Dedebit | Feb 24/2024

By Dr Gebrewahid Woldu
This topic may not seem to be at the right time, but the heavy price has been paid, and we will not settle for realizing less than the Tigray we want, and we should be prepared.
Years ago, I read a report on the stunting of Tigray children, and it was about 51 or 52 percent; the recent report of 49 percent was in 2019, which is an unacceptable level. According to the World Health Organization, stunting 30-39 percent is considered high.
This brief writing is meant to begin a conversation and plan for the daunting task ahead.
STUNTING:
Stunting (chronic malnutrition) -when a child falls below two standard deviation height for age. For Tigray, there is no more pressing issue than the future generation. In 2022, approximately 22 percent (over 148 million) of children under five years of age worldwide were stunted. In Africa, it is 30 percent. In Tigray, it could be more than 50 percent.

CHILD DEVELOPMENT:
The potential of children in third-world countries could not be realized unless child development is given priority. The long-term consequence of stunting (chronic malnutrition) is enormous. It has a significant impact on brain development and lower IQ. Children in lower-income countries are at risk of reaching their full potential of development -physical, socio-emotional, cognition, and motor skills due to stunting. There is an economic cost due to loss of productivity. Chronic malnutrition causes a weakened immune system and leads to recurrent infection. The sad thing is that priority is not given to child development.
In developing countries, the causes of death in children under 5 are:
Malnutrition (54 percent), perinatal condition (20 percent), various infections because of weakened immune system, lack of vaccines, clean water, and a hygienic environment.
The development of the brain is determined by the interaction of genetics (Nature) and Environment (Nurture).

Nurture
Environment (Nurture):
Factors influencing child development are Nutrition, the mother’s health, stress, and a nurturing environment with adequate stimulation. The full potential of a child’s brain development could not be realized without a nurturing environment with adequate stimulation and malnutrition. Research has been done between children with less human contact and children who were raised with caring human contact, and babies in the abandoned home, most did not survive, and those who survived were severely mentally retarded and prone to infection due to weakened immune. So, not only adequate nutrition but early nurturing and stimulation are essential for child development;
NUTRITION: Macronutrients (protein, carbohydrate, fat), Micronutrients (vitamins, minerals)
The first 1,000 days are considered critical time or window of opportunity:
Why is this period so critical?
The brain grows faster than at any other time in a child’s life. According to Harvard University’s Center on Developing Child- babies’ brains form new neuron connections at a rate of more than 1 million every second. Inadequate nutrition during pre-and postnatal periods results in a less developed brain. So, it is essential to have proper nutrition early at the right time. The window extends to 2 to 3 years because the brain is the last organ to complete development. More than 80 percent of a baby’s brain is formed by age 3. Up to 75 percent of each meal builds the baby’s brain. The term brain weighs 10 percent of body weight and uses 44 percent of total energy expenditure. In contrast, the adult brain weighs 2 percent and requires 19 percent.
If a child misses this critical window, the cost to society is enormous.
Calories and weight gain during pregnancy- Adequate macronutrients (Protein, carbohydrate, fat):
Pregnant women require additional calories in the second and third trimesters. During the second and third trimesters of pregnancy, the number of calories should be increased by 15 to 20 percent, and protein requirements should increase by 50 percent.
A pregnant woman needs to gain the right weight for a healthy pregnancy. The correct weight gain means a smarter baby. The volume of the brain correlates to the baby’s birth weight. For normal-weight women, the recommendation is 25 to 28 pounds (about 11 to 12 kilograms) gain. For underweight women, 25 to 40 pounds gain is required.
Between 4 months and birth, the brain is very sensitive to the amount and type of food. Inadequate food during early pregnancy results in a malnourished baby with insufficient brain development.
MICRONUTRIENT: vitamins, minerals, and trace elements.
In developing countries, micronutrient deficiencies are a serious concern.
Some of the essential micronutrients that are critical for the development of nervous systems:
Folic acid(folate) vitamin B9:
This vitamin is necessary for fetal growth, including the brain and spinal cord. Folic acid deficiency has been associated with congenital abnormalities, such as neuronal tube defects, that affect the spine, spinal cord, or brain and may cause death.
In the Western world, it is recommended women start a folic acid supplement, 400 micrograms a day. Food sources of folic acid are Beans, citrus fruit, dark green vegetables, legumes, and whole grains. Pregnant women need to get plenty of these foods.
Too much folic acid (upper limit is 1000 micrograms): Too much can cause a problem, though there is no limit on the intake of natural folate from fruits and vegetables. Getting adequate folate during pregnancy may reduce the risk of autism. However, excessively high blood levels of folate in pregnancy have also been associated with autism.
IRON:
The most widespread essential micronutrient deficiency in the world is iron deficiency. Over 40 percent of pregnant women and 25 percent worldwide will have anemia. Iron requirements increase during pregnancy and lactation because the blood supply increases to deliver oxygen to the fetus. Iron is an essential structural component of the hemoglobin molecule, transporting oxygen to all organs, including the brain. Iron supports the development of the brain and nervous system, and anemia due to iron deficiency is associated with poor mental and motor development—long-term poor cognitive impairment and school achievement.
IODINE:
Worldwide, there is a significant deficiency of iodine intake. It is more prevalent in Tigray. Iodine is needed for the synthesis of thyroid hormone, which is essential for the development of central nervous system. Iodine deficiency can lead to congenital hypothyroidism, growth retardation, and irreversible mental retardation. Some studies showed that in areas with iodine deficiency, children were found to have 12 to 13 percent lower IQs than children in sufficient areas.
Iodine supplements and iodine-fortified salt are recommended.
ZINC:
Low zinc intake during pregnancy has been linked to low birth weight, preterm delivery, and other problems. Zinc is required for brain structure and function through its role in DNA and RNA synthesis. These minerals are also essential for differentiation and specialization (cell growth).
Good source of zinc: Nuts, Seeds, legumes
CHOLINE:
Choline is now classified as an essential nutrient, and a supplement is recommended. Choline is a part of all cell membranes and supports a baby’s neuronal tube formation and cognitive development.
Food sources: Apple with skin, banana, whole grain/ wheat but lost in refined grains, broccoli(cooked).
Omega-3 fatty acids: Omega-3 fatty acids are required to develop the brain, central nervous system, and retinas. These essential fatty acids are critical in pregnancy, and breastfeeding has been associated with an improved, healthy baby. We can’t make omega 3, which must be obtained from food sources or supplements.
Fish is an important source, but mercury toxicity for infants is a risk.
Plant sources are flax and chia seeds.
HOW CAN TIGRAY MEET THIS CHALLENGE?
Long-term: Tigray must solve food security(self-sufficiency) and clean water supply. Teaching and recommending to parents what their offspring needs will not be productive.
A department/Agency on child welfare should be established. ( it could include the health department, parents, religion, and teachers.
As the African saying goes, “ It Takes a Village to Raise a Child.”
Policy on Child Development, vaccination, etc.
Training frontline health workers who could provide education and direct care is vital.
Early start education at small local centers/cooperatives

As I have stated above this topic needs more research and this is just a start point of discussion