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Chris Auricht - overview of population undernutrition

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Overview of Population undernutrition in eastern and southern Africa

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Overview of
 Population
 undernutrition in
 eastern and southern
 Africa
  Australian International
  Food Security Centre
  (AIFSC)

Christopher Auricht
chris@auricht.com and
Anne Marie Sanderson
aifsc@aciar.gov.au

NAIROBI
10 Sep 2012
2




Outline
Elements and consequences of
 maternal and child undernutrition
 and food security
Global and Regional SSA Context
East and Southern Africa Perspective
3




Elements and consequences
 Maternal  and undernutrtion responsible
  for > one third of child deaths
 Undernutrition – includes:
    Stunting
    Wasting
    Underweight
    Micronutrient deficiencies - deficiencies of
     essential vitamins and minerals

    Note - ‘malnutrition’ includes both undernutrion and overnutrition or
     obesity
4



Consequences of undernutrition i.e.
why is undernutrition important?
 Undernourished   children and those not
  optimally breastfed, or those suffering
  from micronutrient deficiencies have
  substantially lower chances of survival
  than those who are well nourished.
 Undernutrition in children  increased
  likelihood of:
   serious infection
   death from common childhood illnesses
    e.g. diarrhoea, measles, pneumonia and
    malaraia, as well as HIV/AIDS
5




Consequences of undernutrition cont.
  Chronic     undernutrion in early childhood
   Reduced cognitive and physical
    development  disadvantaged throughout life
  Nutrition   status affected prior to conception
   Highly  correlated to mother’s nutrition status
    prior to and during pregnancy
  Cyclical
   chronicallyundernorhised woman give birth to
    undernourished child
6




Importance of essential vitamins
 Micronutrients   provide essential vitamins and
  minerals
 Deficiencies occur when body doesn’t have
  sufficient amounts due to
     dietary intake and/or
     insufficient absorption and/or
     suboptimal utilisation
 Consequences       include
     iron deficiency anaemia
     iodine deficiency disorders
     blindness

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Chris Auricht - overview of population undernutrition

  • 1. Overview of Population undernutrition in eastern and southern Africa Australian International Food Security Centre (AIFSC) Christopher Auricht chris@auricht.com and Anne Marie Sanderson aifsc@aciar.gov.au NAIROBI 10 Sep 2012
  • 2. 2 Outline Elements and consequences of maternal and child undernutrition and food security Global and Regional SSA Context East and Southern Africa Perspective
  • 3. 3 Elements and consequences  Maternal and undernutrtion responsible for > one third of child deaths  Undernutrition – includes:  Stunting  Wasting  Underweight  Micronutrient deficiencies - deficiencies of essential vitamins and minerals  Note - ‘malnutrition’ includes both undernutrion and overnutrition or obesity
  • 4. 4 Consequences of undernutrition i.e. why is undernutrition important?  Undernourished children and those not optimally breastfed, or those suffering from micronutrient deficiencies have substantially lower chances of survival than those who are well nourished.  Undernutrition in children  increased likelihood of:  serious infection  death from common childhood illnesses e.g. diarrhoea, measles, pneumonia and malaraia, as well as HIV/AIDS
  • 5. 5 Consequences of undernutrition cont.  Chronic undernutrion in early childhood  Reduced cognitive and physical development  disadvantaged throughout life  Nutrition status affected prior to conception  Highly correlated to mother’s nutrition status prior to and during pregnancy  Cyclical  chronicallyundernorhised woman give birth to undernourished child
  • 6. 6 Importance of essential vitamins  Micronutrients provide essential vitamins and minerals  Deficiencies occur when body doesn’t have sufficient amounts due to  dietary intake and/or  insufficient absorption and/or  suboptimal utilisation  Consequences include  iron deficiency anaemia  iodine deficiency disorders  blindness
  • 7. 7 Importance of diet  Lackof adequate diet for a couple months or more between conception and 2 years of age deprives children of essential nutrients   Micronutrientdeficiencies  Constrained development  Stunting  Beyondtwo years of age most damage cannot be reversed
  • 8. 8 Food security calendar and scale of rural hunger  Nearly one billion people experience debilitation, health-threatening hunger each year  4 out of 5 of these people are rural farmers Trends in maize shortage in Zambia Percentage of farm households with maize shortage The Hunger Period
  • 9. 9 Measures and Indicators of undernutrition A considerable body of work carried out at global, national and subnational levels addressing population nutrition  Demographic and Health Surveys include indicators / measures to help track trends over time.  Involve key measurements of children, and women of child-bearing age (15-49 years).  Specific indicators include wasting, stunting and underweight status amongst children under 5 (0- 59 months), maternal thinness or body mass index (DMI) and prevalence of low birthweight babies ( < 2500 g)
  • 10. 10 Child Undernutrition Measures and Indicators  WHO Child Growth Standards 2006  Standard distribution of height and weight of children < 5 years (0 – 59 months)  Assessment of undernourishment based on comparison with WHO growth standards  Rates of undernutrition expressed in standard deviations or Z-scores from the median of this distribution
  • 11. 11 Child Undernutrition cont Anthropometric measures in children < 5 years  Wasting – low weight for height  Stunting – low height for age  Underweight – low weight for age
  • 12. 12 Child undernutrition metrics  Severe % < - 3Z–scores  Moderate % <-2Z- scores  Population prevalence – low, medium, high and very high
  • 13. 13 Indicator Prevalence (%) Low Medium High Very high Underweight (% with weight-for-age <-2 Z- <10 10 – 19 20 -29 ≥30 scores) Wasting (% with weight-for-height <-2 Z- <5 5-9 10 -14 ≥15 scores) Stunting (% with height-for-age <-2 Z- <20 20 - 29 30-39 ≥40 scores) Source: www.who.org
  • 14. 14 Maternal undernutrition Women 15 – 49 years (child- bearing age) Indicators include:  Body Mass Index (Thinness)  Height (Stature)  Micronutrient deficiencies (Iron, Iodine, Vit A)
  • 15. 15 Maternal undernutrition indicators Short stature – increased risk of obstetric complications Low pre-pregnancy BMI ( <18.5) – risk factor for child development and pregnancy outcomes Low iodine – risk for child development Low iron – risk for poor birth outcomes
  • 16. 16 General context – setting the scene
  • 17. 17 Food Security  “Food security exists when all people, at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”  World Food Summit 1996
  • 18. 18 Global Temporal Dimension Percentage urban and urban agglomerations by size class 2011 1980 2025 1960 Source: UN Pop Division World Urbanisation Prospects, 2011 Revision http://esa.un.org/unpd/wup/Maps/maps_overview.htm
  • 19. 19 Population 2000 and 2040 Sub- Saharan Africa (Millions) Population 2000 2005 2010 2015 2020 2030 2040 Total Pop 659 746 843 952 1,071 1,333 1,623 Rural Pop 447 491 537 586 635 724 795 Urban 212 255 306 366 436 609 828 Agric Pop 403 437 472 508 544 Females in 78 87 97 109 121 Ag Source: UN Pop Division World Urbanisation Prospects, 2011 Revision and FAOStat http://esa.un.org/unpd/wup/Maps/maps_overview.htm and http://faostat.fao.org/site/550/DesktopDefault.aspx?PageID=550#ancor
  • 20. 20 One Billion People Suffer Chronic Hunger and Poverty
  • 21. 21 Trends in Stunting and underweight Many African counties < 0.5 probability of meeting MDG 1 target (underweight) Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Gretchen A Stevens, Mariel M Finucane, Christopher J Paciorek, Seth R Flaxman, Richard A White, Abigail J Donner, Majid Ezzati, on behalf of Nutrition Impact Model Study Group (Child Growth). Lancet July 5,2012
  • 22. 22 Population density of underweight children under five Sources: CIESIN and Hunger Task Force (A and B, unpublished data) And GAEZ database
  • 23. 23 Number of countries where stunting rates are going up, down or are unchanged (latest survey minus the previous one) Region Total Improving No Deteriorating number of change countries Africa 29 12 6 11 Asia 20 13 6 1 S. & Central 14 6 7 1 America and Caribbean Total 63 31 19 13 SCN 6th World Nutrition Report. 2011
  • 24. 24 The Undernutrition Paradigm  Close links exist amongst food security (including agriculture), social protection and health  Links also exist between food security, nutrition and the broader determinants of poverty (including education, water supply, sanitation etc) and cross-cutting issues e.g. gender equity and governance  Such linkages between poverty, food insecurity and other causes and consequences often presented in frameworks
  • 25. 25 Framework of relationships between poverty, food insecurity and undernutrition Source: Black et al 2008
  • 26. 26 AIFSC South and Eastern Africa Perspective
  • 27. 27 AIFSC South and Eastern Africa Perspective  Burundi  Ethiopia  Kenya  Malawi  Mozambique  Rwanda  Uganda  Tanzania  Zambia
  • 28. Child undernutrition rates Prevalence of undernutrition in children under the age of five years (percent) Underweight Stunting Wasting (Weight for age) (Height for age) (Weight-for-height) Country Year <-2 Z-scores <-2 Z-scores <-2 Z-scores Burundi 2010 28.8 57.7 5.8 Ethiopia 2011 28.7 44.4 9.7 Kenya 2008-09 16.0 35.0 7.0 Malawi 2010 12.8 47.1 4.0 Mozambique 2011 14.9 42.6 5.9 Rwanda 2010 11.4 44.2 2.8 Uganda 2006 15.9 38.1 6.1 United Republic of Tanzania 2010 15.8 42.0 4.8 Zambia 2007 14.6 45.4 5.2 Mean - 17.6 44.1 5.7 Source: National Surveys
  • 29. Children Wasting Indicator Prevalence (%) Low Medium High Very high Underweight (% with weight-for-age <-2 Z- <10 10 – 19 20 -29 ≥30 scores) Wasting (% with weight-for-height <-2 Z- <5 5-9 10 -14 ≥15 scores) Stunting (% with height-for-age <-2 Z- <20 20 - 29 30-39 ≥40 scores)
  • 30. Children Underweight Indicator Prevalence (%) Low Medium High Very high Underweight (% with weight-for-age <-2 Z- <10 10 – 19 20 -29 ≥30 scores) Wasting (% with weight-for-height <-2 Z- <5 5-9 10 -14 ≥15 scores) Stunting (% with height-for-age <-2 Z- <20 20 - 29 30-39 ≥40 scores)
  • 31. Children Stunting Indicator Prevalence (%) Low Medium High Very high Underweight (% with weight-for-age <-2 Z- <10 10 – 19 20 -29 ≥30 scores) Wasting (% with weight-for-height <-2 Z- <5 5-9 10 -14 ≥15 scores) Stunting (% with height-for-age <-2 Z- <20 20 - 29 30-39 ≥40 scores)
  • 32. Maternal undernutrition Latest Women 15 – 49 Women 15 – available with height 49 with BMI data <145cm (%) <18.5 (%) Burundi - - - Ethiopia 2011 3.4 26.9 Kenya 2008-09 1.2 12.3 Malawi 2010 2.4 8.8 Mozambique 2003 4.9 8.6 Rwanda 2010 1.8 8.2 Uganda 2006 1.9 12.1 United 2010 3.4 11.4 Republic of Tanzania Zambia 2007 2.6 9.6 Mean - 2.7 12.2
  • 34. Vitmain A - Women Year Population with serum Public health retinol <0.7µmol/L (%) problem Burundi - 12.2 Moderate Ethiopia 1997 13.2 Moderate Kenya 1998 17.3 Moderate Malawi 1999 13.7 Moderate Mozambique 2002 14.3 Moderate Rwanda 1996 6.2 Mild Uganda 2001 23.3 Severe United Republic 2001 14.8 Moderate of Tanzania Zambia 2001 14.0 Moderate
  • 35. Vitamin A - Children Year Population with serum Public health retinol <0.7µmol/L (%) problem Burundi 2005 27.9 Severe Ethiopia 1996/97 46.1 Severe Kenya 1999 84.4 Severe Malawi 2001 59.2 Severe Mozambique 2002 68.8 Severe Rwanda 1996 6.4 Mild Uganda 2001 27.9 Severe United 1997 24.2 Severe Republic of Tanzania Zambia 2003 54.1 Severe
  • 36. Iodine deficiency  Needed from the mother during pregnancy  Deficiencies cause irreversible:  Cretinism (mental retardation)  Deaf-mutism  Dwarfism  Spastic palsy of the lower limbs  Spontaneous abortion and neontal deaths  Goitre – enlargement of the thyroid
  • 38. Iodine nutrition Date % population Classification Classification of iodine with UI <100 of iodine nutrition µg/L intake Burundi Ethiopia 2000 68.4 Insufficient Mild iodine deficiency Kenya 1994 36.7 Adequate Optimal iodine nutrition Malawi No data in 2004 WHO database Mozambique 1998 65.4 Insufficient Mild iodine deficiency Rwanda 1996 0.0 More than Risk of IIH in adequate susceptible groups Uganda 1999 11.9 Excessive Risk of adverse health consequences United Republic of 1996 37.7 Adequate Optimal iodine Tanzania nutrition Zambia 1993 72.0 Insufficient Mild iodine deficiency
  • 39. Iron deficiency  Most common nutritional disorder  Important micronutrient for oxygen transport  Lowlevels of consumption of meat, fish and poultry  Loss or destruction of red blood cells by hook worm and malaria  Measured by low levels of haemoglobin in the blood – low capacity to carry oxygen
  • 40. Anaemia - Public health significance Prevalence of any anaemia (%) Category of public health significance (WHO) ≤4.9 No public health problem 5.0 – 19.9 Mild 20.0 – 39.9 Moderate ≥40 Severe
  • 42. Anaemia % of children 6 – 59 months with % Women 15 – 49 with ‘any’ ‘any’ anaemia (<12.0 g/dl anaemia (<12.0 g/dl haemoglobin) haemoglobin) Burundi 44.6 18.5 Ethiopia 44.3 16.6 Kenya 69.0 46.4 Malawi 62.5 28.0 Mozambique 68.7 53.9 Rwanda 38.2 17.3 Uganda 72.6 49 Tanzania 58.6 40.1 Zambia 52.9 29.1
  • 43. 43 Overview Findings  Provided a snapshot of population nutrition for selected countries using a series of standard indicators  Evidence indicates that stunting and anaemia are the most serious undernutrition issues  Relationships between poverty, food security and undernutrition are strong  Addressing poverty and food security (agriculture production) and improving livelihoods critical to solution
  • 44. 44 Facts (Agriculture Perspective)  According to CGIAR analysis  One billion of the worlds poor within Africa and Asia (those living on less than $1 per day) are fed primarily by:  hundreds of millions of small-holder farmers (often with less than 2 ha of land, several crops, and a cow or two), or  Herders (most with fewer than five large animals)
  • 45. 45 Yield Gap – Aggregate of Major Crops
  • 46. 47 Thanks  Acknowledgements  ACIAR  Questions & Discussion

Editor's Notes

  1. This table shows an overview of the stunting, wasting and underweightprevalence for childrenunder 5 in the selected countries. The red shows a very high and serious rate of stunting in particular, an indication that the nutrtionproblems are underlying, chronic and linked to the longer term, chronic drivers of malnutrition. During the famine in Niger for example, rates of wasting are reachingabove 20 percent – sothings are gettingserious. The recenthorn of Africa crisismay have alsoimpacted on these rates of wasting in particular, as acute and short termshocks to foodsecurity or waves of illnessessuch as cholera or measlesthatcanspike in situations involvingdisplcament or camps. The focus of the workshops in Nairobi willbe to discussthese profiles with the local professionals to see how the underlyingfoodsecurity and nutrtion issues alignwith the capacities of the AIFSC.
  2. Wealsomapped out the distributrionsat the subnationallevel. The distribution was not uniormacrossentire countries withsome areas affected more thanothers. This isunderweight for example. So Redmeansworse, youcanseethat rates of underweight are mostserious in Ethiopia, whereas southern Mozambique isn’tsobad. Again – thesemapswillbesubject of discussion at the workshop, where countries maywish to drill down on important sub national trends in their population undernutrition.
  3. Againhereis the outcome for maternalindicators. Prevalence of short stature is not subkect to any standards or cutoff points for levels of public healthseveretiybecauseitis not somethingthattherecanbe an islated public healthresponse to. Short stature is a hugeproblem in southAsia in particular and causes a lot of maternalhealth complications. The rates of low BMI however are classified by the world health organisation and thisiscolourcodedsothat green meanslow, light organe medium and the dark orange as high whichis a serious situation in Ethiopia. Again – the BMI of women in thisage group maywell have been shocked and affected by the recentfoodinsecurity and instability, so the outcomes for the nextgenerationmaybeaffected by the low BMI of the currentpreganant and lactatingwomen in the famine affected populations.
  4. An estimated 33 percent of preschoolagedchildrenglobally are vitmain A deficiencywhichis about 190 million children. This places them as mentioned, at an increasedrisk of infectiousdiseases, and blindness.
  5. This table is an extractfrom the WHO Global Database on Vitmain A. There is more up to date data, but many of the national surveysusedotherindicators of vitmain A nutrition such as consumption of vitmain A richfoods. I chose this set becauseit has one indicatoramongst all the countries. WHO classifies thesepercentages as moderate, mild and severe.Amongst the focus countries shownheremost are classified as ‘moderate’ with the exception of Rwanda with ‘mild’ and Uganda with a ‘severe’ problem. Again, thesestats are quiteold, and willbe the subject of scrutiny and discussion in the workshop nextweek.
  6. All of the focus countries with the exception of Rwanda are reported in the WHO Global database as havingseverelevels of vitmain A deficiency in preschoolagedchildren..
  7. A second micronutrientisiodine. Iodineis essential for function of ourthyroid gland, and mostimportantlyitis important for the development of ourbrain in utero. The iodine nutrition of a baby isdirectlydependent on the iodine nutrition of theirmotherduringpregnancy. Deficiencies in iodine, in the mother – can lead to irreverible damage includingcertinism a form of mental retardation, itcan cause deafness and mnutness, dwarfism and canalso affect development of the lowerlimbs. Iodinedeficiencyis the mostcommonpreventable cause of mental retardation globally.
  8. Iodinedeficiencycanbemeasured on urinaryiodine concentration. Hereis a map of hte global ditributionDoesanyone know whereweget out iodinefrom? One source? Doesanyone know a common cause of deficiencylinked to geology and soil science?Doesanyone know how iodinedeficiencyiscombattedat the population scale?Rates of saltiodinsation are alsocommonlycollected as an indicator of iodinedeficiency as is Total GiotrePrevalencewhichmeasures how many people are affected by abnormalgrowth of the thyriod gland.
  9. Most of the focus countries have close to universalcoverage of iodisedsalt, sothisis a problemthatisbecomingless of an issue. Iodinedeficiencyislike the hole in the ozone layer of nutrition. Whereasstunintingislikeclimate change – manycomplexunderlying and interconnectingfactorswith out a single silverbullet of a solution.
  10. The public healthsignificance of rates of anaemiaisalsoclassified by WHO. People with concentrations of haemoglobin &lt;12 g/dl are conisderedanaemic and deficient in iron. If Lessthan 5% of the population have anaemiathisis not conisidered a public healthproblem, while rates above 40% in a particular population isconsidered a severeproblem.
  11. Hereis the global distribution of anaemia. The darkercolourissevereanaemia, showingsub-Saharan Africa lit verysignificantly. You cansee the way in whichiscoincideswithbothlowincome countries and areas withendemic malaria.
  12. Here are the rates of anaemia in the focus countries amongstchildren 6 – 59 months and in women 15 – 49. The red shows levelsconsidered to be ‘severe’ as they are greaterthan 40%. You will notice the drasticlevels of anaemiaamongstchildren in these countries. This couldberelated to the impacts of bothinadequatedietaryintake, as well as malria – which destroys redbloodcells; and otherparastic infections that affect redbloodcells.