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Drivers of Undernutrition                 Bruce Cogill Ph.D.              Bioversity International   Nutrition and Marketi...
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Mean anthropometric z-scores using the WHO growth                      standard                                           ...
Mean WAZ z scores by age using the new WHO         standard, according to region (1–59 months)                            ...
The conceptual framework of malnutritionPoor Dietary Quality                                            5
S       Interventions                               Nutritional Status                                        H           ...
What we do in Nutrition: Typical Interventions that                               should workImproving diet quality       ...
Very useful as the conceptual framework is a causal model   that mainly focuses on biological factors MORE COMPLEXIn East ...
Comparing Under Five Nutrition with                                                              Changes in economic well ...
Food Systems, Food Environments, EconutritionInterrelationships among nutrition, human health, agriculture andfood product...
Underweight and obesity in women in 36 highest-stunting                            burden countries**Data on both underwei...
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Bruce Cogill (Bioversity) - Drivers of Undernutrition

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Presentation to the AIFSC-ILRI Nutrition Workshop

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Bruce Cogill (Bioversity) - Drivers of Undernutrition

  1. 1. Drivers of Undernutrition Bruce Cogill Ph.D. Bioversity International Nutrition and Marketing Diversity Programme Leader AIFSC Workshop“Food and nutrition in Eastern and Southern Africa” Nairobi, Kenya 10-11 September CGIAR Research Program on Agriculture for Nutrition and Health 1
  2. 2. 2
  3. 3. Mean anthropometric z-scores using the WHO growth standard Wasting Underweight StuntingSource: Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions usingthe World Health Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print) 3 3
  4. 4. Mean WAZ z scores by age using the new WHO standard, according to region (1–59 months) 4Source: Victora et al. Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions. Figure 2. Pediatrics 2010;125
  5. 5. The conceptual framework of malnutritionPoor Dietary Quality 5
  6. 6. S Interventions Nutritional Status H O R- Breastfeeding T- Complementary feeding Food/nutrient R- Vitamin A Health O intake supplementation U T- Zinc E supplementation S- Hygiene Health, Food Household Care Care Water/- Agriculture Foodsecurity Access Resources Resources Sanitation L- Poverty reduction Services O- Income generation N- Education G- Health systems strengthening INSTITUTIONS R- Women’s O empowerment U POLITICAL & IDEOLOGICAL FRAMEWORK T E ECONOMIC STRUCTURE S RESOURCES ENVIRONMENT, TECHNOLOGY, PEOPLE Adapted from Ruel (2008) & UNICEF (1990) 6
  7. 7. What we do in Nutrition: Typical Interventions that should workImproving diet quality 1,000 days Nutrition serviceand diversity deliveryIron folate supplementation Promotion of breastfeeding (reduces Treatment of severe acute(reduces maternal deaths by 23%) mortality by 13%) malnutrition in facilities (reduces deaths by 55%)Maternal multiple micronutrients Social and behavior change for(reduces LBW infants by 16% and improved complementary feeding Zinc for management of diarrheareduces maternal anemia by 39%) (reduces stunting) (reduces mortality by 9%)Calcium supplementation (reduces Maternal supplements ofrisk of pre-eclampsia by 52%) energy, micronutrients, and proteinConditional cash transfers with (reduces LBW infants by 32%)nutrition education (reduces stunting) Deworming (reduces anemia andIron fortification and increases growth)supplementation (reduces anemia by Neonatal vitamin A (reduces infant28% and maternal mortality) mortality by 21% in South Asia)Dietary diversification (e.g. reduces Delayed cord clamping (reducesanemia and vitamin A deficiency) anemia)Vitamin A fortification orsupplementation (reduces childmortality by 23%)Universal salt iodization (improves IQ 7by 13 points)
  8. 8. Very useful as the conceptual framework is a causal model that mainly focuses on biological factors MORE COMPLEXIn East Africa additional dimensions enhancing undernutrition include:• Socio-Economical (poverty, inequities, behaviors…)• Environmental (sizeable proportion of land arid and semi- arid, prolonged droughts followed by floods exacerbated by climate change)• Political (conflicts, poor governance, rent seeking…) Governance• Behaviours 8
  9. 9. Comparing Under Five Nutrition with Changes in economic well being No Change in Wt/Age Ht/Age Burkina Faso, Mali, Mauriti us, Lesotho and South AfricaAll other countries inBlue had improvednutrition during sameperiod as growth rates Changes in Underweight in Blue countries was 1.3% per year (1996- 2008) to close to zero Growth analysis from Radelet (2011) CGDEV 9 Nutrition data for Underweight and Stunting for same period from UNICEF UNDP
  10. 10. Food Systems, Food Environments, EconutritionInterrelationships among nutrition, human health, agriculture andfood production, environmental health , and economic production 10
  11. 11. Underweight and obesity in women in 36 highest-stunting burden countries**Data on both underweight and obesity prevalence for adult women were available for 29 countries. Stunting based on infants andchildren under-five. Source: WHO Global Database on Body Mass Index (2010) http://apps.who.int/bmi/index.jsp11

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