Tokyo Nutrition for Growth Summit

Lord Rea Excerpts

Tuesday 28th January 2020 Lords Chamber

[Lord Rea (Lab)]

My Lords, I am grateful to my noble friend Lord Collins, because he has chosen a subject on which I did some work 55-odd years ago, based in Lagos in Nigeria. The MD thesis that came out of that study was called Interactions of Nutrition and Infection, so it was very relevant to tonight’s Question. The study was modelled on the Newcastle Thousand Families longitudinal study, which observed a cohort of babies born successively in May and June 1947 and followed up for a number of years afterwards.

Lagos presented very different problems from Newcastle when randomly selecting which families to include in the study cohort. In the end, we were able to follow 420 randomly chosen infants in 250 families. All the children were seen every three months, when they would be weighed, measured and a note made of any illnesses that they had suffered. A visit to the child’s home was made if they did not attend the clinic. They were each allocated an illness score, depending on the severity and duration of the illness. It was possible to relate the illness score—equivalent to morbidity—to their nutritional state and growth over the previous three months, as well as to certain measures of social status such as the parents’ work, education, housing and so on. A weighted sample of well-off Nigerian professional families living a western lifestyle was included to act as a comparison with typical Lagos children. Their nutritional state and pattern of illnesses were very similar to those of typical western children of the same age, but the latter recovered much more quickly than the typical Lagos children from each episode of illness, which in their case was usually less severe.

It is not possible for me to describe the methods of study and analysis in any detail in a short speech, so I will not bore noble Lords with more research details. This type of study has been used in several other longitudinal studies in the UK and the US, and other developing countries.

The well-known signs of malnutrition, such as oedema and skin changes, were not overtly present in most of the children, but—apart from the chosen well-off group, of course—their mean weight and, less so, height was well below the norm, running at barely the 50th percentile of the better-off western norm. However, as I said, malnutrition was not overtly visible. If they were observed playing with other children, for instance, it was difficult to label them as malnourished.

Common childhood infections were present in children of all nutritional and social levels, but there was a tendency for them to be more serious and longer-lasting among those most underweight for their age, who more frequently developed pneumonia or diarrhoea as a complication. This pattern was shown most clearly in measles; the vaccine was then not yet available.

Tropical diseases did not present a great problem in Lagos, apart from some helminth infestation that did not seem to do much harm. Malaria was rare, unusually for Nigeria, because all parents used Nivaquine—that is, Chloroquine—as soon as their child had a fever, so the malaria parasite was more or less drugged out of the city. Compared with this group, a group of children of the same age in a village 20 miles outside was absolutely saturated with pneumonia. They had 2 grams less per 100 millilitres of haemoglobin, too.

It was possible on fuller analysis to show that the illness scores were higher in the most underweight children. Statistically, the episodes lasted longer and more frequently developed into pneumonia or diarrhoea. This tendency has led clinicians to concentrate on treating acute infections, neglecting nutrition in busy clinics. Supplementary nutrition is in fact not acceptable to an acutely ill child, but appetite usually returns during the recovery period—though less so if the child is already undernourished or the illness episode was severe.

I see that I am running towards the end of my time. All noble Lords will have received emails from UNICEF asking us to ask DfID an enormous number of very apposite questions, which we have no time to do—but I am sure that the Minister and her department will have scrutinised them extremely carefully. The most important thing is that the funding for nutrition should continue and possibly be augmented. As I have already passed my time, I will call it a day.