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First 1,000 days’ care of life         determines the Health Prospects for future                 Dr Kuntal Biswas        ...
2
RationaleThe 1,000 days between a woman’s pregnancy and her child’s 2ndbirthday offer a unique window of opportunity to sh...
4
5
Back Ground• On an average, more than 22,000 children < 5 yrs   of age still die every day from preventable causes.• Hunge...
Back Ground•World over 136 million babies are born annually, around  250babies every minute.•WHO’s recommendation of optim...
Breastfeeding in the First Hour:                           Why it MattersAll newborn mammals stay close to their mothers a...
Colostrum – First Food■ Colostrum is the first rich, yellow milk -.contains large amounts of   leukocytes – living cells t...
Intelligence quotient by type of feeding                                             BF 12.9 points    BF 2 points        ...
Nutrition during pregnancyConception to 2nd week              The total cost of supplying•Umbilical cord not formed       ...
Growth Faltering by Age                          12                          12
13
14
Lets make malnutrition visibleMalnutrition is an "invisible crisis" - ignored by governments anddevelopment agencies. Most...
Six key nutrition solutions• Iron, vitamin A and zinc – are typically packaged as  capsules costing pennies per dose, or a...
WHO child growth standards       • WHO standards for MUAC-for-age,                       115 mm is recommended as         ...
Need of Nutrition Not only proper food ,but proper feeding technique is required for proper growth & development.Babies fe...
Human Brain Development        Synapse Formation Dependent on Early Experiences   Required3 Components1. Nutrition2. Preve...
Emerging Brain Structures•At 3 week after conception, the neural plate forms .•At 6 week Spinal Synapse occurs.•50,000 neu...
Eight Phases in Embryonic and Fetal        Development at a Cellular Level1. Mitosi s 2. Migration 3. Aggregation 4.Differ...
Brain Cell Connections in the Early Months newborn       1 month         3 months            6months             146 Years...
Parenting as Primary Prevention of Ill HealthPromoting Parenting Skills in the first 1000 days– Parenting is personal – ma...
Altered Immunity                    Human rights   in PEM & IDA         The International Convention onChildren           ...
Proper Food Handling•Wash caregivers’ and children’s    •Encourage families to continue   hands before food preparation   ...
Food Pyramid               26               26
Broad ObjectiveEvery birth should be safe, supervised & with scientific facilities, target• reducing child mortality by tw...
We can eradicate malnutrition in 20 yearsIt is a movement of individuals and organisations who aredetermined to make nutri...
Thanks           Nation’s           prospect          depends on              the          Nutritional           Status of...
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1000 days

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1000 days

  1. 1. First 1,000 days’ care of life determines the Health Prospects for future Dr Kuntal Biswas Registrar Medical College & Hospitals, Kolkata
  2. 2. 2
  3. 3. RationaleThe 1,000 days between a woman’s pregnancy and her child’s 2ndbirthday offer a unique window of opportunity to shape healthier andmore prosperous futures.Children who do not get adequate nutrition during the 1,000 daysbetween their mother’s pregnancy and their second birthday can sufferfrom stunted physical and cognitive development.Impaired cognitive function means a child can have a diminishedcapacity to learn, leading to lower educational performance andultimately, lower economic productivity.This in turn can hinder a nation’s economic development.Evidence shows that in countries where childhood undernutrition ispervasive, the loss to GDP can be as high as 2 to 3%, not includingthe indirect costs of malnutrition such as health care and lost wagesdue to illness.In the adult life they are greater risk of the NCDs such asdiabetes, heart disease, hypertension, Osteoporosis, Neuro-Psychiatric Disorder, Cancer etc, resulting life long medicalexpenses
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  6. 6. Back Ground• On an average, more than 22,000 children < 5 yrs of age still die every day from preventable causes.• Hunger starts in the womb. Malnutrition in the first 1,000 days can lead to irreversible damage to minds and bodies.• According to UNICEF’s State of the World’s Children 2010, undernutrition contributes to more than one- third of these deaths.• Undernutrition, particularly in children < 2 Yrs of age, prevents them from reaching their full development potential. 6
  7. 7. Back Ground•World over 136 million babies are born annually, around 250babies every minute.•WHO’s recommendation of optimal infant feeding includes: beginning breastfeeding within an hour of birth and exclusive breastfeeding for the first 6 mos, followed by timely and appropriate complementary feeding after 6 mos along with continued breastfeeding for 2 years or beyond.• Every minute more than 250 women need support to practice the first standard of health care for their babies.•According to the UNICEF’s State of World Children Report only 32.6 % (about 44.5 million) of the babies born worldwide are able to practice exclusive breastfeeding for the first six months, i.e. about 7
  8. 8. Breastfeeding in the First Hour: Why it MattersAll newborn mammals stay close to their mothers and start to suckleshortly after delivery.Breastfeeding immediately after birth is a natural behaviour. Human babies are nodifferent.Step 4 of the ‘UNICEF/WHO Ten Steps to Successful Breastfeeding’is “Help mothers initiate breastfeeding within a half-hour of birth.”The uninterrupted journey of a newborn baby to the mother’s breast isguided by the sensory stimulation of touch and smell.Finding the mother’s nipple for the first time outside the shelteredenvironment of the womb, baby and mother’s first encounter is notonly full of wonder but also full of nourishment & benefit for both. 8
  9. 9. Colostrum – First Food■ Colostrum is the first rich, yellow milk -.contains large amounts of leukocytes – living cells that engulf and defend against viruses and infectious micro-organisms.■ It has large quantities of the antibody, secretory immunoglobulin IgA which protects the vulnerable mucous membranes of the throat, lungs and the intestinal tract.■ It has a laxative effect that helps the newborn baby pass early stools and excrete excess bilirubin and prevent jaundice.■ A newborn baby’s stomach holds about 5 to 7 mL, the amount of one teaspoon. Newborn babies need frequent feeds to gain the maximum benefit from colostrum and to stimulate milk production.■ By day 3 the baby’s stomach capacity has grown to nearly 30 mL■ Stomach capacity of newborn to 1 yr increases 10 times 9•Stomach Volume of adult is: 20.4ml/KG of BW& 30gm/KG of BW
  10. 10. Intelligence quotient by type of feeding BF 12.9 points BF 2 points higher than FF higher than FF Study in 9.5 year-olds Study in 3-7 1996 year-olds 1982 BF 8.3 points higher than FF Study in 7.5-8 BF 2.1 points year-olds higher than FF 1992 Study in 6 months to 2 year- olds References: 1988 BM 7.5 points •Fergusson DM et al. Soc higher than no BM SciMed 1982 Study in 7.5-8 •Morrow- Tlucak M et al.BF = breastfed year-olds SocSci Med 1988FF = formula fed •Lucas A et al. Lancet 1992BM = breast milk 1992 •Riva Eet al. Acta Paediatr 1996 10
  11. 11. Nutrition during pregnancyConception to 2nd week The total cost of supplying•Umbilical cord not formed & maintainaning the Foetus•Mother’s food intake does not •Calorie: 40,000KCalhave an effect on the embryo up to •Protein: 910 gm2 wks •Calcium: 30 gmFrom 2 wks mother need extra •Iron: 540 mgEnergy, extra Protein, extra EFA, •Vitamin A: Retinolextra Iron, Calcium & other 5400-7200 micro gramMicronutrients.•Lactating mother need more than Fetal growth & development increases the BMR by 5%in Antenatal Period. during 1st trimester and 12% during 2nd & 3rd trimester. 11
  12. 12. Growth Faltering by Age 12 12
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  14. 14. 14
  15. 15. Lets make malnutrition visibleMalnutrition is an "invisible crisis" - ignored by governments anddevelopment agencies. Most malnourished children may appear healthy- there is no obvious “distress”Most people think malnutrition is all about not having enough food orenough of the right kind of food to eat. But there are many other linksin the chain Dealing with malnutrition means fixing all the links in thechain - food, health, sanitation, water and care... If children aredrinking dirty water or are playing in areas where people are defecatingin the open, diarrhea will ensure that the nutrients are not absorbedand that appetite will be depressed. If children donot receive enough attention from parents and care givers, they will failto receive the stimulation and interaction that helps convert food 15intake into growth.
  16. 16. Six key nutrition solutions• Iron, vitamin A and zinc – are typically packaged as capsules costing pennies per dose, or about $1 to $2 per person, per year.• The other three solutions – breastfeeding, complementary feeding and good hygiene – are behaviour-change solutions, which are implemented through outreach, education and community support. These can be delivered through community nutrition programs at a cost of $15 / household or $7.50/child.• All combined, the entire lifesaving package costs less 16
  17. 17. WHO child growth standards • WHO standards for MUAC-for-age, 115 mm is recommended as it will identify more infants and children as having severe acute malnutrition and have a high specificity of more than 99% over the age range 6–60 mos. mos 5 Types of UndernutritionStunting Under weightWasting Micro nutrient deficiency Over Weight/ Obesity 17
  18. 18. Need of Nutrition Not only proper food ,but proper feeding technique is required for proper growth & development.Babies feed themselves,caregivers’ role is to provide &help them in age appropriatemanner 18
  19. 19. Human Brain Development Synapse Formation Dependent on Early Experiences Required3 Components1. Nutrition2. Prevention of infection3. Psycho Social Stimulation Synaptic Connections 19 19
  20. 20. Emerging Brain Structures•At 3 week after conception, the neural plate forms .•At 6 week Spinal Synapse occurs.•50,000 neurons/ sec are developed.•There can be 15,000 synaptic connections for each cell.•In the 4th month , axons begin to form myelin, which helps to speed transmission&baby can show liking / disliking.Nerve cell generation complete.Cortex beginning to wrinkle.•By 28 weeks after conception, the brain has 100 billion neurons & 1 trillion synaptic beads.By 2 yrs age baby’s brain has double & by 3 yrs triple synaptic connections than adultbrain, but in later life the brain mapping decreases due to inappropriate handling.Nurture is equally important as Nature.•Myelinization completes by 30 yrs 6 Week Fetus 7 Weeks 14 Weeks 6 Months 20 20
  21. 21. Eight Phases in Embryonic and Fetal Development at a Cellular Level1. Mitosi s 2. Migration 3. Aggregation 4.Differentiation5. Synaptogenesis 6. Death 8. Myelination7.Rearrangement Between 40 and 75 % of all neurons born in embryonic and fetal development 21 do not survive.
  22. 22. Brain Cell Connections in the Early Months newborn 1 month 3 months 6months 146 Years Years 22 22
  23. 23. Parenting as Primary Prevention of Ill HealthPromoting Parenting Skills in the first 1000 days– Parenting is personal – makes pediatricians NERVOUS!– “Positive/Nurturing/Supportive” Parenting– Are parenting skills “teachable?” YES ! teachable •Early maternal supportexerts a positive influence onhippocampal development •The positive effect ofmaternal support onhippocampal volumes was greater innondepressed children Lusby et al., 2012. Available at: www.pnas.org/cgi/doi/10.1073/pnas.1118003109 23
  24. 24. Altered Immunity Human rights in PEM & IDA The International Convention onChildren Human Rights, to which nearly all countries of the world adhere, includes the right to access to food. Hunger and malnutrition are a violation of human rights. Nutrition is now so much a part of the consciousness of today’s political leaders, that the current political and economic crisis will not in the long run jeopardize the remarkable progress that has been achieved in overcoming or reducing the burden of IDA children PEM children malnutrition on the population of the Normal children country. 24
  25. 25. Proper Food Handling•Wash caregivers’ and children’s •Encourage families to continue hands before food preparation breastfeeding for ill baby. and eating •Avoid medications or birth•Use clean utensils, cups, and control methods that can bowls to prepare, serve, and affect breastfeeding store food. •Encourage the use of spoons•Avoid the use of feeding bottles and cups for feeding in•Serve foods immediately after responsive method with preparation. complementary foods,•Store foods safely expressed breast milk,• Use safe water. or breast milk substitutes 25
  26. 26. Food Pyramid 26 26
  27. 27. Broad ObjectiveEvery birth should be safe, supervised & with scientific facilities, target• reducing child mortality by two-thirds (MDG 4),• maternal mortality by three-quarters (MDG 5),• improving child nutrition (MDG 1). Success StoriesVietnam, the success in reducing malnutrition was fuelled byeconomic growth by reducing inequality and this led toimportant investments for the poorest.Mexico, a successful cash transfer programme made the receiptof money conditional on visits to health centers. .Brazils Zero Hunger programme was driven by the values ofthat countrys labour movement, by electoral politics, and by thepersonal conviction of then President Lula.India is undertaking ‘Janani Suraksha Yojona’ , JSK & NSSK with these
  28. 28. We can eradicate malnutrition in 20 yearsIt is a movement of individuals and organisations who aredetermined to make nutrition more visible, to raiseresources for it, to support governments which dosomething about it.There are about 170 million young children who aremalnourished, and there are many more adults who aresuffering from the terrible legacy of malnutrition early intheir own lives.Good nutrition and education may be not just the best way, but the ONLY way to reach ALL of the MDGs.  28
  29. 29. Thanks Nation’s prospect depends on the Nutritional Status of Mother & Children of that Country. 29

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