The first thousand days of a baby’s life

The global direct cost of malnutrition on health is estimated to be in the vicinity of 20 to 30 billion dollars per annum.
During the first thousand days of a child’s life, his or her physical, intellectual and emotional progress develops at its quickest rate. In this period, which ranges from conception up to a child’s second birthday, the brain grows by 80%.
“Human Rights Day was marked on March 21, and I would like to focus on each child’s right to have access to the best care during its first thousand days of its life, as it is of critical importance for intellectual development and lifelong health,” says Prof Mariana Kruger, Executive Head of the Department of Paediatrics and Child Health at Stellenbosch University’s Faculty of Medicine and Health Sciences.
There are currently 17 million children, approximately one third of all children worldwide, experiencing weak growth in length, also known as stunting. This irreversible condition, attributed to chronic malnutrition in the first phase, is on the rise in sub-Saharan Africa.
“The influence of chronic malnutrition on brain development leads to poor academic performance, which may result in lifelong poverty,” Kruger says. These adults earn on average 20% less than their counterparts who received good nutrition during childhood.
The global direct cost of malnutrition on health is estimated to be in the vicinity of 20 to 30 billion dollars per annum. Poor nutrition also has an influence on a country’s gross domestic product, which could be up to two to three percent lower. 
Good nutrition should already begin during pregnancy. A healthy mother provides important nutrients to the developing foetus. After birth, exclusive breastfeeding during the first six months is the most important step for a child’s survival. “Babies in developing countries who are exclusively breastfed during the first six months of their lives, have a six times better chance of survival compared to babies who are not breastfed,” says Kruger.
After the first six months, a baby needs access to a healthy balanced diet. Kruger explains that stunting could be decreased by 20% if children receive healthy nutrition up to the age of 12 months.
Many poor countries, such as Brazil, Senegal and Tunisia, deliver healthy child nutrition in spite of poor national wealth; while there is poor child nutrition in countries with relatively high national wealth as can be seen in South Africa, Botswana and Mexico.
“It is therefore interesting that children in poor countries, such as Malawi, Madagascar and Peru, receive healthy nutrition during the first two years of their lives,” says Kruger. “This proves that even under poor circumstances, it is possible to provide healthy nutrition to children.”
“Political will to establish effective strategies is important to address the problem of malnutrition,” says Kruger.
Health workers play a critical role in improving mother and child nutrition during the first thousand days of life. In poor countries, it is mostly the community health workers and midwives who fulfil this important role.
“Doctors are often unavailable and clinics or hospitals too far or too expensive for the general population,” she says. Health workers do screening for malnutrition; training in balanced nutrition; promote breastfeeding, hygiene and sanitation; and assist in early detection of treatable common diseases such as diarrhoea.
“Countries like Malawi and Nepal are particularly successful in the strategic placement of health workers,” says Kruger. “It is important to invest in health workers, especially those who are involved during pregnancy and in primary healthcare clinics.”
Government actions to address malnutrition should also be strengthened. Partnerships between the public and private sector can help to ensure that the necessary nutritional plans and assistance are provided to all mothers and children.
“Legislation, policies, regulations and other interventions, which are affordable to poor countries, should be revised and developed to improve the first thousand days of a child’s life,” says Kruger. 
This includes investment in low-cost solutions, such as breastfeeding, appropriate complimentary nutrition, supplements like iron (improved resistance to infections), vitamin A (prevents blindness and reduces risk of dying from common childhood infections), zinc and good hygiene (prevents mortalities due to diarrhoea).
Breastfeeding is one of the most important interventions, but is not acceptable in many public places. “Mothers must be able to breastfeed in the workplace,” says Kruger. “Public transport should also be equipped with special seats, reserved for mothers who are breastfeeding.”
According to Kruger, it is not only poor countries that have to focus on the first thousand days. “Regrettably the USA, a country with a strong economy, is the country with the most unfriendly attitude towards mothers who want to breastfeed,” she says.
Future mothers must be trained to fight malnutrition with knowledge. “All girls should be fully schooled, which means they have to complete twelve years of schooling,” says Kruger.
Right Start, Bright Future
The Department of Health in the Western Cape has put a campaign, entitled “Right Start, Bright Future” in motion which focusses on the first thousand days of life.
The three pillars of the programme is ensuring the health of the mother and baby; support of mothers and babies by fathers, families and communities; as well as the correct stimulation for the baby’s cognitive needs, namely a community free of substance abuse and where health is promoted.
One such an intervention aimed at stimulating brain development in children is the reading project which was implemented at the Tygerberg Children’s Hospital last year. Mothers are taught to read to their children from children’s books to stimulate intellectual development.
» Read more about the Reading Project
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