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In This Newsletter Spring 2003

Advancing Child Survival and the Millennium Development Goals in Ottawa

The heads of agencies on the Health, Nutrition and Population (HNP) Millennium Development Goals (MDGs) will meet in Ottawa, Canada May 8, 2003. The meeting, "Harmonized Action on the Health, Nutrition and Population MDGs" will gather leaders who are interested in supporting acceleration of progress toward the HNP MDGs in developing countries.

The Millennium Development Goals grew out of the agreements and resolutions of world conferences organized by the United Nations in the past decade. These goals have been commonly accepted as a framework for measuring development progress. The first seven Millennium Development Goals are directly or indirectly linked with the activities of the health, nutrition, and population sector in the World Bank, either as health and nutrition status indicators or as determinants of health outcomes.

This meeting will engage developing countries, donors and multilateral champions in the formulation of a common approach, to ensure relevance, feasibility and broad ownership of the development and implementation of a joint framework for action.

On May 7, 2003, in Ottawa, one day prior to the heads of agencies meeting, USAID and the Canadian International Development Agency (CIDA) are hosting "Advancing Child Survival: Reaching the Child Mortality MDG." This forum will provide participants with an opportunity to focus on coordinated action among partners to reach the Millennium Development Goal target of reducing the mortality rate among children under five by two-thirds by 2015. About ten and a half million children will die this year from easily preventable causes like pneumonia, diarrhea and malaria.

Child Survival Funding Update

In early February, President Bush released his budget proposal for FY 2004. As expected, his request for child survival and maternal health programs under the Foreign Affairs budget was $284.6 million for programs at USAID. This is a 23% cut from the $351 million appropriated for fiscal year 2003.

Time and again, cuts in funding for maternal and child health programs have been made in order to make room for increases in other programs such as global HIV/AIDS. It is no different this year. In his State of the Union address, President Bush announced an historic $15 billion, five-year initiative to fight the global AIDS pandemic. While such a commitment is welcomed and needed, it should not come at the expense of other important global health programs.

On April 3, 2003, Dr. Nils Daulaire, President and CEO of the Global Health Council and Bob Laprade, Director of the Children in Emergencies and Crisis Unit with Save the Children, testified before the House Foreign Operations Appropriations Subcommittee. Dr. Daulaire submitted written testimony that outlined funding requests for all global health issues. His oral testimony, however, focused on the importance of a much-needed increase in funding for child survival and maternal health. Dr. Daulaire demonstrated simple, low-tech interventions used to save mothers and children, such as Oral Rehydration Therapy (ORT) salts, bed nets, and antibiotics. Mr. Laprade, who has spent much of his career working in war-torn countries, focused his testimony on the global challenges of poverty, disease and disaster, especially as they relate to women and children. He urged the Subcommittee to consider a number of increased appropriations for FY 2004, including an additional $150 million for child survival and maternal health. These increases would help "to assure the ability of mothers and children to survive and thrive" through a "combination of bilateral assistance and new monies available for the Millennium Challenge Account."

What you can do!
In the coming weeks, the Coalition will be calling on you to contact key policymakers in support of increases in child survival funding. Working together, we can make a difference! As the Appropriations process continues, we will keep you apprised of developments and how else you can help. If you have any questions, please do not hesitate to contact , Legislative Associate at the Global Health Council.

View the full text of the testimonies:
Dr. Nils Daulaire, Global Health Council
Bob Laprade, Save the Children

Student Campaign for Child Survival Advocacy Day at Spring Conference

On March 10th, the Student Campaign for Child Survival (SCCS) held an Advocacy Day during its annual spring conference, "Child Survival: Make your Mark." Students from across the country met with their elected officials in support of effective programs that could save millions of children's lives. The successful event produced sixty-two visits to congressional offices, demonstrating well-coordinated grassroots support for child survival. Congressional offices responded with positive feedback, such as offering help with the budget process, offering letters of support, and commitments to put "the ask" for increased funding on their wish lists.

Representative Tom Lantos (D-CA) headlined the conference, updating participants on child survival and the Millennium Challenge Account. He then gave tips on how grassroots advocates could be more effective and pledged his own supporting leadership for child survival. Next, Mary McClymont of InterAction talked about political strategy and how SCCS fits into the broader coalition of child survival advocates. Eric Coleman, SCCS Co-Coordinator, provided a review of the Campaign since November of 2002.

In addition, SCCS Research Coordinator Erica Franklin outlined problems and successes of child survival in a PowerPoint that can be used by local student chapters. Dr. Al Bartlett of the U.S. Agency for International Development then gave attendees an idea of how programs work "on the ground." To provide a specific example of child survival programs in action, Emanuel Wansi from the BASICS project spoke about child survival programs in Senegal. Meg Bostrom of Public Knowledge Inc. offered advice on how to frame grassroots messages to different audiences. She stressed a "values-based" approach relating to the audiences' values, rather than focusing on statistics or other peripheral issues.

Following SCCS elections, Michael Bernstein clarified the Millennium Challenge Account, the Millennium Development Goals, and the current "ask" to Congress. Capping the conference was a speech by Global Justice's founder and Executive Director, Adam Taylor.

Advocacy for Child Health

The CORE Group and the US Coalition for Child Survival recently co-sponsored an advocacy training session focused on child survival. The half-day event, conducted March 24th on Capitol Hill, provided participants with the skills to translate their professional and technical expertise into effective advocacy.

Presentations included a policy review of the Millennium Challenge Account by Nisha Desai, InterAction's Director of Public Policy. An overview of The Global Fund to Fight AIDS, Tuberculosis, and Malaria and current child survival funding was provided by Michele Sumilas the Director of Government Relations at the Global Health Council.

USAID's Celeste Carr gave a presentation entitled, "Reporting Program Progress to USAID: Developing the Child Survival and Health Reports to Congress." A skills building session led by Josh Lozman, Grassroots Coordinator for the Global Health Council, walked participants through the legislative process and identified effective grassroots strategies. Lastly, the group learned firsthand from Christos Tsentas, a Legislative Assistant with the Office of Representative Barbara Lee (D-CA), about how constituents can influence the decisions of their Congressional representatives. All participants were invited to put their skills into practice by visiting their elected officials following the event.

Businesses Acting to Promote Health in Children

"Healthy Environments for Children" is the theme of this year's World Health Day, 7 April 2003. In support of World Health Day, the Global Health Initiative, in cooperation with the Global Corporate Citizenship Initiative, asked businesses to submit descriptions of their workplace or community projects targeting children infected or affected by HIV/AIDS, tuberculosis or malaria. Here are some of their stories.

Step Forward ... For the World's Children: Building Models Locally to Work Globally
Currently there are some 14 million children orphaned by AIDS and it is projected that the number will rise to more than 40 million by 2010. As a company with long traditions in both AIDS and pediatric medicine, Abbott Laboratories created Step Forward to help orphans and vulnerable children who are infected and affected by HIV/AIDS, and the communities that care for them. Step Forward supports model programmes in Tanzania and Burkina Faso on the African continent, as well as India and Romania by contributing grant funding, donated healthcare products and the time and skills of Abbott volunteers. Working with international partners (Axios Foundation, International HIV/AIDS Alliance and Baylor College of Medicine/Texas Children's Hospital), local governments and in-country non-governmental organizations (NGOs), the initiative aims to develop and support models to address specific community needs in four interrelated areas: (1) healthcare services and infrastructure; (2) voluntary HIV counselling and testing; (3) education; (4) basic community needs such as clean water. The long-term vision of Abbott through the Step Forward programme is to share its success in increasing the coverage and quality of care for orphans and vulnerable children by encouraging the adaptation and use of these models around the world.

Preventing malaria in a community in Mozambique
Malaria has a strong impact on the children in the community surrounding BHP Billiton's aluminium smelter, which is located in Mozal, Mozambique. In 2001, South Africa's Medical Research Council (MRC) estimated a malaria prevalence of 72-85%. This clearly had a significant impact on human development. More specifically, it also resulted in daily malaria-related absenteeism of up to 20% in some schools according to the MRC. In 2001, BHP Billiton decided to address these concerns by joining the Lubombo Spatial Development Initiative (LSDI), a public private partnership focused on malaria control. The partnership addressed this problem through a comprehensive intervention, including residual spraying of more than 200,000 residential structures. The MRC estimated that malaria prevalence has been reduced by as much as 70% in Mozambique as a result of this intervention, and a 2002 MRC survey has observed a sharp decrease in malaria-related absenteeism - in some schools near the BHP smelter, it dropped to less than 1%.

Investing in the families and children of workers in Nigeria
ChevronTexaco's operation in Nigeria, Chevron Nigeria Limited (CNL), designed the Adolescent Reproductive Health Program (CHARP) which focuses on workers' children ages 12-19. The programme is an edu-tainment model that addresses issues of adolescent reproductive health, career guidance, violence and role modelling. About 200 children and parents have participated in the annual HIV/AIDS workshops. Some of the adolescents who pass through the workshop become members of the Chevron's Lifeline Adolescent Reproductive Education Klub (CLARK). They serve as resource persons for other youth-to-youth programmes and as dramatists and poets in programmes for parents. In 2002, CNL encouraged 99% of its approximately 120 pregnant employees or dependants to undergo voluntary confidential counselling and testing. Through this service, CNL was able to successfully prevent mother to child transmission of HIV/AIDS through comprehensive treatment, including the use of anti-retrovirals.

Promoting HIV/AIDS prevention for high school students in Brazil
UNAIDS estimates indicate that there are currently 597,000 people living with HIV in Brazil. In 2001, the "International Year of Volunteering", Philips launched "DOE VIDA" (Donate Life), a project whose goal is both to provide state high school students with information about the risk of sexually transmitted diseases (STD/Aids) and to encourage lower-risk behaviours. To design the project, Philips Brazil worked with GTPOS (Grupo de Trabalho e Pesquisa em Orientacao Sexual - Sexual Orientation Research and Work Group), State Education Agencies and the Conselho Nacional Empresarial para Prevencao de DST/Aids - Brazilian Corporate Council for STD/Aids Prevention. Philips trained approximately 250 employees both in reproductive health as well as techniques to convey these ideas to children. Since 2001, Philips employees have reached 21,000 students. In order to affect the development of new habits, the project uses student interaction through emotion. The activities were integrated into the curriculum and employees were excused from work with pay so that they could participate. UNAIDS believes that Brazil has averted many potential HIV infections through effective campaigns and strong partnerships between the government and a vast range of organizations.

For more information on the Global Health Initiative (GHI), please contact them at or

For more information on the Global Corporate Citizenship Initiative (GCCI), please contact them at or

Does iron supplementation increase the risk of infectious diseases in children?

Evidence for Action logo

Evidence for Action is a series of articles that present key findings from systematic reviews of health care interventions. It is designed to help decision-makers cope with the ever-increasing volume of health literature through targeted summaries of reviews that evaluate the effects of health care interventions. Monthly additions to the series will be posted on

Does iron supplementation increase the risk of infectious diseases in children?

  • Iron deficiency is a significant health concern, most notably in children living in low-income communities.
  • Iron fortified foods and supplements aim to reduce iron deficiency anemia and its associated health risks.
  • Some research suggests that iron supplementation may promote infections in children.
  • This systematic review found that iron supplementation produced no harmful effects on the overall incidence of infectious disease in children. However, it slightly increased the risk of diarrhea.

Iron deficiency is the most common form of malnutrition, affecting an estimated 4 to 5 million people globally. According to WHO, nearly 50 percent of children under five in developing countries may be iron deficient, often due to diets low in this micronutrient. In tropical environments the problem may be exacerbated by malaria and worm infestations.

Iron Deficiency Anemia (IDA), a condition in which the body contains inadequate amounts of iron to meet its demands, is common and often severe in poor communities. IDA can impair both physical and mental development in children, with even mild anemia negatively affecting normal development in infants and young children. With early intervention, these effects can be reversed.

As iron-rich foods may not be available or accessible in low- and middle-income countries, programs aimed at providing iron through supplementation or fortification of basic food are widely advocated. However, data on the effect of iron supplementation are conflicting, especially in populations with a high infectious disease burden. Some research indicates that iron deficiency may prevent bacterial growth that in turn may offer an important defense mechanism against infection. Other studies suggest that iron deficiency may weaken the immune system, thus increasing susceptibility to infection. The evidence from prospective research of iron supplementation has been inconsistent, with studies showing either lower infection rates, no effect or higher infection rates. As children in developing countries are at substantial risk of illness and death due to infectious disease, it is vital to clearly establish the safety of iron supplementation.

To evaluate the effect of iron supplementation on the incidence of infections in children.

Of the 47 trials identified, 28 met the review inclusion criteria.

Iron supplementation in children has no apparent harmful effect on the overall incidence of infectious illnesses.
Iron supplementation is associated with a small increase in the risk of diarrhea.

There appears to be no increase in infections in children receiving iron supplements or foods fortified with iron. While there was an increased risk for developing diarrhea, the risk equates to an incidence rate difference of only 0.05 episodes per child per year. It cannot be determined from this study whether diarrhea resulted from infection (dysentery) or from the known irritating effect of iron on the stomach and intestine. Further analysis showed there was no increased incidence of diarrhea among those receiving fortified foods. This suggests that foods fortified with iron may provide a safer and more beneficial route when administering iron supplementation.

While clinical and methodological variations (heterogeneity) were present, the main findings remained constant when sensitivity analyses were performed. Uniform definitions and active disease surveillance would have provided greater weight to findings.

Due to a potential protective effect against respiratory tract infections, further research evaluating the effect of iron-fortified foods on iron levels in the blood and their relationship to infection is suggested.

It will be difficult to ascertain the safety of iron in people with anemia, most notably in malaria-endemic regions, due to the ethical problem of withholding treatment in the placebo group of a controlled clinical trial.


Search strategy for studies.
  • Cochrane controlled trials register, MEDLINE, EMBASE, IBIDS and Healthstar Reference lists of identified articles
  • Handsearching of reviews, book bibliographies, international conference abstracts and proceedings
  • Donor agencies, "experts" and authors of recent iron supplementation trials contacted

  • Selection criteria for studies.
  • Randomized controlled trials comparing iron supplementation (oral route or parenterali) or fortification (formula milk or cereal) with placeboii
  • Trials evaluating one or more infectious illnesses as an outcome

  • Studies reviewed.
  • Twenty-eight trials (22 published and 6 unpublished) including 7,892 children followed up for 5,650 child years
  • Trials were conducted in Africa (11), Asia (8), the Americas (5), Europe (2), and Australasia (2)
  • 20 trials used oral supplementation; 3 trials used parenteral administration; and 5 trials used fortified foods.

  • Outcomes.
    Incidence rate ratios (IRR) for:
    All recorded illnesses (26 trialsiii)
  • 1.02, 95% CIiv 0.96 to 1.08

  • Diarrhea (17 trials)
  • 1.11, 95% CI 1.01 to 1.23

  • Non-diarrheal infections (24 trials)
  • 0.97, 95% CI 0.95 to 1.06

  • Dysentery (2 trials)
  • 1.00, 95% CI 0.87 to 1.15

  • Malaria (5 trials)
  • 1.07, 95% CI 0.94 to 1.24

  • Respiratory tract infections (17 trials)
  • 0.98, 95% CI 0.90 to 1.06

  • Lower respiratory tract infections (8 trials)
  • 0.97, 95% CI 0.83 to 1.23

  • Other infections (13 trials)v
  • 1.04, 95% CI 0.98 to 1.11

  • iAdministered in a manner other than through the digestive tract.
    iiTrials could not be placebo controlled if iron was given parenterally as administering a similar placebo would be difficult.
    iiiThree trials were treated as 6 in analysis due to two arms in the study.
    ivConfidence interval (random effects model). Random effects model used due to statistical heterogeneity.
    vIncluded septicemia, urinary tract infection, tuberculosis, unspecified fever, pyoderma and infectious illnesses not classifiable under RTI, diarrhea or malaria.

    Evidence for Action review summaries are produced by the Global Health Council. We have made every effort to provide an accurate summary of the review article profiled here. If further information is required, we encourage you to read the original review article: Source: Gera T, Sachdev HPS. Effect of iron supplementation on incidence of infectious illness in children: systematic review. BMJ 2002; 325:1142

    Evidence for Action review summary is written by Colleen Murphy, Research Associate, Research and Analysis Department, Global Health Council, 1701 K Street, NW, Suite 600, Washington, DC 20006, USA; ;

Read the February/March 2003 newsletter.

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This newsletter published by the US Coalition for Child Survival.