Dear Sir or Dear Madam,
Here are my opinions and responses to the four questions. Really is to the 3rd question where pediatric nutrition could be more related and has a scientific base. If any additional information may be of interest, please do not hesitate contacting me.
1st Q.
R: The main drivers are heavily influenced by politicians' will. Education and decreasing corrupts chain's impunity can be achieved by applying the constitution directives at all administrative levels. The obstacles are the chronicity of the situation, the current level of welfare, subsidies, lack of health efficacy over the whole country and food insecurity.
2nd Q.
R: The scenarios for Malawi represent quite accurately the present situation. The actions should be timed and priorized in order to gain efficacy. Perhaps the judicial branch should be the first to clean up (2nd and 4th scenarios).
3rd Q.
R: On behalf of the International Pediatric Association and as Chair of its Technical Advisory Group on Nutrition, I consider food security paramount and by extension the influence exerted over it by climate change. In order to improve the nutritional status of children in Malawi, the crops of sorghum grain should be preserved or even promoted. The reasonable content of protein (not in lysine) of these crops and their resilience to climate threats would justify this action. Another point that should be taken into account is to maintain or even increase the goat herds. By mixing the sorghum flour and the goat's milk (~3 L/day/animal) the DRIs requirements for lysine will be met. If nutrition improves so do infectious diseases issues. More technical data can be provided if necessary.
Furthermore IPA has contacts with the Malawi Pediatric Association and also with the Mzuzu University (HIRS center) so a plan for health providers education, as it is currently in place in some other countries of Sub-Saharan Africa, could be considered
4th Q
R: First step: if agriculture will continue to be the main basis for economy, transparency in its management and pertinent directions should be a priority, followed by transparency in politics and Education quality and development. Once these steps are ongoing the adaptation to climate change and health improvement should become easier
Manuel Moya
E Professor and Head
Chair of Technical Adviser Group on Nutrition. International Pediatric Association(IPA)
Chief Editor of IPA Newsletter
International Pediatric Association Foundation, Board of Directors
Vice President European Pediatric Association
Academician of the Real Academia de Medicina
Manuel Moya