Bridging the gap between knowledge and effective interventions in nutrition

Transform Nutrition, a five year multi-country project in which icddr,b is a partner, aims to accelerate progress and improve nutrition outcomes in developing countries by  filling existing knowledge gaps, mobilising stakeholders across sectors and ensuring prioritisation of nutrition in development policy.
Nutrition has emerged as a key global health challenge in the post-2015 development agenda. Evidence indicates that undernutrition exacts enormous human and economic costs – every year it contributes to the deaths of 3.1 million children, causes stunting, cognitive deficit and long-term susceptibility to diseases and can cost the global economy up to US$125 billion. Investment in improving nutrition, on the other hand, has been shown to generate considerable returns: cost-benefit research says that every dollar spent on nutrition in the first 1000 days of a child’s life can lead to improved income potential of about $62 for Bangladesh (and as much as $166 in more economically advanced countries like Indonesia) as well-nourished children stay in school longer, develop better cognitive skills and as a consequence earn higher wages as adults.

Photo by International Maize and Wheat Improvement Center / CC BY-NC-SA 2.0
In Bangladesh, undernutrition is responsible for over 45% of childhood deaths and 41% of stunted children under the age of five years. While policy initiatives have been put in place to tackle undernutrition, there is little if any intersectoral coordination of policy. Moreover, emerging challenges such as rising food prices, increasing urbanisation, climate change and natural disasters threaten to further deteriorate the state of nutrition in Bangladesh.
Despite the enormity of the undernutrition problem, global progress on reducing undernutrition has been slow – the world is currently not on track to meet any of the six nutrition goals set by the World Health Assembly, which include a 40% reduction in the number of under-five children who are stunted by 2025.
One of the key reasons is the complex nature of the problem. Evidence indicates that even if we applied direct nutrition interventions that are known to work (e.g., vitamin A supplementation, which boosts growth in children, or breastfeeding) at scale, together they can only reduce overall incidence of stunting by around a fifth. Experts now agree that concerted efforts across multiple sectors such as health, agriculture and education are needed for rapid reduction of under-nutrition in line with global goals. However, little is known to date about how multi-sector action could be designed and effectively implemented.
The Transform Nutrition consortium was set up to help fill this knowledge gap. Over five years, between 2012 and 2017, it aims to strengthen the evidence base for nutrition interventions, particularly focusing on the first 1000 days of life, the critical period when interventions are most effective. Four developing countries with the highest burdens of undernutrition have been chosen as focal countries for research – Bangladesh, Ethiopia, India and Kenya.
The consortium is comprised of five organisations -the US-based International Food Policy Research Institute, the UK-based Institute of Development Studies, icddr,b, the Public Health Foundation of India and Save the Children. Dr Shams El Arifeen, director of icddr,b’s Centre for Child and Adolescent Health is one of two research directors of Transform Nutrition and the pillar-lead for the nutrition-specific interventions. icddr,b is also leading on the research uptake component of the project, which aims for the knowledge produced to be effectively used for policy and action.
Transform Nutrition is focusing on three research areas: 1) how to scale up nutrition-specific interventions that target the immediate cause of undernutrition (such as preventing and treating vitamin and mineral deficiency, supporting exclusive breastfeeding, etc.) in a sustainable manner in low-resource settings and targeting them towards the window of opportunity of the first 1000 days of life; 2) nutrition ‘sensitive’ interventions – how to align policy and actions in areas such as women’s empowerment, education and agricultural policy, which have been shown to have a major impact on nutrition outcomes; and 3) enabling environment – how to create a supportive environment in which nutrition-specific and nutrition-sensitive interventions can succeed. This entails understanding better how to improve leadership, political commitment, and the capacity of institutions (such as government ministries) to address nutrition; help prioritise nutrition at national, regional and international levels; and mobilise resources.
In addition to generating knowledge, Transform Nutrition is helping to facilitate conversations between researchers, government and civil society organisations implementing solutions in Bangladesh and the other three focal countries to ensure that the research leads to concrete action on the ground.
Transform Nutrition is funded by UKAid from the Department for International Development. A TEDxDhaka 2014 presentation by icddr,b’s Dr Anisul Karim, a Transform Nutrition co-investigator, lays out Bangladesh’s challenges and progress on malnutrition.