes de la sous-nutrition. Il s'agit principalement de l'insécurité alimentaire, du manque d'accès aux centres de santé et à des soins de qualité, mais également des mauvaises habitudes alimentaires. Autant de facteurs exacerbés par la pauvreté et les inégalités fondées sur le genre. La lutte contre les inégalités fait partie intégrante de la solution à la malnutrition infantile et doit être une des priorités des stratégies pour la réduction de la pauvreté, tout comme la mise en place de politiques vouées spécifiquement à améliorer la santé, la nutrition et le statut social des filles et des femmes. ; PR ; IFPRI1; GRP24 ; DGO; PHND; COM
Die Welt nähert sich dem Jahr 2015 und damit dem Ablauf der Frist zum Erreichen der Millenniumsentwicklungsziele (MDGs), die unter anderem die Halbierung des Anteils hungernder Menschen anstreben. Gerade zu diesem Zeitpunkt bietet der Welthunger-Index (WHI) eine nützliche und mehrdimensionale Momentaufnahme der weltweiten Hungersituation. Der weltweite WHI-Wert 2010 zeigt gegenüber dem WHI 1990 eine Verbesserung: Er ist um fast ein Viertel gesunken. Dennoch bleibt der WHI weltweit auf einem Niveau, das als ernst zu bezeichnen ist. Dies überrascht nicht, wenn man bedenkt, dass die Gesamtzahl der hungernden Menschen 2009 die Milliardengrenze überschritten hatte. Die höchsten regionalen WHI-Werte erzielen Südasien und Afrika südlich der Sahara, wobei Südasien seit 1990 deutlich größere Fortschritte gemacht hat. Dort geht der hohe Anteil untergewichtiger Kinder unter fünf Jahren zu einem großen Teil auf den schlechten Ernährungs-, Bildungs- und Sozialstatus der Frauen zurück. In Afrika südlich der Sahara erklären sich dagegen die hohe Kindersterblichkeit und der hohe Anteil an Menschen, die ihren Kalorienbedarf nicht decken können, hauptsächlich aus einer schlechten Regierungsführung, Konflikten, politischer Instabilität und hohen HIV-/Aids-Raten. Einige Staaten haben bedeutende Fortschritte bei der Bekämpfung des Hungers erzielt: Zwischen 1990 und 2010 konnten Angola, Äthiopien, Ghana, Mosambik, Nicaragua und Vietnam ihre absoluten Werte im WHI besonders deutlich verbessern. In 29 Ländern ist die Hungersituation noch immer gravierend beziehungsweise sehr ernst. Die Länder mit gravierenden WHI-2010-Werten – Burundi, die Demokratische Republik Kongo, Eritrea und der Tschad – liegen in Afrika südlich der Sahara. Sehr ernste WHI-Werte sind in afrikanischen Ländern südlich der Sahara und in Südasien zu finden. Die deutlichste Verschlechterung der WHI-Werte zeigte die Demokratische Republik Kongo, größtenteils aufgrund von Konflikten und politischer Instabilität. Wirtschaftliche Leistung und Hunger stehen in negativer Korrelation zueinander. Länder mit einem hohen Bruttonationaleinkommen (BNE) pro Kopf, ein wichtiger Messwert für wirtschaftliche Leistung, haben in der Regel niedrige WHI-Werte, während Länder mit einem niedrigen BNE pro Kopf eher hohe WHI-Werte aufweisen. Dieser Zusammenhang besteht jedoch nicht immer. Konflikte, Krankheiten, ungleiche Einkommensverteilung, schlechte Regierungsführung und Diskriminierung von Frauen sind Faktoren, die die Hungersituation in einem Land gegenüber dem, was gemäß dem BNE zu erwarten wäre, verschlechtern können. Andersherum können breitenwirksames wirtschaftliches Wachstum, eine starke Landwirtschaft und die verbesserte Gleichberechtigung von Mann und Frau den Hunger-Index gegenüber dem, was das BNE erwarten ließe, verbessern. Ein hoher Anteil von unterernährten Kindern trägt entscheidend dazu bei, dass Hunger weiterhin existiert. Global gesehen trägt Untergewicht bei Kindern am meisten zum weltweiten WHI-Wert bei. Obwohl der Anteil der untergewichtigen Kinder unter fünf Jahren nur eines von drei Elementen des WHI darstellt, ist er für fast die Hälfte des globalen WHI-Werts verantwortlich. Das Auftreten von Unterernährung bei Kindern ist dabei nicht gleichmäßig über den Globus verteilt, sondern konzentriert sich auf wenige Länder und Regionen. Über 90 Prozent der stunted Kinder (Kinder, die für ihr Alter zu klein sind) weltweit leben in Afrika und Asien, wo die Stunting-Raten von Kindern 40 beziehungsweise 36 Prozent betragen. Um ihre WHI-Werte zu verbessern, müssen die Länder die Bekämpfung der Unterernährung von Kindern vorantreiben. Neue Belege zeigen, dass das entscheidende Handlungsfenster zur Verbesserung der Ernährungssituation von Kindern den Alterszeitraum -9 bis +24 Monate umfasst (also die 1.000 Tage zwischen Empfängnis und der Vollendung des zweiten Lebensjahres). In diesem Zeitraum haben Kinder den größten Bedarf an nahrhafter Kost, Gesundheitsvorsorge und medizinischer Behandlung sowie einer altersgerechten Fürsorge für eine gesunde Entwicklung. Zudem beugen innerhalb dieser Zeitspanne entsprechende Maßnahmen einer Unterernährung am wirkungsvollsten vor. Ab einem Alter von zwei Jahren hingegen lassen sich die Folgen von Unterernährung größtenteils nicht mehr rückgängig machen. Um der Unterernährung bei Kindern entgegenzuwirken, müssten die Regierungen in wirksame Ernährungsprogramme investieren, die innerhalb dieses Handlungsfensters sowohl bei den Müttern als auch bei den Kindern ansetzen. Diese Maßnahmen müssten auf eine bessere Ernährung der Mütter während Schwangerschaft und Stillzeit abzielen, gesunde Stillpraktiken und altersgemäße Beikostgabe fördern, wichtige Mikronährstoffe zur Verfügung stellen, die Anreicherung der Nahrung mit Jodsalz fördern sowie angemessene Schutzimpfungen gewährleisten. Eine umfangreiche Umsetzung dieser Maßnahmen wird eine schnelle Verbesserung der Ernährungssituation in der frühen Kindheit zur Folge haben. Die Regierungen sollten zudem die indirekten Ursachen der Unterernährung wie Ernährungsunsicherheit, begrenzter Zugang zu medizinischer Versorgung sowie unzureichende Versorgungs- und Ernährungspraktiken, die durch Armut und mangelnde Gleichberechtigung verstärkt werden, stärker in ihre Politik einbeziehen. Strategien zur Armutsbekämpfung, die auf eine Verminderung von Ungleichheit ausgerichtet sind, sind daher ebenso Teil der Bekämpfung frühkindlicher Unterernährung wie politische Maßnahmen zur Verbesserung der Gesundheit, der Ernährungssituation und des sozialen Status von Frauen und Mädchen. ; PR ; IFPRI1; GRP24 ; DGO; PHND; COM
Mentre il mondo si avvicina alla scadenza fi ssata nel 2015 per il raggiungimento degli Obiettivi di Sviluppo del Millennio (MDG, Millennium Development Goals) - tra i quali rientra il dimezzamento della percentuale di persone che soffrono la fame - l'Indice Globale della Fame (GHI, Global Hunger Index) 2010 offre una utile fotografi a pluridimensionale della fame nel mondo. Il GHI 2010 mostra alcuni miglioramenti rispetto al GHI 1990, essendo diminuito di un quarto. Cionononostante, l'indice della fame nel mondo resta a un livello "grave". Questo risultato non sorprende se si pensa che il numero complessivo di persone affamate ha superato il miliardo nel 2009. I punteggi più elevati di GHI a livello regionale si registrano in Asia meridionale e Africa subsahariana, ma l'Asia meridionale ha fatto molti più progressi rispetto al 1990. In Asia meridionale, tra i principali fattori che contribuiscono a un'alta prevalenza dei bambini sottopeso in età compresa tra 0 e 5 anni, ci sono lo scarso accesso delle donne a una nutrizione ed educazione adeguate e il loro basso status sociale. In Africa subsahariana, invece, la scarsa effi cienza dei governi, i confl itti, l'instabilità politica e gli alti tassi di HIV e AIDS sono tra i principali fattori responsabili dell'alta mortalità infantile e dell'alta percentuale di persone che non possono soddisfare il proprio fabbisogno calorico. Alcuni paesi hanno fatto passi avanti signifi cativi in termini assolutinel miglioramento del proprio GHI. I progressi più evidenti tra il GHI 1990 e il GHI 2010 si sono registrati in Angola, Etiopia, Ghana, Mozambico, Nicaragua e Vietnam. Ventinove paesi hanno comunque ancora livelli di fame "estremamente allarmanti" o "allarmanti". I paesi con punteggi di GHI 2010 "estremamente allarmanti" - Burundi, Ciad, Repubblica Democratica del Congo e Eritrea - sono in Africa subsahariana. La maggior parte dei paesi con punteggi di GHI "allarmanti" sono in Africa subsahariana e in Asia meridionale. Il più grave deterioramento dei livelli di GHI si è registrato nella Repubblica Democratica del Congo, in gran parte a causa dei confl itti e dell'instabilità politica. Prestazioni economiche e fame sono inversamente correlate. I paesi con alti livelli di reddito nazionale lordo (RNL) pro capite - un'importante misura dell'attività economica - hanno tendenzialmente bassi punteggi di GHI 2010, e i paesi con bassi livelli di RNL pro capite hanno tendenzialmente alti punteggi di GHI. Ma questa non è una relazione sempre valida. Confl itti, malattie, disuguaglianze, cattive pratiche di governo e discriminazione di genere sono fattori che possono rendere il livello di fame di un paese più alto di quanto ci si aspetterebbe sulla base del suo reddito. Al contrario, una crescita economica favorevole ai poveri, una solida attività agricola e una crescente parità di genere possono ridurre la fame oltre i livelli attesi sulla base delle entrate procapite. L'alta prevalenza della denutrizione infantile è uno dei fattori maggiormente responsabili della persistenza della fame. A livello generale, il fattore che più contribuisce al livello di GHI mondiale è l'insuffi cienza di peso tra i bambini. Anche se la percentuale di insuffi cienza di peso nei bambini al di sotto dei cinque anni è solo uno dei tre elementi che compongono il GHI, è responsabile di quasi la metà del punteggio mondiale di GHI. La denutrizione infantile non è uniformemente diffusa nel mondo, ma piuttosto si concentra in pochi paesi e regioni. Oltre il 90% dei bambini al mondo che soffrono di ritardi nella crescita (bambini la cui statura è inadeguata in rapporto all'età) vivono in Africa e in Asia, dove i tassi di ritardo nella crescita sono rispettivamente al 40 e al 36%. Per migliorare i rispettivi punteggi di GHI, ai paesi servono progressi più rapidi nella riduzione della denutrizione infantile. Dati recenti mostrano che l'intervallo utile per migliorare l'alimentazione del bambino va dai -9 ai +24 mesi (ovvero i mille giorni che intercorrono tra il momento del concepimento e il secondo compleanno). È in questa fase che i bambini hanno maggior necessità di adeguate quantità di cibo nutriente, di assistenza sanitaria preventiva e curativa, e di cure adatte alla loro età che favoriscano uno sviluppo sano; inoltre è il momento in cui gli interventi hanno più probabilità di prevenire l'insorgere di uno stato di malnutrizione. Dopo i due anni di età, gli effetti della sottonutrizione sono in gran parte irreversibili. Per ridurre la malnutrizione infantile, i governi dovrebbero investire in interventi alimentari effettivi diretti alle madri e ai fi gli durante i primi mille giorni. Questi interventi dovrebbero concentrarsi sul miglioramento dell'alimentazione materna durante la gravidanza e l'allattamento, promuovendo un corretto allattamento al seno e pratiche alimentari integrative, fornendo i micronutrienti essenziali, praticando la iodurazione del sale e garantendo al contempo appropriate vaccinazioni. Un'elevata copertura di questi interventi potrebbe comportare un rapido miglioramento dell'alimentazione della prima infanzia. I governi dovrebbero anche adottare strategie in grado di affrontare con più ampio respiro le cause alla radice della sottonutrizione, come l'insicurezza alimentare, la mancanza di accesso ai servizi sanitari e le cattive pratiche nutrizionali e di cura del bambino: problemi resi ancor più gravi dalla povertà e dalla disparità di genere. Le strategie di riduzione della povertà basate sulla riduzione delle disuguaglianze sono quindi parte della soluzione dei problemi di alimentazione nella prima infanzia, così come le politiche mirate al miglioramento della salute, dell'alimentazione e dello status sociale delle bambine e delle donne. ; PR ; IFPRI1; GRP24 ; COM; DGO; PHND
