The nutrition scene was very eventful in Africa in the year 2010. I am sure that there will be plenty to report in 2011 also. It’s important to reflect on the past – this helps to avoid making the same mistakes. I like to show a serene riverside or sunset every month (as here in Namibia), to encourage stepping back and reflecting on our experience. So this month I’ll reflect on 2010 as I have experienced it.

Malnutrition

It all begins with children

When I joined the Association and was asked by Barrie Margetts and Geoffrey Cannon if I would write a column focused on Africa, I accepted enthusiastically. This work has confirmed to me that malnutrition – meaning undernutrition – remains the most important public health crisis in Africa. Children and women are the most vulnerable, and sub-Saharan Africa is the most affected region. This has generally been my focus in 2010. The issues of nutrition in Africa sometimes make us rejoice and sometimes lament.

RUTF politics

Ready to use therapeutic food has been and remains a hot topic debate. For me it started in late 2009 in Bangkok at the International Congress of Nutrition. There have been a series of debates on the website of the International Malnutrition Task Force website at www.imtf.org. There has been a paper entitled ‘Should India use commercially Produced RUTF for severe acute malnutrition?’ by Vandana Prasad and colleagues. And there have been media reports that the government of India had asked UNICEF to stop distributing RUTFs with a value of millions of dollars.

Medicins Sans Frontiers (MSF), a leading non-government organisation that treats malnutrition in many low-income countries, has written to Nutriset, manufacturers of the RUTF ‘Plumpy’Nut’, concerning patents and other licensing issues. Then there has been the legal battle between US companies demanding that Nutriset relinquishes patents on RUTF, arguing that this limits production and hinders availability and access to treatment for malnutrition. In response Nutriset has argued that the need for licensing does protect its patent but also protects local producers in Africa who cannot compete with big US firms.

One of the uncomfortable truths here has been that the survival of innocent little children was at stake. Everybody agreed that it was unacceptable for these children to be caught in the crossfire of opposing forces. Many also agreed that the different sides to these debates all had the interest and welfare of children at heart. Hence, all stakeholders were encouraged to work together and amicably. Now at least local production of RUTF is beginning in Africa

Effective interventions

The causes of malnutrition are still pervasive in Africa. Food insecurity, inadequate maternal and child care practices, unhealthy environment, and lack of access to health services, are the main underlying causes. Nutritionists need to partner with other disciplines to effectively address the situation.

It’s not all doom and gloom. Effective interventions do exist. In one of my columns I looked at the approaches used by UNICEF. These are based on four main programmatic areas. These are infant and young child feeding, micronutrient interventions, nutrition in emergencies; and nutrition in HIV/AIDS. Interventions can and do work, especially when implemented at scale. These include exclusive breastfeeding for the first months of life, appropriate complementary feeding, food fortification, and micronutrient supplementation. Sometimes the simplest and most accessible approaches are the most effective.

Personal leadership

Seven lessons to build our capacity

In my first columns in April and May I wrote about leadership. The lessons I shared were those I learned at the African Nutrition Leadership Programme – and here it is in action, above. The public health nutrition cycle involves identifying a problem or knowing the situation, looking for and implementing programmes to address the problem, and evaluating to see if a difference has been made. This means that researching or finding scientific evidence should not end there. We should not only describe problems but find solutions to them. Public health nutritionists should be change agents.

Effective leadership is for me the key to development in Africa in general and for ensuring progress in health and well being. Good leadership is also needed to address the nutritional issues in Africa through lobbying and advocacy, networking and collaboration, teamwork and team building, effective communication – the list goes on.

So how do I seek to lead? The seven lessons I learnt were these. One. Be the person who unleashes people’s potential through mentoring and motivation. Two. Know yourself: your strengths, weaknesses, capabilities and limits. Three. Communicate effectively. Four. Build teams, work in teams and trust people to deliver without being over-critical. Five. Be a responsible and caring leader. Six. Be the change, by changing your own self. Seven. Try the new style of leadership by letting other people shine. And also I am fortunate in having mentors who have encouraged me enormously, but I won’t say who because they don’t want me to.

Political leadership

First ladies make big steps forward

Successive resolutions to improve nutrition in Africa were made in 2010, and many programmes have been launched. Yes, I do believe that good and effective people are committed to turn things around for the better. The Johannesburg resolution agreed at the International Paediatric Congress, called for core competencies for paediatricians and health workers on prevention and treatment of malnutrition. This was a major step. Then the Nairobi Declaration similarly called for educational and professional core competencies for nutritional practice and nutritional support, and training of health workers in the treatment and prevention of nutritional problems across the life cycle.

Wives of African presidents came forward together in 2010, committing to the fight against malnutrition in support of child survival and development. These First Ladies, shown above as they signed their own declaration, committed themselves to improve nutrition, improve food and nutrition security, mobilise society, and support advocacy efforts. They also agreed to call upon world leaders to put improved nutrition at the heart of development.

There have indeed been commitments made by world leaders, and initiatives championed by a former US First Lady Hillary Rodham Clinton, and others including the UN Secretary General Ban Ki-moon. These include the Scaling Up Nutrition (SUN) initiative and The 1000 days, Change a Life, Change the Future initiative.

Africa is ready. We know what to do through research and past programmes, we have formulated programme, signed declarations pointing to action, and funds have been promised. So let us all act together.

Africa now and in future

What I see

So much is said in pictures. I think about this always as I select pictures from Africa for my columns. Some tell stories that may seem all too familiar. Others may be unexpected. The pictures of riversides, sunsets and serene beaches in Africa are to remind me and I hope you also, not to lose heart as we try to be change agents. The pictures of children for me are mainly calling for help because they cannot help themselves, and all too often parents, families and communities in Africa struggle to look after their children for reasons that are not their fault.

So when I look at the children above, I feel them looking at us, echoing what the UN Secretary General said prior to the Summit on the Millennium Development Goals in September: ‘We must not fail the billions who look to the international community to fulfill the promise of the Millennium Declaration for a better world’. We are looking up to you. Don’t fail us, I feel these children are saying.

And now I look at the picture of the boy below, taking care of his little brother. The little boy is eating roasted corn directly from the cob. I feel that their message is simple. ‘Promoting nutrition is not rocket science. The solutions are simple. You know what to do, please act. Otherwise we may perish’.

The severely malnourished child below for me stands for all the hungry children in Africa who still have a glimmer of hope. For if the right training and systems are put in place to give these children food and care – and yes, love - they can still survive and have a future.

These children below, standing behind heaps of rubbish in an urban slum are for me saying: ‘There are many many more like us. We live in cities, just few kilometres away from luxury, but our families cannot make ends meet. Remember us while you address nutrition issues. Remember to work with other disciplines in order to address fundamental causes of malnutrition and hunger’.

The younger scientists

Tomorrow’s leaders

And so, what then about the future for Africa? Here are some of the young nutrition scientists in Africa and their mentors. It was taken at the 3rd biennial congress of the African Graduate Nutrition Students Network. It is one of my favourite pictures. When I wrote about this network I titled it ‘Building capacity in Africa; passion, love, and autonomy’. These young leaders are the future of nutrition leadership in Africa. They may have passion and love for the continent. But they might end up joining the ‘brain drain’ to rich countries. Others have had the opportunity of receiving training outside Africa. There could be a ‘brain gain’ if an enabling environment encourages them to return and contribute to the development of Africa.

Capacity building, in the spirit of partnership and sustainability, is the way forward.

Acknowledgement and request

You are invited please to respond, comment, disagree, as you wish. Please use the response facility below. You are free to make use of the material in this column, provided you acknowledge the Association, and me please, and cite the Association’s website.

Please cite as: Annan R [Column] It all begins with children, and other items. Website of the World Public Health Nutrition Association, January 2011. Obtainable at www.wphna.org

The opinions expressed in all contributions to the website of the World Public Health Nutrition Association (the Association) including its journal World Nutrition, are those of their authors. They should not be taken to be the view or policy of the Association, or of any of its affiliated or associated bodies, unless this is explicitly stated.

This column is reviewed by Geoffrey Cannon.