- Email: [email protected]
Effect of parental education on child stunting
Correspondence
Christoph Benn
Authors’ reply
[email protected]
We fully agree that people living with HIV and AIDS in Africa need urgent support, and that the resources channelled to the Global Fund have saved many lives. But should this stop us from reflecting on whether (RED) is an appropriate business response in the long term, and from interrogating the role that (RED) plays in engaging a “wealthy, insulated, and privileged citizenry” with one of the worst pandemics in human history? In other words, the urgency of saving lives today should not prevent us from carefully analysing the complex effects of linking luxury consumption in the West with the provision of lifesaving treatment for people living with HIV and AIDS in Africa. We are also not arguing “that (RED) is only worthwhile if it takes on the burden of political education.” Indeed, (RED) does educate, and it is political; but what is the “this message” it is “taking to the masses”? (RED) affects our imagined perception of “AIDS in Africa” and our imagined agency as consumers in ways that we think are problematic. To construct consumption as an act of justice and compassion, and brand the corporations involved as leaders in global social responsibility, hides the relations of oppression that underlie the current global production regime. Commodities seem disconnected from those who have produced them, and the resources on which their production is based. The HIV/AIDS pandemic, in turn, is disconnected from its historical and contemporary roots in the global economy and posited as a technical or medical problem for which there is a simple solution. We have no doubt that people who buy (RED) care, and that (RED) saves lives. But we are concerned by the movement towards a governance structure of the pandemic that is tilting toward a more privatised, vertical, consumptionbased, and charity-oriented policy response. In a discussion paper, Richey and Ponte1 describe (RED) as the new
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, 1214 Vernier, Geneva, Switzerland 1
O’Manique C, Labonte R. Rethinking (Product) RED. Lancet 2008; 371: 1561–63.
The (RED) model of private-sector engagement1 has not just been effective by saving countless lives. It has also wet the ground through which a lot of corporate money can be channelled to the Global Fund from all over the world by generating more than US$100 million. This money makes up nearly all the private-sector contributions that the Global Fund has received so far. The effect of the (RED) model certainly set in motion a bandwagon effect for private-sector donations to the Global Fund, evidenced by Chevron’s recent commitment of $30 million to the Global Fund over the next 3 years. Friends of the Global Fund Africa’s mandate is focused on mobilising strategic political and financial support for sub-Saharan African countries in the fight against AIDS, tuberculosis, and malaria, and we have personally seen (RED) money reduce the ravaging effects of the three pandemics on families, communities, and continents in Ghana, Rwanda, Swaziland, and Lesotho, where private-sector participation is very little. (RED) is blazing a trail in Africa through its model of private-sector engagement that is a strong selling point on a continent where the private sector views the fight against disease as being the purview of civil society and governments alone. We would like to urge you to visit personally the African countries that (RED) has affected and see first-hand how the money raised has augmented their health systems in the face of challenging economic circumstances.
Akudo Anyanwu Ikemba [email protected] Friends of The Global Fund Africa, Plot 11B Fatai Idowu Arobieke Street, Lekki Phase one, Lagos, Nigeria 1
1836
O’Manique C, Labonte R. Rethinking (Product) RED. Lancet 2008; 371: 1561–63.
frontier of development assistance in which the “marriage of consumption and social causes has become one and indivisible.” (RED) can also be seen as the most recent in a growing list of market-driven social justice initiatives, a signal of the deeper entrenchment of “market citizenship” and a strategy, deliberate or otherwise, of obfuscation of the relation between contemporary global capitalism and the health of the poor. We fail to see how a fulsome examination of any intervention affecting people’s lives in profound ways is patronising to those living with HIV and AIDS in Africa. We declare that we have no conflict of interest.
Colleen O’Manique, *Ronald Labonté [email protected] Eaton College, Trent University, Peterborough, Ontario, Canada (CO’M); and Faculty of Medicine, University of Ottawa, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada (RL) 1
Richey LA, Ponte S. Better (RED) than Dead: ‘Brand Aid,’ celebrities and the new frontier of development assistance. DIIS Working Paper no 2006/26. Copenhagen: Danish Institute for International Studies, 2006.
Effect of parental education on child stunting We have some comments about Richard Semba and colleagues’ study on parental education and the risk of child stunting in Indonesia and Bangladesh (Jan 26, p 322).1 First, the observed difference in the prevalence of stunting between Indonesia and Bangladesh, with growth charts from WHO (33·2% and 50·7%, respectively) and the US National Center for Health Statistics (30·7% and 57·5%, respectively) is interesting and needs more explanation. WHO growth charts are recommended to be useful in infancy and region-specific growth charts for later ages.2 Second, birthweight is a major determinant of adult height.3 To draw conclusions in the Bangladeshi population without these data is unjust. Catch-up www.thelancet.com Vol 371 May 31, 2008
Correspondence
1
I declare that I have no conflict of interest.
We declare that we have no conflict of interest.
*Hari K V S Kumar, K D Modi hariendo@rediffmail.com
2
3
4
Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonsia and Bangladesh: a cross-sectional study. Lancet 2008; 371: 322–28. de Onis M, Onyango AW, Borghi E, Garza C, Yang H; WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) child growth standards and the National Center for Health Statistics/ WHO international growth reference: implications for child health programmes. Public Health Nutr 2006; 9: 942–47. Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev 2007; 28: 219–51. Finken MJ, Dekker FW, de Zegher F, Wit JM; Dutch Project on Preterm and Small-for-GestationalAge-19 Collaborative Study Group. Long-term height gain of prematurely born children with neonatal growth restraint: parallellism with the growth pattern of short children born small for gestational age. Pediatrics 2006; 118: 640–43.
Richard D Semba [email protected] Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA 1
de Onis M, Onyango AW, Borghi E, Garza C, Yang H, WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) child growth standards and the National Center for Health Statistics/ WHO international growth reference: implications for child health programmes. Public Health Nutr 2006; 9: 942–47.
Office 2.0: a web 2.0 tool for international collaborative research
Author’s reply The new WHO child growth standards are based on primary growth data from about 8500 children from widely different ethnic and cultural settings in Brazil, Ghana, India, Norway, Oman, and the USA and are meant to provide a single international standard that describes normal child growth from birth to 5 years under optimum environmental conditions and can be applied to all children everywhere, irrespective of ethnic origin, socioeconomic status, and type of feeding. The new WHO growth standard yields slightly higher estimates of stunting than does the NCHS growth reference.1 The “offending agent” in terms of height potential is poverty for www.thelancet.com Vol 371 May 31, 2008
Collaborative research is on the increase.1 International teamwork has been greatly facilitated by the internet and email, yet scientific collaboration goes beyond the mere exchange of messages and often requires computer tools such as spreadsheets and text editors. Although emails can carry attachments, they can prove impractical when documents need several revisions. Luckily, there are some new applications that can turn the internet into an even more powerful collaborative tool. These are broadly known as Web 2.0.2 Web 2.0 is a new manifestation of the internet, offering services and devices generally referred to as “social
software”. Web 2.0 is as “revolutionary” today as search engines and online multimedia content were 10 years ago.3 Wikis, blogs, and podcasts are probably the best known pillars of Web 2.0, but we would like to draw attention to another Web 2.0 tool, the “web office” or so-called Office 2.0. Enterprises such as Google and ThinkFree offer a free set of typical office productivity software (text editor, spreadsheet, presentations) that are used directly over the internet without any need to have the programmes on a local computer. As collaborating researchers living in different countries, we see many advantages to that. For instance, this letter was conceived on the internet as a Google Docs document. The web-stored document was accessible to each of us at any time, and from any computer or other device connected to the internet, irrespective of the “on board” office software. Revisions and editing were made directly on the same web-based file by both of us, so that we could avoid the fuss of different, and maybe asynchronous, versions of this letter. We could easily “invite” a colleague to peer review our work, and we could use hypertext links and notes to help us brainstorm. All these internet-related extras come together with standard capabilities such as full text formatting, spell check, word count, and the possibility to export the file in many of the commonest standards. In conclusion, our experience with Office 2.0 has shown what a powerful tool it is, and we commend it to our medical and scientific colleagues. We believe that use of Office 2.0 could greatly help international collaborative research and communication. And it is free!
For more on Google Docs see http://docs.google.com For more on ThinkFree see http://www.thinkfree.com/
Photolibrary
Department of Endocrinology, Medwin Hospitals, Chirag Ali Lane, Nampally, Hyderabad 500001, Andhra Pradesh, India
several generations. Unless a child’s environment substantially improves, the child will not show adequate catchup growth. Stunting is multifactorial in origin, and low birthweight is one of the causes. Finally, there were relatively fewer mothers and fathers within the categories of completing 10 or 11 years of education, which probably decreased the precision of the estimates for these particular points in figures 1 and 2. As shown in multivariate models in tables 3 and 4, there was a decreased odds of child stunting with greater levels of both maternal and paternal formal education.
growth is an important natural defence for short stature and these short individuals reach normal adult height after removal of the offending agent.4 Finally, the graphs comparing parental education with Z score (height for age) showed a negative trend at around 10–11 years of paternal education in both countries. What could be the reason for such an interesting similar observation?
We declare that we have no conflict of interest.
*Pietro Gambadauro, Adam Magos [email protected] Instituto Universitario IVI (Instituto Valenciano de Infertilidad, University of Valencia), 46015 Valencia, Spain (PG); and University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK (AM)
1837
Christoph Benn
Authors’ reply
[email protected]
We fully agree that people living with HIV and AIDS in Africa need urgent support, and that the resources channelled to the Global Fund have saved many lives. But should this stop us from reflecting on whether (RED) is an appropriate business response in the long term, and from interrogating the role that (RED) plays in engaging a “wealthy, insulated, and privileged citizenry” with one of the worst pandemics in human history? In other words, the urgency of saving lives today should not prevent us from carefully analysing the complex effects of linking luxury consumption in the West with the provision of lifesaving treatment for people living with HIV and AIDS in Africa. We are also not arguing “that (RED) is only worthwhile if it takes on the burden of political education.” Indeed, (RED) does educate, and it is political; but what is the “this message” it is “taking to the masses”? (RED) affects our imagined perception of “AIDS in Africa” and our imagined agency as consumers in ways that we think are problematic. To construct consumption as an act of justice and compassion, and brand the corporations involved as leaders in global social responsibility, hides the relations of oppression that underlie the current global production regime. Commodities seem disconnected from those who have produced them, and the resources on which their production is based. The HIV/AIDS pandemic, in turn, is disconnected from its historical and contemporary roots in the global economy and posited as a technical or medical problem for which there is a simple solution. We have no doubt that people who buy (RED) care, and that (RED) saves lives. But we are concerned by the movement towards a governance structure of the pandemic that is tilting toward a more privatised, vertical, consumptionbased, and charity-oriented policy response. In a discussion paper, Richey and Ponte1 describe (RED) as the new
The Global Fund to Fight AIDS, Tuberculosis and Malaria, Chemin de Blandonnet 8, 1214 Vernier, Geneva, Switzerland 1
O’Manique C, Labonte R. Rethinking (Product) RED. Lancet 2008; 371: 1561–63.
The (RED) model of private-sector engagement1 has not just been effective by saving countless lives. It has also wet the ground through which a lot of corporate money can be channelled to the Global Fund from all over the world by generating more than US$100 million. This money makes up nearly all the private-sector contributions that the Global Fund has received so far. The effect of the (RED) model certainly set in motion a bandwagon effect for private-sector donations to the Global Fund, evidenced by Chevron’s recent commitment of $30 million to the Global Fund over the next 3 years. Friends of the Global Fund Africa’s mandate is focused on mobilising strategic political and financial support for sub-Saharan African countries in the fight against AIDS, tuberculosis, and malaria, and we have personally seen (RED) money reduce the ravaging effects of the three pandemics on families, communities, and continents in Ghana, Rwanda, Swaziland, and Lesotho, where private-sector participation is very little. (RED) is blazing a trail in Africa through its model of private-sector engagement that is a strong selling point on a continent where the private sector views the fight against disease as being the purview of civil society and governments alone. We would like to urge you to visit personally the African countries that (RED) has affected and see first-hand how the money raised has augmented their health systems in the face of challenging economic circumstances.
Akudo Anyanwu Ikemba [email protected] Friends of The Global Fund Africa, Plot 11B Fatai Idowu Arobieke Street, Lekki Phase one, Lagos, Nigeria 1
1836
O’Manique C, Labonte R. Rethinking (Product) RED. Lancet 2008; 371: 1561–63.
frontier of development assistance in which the “marriage of consumption and social causes has become one and indivisible.” (RED) can also be seen as the most recent in a growing list of market-driven social justice initiatives, a signal of the deeper entrenchment of “market citizenship” and a strategy, deliberate or otherwise, of obfuscation of the relation between contemporary global capitalism and the health of the poor. We fail to see how a fulsome examination of any intervention affecting people’s lives in profound ways is patronising to those living with HIV and AIDS in Africa. We declare that we have no conflict of interest.
Colleen O’Manique, *Ronald Labonté [email protected] Eaton College, Trent University, Peterborough, Ontario, Canada (CO’M); and Faculty of Medicine, University of Ottawa, 1 Stewart Street, Ottawa, Ontario K1N 6N5, Canada (RL) 1
Richey LA, Ponte S. Better (RED) than Dead: ‘Brand Aid,’ celebrities and the new frontier of development assistance. DIIS Working Paper no 2006/26. Copenhagen: Danish Institute for International Studies, 2006.
Effect of parental education on child stunting We have some comments about Richard Semba and colleagues’ study on parental education and the risk of child stunting in Indonesia and Bangladesh (Jan 26, p 322).1 First, the observed difference in the prevalence of stunting between Indonesia and Bangladesh, with growth charts from WHO (33·2% and 50·7%, respectively) and the US National Center for Health Statistics (30·7% and 57·5%, respectively) is interesting and needs more explanation. WHO growth charts are recommended to be useful in infancy and region-specific growth charts for later ages.2 Second, birthweight is a major determinant of adult height.3 To draw conclusions in the Bangladeshi population without these data is unjust. Catch-up www.thelancet.com Vol 371 May 31, 2008
Correspondence
1
I declare that I have no conflict of interest.
We declare that we have no conflict of interest.
*Hari K V S Kumar, K D Modi hariendo@rediffmail.com
2
3
4
Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonsia and Bangladesh: a cross-sectional study. Lancet 2008; 371: 322–28. de Onis M, Onyango AW, Borghi E, Garza C, Yang H; WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) child growth standards and the National Center for Health Statistics/ WHO international growth reference: implications for child health programmes. Public Health Nutr 2006; 9: 942–47. Saenger P, Czernichow P, Hughes I, Reiter EO. Small for gestational age: short stature and beyond. Endocr Rev 2007; 28: 219–51. Finken MJ, Dekker FW, de Zegher F, Wit JM; Dutch Project on Preterm and Small-for-GestationalAge-19 Collaborative Study Group. Long-term height gain of prematurely born children with neonatal growth restraint: parallellism with the growth pattern of short children born small for gestational age. Pediatrics 2006; 118: 640–43.
Richard D Semba [email protected] Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA 1
de Onis M, Onyango AW, Borghi E, Garza C, Yang H, WHO Multicentre Growth Reference Study Group. Comparison of the World Health Organization (WHO) child growth standards and the National Center for Health Statistics/ WHO international growth reference: implications for child health programmes. Public Health Nutr 2006; 9: 942–47.
Office 2.0: a web 2.0 tool for international collaborative research
Author’s reply The new WHO child growth standards are based on primary growth data from about 8500 children from widely different ethnic and cultural settings in Brazil, Ghana, India, Norway, Oman, and the USA and are meant to provide a single international standard that describes normal child growth from birth to 5 years under optimum environmental conditions and can be applied to all children everywhere, irrespective of ethnic origin, socioeconomic status, and type of feeding. The new WHO growth standard yields slightly higher estimates of stunting than does the NCHS growth reference.1 The “offending agent” in terms of height potential is poverty for www.thelancet.com Vol 371 May 31, 2008
Collaborative research is on the increase.1 International teamwork has been greatly facilitated by the internet and email, yet scientific collaboration goes beyond the mere exchange of messages and often requires computer tools such as spreadsheets and text editors. Although emails can carry attachments, they can prove impractical when documents need several revisions. Luckily, there are some new applications that can turn the internet into an even more powerful collaborative tool. These are broadly known as Web 2.0.2 Web 2.0 is a new manifestation of the internet, offering services and devices generally referred to as “social
software”. Web 2.0 is as “revolutionary” today as search engines and online multimedia content were 10 years ago.3 Wikis, blogs, and podcasts are probably the best known pillars of Web 2.0, but we would like to draw attention to another Web 2.0 tool, the “web office” or so-called Office 2.0. Enterprises such as Google and ThinkFree offer a free set of typical office productivity software (text editor, spreadsheet, presentations) that are used directly over the internet without any need to have the programmes on a local computer. As collaborating researchers living in different countries, we see many advantages to that. For instance, this letter was conceived on the internet as a Google Docs document. The web-stored document was accessible to each of us at any time, and from any computer or other device connected to the internet, irrespective of the “on board” office software. Revisions and editing were made directly on the same web-based file by both of us, so that we could avoid the fuss of different, and maybe asynchronous, versions of this letter. We could easily “invite” a colleague to peer review our work, and we could use hypertext links and notes to help us brainstorm. All these internet-related extras come together with standard capabilities such as full text formatting, spell check, word count, and the possibility to export the file in many of the commonest standards. In conclusion, our experience with Office 2.0 has shown what a powerful tool it is, and we commend it to our medical and scientific colleagues. We believe that use of Office 2.0 could greatly help international collaborative research and communication. And it is free!
For more on Google Docs see http://docs.google.com For more on ThinkFree see http://www.thinkfree.com/
Photolibrary
Department of Endocrinology, Medwin Hospitals, Chirag Ali Lane, Nampally, Hyderabad 500001, Andhra Pradesh, India
several generations. Unless a child’s environment substantially improves, the child will not show adequate catchup growth. Stunting is multifactorial in origin, and low birthweight is one of the causes. Finally, there were relatively fewer mothers and fathers within the categories of completing 10 or 11 years of education, which probably decreased the precision of the estimates for these particular points in figures 1 and 2. As shown in multivariate models in tables 3 and 4, there was a decreased odds of child stunting with greater levels of both maternal and paternal formal education.
growth is an important natural defence for short stature and these short individuals reach normal adult height after removal of the offending agent.4 Finally, the graphs comparing parental education with Z score (height for age) showed a negative trend at around 10–11 years of paternal education in both countries. What could be the reason for such an interesting similar observation?
We declare that we have no conflict of interest.
*Pietro Gambadauro, Adam Magos [email protected] Instituto Universitario IVI (Instituto Valenciano de Infertilidad, University of Valencia), 46015 Valencia, Spain (PG); and University Department of Obstetrics and Gynaecology, Royal Free Hospital, London, UK (AM)
1837