Today, we are going to talk about opportunities beyond 1000 days and our
guesses for today is Professor Benjamin Crookston, who is a professor of
public health nutrition at Brigham Young University in Utah United States and
also we have dr. Kirk Dearden who's been working with IMA World Health
in Tanzania in a project to prevent stunting in five regions in Tanzania.
Thank you very much for being here, and my first questions is related to the
study published in American Journal of Clinical Nutrition, which is authored by Ben
and also Kirk, which talked about post infancy growth, schooling and cognitive
achievement. So, can you tell us more about the design, the subjects, and the
main findings of the study, Ben? Yes, so Dr. Dearden, myself, and a number of other
colleagues from various countries around the world
works on the study working with in collaboration with a study group of Oxford, England,
Oxford University, called the young life study, and the young life
study follows 8,000 children in four different countries: Ethiopia, Peru,
Vietnam, and India, and follows these children from when they are 1 year of
age and forward several years. And in our study, specifically we looked at
measurements of growth and cognition at years 1, 5, and 8, and the primary purpose
of our study was to determine how kids who experience growth recovery following
early nutritional insults and deficits. How well they did
cognitively when they were age 8 compared to kids who experience
persistent stunting, or with children who never experienced nutritional deficiencies.
And what we found in our study the results showed that children
who experience some form of growth recovery
did better in the three different tests that we looked
at mathematics, receptive vocabulary, and reading comprehension. They're also more
likely to start school on time than their peers who experience stunting and
who didn't recover. That's very interesting, and Kirk, can you tell us
the relevance of study findings with Tanzania context or perhaps Indonesia?
Yes, so as somebody who's trained in epidemiology, I almost
almost always a little reluctant to say it's directly relevant to Tanzania,
but because one of our countries was Ethiopian, because we looked at four
countries across three continents, I think there is relevance to Tanzania.
And for Indonesia, perhaps? I think as well, I think the closest country to
Indonesia is Vietnam in the study. So, like I say, we need to be careful in our
interpretation, but because there are multiple studies even beyond ours that
are showing this, I think we do need to look at the results and consider how
they might be applied in Indonesia or Tanzania. And these eight thousand children represent
quite a range of different households, wealth quintiles, ethnicities,
and so there was really you know rural and urban mix, and so there's really
quite, you know Kirk says you can't generalize results to every other place,
we think these are pretty informative for countries even that weren't included in the study
Alright, so what do you think of the
first 1000 days which is widely believed as the most, or maybe for some,
the only important period of child development? So, I would agree with those
who believe that it's the most important period of development. The research, study
after study has shown that window of opportunity from conception until the
second birthday includes very rapid brain development, as well as the rest of
the body, and that the nutrients that a child receives during that time are very
critical for the long run experience,
proactivity of that person in a population, and the investments made
during that time are really really valuable.
Kirk? I think that I think there is a change in mindset for policymakers,
program planners, implementers, evaluators, because we tend to get fixated on the first
1000 days of life, but in fact there's quite a bit of potential for
catch-up growth and improvements in cognition and performance in school,
so we should not ignore beyond 1,000 days because many children actually do
recover from something. Okay, so what are the opportunities beyond 1000 days?
So, our study showed the children beyond that thousand days can recover, and so
while we didn't measure specific interventions to look at what would make
a difference, we do know from other studies that maternal education plays a role,
the wealth of the family, whether or not they live in an area that has
various services. The children who lived in urban areas were more likely to recover.
So, what we... You know Kirk mentioned children beyond that 1000 days
can still experience meaningful recovery and improvements.
Those translate into other cognitive benefits as well.
What can we do to improve growth and development? For example, if the child was stunted in
the first three years of life? I think we can change the dialogue and what we're
thinking about in nutrition. So, obviously it's beyond the first 1000 days of
life we need to focus, and that means initiating a discussion with
policymakers and government, donors multilateral organizations, there is some
pushback at times on this concept. But, I think we have some compelling evidence
that we can make a difference and you know one of the best venues I think
is working with Departments of Education, Ministries of Education, because they do
recognize the importance both of nutrition
and child element across a long period of time. So, that would impact of course
national nutrition policy and programs, for example, in Indonesia we have 1000
days movement. Do you think it needs to be expanded? Absolutely,
absolutely. I think we can have a much greater impact on children if we expand
it beyond 1000 days, so looking at pre-primary school as well as primary
school because subsequent studies we've done suggests that that catch-up growth
continues even beyond five years of age. And, what do you think, Ben?
I agree with Kirk. I think that we need to maintain a strong focus on the first
1000 days, but an openness to working with children beyond that, and investing
in programs that continue to benefit children and their households.
Great, thank you very much.
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