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Adolescent Nutrition_Ruel-Bergeron
- 1. Adolescents in Low and
Middle-Income Contexts
Julie Ruel-Bergeron
Program in Human Nutrition
April 14, 2015
- 2. ©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Adolescent Demographics in LMIC:
Global Trends
1.2 billion and
growing 18% of
the world’s
population, 90% of
which live in LMIC
Source: UNICEF, 2012
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Adolescent Demographics in LMIC:
Regional Trends
Source: UNICEF, 2012
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Nutrition: Determinants of Nutritional
Status in Adolescence
Source: WHO, 2005.
- 5. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Risks and Challenges in Adolescence:
Nutrition, Early Marriage and Early
Pregnancy
• Adolescent girls often enter pregnancy with reduced
nutritional stores
– Competition for dietary energy and nutrients
• Physical immaturity of the mother
– More immature = ↑ obstetric risk
– ↑ maternal mortality
– ↑ prematurity, LBW
• Higher incidence of poor child health care and child
feeding behaviors
– Varies by SES
– Interference of pregnancy with schooling completion
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© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Impact of Adolescent Pregnancy on Birth
Outcomes: LBW and Preterm
Gibbs et al, Pediatr Perinatal Epi 2012
- 7. © 2014, Johns Hopkins University. All rights reserved.
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Predictors of Stunting in Pregnant and Non-
Pregnant Adolescent Girls (Bangladesh)
Source: Rah et al., 2009.
- 8. © 2014, Johns Hopkins University. All rights reserved.
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Annual changes in anthropometric
measurements by pregnancy status
- 9. © 2014, Johns Hopkins University. All rights reserved.
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Mean annual changes in height by time
since menarche and pregnancy status
Rah et al., 2008.
- 10. © 2014, Johns Hopkins University. All rights reserved.
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Mean Annual Changes, by Time Since
Menarche
Rah et al., 2008.
- 11. The Condition of the Adolescent in LMIC:
Burkina Faso, Indonesia, Zambia
Risks and Challenges
- 12. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Population characteristics
Burkina Faso Indonesia Zambia
- 13. © 2014, Johns Hopkins University. All rights reserved.
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Risks and Challenges: Education,
Reproductive Health, Sexual Practices
and Marriage
• Disparities by residence, wealth quintiles, and sex in
young adolescents
• In some instances, disparities become more
pronounced in older adolescents (education gap)
• Some unexpected trends:
• Early marriage in Indonesia
• Family planning in Indonesia and Zambia
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© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Risks and Challenges in Adolescence:
Nutritional
• Girls at greater risk of suffering nutritional difficulties than boys,
with more severe consequences as it relates to childbearing and
perpetuating the cycle of malnutrition
– Underweight
– Stunting
– Micronutrient deficiencies (anemia especially)
– Obesity
Sources: UNICEF 2011, UNICEF 2012
- 15. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Risks and Challenges in Adolescence:
Nutritional (cont)
• Lifestyle and eating behaviors, and underlying psychosocial factors also
threaten adequate nutrition
• Adolescent pregnancy imposes additional physiological and
nutritional stress, especially in stunted or underweight mothers
- 17. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
School and Education-Based
Programming
• School feeding
• Anemia control
• Nutrition-friendly school initiatives
• Other school-based adolescent-focused
programs
– India’s Saloni Swasth Kishori Yojna, Uttar Pradesh
– Zambia’s UN Girls Education Initiative
- 18. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Social Safety Net Programing
• Cash Transfers: conditional and unconditional
– Impact on HIV and education in Malawi
– Unconditional
• Varying impact based on recipient (mother/father)
and conditionality
– Conditionality matters more than recipient in terms of
improved child health outcomes
• Not a lot of evidence specific to adolescents, but a
promising avenue for addressing factors proximally
associated with adolescent nutrition and with
broader social benefits
– Education, early marriage, sexual behaviors, STIs, and early
pregnancy
• Microfinance interventions
- 19. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Youth Development and Community-
Based Approaches
• Peer education
• Adolescent and youth centers
• Faith-based community approaches
• Other community-based approaches
– Indonesia linking of marriage registries to target
health messages and IFA supplementation
– Promotion of gender equality at the community
level to address violence and SRH
- 20. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Technology-Based Platforms and
Sensitization/Mobilization
• Mhealth/nutrition
• Mass media communication
• Community-based sensitization
- 21. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Other Interventions/Programming
• Health Center-Based Programming
– Youth-Friendly Health and Nutrition Services
• Policy-level interventions
– National-level
• Incentives to delay early marriage (India and
Bangladesh)
• Scholarships for secondary education or life-skills
training
• HIV-specific legislation
– Policies by large donor institutions
• USAID’s Youth in Development Policy
- 22. © 2014, Johns Hopkins University. All rights reserved.
© 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.
Summary and Key Points
• Adolescents face many health and nutritional risks
– Injuries are the leading cause of death
– Other risks and challenges include mental health, substance
abuse, sexual and reproductive health (HIV especially),
education, violence and abuse
– Girls are more vulnerable nutritionally, as a result of the link
with early pregnancy and its impact on education, maternal
obstetric outcomes, and child outcomes.
• Various types of delivery platforms to reach
populations with health and nutrition services in LMIC
exist, but their potential for reaching adolescents
(girls especially) has yet to be unleashed