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Adolescent Nutrition_Ruel-Bergeron

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Adolescent Nutrition_Ruel-Bergeron

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Adolescent Nutrition_Ruel-Bergeron

  1. 1. Adolescents in Low and Middle-Income Contexts Julie Ruel-Bergeron Program in Human Nutrition April 14, 2015
  2. 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
  3. 3. ©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Adolescent Demographics in LMIC: Regional Trends Source: UNICEF, 2012
  4. 4. © 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. Nutrition: Determinants of Nutritional Status in Adolescence Source: WHO, 2005.
  5. 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
  6. 6. © 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. Impact of Adolescent Pregnancy on Birth Outcomes: LBW and Preterm Gibbs et al, Pediatr Perinatal Epi 2012
  7. 7. © 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. Predictors of Stunting in Pregnant and Non- Pregnant Adolescent Girls (Bangladesh) Source: Rah et al., 2009.
  8. 8. © 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. Annual changes in anthropometric measurements by pregnancy status
  9. 9. © 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. Mean annual changes in height by time since menarche and pregnancy status Rah et al., 2008.
  10. 10. © 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. Mean Annual Changes, by Time Since Menarche Rah et al., 2008.
  11. 11. The Condition of the Adolescent in LMIC: Burkina Faso, Indonesia, Zambia Risks and Challenges
  12. 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. 13. © 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: 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
  14. 14. © 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 • 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. 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
  16. 16. Reaching Adolescents: Delivery Platforms
  17. 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. 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. 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. 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. 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. 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
  23. 23. Questions?

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