In a "Viewpoint" published in The Lancet, Rainer Gross, PhD, UNICEF's chief of nutrition, and Patrick Webb, PhD, dean for academic affairs at the Friedman School of Nutrition Science and Policy at Tufts University, discuss five facts about world hunger, children and wasting, a condition that represents severe malnutrition.

Wasting is defined by a low weight-to-height ratio; it is visible in the form of skeletally thin children usually found in the middle of a famine. The authors note that a public health disaster is generally declared if more than 15 percent of the children in a country suffer from wasting.

Gross and Webb analyzed countries with the highest child mortality rates and child wasting rates. Based on their assessment of the data, the authors present five surprising facts about severe children malnutrition and argue that such conditions must be resolved in non-emergency settings to prevent future public health crises.

First, contrary to popular belief, Africa does not have the most children suffering from wasting. "Although in the past 10 years, every subregion of Africa saw a rise in both the number of wasted children under the age of five and in the overall rate of wasting, about 78 percent of the world's 5.5 million wasted children live in India, Pakistan, and Bangladesh; nearly two thirds of those in India alone," says Webb.

Secondly, the absence of conflict, such as political instability, does not prevent or resolve wasting in children. When the authors compared countries without recent conflict to countries that have recently emerged from periods of conflict or remain continually unstable, they found that, "...stability, economic growth, and even political transparency are not in themselves sufficient factors to overcome the persistence of wasting in marginalized vulnerable groups."

Wasting is a complex condition that is not simply caused by conflict or famine alone. Gross and Webb conclude that "effective, targeted actions are needed as part of the development agenda."

Third, HIV does not appear yet to contribute substantially and directly to severe wasting in children, although the authors state that "as the pandemic progresses, high HIV/AIDS rates will contribute to worsening nutrition, both from the direct effects of the disease and from an indirect impact on household food security and childcare. Without dual action against wasting and HIV/AIDS, the deadly synergy of these two factors is likely to grow in coming years."

Fourth, political and economic growth do not always automatically improve child nutrition. According to the authors, "wealth creation at a national level does not preclude the persistence of wasting on a large scale." For example, the United Arab Emirates, a wealthy country, has a wasting rate of 14 percent.

"Similarly," state the authors, "both India and Brazil have shown remarkable rates of economic growth without proportional gains in the nutritional status of poorer people in their society."

Finally, Gross and Webb state that the development agenda must tackle child wasting in order to make a lasting impact on human well- being. "The problem of wasting needs to be addressed wherever it is identified, not just in emergencies," says Webb. "Wasting in emergencies represents the tip of the iceberg," write the authors.

"Ironically, the international community has become much more adept at saving the lives of wasted children in the context of catastrophes than in the context of typical development," state the authors.

The authors give several examples of development that will reduce the chronic undernutrition that results in wasting of children. These include improving nutrition in pregnant and lactating women to prevent low-birthweight babies, effective protection against infectious disease, improved water and sanitation systems, promotion of breastfeeding during an infant's first six months, enhanced health and nutrition information for parents, and micronutrient supplementation.

"The wasted child cannot wait," conclude the authors. "Millions of children need immediate, life-saving attention coupled with coordinated longer-term investments that will help prevent repetitions of nutrition and health insults as they grow into adulthood. The world cannot afford to waste another decade talking about global targets, waiting for the macro-effects of economic and political development to reach children ignored by the development process."

Patrick Webb served as chief of nutrition for the United Nations World Food Programme until August 2005. Previously, he was a member of the Steering Committee of the United Nations Standing Committee on Nutrition and of the Millennium Project Task Force on Hunger.

Webb serves as a member of the board of the International Nutrition Foundation and is focal point for academic outreach for the World Food Programme. Webb was also the chair of a World Health Organization expert advisory panel on household food and nutrition security.

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