Overview final 20.06.13

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Overview final 20.06.13

  1. 1. Mejorando sistemas para empoderar comunidadesOverview: Malnutrition, a clinical andpublic health problem; understanding itscauses, measuring it and effectiveinterventionsCollaboratives Improvement in Adolescence and Child Health WorkshopBelize June 21st 2013.MA Hinojosa-Sandoval - URC.
  2. 2. Malnutrition the facts• Children have the same growth potential upto age five, irrespective of where they areborn.• In a healthy, well-nourished population onlyaround 2% of children would naturally beshort enough to be classed as stunted.J L Smith and S Brooker, 2010, ‘Impact of hookworm infection and deworming on anaemia in non-pregnantpopulations: a systematic review’, Tropical Medicine & International Health, 15(7): 776–795R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures andhealth consequences’, The Lancet, 2008, Jan 19, 371 (9608), 243–60
  3. 3. Estado nutricional de los niños y las niñas menores de cinco años del EcuadorFuente: INEC - ECV 2005-2006 Quinta RondaRealizado por M. A. Hinojosa-Sandoval. Junio 20071,19 1,191,150,90,90,830,740,550,40,50,60,70,80,911,11,21,3ZscoreTENDENCIA DEL DIFERENCIAL Z CON LOSDATOS DE REFERENCIA INTERNACIONALT/E
  4. 4. Evaluación del estado nutricional de los niños y las niñasFuente: INEC - ECV 2005-2006 Quinta RondaRealizado por M. A. Hinojosa-Sandoval.Junio 2007Prevalencia de Desnutrición por edadDesnutricióncrónica (T/E)Desnutriciónglobal (P/E)Desnutriciónaguda (P/T)0 Meses 3,1 3,1 3,90-5 Meses 3,4 1,6 1,56-11 Meses 7,9 5 1,80-11 Meses 5,9 3,5 1,712-23 Meses 24,8 13,7 4,224-59 Meses 19,8 8,6 10-59 Meses 18,1 8,6 1,70510152025300 Meses 0-5 Meses 6-11 Meses 0-11 Meses 12-23 Meses 24-59 Meses%DesnutricinGlobalycronicaTENDENCIA DE LADESNUTRICIONDURANTE LA NIÑEZ
  5. 5. The smallest• El hombre mas pequeño del mundo visita al pastorchino Bao Xishun de 2,36 m, ese momento el masalto del mundo• The shortest man in theworld, He Pingping, 0,73 m– 19 years old, with thelongest legs’ woman of theworld
  6. 6. Malnutrition the facts• Globally, 165 million children are stunted;undernutrition underlies 3·1 million deaths inchildren younger than 5 years• As in Belize (22% EMI-UNICEF 2013 ), one infour of the world’s children are stunted,. Thatmeans their body and brain has failed todevelop properly because of malnutrition.• Moreover, malnutrition is underlying cause ofone-third of the global children’s deaths.• Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Zulfi qar ABhutta, Jai K Das, Arjumand Rizvi, Michelle F Gaff ey, Neff Walker, Susan Horton, Patrick Webb, Anna Lartey, Robert E Black. PublishedOnline June 6, 2013. http://dx.doi.org/10.1016/S0140-6736(13)60996-4
  7. 7. Malnutrition the facts• Stunting, or chronic malnutrition, isa result of a child having a poor diet(too few calories or too littlenutritious food, or both) for anumber of years, or an infectionleading to a deficient absorption ofnutrients.M de Onis, M Blossne and E Borghi, (2011) ‘Prevalence of stunting among pre-school children 1990-2020’, Growth Assessment and Surveillance Unit,Public Health Nutrition, 2011, Jul 14:1–7 2 R E Black, L H Allen, Z A Bhutta, et al (2008)‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 43–60R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet,2008, Jan 19, 371 (9608), 243–60
  8. 8. Malnutrition the facts• The first 1,000 days of life, beginningwith conception, through a mother’spregnancy and up until the age of two, isthe most critical period in a child’sdevelopment.• Even if a child’s diet improves later in lifeand any health issues are resolved,damage done during this period is largelyirreversible.M de Onis, M Blossne and E Borghi, (2011) ‘Prevalence of stunting among pre-school children 1990-2020’, Growth Assessment and Surveillance Unit,Public Health Nutrition, 2011, Jul 14:1–7 2 R E Black, L H Allen, Z A Bhutta, et al (2008)‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 43–60R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet,2008, Jan 19, 371 (9608), 243–60
  9. 9. Malnutrition the facts• Stunting can have an intergenerational effect:a mother who is stunted may in turn give birthto a small baby, because the fetus’s growth inthe womb may have been restricted.• Besides, a long-term lack of nutritious food, orhaving an infection such as worms, can resultin a lack of micronutrients (vitamins andminerals) in a child’s diet.• Nearly all deaths linked to micronutrientdeficiency are due to a lack of vitamin A, zincor iron.UN Inter-agency Group for Child Mortality Estimation (2011) Levels & Trends in ChildMortality:Report 2011, New York: UNICEFN S Scrimshaw and J P San Giobanni (1997) ‘Synergism of nutrition, infection, and immunity: an overview’, American Journal of ClinicalNutrition,Vol 66, 464S–477SSee 1,000 Days Partnership website: http://www.thousanddays.org/about/M H N Golden (1988) ‘The role of individual nutrient deficiencies in growth retardation of children as exemplified by zinc and protein’,In: J C Waterlow (ed) (1988) Linear Growth Retardationin Less Developed Countries, New York: Raven press
  10. 10. Malnutrition the facts• The presentation ofKwashiorkor is no differentfrom septicemia, often affectsmultiple organ systemsKwashiorkor
  11. 11. YEAR U5MR LBW% BBF% EBF<6M% BFU2% Stunting%2013 106 14 51 10 27 222012 113 14 51 10 27 222009 97 8 10 27 182007 125 6 24 232005 79 6 24 232003 84 4 24 232000 83 4 24SOURCE: EMI UNICEF 2000 TO 2013. Published June 2013
  12. 12. EVIDENCE BASEDINTERVENTIONS TO TACKLEUNDERNUTRITION
  13. 13. Malnutrition the options• There are many examples of success in reducing theprevalence of chronic malnutrition (Brazil 1996-20061998-2006 Mexico, Peru 1990) . These experienceshave had in common interventions such as educationof women, an increased purchasing power of thepoorest families, increasing access and improvedquality of health services, health care models forfocalizing beneficiaries and the establishment of asurveillance system and evaluation on the impact. Allof these interventions are considered as nationalpriorities, for public health in Belize.50º CONSEJO DIRECTIVO, 62ª SESIÓN DEL COMITÉ REGIONAL. Washington DC ESTRATEGIA Y PLAN DE ACCION PARA REDUCIR LADESNUTRICIÓN CRÓNICA, EUA del 27 de septiembre al 1 de octubre de 2010. Punto 4.9 del orden del día provisional. CD 50/13Standards nutrition update 2011
  14. 14. Malnutrition the options• Besides, recommendations to tackle thechronic malnutrition in children undertwo are in the following scheme, mainlyfrom the electronic library on nutritionactions (eLENA) and existing evidenceused by WHO for development ofguidelines and policies for actionOPS/OMSStandards nutrition update 2011Zulfi qar A Bhutta, Jai K Das, Arjumand Rizvi, Michelle F Gaff ey, Neff Walker, Susan Horton, Patrick Webb, Anna Lartey, Robert E Black, TheLancet Nutrition Interventions Review Group, and the Maternal and Child Nutrition Study GroupEvidence-based interventions forimprovement of maternal and child nutrition: what can be done and at what cost? www.thelancet.com Pubished online June 6, 2013http://dx.doi.org/10.1016/S0140-6736(13)60996-4
  15. 15. Malnutrition the options
  16. 16. RESEARCH
  17. 17. RESEARCH
  18. 18. HEALTH SYSTEM OF BELIZE,AWARE OF THE NEED FORTACKLING CHRONICMALNUTRITION, CONSIDER:1.PREVENTIVE & EARLYINTERVENTION2.COMMUNITYEMPOWERMENT3.QUALITY INIMPROVEMENT HEALTHCARE SERVICES4.ASSURE SUSTAINABILITYTHROUGH QUALITYIMPROVEMENT PROCESS
  19. 19. Collaborative Improvement in Child HealthBelize June 21st 2013.MA Hinojosa-Sandoval - URC.
  20. 20. Collaborative Improvement in Child HealthBelize June 21st 2013.MA Hinojosa-Sandoval - URC.

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