Malnourished children in a nutrition center in Niger. Image: Reuters The first 1,000 days of growth are crucialIn sub-Saharan Africa 66% of children are at risk Although infant mortality has declined worldwide, approximately 250 million children (43%) in low and middle-income countries are at risk of not fulfilling their development potential due to extreme poverty and delays in growth, according to the findings of a series of three documents on early childhood development, published in the journal The Lancet.The first thousand days in a child’s life, from conception, are recognized as a crucial period of development, but many children are exposed to poor sanitation, infections, lack of affective care and inadequate stimulation during this time. The new estimates suggest that children who do not meet their development potential may lose up to a quarter of the average development capacity and that the overall cost to countries can be up to twice their national health expenditure. The findings reveal the importance of providing nutritional care – defined as care that promotes health, nutrition, safety and early learning – to help children reach their developmental potential. Although most families provide this type of care for their children, many cannot because of poverty, poor working conditions, violence or lack of support policies. The authors find that there is good evidence to support early childhood development programs but that many lack adequate funding or lack resources. “A growing number of children are surviving, but they begin their life at a disadvantage because they do not receive the nutritional care they need. Prioritizing the policies, laws and financing of early childhood development programs is essential to ensure their success , such as creating a policy environment that supports affective care, free preschool education and breastfeeding support, “says series author Linda Richter, a professor at the University of the Witwatersrand in Johannesburg, South Africa. “Our economic analysis shows that the cost of inaction is huge and in many countries it is much higher than your health expenditure. Supporting affective care is a good investment and should be a priority in all countries,” says the co-author of the Gary Darmstadt series, professor at the Stanford University School of Medicine in the United States. Need for parenting support A new analysis, published in the magazine The Lancet Global Health To accompany the series, it offers updated estimates on the number of children at risk of poor development. While universal standards for measuring child development are not yet available, there is strong evidence that exposure to developmental slowdown and extreme poverty are associated with poorer cognitive and educational development, worse adult health and health. lower income The analysis estimates that in 2010, 249.4 million children (43%) in low and middle-income countries were at risk of poor development as a result of deficiencies and extreme poverty, having declined since those of 279.1 million in 2004 In sub-Saharan Africa, it is estimated that 66% of children are at risk of poor development due to stunted growth and poverty; 65% in South Asia, and 18% in the Caribbean and South America. The evidence strongly suggests that parents, caregivers and families need support in foster care. A number of policies are known to be effective, but there are still large differences in their dispensation, such as early schooling, since only 4% of countries provide at least one year of free preschool education and even in high-income countries , almost a third do not offer free preschool education. Only 40 countries provide the recommended amount of free preschool education at 2 years. As regards paid parental leave – which can support the union and care of young children – eight countries do not guarantee paid maternity leave and most establish a minimum of 12 weeks with the payment of at least two thirds of the salary , but without reaching the submerged economy, and only 77 countries provide some kind of parental permission. Breastfeeding reduces the risk of several childhood illnesses and improves cognitive function, so in 139 countries they guarantee breastfeeding permits for at least six months and in 43 countries the payments of those permits are guaranteed. However, this does not cover the submerged economy and many women cannot breastfeed in the workplace, do not have a place in employment where milk is extracted or does not have available refrigeration systems. Having a basic income can help provide children with basic needs such as health and education. Although minimum wage policies exist in 88% of countries, many of them do not guarantee an income that is above the poverty level of two dollars per day for a parent who supports a child. To assess the ability to pay for interventions, the authors estimated the cost of expanding two actions aimed at promoting the care of parenting and the treatment of maternal depression. The extension of coverage to 98% would have an estimated additional cost of $ 34,000 million over the next 15 years for both interventions and an additional cost of $ 0.5 per capita in 2030, or a 10% increase in spending on previously published estimates for a comprehensive set of women and children’s health services. The authors also calculated the cost of inaction. For the 249.4 million children in low- and middle-income countries at risk of poor development due to extreme poverty and stunted growth, their average income as adults per year is likely to be reduced by approximately 26%. At the national level, the cost of inaction in the future may be much higher than the current national health expenditure of some countries.