2. Learning objectives
At the end of this session, the learner should
be able to:
• Describe what is meant by a lifespan approach to
the study of nutrition and health
• Describe the advantages of approaching nutrition
in a life cycle perspective
• Describe how nutritional status is influenced by the
stage of life due to the variation in specific factors
controlling nutrient availability and requirements
• Understand the different nutrition issues and
recommendations through the life cycle.
1/28/2024 Melese.S 2
3. Cont …
Identify and define the different stages of the human life cycle.
Explain how the human body develops from childhood through the elderly years.
Summarize nutritional requirements and dietary recommendations for school-aged
children.
Discuss the most important nutrition-related concerns during childhood.
Summarize nutritional requirements and dietary recommendations for preteens.
Discuss the most important nutrition-related concerns at the onset of puberty.
Discuss the growing rates of childhood obesity and the long-term consequences of
it.
Discuss the most important nutrition-related concerns during adolescence.
Discuss the most important nutrition-related concerns during young adulthood.
Summarize nutritional requirements and dietary recommendations for middle-
aged adults.
Discuss the most important nutrition-related concerns during middle age.
Define “preventive nutrition” and give an applied example.
Summarize nutritional requirements and dietary recommendations for elderly
adults.
Discuss the most important nutrition-related concerns during the senior years.
Discuss the influence of diet on health and wellness in old age.
1/28/2024 Melese.S 3
4. Nutrition:
Is the study of foods ,their nutrients and other
chemical constituents ,and the effects of food
constituents on health.
• Nutrition: is the science that interprets the interaction of
nutrients and other substances in food (e.g. Phytonutrients,
anthocyanins, tanins etc..) in relation to health and
maintenance, growth, reproduction, disease of an organism.
• Nutrition (also called nutrition science) studies the relationship
between diet and states of health and disease.
• The scope of nutrition science ranges from malnutrition to optimal
health. Many common symptoms and diseases can often be prevented
or alleviated with better nutrition.
1/28/2024 Melese.S 4
Introduction
5. Principles of human Nutrition
Food is a basic need of humans.
Food provide energy (calories)
,nutrients, and other substances
needed for growth and health.
Poor nutrition can result from both
inadequate and excessive levels of
nutrient intake.
1/28/2024 Melese.S 5
6. Nutrients:
Chemical substances in foods that are used by the body
for growth and health.
Malnutrition can result from poor diets and
from diseases states, gentic factors, or
combination of these causes.
Some groups of people are at higher risk of
becoming inadequately nourished than others.
1/28/2024 Melese.S 6
7. Poor nutrition can influence the
development of certain chronic
diseases.
Adequacy and balance are key
characteristics of a healthy diet.
1/28/2024 Melese.S 7
8. Scope and Categories of Nutrition
Problems
• Sufficient quantity
of
• Macronutrients
• Micronutrients
• Excessive or
Insufficient quantity
of
• Macronutrients
• Micronutrients
• Insufficient
quantity of
• Macronutrients
• Micronutrients
Health status and nutrition are integral to one another—that is, poor
nutritional status negatively impacts health, and poor health status can
negatively impact nutritional status.
1/28/2024
Melese.S
8
9. CONCEPT ----------
NUTRITION
Nutrition
The process by which
the body ingests,
absorbs, transports
uses and eliminates
nutrients and foods
(NC)
Nursing Care
Antecedents
Normal Alimentary Tract
and Associated Organs
Adequate Ingestion of
Nutrients and Water
Normal Temperature
Normal ph
Attributes
Adequate Intake for:
Development-Energy- Growth-
Tissue Repair
Ideal Ht-Wt-BMI—(MAC) (MAMM)
Muscle Tone-Strength-Agility-Reflex
Response
Cognitive & Mood Response.
Albumin WNL
Hemoglobin & Hematocrit WNL
Electrolytes WNL
Interrelated
Concepts
Human Development
Thermoregulation
Sub -
Concepts
Lifestyle Behaviors
Age-Gender-Genetics
Ethnicity
Socioeconomics
Knowledge
Consequences
(Outcomes)
Malnutrition
Insufficient/Excess Intake
Failure to thrive--Obesity
Growth/ Developmental Delay
Decreased Bone Density
Delayed-Inadequate Healing
Illness-Muscle wasting-Death
Low energy-Fatigue
Depression-Isolation
Positive
Negative
Engage in Physical Activity
Homeostasis/Adequate
Nutrition Hydration
Physiological and
Psychological
Wellness
Clotting
Malnutrition
Physiological-Psychological- Dysfunction
Ingestion- Digestion-Absorption-Metabolism
Diversity-(Lifestyle-Culture)
Medical
Conditions
Medications
Physiological &
Psychological
Development
Risk factors
Growth &
Tissue
Repair
Cognition
Fluid and Electrolytes
Food Allergies
Altered Hydration Status
Metabolis
m
Diets
Nutrients
Patient Education
1/28/2024
Melese.S
9
13. Birth
Pregnancy Infancy Childhood Adolescence Adulthood
Nutrition Throughout the Life Cycle
High Impact
Pregnancy until 2 years old
Micronutrient Supplements
• Vitamin A
• Iron-Folate
• Zinc
Malaria Prevention
using Insecticide
Treated Nets
Breastfeeding Promotion & Infant
and Young Child Feeding
(including complementary feeding)
Improve Hygiene and Sanitation
Universal Salt
Iodization
Zinc Mgmt of Diarrhea
Deworming
Treatment of severe
undernutrition with RUTF
Community Management of
Acute Malnutrition (CMAM)
Improved Nutritional
Value of Food
• Better quality crops
• Household Dietary
Diversity
• Fortification
1/28/2024 Melese.S 13
14. Definition
• The life cycle approach provides a
powerful framework for understanding
the vulnerabilities and opportunities for
investing at critical periods.
• These sensitive periods also represent
windows of opportunity through
interventions in a range of sectors
1/28/2024 Melese.S 14
15. Nutritional Needs Throughout
Life
• Nutritional needs throughout your life are
based on:
–MyPlate recommendations
–Dietary Guideline recommendations
–Age
–Gender
–Activity Level
1/28/2024 Melese.S 15
20. • The genotype is the set of genes in our DNA
which is responsible for a particular trait.
• The phenotype is the physical expression, or
characteristics, of that trait.
• For example, two organisms that have even
the minutest difference in their genes are
said to have different genotypes.
1/28/2024 Melese.S 20
22. Four main types of Growth and
Development
• Physical: body growth
• Mental: mind development
• Emotional: feelings
• Social: interactions and relationships
with others
1/28/2024 Melese.S 22
23. The four phases of human Growth
• Phase1(Intra Uterine period)
• Phase 2 (Infancy)
• Phase 3 (Childhood)
• Phase 4 (Adolescence)
1/28/2024 Melese.S 23
24. Growth Velocity curve
1/28/2024 Melese.S 24
The fastest
growth
occurs
during
intrauterine
life followed
by infancy
period and
puberty
26. Anthropological Perspective
on the Human Life Course
I. Fundamentals of Growth and
Development
II. Nutritional Effects on Growth and
Development
III. Early Evolution of Human Diet
IV. Diets of Humans Before Agriculture
V. Human Diet Today
VI. The Human Life Cycle
1/28/2024 Melese.S 26
27. I. Growth and Development
A. Growth refers to an increase in mass or
number of cells. An increase in cell number is
referred to as hyperplasia. An increase in cell
mass is referred to as hypertrophy.
B. Development refers to differentiation of cells
into different types of tissues and their
maturation.
C. The terms growth and development are often
used interchangeably, but they are different
processes involved in…
D. Stature and…
E. Brain growth.
1/28/2024 Melese.S 27
28. GROWTH & DEVELOPMENT
An essential feature of children which
distinguishes them from adults
Growth : Net increase in size or mass of
tissues. Due to
• increase in number of cells (2X 10 at birth, 6
X 10 in adults)
• increase in size of cells
• increase in ground substance
Development: Maturation of function
• Acquisition of skills
• Due to myelination of neurons
1/28/2024 Melese.S 28
29. I D. Stature
1. Stature is influenced by genetics, health and
nutrition.
2. Children with good health and adequate nutrition
are more likely to reach their genetic potential for
height.
3. Children who are malnourished or experience
prolong periods of poor health may not reach that
potential.
4. Members of higher socioeconomic groups tend
to be taller than members of lower
socioeconomic classes, reflecting the impact of culture
and economic status on the processes of growth and
development.
1/28/2024 Melese.S 29
30. I E. Brain Growth
Human brain growth is unusual among mammals:
1. At birth the brain is about 25 % of its adult
size.
2. Six months after birth it has doubled in size
and reached 50% of its adult size.
3. By age 5, the brain has reached 90 % of its
adult size.
4. By age 10 the brain is at 95 % of its adult size.
1/28/2024 Melese.S 30
31. Advancing Early Childhood Development: from Science to Scale
Sensitive periods and the developing brain
Cell division
and
migration
1/28/2024 Melese.S 31
33. II. Human Nutrition
A. Nutrition has an impact on human growth and
development at every stage of the life cycle.
B. There are five basic nutrients:
1. Proteins are composed of amino acids and are the
major structural components of the body, but serve other
purposes.
2. Carbohydrates are an important source of energy.
3. Lipids include fats and oils and protect as well as act to
store.
4. Vitamins serve as enzymes, substances that speed up
the chemical reactions necessary for running the body.
5. Minerals contribute to normal functioning and health,
and act as catalysts or structural components as well.
1/28/2024 Melese.S 33
34. III. Early Evolution of Human Diet
A. Our nutritional needs have evolved with the types
of foods that were available to our evolutionary
ancestors.
B. We have inherited the ability to digest animal
protein from our mammalian forebears.
C. Early primates also evolved the ability to digest
plants.
D. Immediate ape-like ancestors were primarily fruit-
eaters and passed on their ability to process fruit
to us.
E. Bottom line: Human needs for specific vitamins
and minerals reflect ancestral nutritional
adaptations. For instance…
1/28/2024 Melese.S 34
35. Bottom Line: Essential Amino Acids
• Adult humans lack the ability to synthesize 8/9
of the amino acids and must obtain these
from the diet.
– The amounts amino acids needed nutritionally
parallel the amount present in animal protein.
– This suggests that food from animal sources may
have been an important component of ancestral
hominid diets when nutritional needs were
evolving.
– So….
1/28/2024 Melese.S 35
36. IV. Pre-agricultural Diet
A. The pre-agricultural diet was high in protein
and complex carbohydrates and low in fats.
B. Many of our biological and behavioral
characteristics contributed to our ancestors'
adaptation, but may be maladaptive in our modern
industrialized societies.
e.g Today there is a relative abundance of foods in
western nations. The formerly positive ability to store
extra fat has now turned into a liability which leads to
degenerative diseases.
C. The human population began to increase when
people began to live in permanent settlements.
1/28/2024 Melese.S 36
37. V. Human Diet Today
A. Undernutrition means an inadequate quantity of
food.
– It is estimated that between 16 and 63% of the world's
population is undernourished.
B. Malnutrition refers to an inadequate amount of
some key elements in the diet.
– Malnutrition greatly affects reproduction and infant
survival.
– Malnourished mothers have more difficulties in producing
healthy children.
– Children born of malnourished mothers are behind in
most aspects of physical development.
1/28/2024 Melese.S 37
38. VI. The Human Life Cycle.
• Humans have five phases to their life cycle.
Prenatal begins with conception and ends with birth.
Infancy is the period in which the baby nurses.
Childhood is the period from weaning to puberty.
Adolescence is the period from puberty to the end of
growth.
Adulthood is marked by the completion of growth.
An extra period in females is menopause, recognized as
one year after the last menstrual cycle.
1/28/2024 Melese.S 38
39. Advancing Early Childhood Development: from Science to Scale
Environment in
Infancy/Childhood
Pregnancy
Environment
Parent’s
Health/Wellbeing
Pre-pregnancy Health
Learning
Quality and timing of early environments shape a child’s future potential
Genetic Blueprint for Development
Behavior
Environments across the life-course
1/28/2024 Melese.S 39
40. Advancing Early Childhood Development: from Science to Scale
Multi-generational impact of early
environments
Health of the mother
Pregnancy environments impact multiple
genomes.
The pregnancy contains the genomes of the
mother, the child and the grandchild.
Health of the father
Paternal pre-pregnancy health and well being
impacts the health and development of infants and
children.
1/28/2024 Melese.S 40
41. Advancing Early Childhood Development: from Science to Scale
Development
Variations in
Genetic
Sequence
Environment
Epigenetic
Modification
Adult Health and Wellbeing
Cardiovascular disease
Obesity/diabetes
Mental health
Cognitive function
Behaviour/social function
Gene environment interactions underlie
developmental programming
1/28/2024 Melese.S 41
42. Definition: Nutritional intervention refers to
corrective measures undertaken to rectify the
occurrence of overall malnutrition or specific
nutrient deficiency or excess.
• In the Ethiopian context, the commonest nutritional
problems are deficiency diseases.
• There are different options for nutritional
intervention based on the nature of various causes
underlying the problem.
1/28/2024 42
Melese.S
43. What is nutrition intervention?
• Intervention translates assessment data into
strategies, activities, or interventions that will
enable the patient or client to meet the
established objectives.
• Interventions should be specific:
—What? —When?
—Where? —How?
• Therefore, this chapter focuses on the
interventions against deficiency states.
1/28/2024 43
Melese.S
44. Timing of interventions
• Poor nutrition during the first 1,000 days—from
pregnancy through a child’s second birthday
results life-long and irreversible damage.
• As undernourished children become adults, they
are more likely to suffer from chronic diseases
– Obesity , High blood pressure , Diabetes,
heart disease etc..
1/28/2024 44
Melese.S
45. Timing of interventions
When we intervene ?
1. Critical period in life cycle
The critical window during “1,000 days” .
Interventions during this period can potentially reduce
under nutrition-related mortality and morbidity by 25
percent if implemented appropriately.
2. Intervention should continue through out life cycle
1/28/2024 45
Melese.S
46. Stunting is preventable : BUT
Need to act before the child is 2 years
Source: Victora et al 2010
The Critical “Window of Opportunity”:
1000 DAYS
Pregnancy: 9*30= 270 days
2 years: 365*2=730 days
Melese.S 46
1/28/2024
48. IRON & FOLIC ACID
USE IODIZED SALT
CORRECT FEEDING OF A SICK CHILD
SLEEP UNDER TREATED BED NETS
SAFE BIRTH &
NORMAL BIRTH
WEIGHT BABY
DEWORMING
VACCINATIONS
EXTRA MEAL/ DIVERSE DIET
CORRECT COMPLEMENTARY FEEDING & FOODS
VITAMIN A
ANTENATAL CARE
SAFE WATER & CAREFUL HYGIENE
GROWTH MONITORING & PROMOTION
EXCLUSIVE BREASTFEEDING CONTINUED BREASTFEEDING
FORTIFIED STAPLES
1 , 0 0 0 C R I T I C A L DAY S
PMTCT (NUTRITION AND BREASTFEEDING OPTIONS)
Melese.S 48
1/28/2024
50. General Principles of Nutrition
Intervention
• Should consider the conceptual framework
• Should be evidence based
• Should Cost effective
• Should integrate long term and short term
intervention( Lead to sustainability)
• Should be multi- sectoral
– Should consider nutrition specific and nutrition
sensitive interventions
1/28/2024 50
Melese.S
54. The UNICEF Framework and WASH
• Immediate Causes
– Directly impact nutrition status- food intake,
disease
• Underlying Causes
– Household and community level: care practices,
household food security, health services and
underpinned by poverty
• Basic causes
– Broad set of causes that operate at sub-national,
national and international levels. Can include
structural, infrastructure issues, and
environmental, political and cultural contexts
Source: https://www.spring-nutrition.org
Melese.S 54
55. Integrated Approaches
• It is an appropriate approaches to improve
nutritional status of vulnerable group in life cycle
Life cycle approach
Multi- sectoral approach
1/28/2024 55
Melese.S
56. Advancing Early Childhood Development: from Science to Scale
Foetal
development
Infant & child
growth &
development
Adolescent
education &
health
Adult health &
human capital
Inter-
generational
effects
Life-course
approach
1/28/2024 Melese.S 56
58. Life cycle Approach Nutrition
Intervention
Why?
1/28/2024 Melese.S 58
Figure 1: The burden of malnutrition through the life cycle and across generations.
OLDER
PEOPLE
Malnourished
BABY
Low
Birthweight
CHILD
Stunted
ADOLESCENT
Stunted
WOMAN
Malnourished
PREGNANCY
Low weight gain
Inadequate
food, health, &
care
Reduced capacity to
care for child
Higher
mortality
rate
Impaired
mental
development
Increased risk
of adult chronic
disease
Inadequate
catch-up
growth
Untimely / inadequate
feeding
Frequent infections
Inadequate food,
health, & care
Reduced
mental
capacity
Inadequate food,
health, & care
Inadequate food,
health, & care
Higher
maternal
mortality
Inadequate fetal
nutrition
Inadequate
infant
nutrition
Reduced physical
labor capacity,
lower educational
attainment,
restricted economic
potential,
shortened life
expectancy
Reduced physical
labor capacity,
lower educational
attainment
59. Why Life Cycle approach to
Nutrition ?
• What has happened in the past may continue to
affect the individual and will interact with
events and nutritional stresses later in life ,
• Provides a life course perspective to nutritional
problems that manifest at the various life stages
throughout the life cycle
• Enables one to discuss important interactions
of various stages in a more meaningful manner
than a didactic and reductionist approach to the
science of human nutrition
1/28/2024 Melese.S 59
60. Why...
• Maximum benefits in one age group come
from investments in an earlier age group
(there is a cumulative effect in the next
generation)
• Health and nutrition programs implemented
well before women become pregnant, and
within a life-cycle perspective, have long
term impacts on succeeding generations.
• Nutritional status is an intergenerational
continuum
1/28/2024 Melese.S 60
61. Why....
• All stages of life from the moment of
conception through to the elderly years are
associated with a series of specific
requirements for nutrition
• The consequences of less than optimal
nutrition at each stage of life will vary,
according to the life stage affected
• The nature of nutrition-related factors at
earlier stages of life will determine how
individuals grow and develop later in life
1/28/2024 Melese.S 61
62. Advantages of Life Cycle
Approach
• It helps recognize age-specific vulnerability
throughout the life cycle
• Summarize the various critical transitions
and life events in human development, which
occur side by side with the biological growth
and development of the individual and may
characterize periods of vulnerability of an
individual in society
1/28/2024 Melese.S 62
63. Advantages
• Reinforces the view that interventions at several
points across the life cycle are needed to sustain
improvements in health and nutritional outcomes
• Enables us to consider risks and benefits through
the entire life cycle and across generations
• Can help us to assess risks at various life stages,
recognize important environmental influences that
may be unfavorable to good nutrition and health, and
identify key interventions at the various stages
1/28/2024 Melese.S 63
64. Why Invest in the Life
Cycle?
• It reduces health care costs
• It reduces the burden of non-
communicable diseases
• It improves productivity and
economic growth
1/28/2024 Melese.S 64
69. Consequences of Hidden Hunger throughout life
cycle
Source: MI Global Report, 2009. Investing in the Future. A united call to action on vitamin and mineral deficiencies
1/28/2024 Melese.S 69
70. Global Targets 2025
2012 World Health Assembly
Stunting
Anemia
Low birth weight
Childhood obesity
Breastfeeding
Wasting
1/28/2024 Melese.S 70
78. A VICIOUS CYCLE: MALNUTRITION AND INFECTION
1/28/2024 Melese.S 78
79. The vicious cycle of poverty and malnutrition
1/28/2024 79
Indirect loss in
productivity from poor
cognitive development
and schooling
Direct loss in
productivity from
poor physical
status
Loss in resources
from increased
health care costs
of ill health
Income poverty
Low food intake Frequent
infections
Hard physical labor Large
families
Frequent
pregnancies
Malnutrition
Source: Modified from World Bank (2002a); Bhagwati et al. (2004).
Melese.S
81. CONSEQUENCES OF MALNUTRITION
Increased risk of infections
Poor physical growth and brain development
Weakened immunity, increased morbidity and mortality
Faster disease progression in people with HIV and TB
Increased risk of mother-to-child transmission of HIV
Reduced medication effectiveness and adherence
Increased poverty and disease
Lower educational and economic prospects
Increased health and education costs
Increased risk of chronic diseases (e.g., diabetes from
overnutrition)
1/28/2024 Melese.S 81
84. Human Costs of Malnutrition
Negative outcomes associated
with malnutrition
Delayed wound healing
Impaired immunity
Lower quality of life
Impaired function
Increased length of stay,
readmission, mortality and/or
morbidity rates
Correia M.I. Et al: Clin Nutr. 2003; 22:235-9.; Covinsky K.E. et al: J Am Geriatr Soc. 2002; 50:631-7.;
Middleton M.H. et al:. Intern Med J 2001;31:455-61.; Ferguson M. et al. J Am Diet Assoc 1998;98
(suppl.): A22. Suominen M et al. Eur J Clin Nutr 2005; 59: 578-583.; Neumann SA et al. J Hum Nutr
Dietet 2005; 18: 129-136.; Norman K et al. World J Gastroenterol 2006; 12: 3380-3385.; Pauly L et al. Z
Gerontol Geriatr 2007; 40: 3-12.; Keller H, Can J Rehab 1997; 10(3): 193-204; Keller H, J Nutr Elder
1997;17(2):1-13.
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Melese.S
85. Economic Impact of Child Undernutrition
The aggregate cost estimation for Health, Education and
Productivity are equivalent to between 1.9% to 16.5% of GDP
.
BURKINA
FASO
7.6% of GDP
$ 802
million
MALAWI
10.3%
GDP
$ 597
million
Rwanda
11.5_% of
GDP
$ 820
million
Country
Losses in
Currency
Annual
in USD
Egypt
EGP 20.3
billion
$3.7 billion
Ethiopia
ETB 55.5
billion
$4.5 billion
Swaziland
SZL 783
million
$76 million
Uganda
UGX 1.8
trillion
$899 million
Burkina Faso
FCFA 409
billion
$ 802
Ghana
GHC 4.6
trillion
$2.6 billion
Rwanda
RWF 503
billion
$ 820
Malawi
MWK 147
billion
$597 million
1/28/2024 85
Melese.S
88. Nutrition and Fertility
• ~15% of all couples in the Western world are
involuntarily childless. They are generally
considered to be infertile, or more
correctly infecund. (5% in Ethiopia , 2005)
• ~ 40% of couples diagnosed as infertile
will conceive a child in 3 years without
the help of technology
• Healthy couples have a 30–50% chance of a
diagnosed pregnancy within a given
menstrual cycle
1/28/2024 Melese.S 88
89. Nutrition and Fertility
Chromosomes in ova may be damaged by
• Oxidation
• Radioactive particle exposure
• Aging
• Women >35 years more likely to have
disorders related to chromosomal defects
than younger women
1/28/2024 Melese.S 89
91. Nutrition and infertility
• Antioxidant nutrients Protect sperm
from oxidative damage
• Vitamin D—Low status related to
infertility?
• Alcohol intake—toxic effect on testes
• Heavy metal exposure
• Lead—impacts testes & sperm
• Mercury—decreases sperm & semen
1/28/2024 Melese.S 91
92. Nutrition related disruption
of fertility
• Undernutrition
• Weight loss
• Obesity( in males)
• High exercise levels
• Intake of specific foods and food
components
1/28/2024 Melese.S 92
93. Vitamin A intake
• An essential nutrient but intake should be
restricted during pregnancy
• Its teratogenic effect was first seen in animal
studies
• The evidence in humans is based on adverse
effects after exposure to pharmacological agents
(in the form of 12-cis-retinoic acid)
• Craniofacial, heart defects and central nervous
system abnormalities
• There are few recorded cases of such effect with
dietary exposure
1/28/2024 Melese.S 93
94. Vitamin A intake and Fetal
Malformations
1/28/2024 Melese.S 94
Martinez-Frias and Salvador (1990)
95. Caffeine and fertility
• Caffeine appears to prolong time to conception
• Daily caffeine intake & reduction in conception :
–>300 mg/d results in ~27%
–>500 mg/d (>4 cups of coffee) results in
~50%
–Caffeine may affect ovulation and corpus
luteum functioning through alterations to
hormone levels (Klonoff-Cohen, H., Bleha,J. et al. 2002. “A prospective study of
the effects of female and male caffeine consumption on the reproductive endpoints of IVF and gamete
intra-Fallopian transfer.” Human Reproduction 17(7): 1746-1754.)
1/28/2024 Melese.S 95
96. Factors related to Infertility in
Males and females
1/28/2024 Melese.S 96
97. Folic acid and neural tube defect (NTD)
• Common in the West than in Africa
• 150-200 cases in UK/year
• Can be detected by antenatal ultrasound
scan and termination can be considered
• NTD results from failure of closure of the
neural canal (tube) at fourth week of
gestation
• Severity depends of the location of the NTD
1/28/2024 Melese.S 97
98. Risk factors for NTD
• Family history of NTD
• Previous birth of a baby with NTD
• Increased demand for folate (competition with RBC
formation and NT closure)
• RCTs with and without folate showed significant
reduction in NTD risk and the RNI for folate
increased from 200 to 600mg/d
• The supplementation should start prior to
conception especially for at risk women
• Public health strategies should target folate for
supplementation/fortification
1/28/2024 Melese.S 98
102. Neural Tube Defects in Ethiopia…
0
10
20
30
40
50
60
70
80
National Tigray Afar Amhara Oromia Somali B/G SNNPR Gambella Harari Addis
Ababa
Dire
Dawa
Prevalence of Red Blood Cell (RBC) and Serum folate concentrations
(RBC folate <340nmol/L) (Serum folate <10nmol/L)
Source: National Micro Nutrient
Survey, 2015
1/28/2024 Melese.S 102
103. Neural Tube Defects in Ethiopia
83.7
87.4
100
72.9
87.4 88.2
95.3
62.6
79.5
96.8
84.8
90.7
National Tigray Afar Amhara Oromia Somali B/G SNNPR Gambella Harari Addis
Ababa
Dire Dawa
Regions
Percent (Risk for NTDs) RBC folate <906nmol/L
1/28/2024 Melese.S 103
104. 104
Maternal Health
Status
• Maternal folate
insufficiency
• Nutrients, including
vitamin B12, vitamin
B6, iron, and
riboflavin influence
folate metabolism and
status
• The risk further
exacerbated due to a
late start and
intermittent provision
of folic acid during
pregnancy.
Maternal occupation status,
such as
working in industries, and
farming may lead to
possible occupational
exposure to noxious agents
organic solvents,
anesthetic agents, x
radiation
-Maternal exposure to
contaminated drinking
water
Maternal health issues like
- Host of physical agents
(e.g. X-irradiation,
hyperthermia, stress),
- Drugs,
- androgenic hormones,
- antiepileptics
- Substance abuse
- Chemical agents,
- Maternal infections
- Maternal metabolic
conditions
Cause of Neural Tube Defect
Nutritional Factor
Environmental
Factor
1/28/2024 Melese.S
105. WHO’s Recommendation for
prevention of NTD
• Advise women trying to conceive to take a dose
of 400 μg folic acid daily, starting two months
before the planned pregnancy and to
continue until they are 12 weeks(3 months)
pregnant.
• Pregnant women with Previous history of baby
born with NTD, who have diabetes or who are
under anticonvulsant treatment about the
increased risk of a future food intake of to take
5 gram of folate daily.
1/28/2024 Melese.S 105
106. Maternal and Child Nutrition
Why focus on maternal and child nutrition
1. Global Epidemiology and country high prevalence
rate of
stunting ,underweight, wasting
IDA.IDD .VAD and other nutrient deficiency
Globally, in 2011 about 101 million children under 5 years
of age were underweight and 165 million stunted. At the
same time, about 43 million children under 5 were
overweight or obese(UNICEF, WHO & World Bank, 2012)
1/28/2024 106
Melese.S
107. …… focus on maternal AND CHILD nutrition
In Ethiopia
• MMR 353 per 100,000 live births and LBW 20 %
• Twenty two % of Women who gave birth before age 18
(DHS, 2011).
• Twenty seven % of Women with low BMI (<18.5 kg/m2 ).
(DHS,2016).
1/28/2024 107
Melese.S
108. focus on maternal nutrition
2.Intergenerational malnutrition cycle
– Malnourished at birth
• Stunted in childhood
– Pregnant during adolescence & Early marriage
– Inadequate dietary intake and overworked during
pregnancy and lactation
– Short intervals between pregnancies
1/28/2024 108
Melese.S
115. Intergenerational malnutrition
3. Other cause Throughout life
Heavy workloads
Poor health care
Gender inequities
Food insecurity
1/28/2024 115
Melese.S
117. Introduction
A tripling of weight between 28 and 40
weeks from about 1000g to 3200-3600
Mother subsidizes fetal growth (uses fat
stores) if her intake is not sufficient -she
will loose weight
The last trimester is the most vulnerable
period for the fetus in terms of birth weight
5
1/28/2024 Melese.S Jimma University
118. Nutrition During Pregnancy
• A balanced, nourishing diet throughout
pregnancy provides the nutrients needed
and:
– Supports fetal growth and development
– Provides the mother with the nutrients she
needs
– Minimizes the risks of excess energy intake
1/28/2024 Melese.S 118
119. Nutrition during
pregnancy
• Women should gain at least 11 kg during
pregnancy.
• If the mother gains less than this,
– IUGR (Symmetric VS asymmetric)
– The baby will be low birth weight
– the baby’s chances of survival and health declines.
• If a mother is overweight, she still needs to gain for
her baby’s health.
• She should not try to lose weight while she is
pregnant.
1/28/2024 Melese.S 119
121. Breast = 2 kg
Blood and fluid = 4 kg
Placenta =0.7 kg
Baby =3.3 kg
Uterus = 1 kg
Total weight gain at least 11 kg
Distribution of weight gain during pregnancy
1/28/2024 121
Melese.S
123. • During pregnancy, there is an Increased
requirements of
– Energy
– protein,
– essential fatty acids
– Micronutrients: vitamin A, vitamin C, B vitamins
(B1, B2, B3, B5, B6, B12, folate), calcium,
phosphorus, iron, zinc, copper and iodine.
1/28/2024 Melese.S 123
124. Con’t
Energy
• Energy is the chief nutritional determinant of gestational weight gain
• During pregnancy, additional energy is required
For growth and maintenance
Energy metabolism changes Vs weight gain.
• First trimester – same as non pregnant women
• Second trimester - 300 to 340 kcal/ day
• third trimester - 112 kcal/ day
1/28/2024 124
125. The components of maternal weight gain
during pregnancy
8
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129. Nutrition During Pregnancy
(cont.)
• Full-term pregnancy (gestation) lasts 38
to 42 weeks:
– Three trimesters lasting 13 to 14 weeks each
• Zygote: a single, fertilized cell
• Embryo: weeks 3 to 8 after fertilization
• Fetus: week 9 to birth
1/28/2024 Melese.S 129
130. Fetal development
Fertilization: the union of sperm and egg
Cells divide and differentiate (specialize) for 40 weeks of
gestation (pregnancy)
About a week after fertilization, the embryo implants in
the lining of the uterus
Embryo - developing human from 2 to 8 weeks after
fertilization;
Implantation - embedding of an embryo in the uterine
lining
After 9 weeks, an embryo becomes a fetus
1/28/2024 Melese.S Jimma University
131. First Trimester
• Zygote travels through the fallopian tube and
implants in the wall of the uterus
• Development of organs, limb buds, facial
features, placenta
• Vulnerable to teratogens during this time
• Spontaneous abortion (miscarriage)
• Placenta provides nutrients via the umbilical
cord
Melese.S
135. Second Trimester
• Continued growth and maturation
• Growth from about 3 inches to over a foot long
by the end of the second trimester
• Some babies born prematurely (the end of
second trimester) survive with intensive
neonatal care
Melese.S
136. Third Trimester
• Time of intense growth and maturation
• Fetus gains ½ to ¾ of its weight
• Brain growth is also extensive
• Lungs become fully mature
• A balanced, adequate diet for the mother
continues to be critical
Melese.S
142. Fetal nourishment
Placenta :
…
Prevents passage of red blood cells, bacteria,
and many large proteins from mother to fetus
…
Alcohol, drugs, and other potentially harmful
substances can cross the placenta
15
1/28/2024 Melese.S Jimma University
143. Growth and development during
pregnancy
Critical periods impact fetal development
Periods of rapid cellular activity are highly vulnerable to
nutritional deficiencies, toxins, and other insults
Famine associated with a high cumulative incidence of
heart disease
Inadequate iron during early pregnancy associated with
poor cognitive development
Metabolic or fetal programming may be able to alter
how genes are expressed during critical periods of
development
16
1/28/2024 Melese.S Jimma University
144. Nutrition during the first trimester
Pica
…
Abnormal, compulsive intake of substances
that have no nutritional value
e.g. Consumption of clay or soil (geophagia), or ice
(pagophagia) dirt, paint chips, soap, chalk etc,
…
Can be associated with mental illness and
some micronutrient deficiencies ( iron, zinc);
stress, anxiety
…
Most commonly associated with women of low
socioeconomic status
…
Pica could introduce toxins and ingestion of
clay could lead to decreased absorption of iron,
zinc or copper 23
1/28/2024 Melese.S Jimma University
147. Adverse birth outcomes
• Poor maternal nutritional status has been related
to adverse birth outcomes .
Adverse birth outcome
1. Low Birth Weight (LBW): is defined as a birth
weight less than 2,500 g
perinatal morbidity and increased risk of long
term disability .
Increased risk of adult chronic disease
1/28/2024 147
148. Low-Birth-Weight Infants
• Likely among undernourished mothers
• Low birth weight: baby born weighing <5.5 lb
• Increased risk of infections, learning disabilities,
impaired physical development, and death in the
first year of life
• Preterm babies are born before 38 weeks
• Infants that are small for gestational age (SGA)
are full-term but weigh less than expected for age
Melese.S
151. Cont …
2. Preterm baby : defined as a gestational age less than 37 completed weeks.
contributes to the incidence of LBW
leading underlying cause of IMR with
congenital anomalies
3. Intra uterine Growth Restriction (IUGR) It has short and long term consequences
Short term
increased risks of perinatal and infant mortality
and morbidity
Long term
increased risks of learning disabilities, childhood
psychiatric disorders & mental retardation
1/28/2024 151
152. 4. Stunting( long term effect)
• Understanding this relationship may provide a basis for developing nutritional
interventions to
improve birth outcomes
long-term quality of life
Extra energy intake/reduction of energy expenditure.
reduce mortality &morbidity
Reduce health-care costs.
1/28/2024 152
154. Pregnant women who might need special
help include:
• Women from poor families, or who are
unemployed
• Women who are widows/separated, and
have no support
• Mothers who have given birth to many
babies over a short time
• Women who are ill from diseases like
Tuberculosis (TB)
• Women who look thin and depressed
1/28/2024 Melese.S 154
155. Cont…
• Mothers whose previous babies were small
and malnourished
• Teenagers
• Women with a history of their baby or
babies dying in their first year of life
• Mothers overburdened with work
• Mothers who are very worried, particularly
first time pregnancies.
1/28/2024 Melese.S 155
156. Food Choices for Pregnant Women
• Foods to avoid
1. Alcohol
2. Large fish
• Why?
3. Less than 300
milligrams of caffeine
per day
1/28/2024 Melese.S 156
157. Foods to avoid during
pregnancy
• Alcohol
• Certain types of fish
1/28/2024 Melese.S 157
Insel, Turner & Ross, 2010
158. Substance Use and Pregnancy
Outcome
1. Tobacco
– Risk for miscarriage, stillbirth, preterm
delivery, and low birth weight
2. Alcohol
– Risk for fetal alcohol syndrome
3. Drugs
– Risks for miscarriage, preterm delivery, low
birth weight, birth defects, and infant addiction
1/28/2024 Melese.S 158
159. Strategies to Avoid GI Distress:
• Slowed GI movement nausea, heartburn and constipation
• Smaller/frequent meals, drinking liquids between meals, fiber and
fluids are recommended
1/28/2024 Melese.S 159
160. GUIDELINES FOR PHYSICAL
ACTIVITY
DO’s and DONT’S
• Do exercise regularly all days of the week
• Do warm up with 5 – 10 minutes of light activity
• Do 30 minutes or more of moderate physical activity, 20
– 60 minutes of more intense activity on 3 to 5 days per
week will provide greater fitness.
• Do cool down with 5-10 minutes of slow activity and
gentle stretching.
• Drink water before, during and after exercise.
• Eat enough to support the additional needs of pregnancy
plus exercise.
1/28/2024 Melese.S 160
161. Cont …
• Don’t exercise vigorously after long periods of
inactivity.
• Don’t exercise in hot, humid weather
• Don’t exercise when sick with fever
• Don’t exercise while lying on your back after the first
trimester of pregnancy or stand motionless for prolonged
periods.
• Don’t exercise if you experience any pain or discomfort
• Don’t participate in activities that may harm the
abdomen or involve jerky, bouncy movements
1/28/2024 Melese.S 161
163. Definitions
• IUGR: Failure of normal fetal growth
caused by multiple adverse effects on
the fetus.
• SGA(Small for gestational age):
Infant with wt < 10% lie for GA, or <
-2 SDs.
1/28/2024 Melese.S 163
164. Pathological decrease of fetal growth
IUGR: definition
Birth weight < 2.5 Kg for gestational age of 37 weeks
Birth weight < 2SD below the mean value for gestational age
Birth weight < 10th (or 5th) percentile for gestational age
1/28/2024 Melese.S 164
165. Definition of Small for Gestational Age (SGA)
Birth weight and/or length of 2 or more standard deviations
(SD) below the mean for gestational age and sex
1/28/2024 Melese.S 165
166. Easiest way to think
about these terms are
• IUGR: is a term used by
Obstetricians to describe a pattern
of growth over a period of time.
• SGA: is a term used by
Pediatricians to describe a single
point on a growth curve.
1/28/2024 Melese.S 166
167. IUGR and SGA newborns : Definition of clinical conditions at birth
secondary to birth length (height) or birth weight according to
gestational age
Birth Length
Below –2 SD Normal Greater than +2SD
(IUGR or SGA)
Chatelain P, Endocrine Regulation 200
Birth weight overweight overweight macrosomic
greater than +2SD IUGR1 “proportionate”
(or SGA2) or “symmetrical”
Birth weight IUGR1 normal eutrophic
normal (or SGA2) or proportionate
Birth weight proportionate SGA1 hypotrophic
below -2 SD (“symmetrical”) or hypotrophic tall newborn
(SGA2) SGA2
1 IUGR is defined by birth length
2 SGA is defined by both birth length or birth weight
1/28/2024 Melese.S 167
168. Boy, 5.2 years old. He is 95.3 cm
tall and weighs 11.9 kg, which is
–4.2 SD score below the
mean. His birth weight was
2,160 grams, which is –2.59
SD scores below the mean. His
physical appearance is typical
of SGA children showing a
triangular-shaped face with a
relatively large head and high
forehead, a very lean body
mass which is especially
evident in his thinner than usual
arms and legs.
Courtesy of Dr. Anita Hoekken-Koelega
1/28/2024 Melese.S 168
169. What are the causes of SGA?
Maternal
• Vascular disease
• Environmental
factors
• Infection
• Nutrition
Placental
• Insufficiency
• Abruption
• Infarction
• Vascular
abnormalities
Fetal
• Genetic
abnormalities
• Congenital
malformations
• Metabolic
problems
• Multiple
gestations
Demographic
• Maternal age and
height
• Father’s size
• Obstetric history
• Race
1/28/2024 Melese.S 169
170. Causes of SGA:
Fetal growth occurs in 3 phases.
1. 4-20 weeks' gestation – rapid cellular
development with mitosis
2. 20-28 weeks – increase in cellular size combined
with ongoing mitosis.
3. 28-40 weeks – cells rapidly increasing in size, with
peak at 33 weeks. In addition, rapid accumulation
of fat, muscle and connective tissue occurs.
1/28/2024 Melese.S 170
171. Incidence
• 3 - 10 % of all pregnancies.
• 20 % of stillborns are growth retarded.
• 30 % of infants with SIDS(Sudden infant death
syndrome ) were IUGR.
• 1/3 of infants with BW < 2800 gms are growth
retarded and not premature.
• 9 - 27 % have anatomic and/or genetic
abnormalities.
• Perinatal mortality is 8 - 10 times higher for
these fetuses.
1/28/2024 Melese.S 171
174. Types of IUGR
• Symmetric IUGR: weight, length and head
circumference are all below the 10th
percentile. (33 % of IUGR Infants)
• Asymmetric IUGR: weight is below the
10 th percentile and head circumference
and length are preserved. (55 % of IUGR)
• Combined type IUGR: Infant may have
skeletal shortening, some reduction of soft
tissue mass. (12 % of IUGR)
1/28/2024 Melese.S 174
179. Normal Intrauterine
Growth pattern
• Stage I (Hyperplasia)
- 4 to 20 weeks
- Rapid mitosis
- Increase of DNA content
• Stage II (Hyperplasia & Hypertrophy)
- 20 to 28 weeks
- Declining mitosis.
- Increase in cell size.
1/28/2024 Melese.S 179
180. Normal Intrauterine Growth
pattern…
• Stage III ( Hypertrophy)
- 28 to 40 weeks
- Rapid increase in cell size.
- Rapid accumulation of fat, muscle and
connective tissue.
• 95% of fetal weight gain occurs during
last 20 weeks of gestations.
1/28/2024 Melese.S 180
181. Etiology
• Growth inhibition in stage I:
- Undersized fetus with fewer cells.
- Normal cell size.
Result in symmetric IUGR.
Associated conditions:
- Genetic
- Congenital anomalies
- Intrauterine infections
- Substance abuse
- Cigarette smoking
- Therapeutic irradiation
1/28/2024 Melese.S 181
182. Etiology
• Growth Inhibition in Stage II/III
– Decrease in cell size and fetal weight
– Less effect on total cell numeric, fetal length,
head circumference.
– Result in asymmetric IUGR.
Associated Conditions:
– Uteroplacental insufficiency.
• Combination above associated mixed type
IUGR.
1/28/2024 Melese.S 182
183. Pathophysiology
1) Fetal factors:
• Genetic Factors:
- Race, ethnicity, nationality
- sex ( male weigh 150 -200 gm more than
female )
- parity ( primiparous, weigh less than
subsequent siblings)
-genetic disorders ( Achondroplasia, Russell -
silver syndrome.)
• Chromosomal anomalies:
- Chromosomal deletions
- trisomies 13,18 & 21
1/28/2024 Melese.S 183
184. Pathophysiology
• Congenital malformations:
examples:Anencephaly, GI atresia, potter’s
syndrome, and pancreatic agenesis.
• Fetal Cardiovascular anomalies
• Congenital Infections:
mainly TORCH infections.
Perinatal infections account for 2% to 3% of all congenital anomalies. TORCH, which includes
Toxoplasmosis, Other (syphilis, varicella-zoster, parvovirus B19), Rubella, Cytomegalovirus
(CMV), and Herpes infections, are some of the most common infections associated with
congenital anomalies.
• Inborn error of metabolism:
- Transient neonatal diabetes
- Galactosemia
- PKU
1/28/2024 Melese.S 184
203. Summary of maternal anabolic and catabolic
phases of pregnancy
Maternal anabolic phase Maternal catabolic phase
0-20 weeks 20+ weeks
Blood volume expansion, increased Mobilization of fat and nutrient stores
cardiac output Increased production and blood levels
Buildup of fat, nutrient, and liver of glucose, triglycerides, and fatty
glycogen stores acids; decreased liver glycogen stores
Growth of some maternal organs Accelerated fasting metabolism
Increased appetite, food intake Increased appetite and food intake
(positive caloric balance) decline somewhat near term
Decreased exercise tolerance Increased exercise tolerance
Increased levels of anabolic hormones Increased levels of catabolic hormones
18/04/2016 DPFH 36
1/28/2024 Melese.S Jimma University
204. Recommendations
Women’s nutrition during pregnancy
and lactation should focus on
• The three micronutrients (vitamin A,
iron and iodine) and
• Extra energy intake/reduction of
energy expenditure.
1/28/2024 Melese.S 204
205. Cont…
Therefore the following are essential nutrition
actions
• A pregnant woman needs diversified foods,
especially those that are good sources of iron.
• Pregnant women need at least one additional meal
(200 Kcal) per day during the pregnancy.
• A pregnant woman needs to cut down her energy
expenditure.
• Pregnant women should eat iodized salt in their
diet.
1/28/2024 Melese.S 205
206. Cont…
• Pregnant women should take vitamin A rich foods
(such as papaya, mango, tomato, carrot, and green leafy vegetable) and
animal foods (such as fish, milk, egg and liver).
• In the malarious areas, pregnant women should
sleep under an insecticide-treated bed net.
• Pregnant women during the third trimester of
pregnancy should be de-wormed using
mebendazole or albendazole
• Pregnant women need Diversified diet( well
balanced diet containing mixture of foods from
the different food groups (animal products, fruits,
vegetables, cereals and legumes).
1/28/2024 Melese.S 206
207. Nutrition risks across the years of transition to first pregnancy for 1990 and 2016
G C Patton et al. Nature 554, 458–466 (2018) doi:10.1038/nature25759
1/28/2024 Melese.S 207
210. Lactation
• Lactation is Physiologically
demanding especially for mother
who is nursing her baby for several
months who
• Milk production is affected by:
–Frequency of suckling
–Maternal hydration
–Prolactine
1/28/2024 Melese.S 210
211. Energy
• RDA for Energy is 500Kcal during
the first and the second 6 months of
pregnancy.
• Obese and overweight may not
need to add the entire calories they
required.
• Production of 100ml of milk requires
expenditure of 85 Kcal
1/28/2024 Melese.S 211
212. In the first 6 months
of lactation
• Milk Production is 750 ml per day
• So, total energy required for daily
milk production is 750 x
85/100ml=637.5 kcal.
• Deposited fat during preganancy will
provide: 3000g fatx9=27,000 kcal
1/28/2024 Melese.S 212
213. Cont...
• So if stored fat is utilized for the first 6
months(180 days) of lactation, then the
DAILY energy extracted from these
stores == 27000kcal/180 days==150
kcal
• Then by subtracting 150kcal from
637.5kcal, the additional energy needed
from food daily during the firt 6 months of
lactaion is 637.5-50 = 500kcal
1/28/2024 Melese.S 213
214. In the 2nd 6 months of lactation
• On average the milk volume produced daily =
600ml.
• So, daily energy required for milk production
= 600x85/100= 510kcal
• The fat stored during pregnancy has been
utilized during the first 6months of
lactation
• So lactating mothers need an additional
energy intake of at least 500kcal per day
1/28/2024 Melese.S 214
215. • It is advisable to maintain an energy intake
of 180kcal per day.
• Drink an ample amount of water(2-3
litters), especially in hot weather areas
• Breast feeding mothers can also lose as
much as one pound weight per week, but
still supply adequate amount of milk.
1/28/2024 Melese.S 215
217. Fat Requirement
• Fat constitutes 35-30% of total daily
energy intake
• PUFAs are present in all cell
membranes
• They are essential for the development of
brain and retina development of infants
(half of PUFA are Omega 3 and Half are
Omega 6)
1/28/2024 Melese.S 217
219. Nutrition Recommendations during
lactation (breastfeeding) in Ethiopia
• A lactating woman needs at least two extra
meals (650 Kcal) of whatever is available at
home
• In addition a dose of vitamin A (200,000IU)
should be given once between delivery and six
weeks after delivery
• Iodized salt in her diet
• At least one liter of water per day
• Vitamin A rich foods
• Iron/Folate ( Bednet, Dewarming)
1/28/2024 Melese.S 219
220. •Greater breathing efficiency
•Higher oxygen saturation
•Increased body temperature
•Fewer episodes of disease
•Increased breast milk volume
•Superior nutritional content
•Lower risk of bacterial contamination
•Optimal Mandibular Development
Benefits to mother
Less risk of mastitis
Lower risk of damage to nipple from
breast pump
Decreased incidence of type 2 diabetes
& breast cancer
Potential reduction in perceived stress
and negative mood
Less time in preparing and cleaning of
supplies
Breast milk at optimal temperature
without preparation
Cost savings in not renting or buying
Benefits to infant
1/28/2024 Melese.S 220
221. Breast milk
• Health Benefits for baby:
• Designed by the human body to feed human
babies, its composition changes to meet the needs of
your baby or toddler.
• Valuable antibodies protect babies against viral and
bacterial infections such as:
Ear infections
Respiratory tract infections
Urinary tract infections
Bacterial meningitis
Necrotizing Enterocollitis
1/28/2024 Melese.S 221
222. Cont …
• The longer you breastfeed, the more protection your baby
has.
• Decreases the risk of Sudden Infant Death Syndrome
(SIDS).
• Improves baby’s brain development.
• Easier to digest, decreasing baby’s risk of:
Diarrhea
Stomach Infection
Inflammation of the stomach
• Has an analgesic effect, meaning it comforts baby when he
or she experiences pain.
1/28/2024 Melese.S 222
223. Cont …
• Decreases your baby’s risk of developing health issues later
in life such as:
Obesity
Crohn’s Disease
Ulcerative colitis
Celiac Disease
Type I & II Diabetes
High blood pressure
Heart Disease
High cholesterol
Cancers such as acute lymphoblastic leukemia and
neuroblastoma
1/28/2024 Melese.S 223
224. Benefits to mother
• Helps in involution of uterus
• Delays pregnancy
• Decreases mother’s workload, saves time and
energy
• Lowers risk of breast and ovarian cancer
• Helps reduce weight faster
1/28/2024 224
Melese.S
225. Health benefits for mom:
• Breast milk is always available, always the right temperature
and always free. Breast milk requires no preparation.
• Decreases your risk of developing:
Breast cancer
Ovarian cancer
Cardiovascular Disease
Type II Diabetes
Metabolic syndrome
Postpartum Depression
Hypertension
Osteoporosis
1/28/2024 Melese.S 225
226. Benefits to family and society
• Contributes to child survival
• Saves money
• Promotes family planning
• Environment friendly
1/28/2024 226
Melese.S
231. Summary of differences between milks
Human milk Animal milks Infant formula
Protein
correct amount, easy
to digest
too much, difficult to
digest
partly corrected
Fat
enough essential fatty
acids, lipase to digest
lacks essential fatty
acids, no lipase
no lipase
Water enough extra needed may need extra
Anti-infective
properties
present absent absent
1/28/2024 231
Melese.S
236. Nutrition During infancy and
childhood
Energy needs remain high through the early formative
years. While most adults require 25–30
calories/kg/day
• Infant up to 4 months requires more than 100
kilocalories per kg (430 calories/day).
• Infants of four to six months require roughly 82
kilocalories per kg (490 calories/day).
• Children of one to three years require
approximately 83 kilocalories per kg (990
calories/day).
• Energy requirements decline thereafter and are
based on weight, height, and physical activity.
1/28/2024 Melese.S 236
237. • Increased requirements of energy, protein,
essential fatty acids, calcium and
phosphorus.
1/28/2024 Melese.S 237
238. Nutritional Needs for Infants-
Matching Game
Age of Infant
1. Birth to six months
2. Six to eight months
3. Seven to ten months
4. Eight to Twelve months
5. One to two years
Food Options
A. Soft or cooked table foods
B. Breast milk only
C. Cut foods into smaller, ¼-
inch squares
D. Pureed or mashed fruits
and vegetables
E. Finger foods
1/28/2024 Melese.S 238
1.B
2.D
3.E
4. A
5.C
239. Recommendations
• Essential Nutrition actions during the
first 24 months
– Optimal Breast feeding
– Optimal Complementary feeding
• Essential Nutrition actions 2-9 years
– Diversified diet (Animal source food is essential)
– Iron, vitamin A, iodine
– Increase energy
1/28/2024 Melese.S 239
240. Recommendations
Focus Behavior Change Communication
(BCC) on the seven essential nutrition
actions (ENA)
1. Optimal Breast feeding and its benefits
2. Optimal complementary feeding from 6
months onwards
3. Sick child feeding
4. Maternal nutrition during pregnancy and
lactation
5. Control of vitamin A deficiency,
6. Iron deficiency anemia and
7. Control of Iodine deficiency disorders
1/28/2024 Melese.S 240
241. 1. Key messages for Optimal
breast feeding
• Initiate breast feeding within half hour after
delivery
• Give colustrum
• Exclusive breastfeeding for the first 6 months
• Breastfeeding day and night on demand at least
8-12 times a day
• Let the baby finish one breast before switching
the other
• Position and attach the baby to the breast
correctly
• Initiate complementary food at 6 months
• Continue breast feeding up to 24 months
1/28/2024 Melese.S 241
242. Key….
2. Key messages for optimal
Complementary feeding
• Give solid/ semi solid complementary food at 6
months
• The CF should fulfill “FADUA” criteria
–F= frequency
–A= amount
–D= Density
–U= utilization (hygiene)
–A= Active feeding
1/28/2024 Melese.S 242
243. Frequency = increase frequency of
feeding with age of the child…
Age
(mont
hs)
Meal frequency
per day for
breast fed baby
Meal frequency
per day for
non-breastfed
baby
6-9
2-3 times
+
1-2 snacks 4-5 times
+
1-2 snacks
10-23
3-4 times
+
1-2 snacks
1/28/2024 Melese.S 243
245. Amount: Mother increases the amount
of food the baby eats as the baby grows older.
Age
(mont
hs)
Amount of K
calorie for the
breast fed
baby
Amount of K
calorie for the
non-breast fed
baby
6-8 200 Kcal 600Kcal
9-11 300Kcal 700Kcal
12-23 550Kcal 900Kcal
1/28/2024 Melese.S 245
246. Density: Increases food thickness (density)
and variety as the child gets older, adapting to the
child's nutritional requirements and physical
abilities
• At 6 months mother or caregiver gives infant pureed,
mashed, and semi-solid foods.
• Mother breastfeeds until child is at least 2 years old
(continue breastfeeding).
• Add protein-rich foods (animal/plant): power flour,
beans, soya, chick peas, groundnuts, eggs, liver, meat,
chicken, milk.
• Diversify the child’s food
• Fermentation, germination[ARF]
1/28/2024 Melese.S 246
247. Utilization: Mother or caregiver practices
good hygiene and safe food preparation.
• Feeds liquids from a small cup or bowl.
• Avoid bottle feeding as they are difficult to keep
clean, and contaminated bottles can cause diarrhea.
• Before feeding child, mother or caregiver washes
her/his hands and child’s hands with soap and water
and uses clean utensils and bowls or dishes to avoid
introducing dirt and germs that might cause diarrhea
and other infections.
• Mother/caregiver can use her fingers (after
washing) to feed child. Mother or caregiver serves
food immediately after preparation.
1/28/2024 Melese.S 247
248. Active feeding: Mother or caregiver
interacts with child during feeding (responsive
feeding)
Mother or caregiver :
• The child should have his/her own plate.
• Feeds infant directly and helps older child eat.
• Experiments with food combinations, tastes,
textures, and ways to encourage child who
refuses many foods.
• Minimizes distractions during meals if child
loses interest easily.
• Remembers that feeding times are periods of
learning and love, talking to child during feeding
with eye-to-eye contact.
1/28/2024 Melese.S 248
249. 3. Key Messages for sick
child feeding
• Breast-feeding a sick child:
• During illness breastfeed more frequently
• After illness continue to breastfeed more
frequently for two weeks
• If infant is too sick to suckle, then
express breast milk and give with a cup
1/28/2024 Melese.S 249
250. 7 Food groups for Complementary
feeding
1/28/2024 Melese.S 250
> 4 food groups is acceptable( World Health Organization 2010)
251. Minimum Meal Frequency(WHO
Recommendation)
• Minimum meal frequency (%)Proportion of
breastfed and non-breastfed children 6-23.9
months of age who receive solid, semi-solid,
or soft foods or milk feeds the minimum
number of times or more.
• Minimum meal frequency is defined as:
– 2 times for breastfed infants 6–8 months
– 3 times for breastfed children 9–23 months
– 4 times for non-breastfed children 6–23 months
1/28/2024 Melese.S 251
252. Key Message on the prevention of
Vitamin A deficienciency
1/28/2024 Melese.S 252
Prevention of and control of Vitamin A deficiency
1. High Dose vitamin A Supplementation
Targets : Children 6-59 months and Lactating women:
a) Universal Supplementation Schedule
Children 6-11 moths = 100,000 IU every 6 months
Children 12-59 months= 200,000 IU every 6 months
Lactating women within 6 week after delivery =200,000IU A
single dose
253. Key Message on the prevention
of VAD…
1/28/2024 Melese.S 253
b) Diseases Targeted Supplementation Schedule
Preventive dose: a single dose of vitamin A at the contact of a child with
acute respiratory infection (ARI), Diarrheal disease(DD) and Severe acute
malnutrition (SAM)
Therapeutic dose: For Measles and Xerophthalmia - Give therapeutic
doses of vitamin A (i.e. 3 doses) on day 1, day 2 and day 14, with the
strength of the dose as stated above
Note: this dose should not be given to children who have already received a
high dose vitamin A supplement within the preceding month
254. Key Message on the
prevetion of VAD…
1/28/2024 Melese.S 254
2. Breast feeding = Colustrum has high concentration of
vitamin A, it is called the first immunization of the baby
3. Dietary Modification: Fortification of oil, floor ,
sugar
4. Dietary Diversification – Behavior change
communication on the consumption of vitamin A friendly foods
eg. Growing and consuming Orange fleshy sweet
potatoes
255. Key Messages for Prevention
of Iodine deficiency Disorders
1/28/2024 Melese.S 255
Intervention
1. Supply iodized salt for the whole family
•The Quality and Standards Authority of Ethiopia, has set the
iodine level to be 60-80 PPM as potassium iodate, after
making allowance for losses of iodine during storage and
distribution.
In Ethiopia, an iodine content of 80 – 100 PPM is required as KIO3
at the port of entry or at the packaging factory to satisfy the
recommended daily requirement of 150µg of iodine per a
person to prevent IDD
256. Key Messages for
Prevention of IDD…
1/28/2024 Melese.S 256
Universal salt iodization (USI) is the most widely practiced
intervention in eliminating iodine deficiency disorders (IDDs).
Salt iodine testing is an important process indicator for monitoring
progress towards USI.
Although considerable success in eliminating or reducing endemic
goiter has been achieved through national salt iodization programs
and mandatory iodization programs of household salt, IDD remains a
problem
Consumption of iodized salt by the family can be communicated through the
six contacts of women and children with the health services, (ANC, delivery,
PNC/FP visit, immunization visits, well baby and growth monitoring and
promotion visits and sick child visits.
257. Key Messages for Prevention
of IDD…
1/28/2024 Melese.S 257
Severity of
IDD
Choice of intervention methods
Mild IDD
Iodized salt at the concentration of 10-25 mg/kg. It
may disappear with socioeconomic development
Moderate
IDD
Can be controlled with iodinated salt at the
concentration of 25 to 40mg/kg if the salt can be
produced and effectively distributed. Otherwise iodized
oil ether orally or by injection should be used through
the primary health care system contacts
Severe IDD
Iodized oil either by injection or orally for the prevention
and control of central nervous system defects
Source: Shils OS, Modern nutrition in Health
and Diseases Vol II: 261.
258. Key Messages for
Prevention of IDD…
1/28/2024 Melese.S 258
2. Supplementation of Iodine Capsules
•As a short-term strategy in highly endemic areas, Lipiodol (iodized oil
capsules), should be distributed on a one - time basis to individuals.
•This will cover the recipients for one to two years until salt iodization
processes are in place.
Dosages are:
-1 Capsule (200mg) for pregnant women and children under 5
- 2 Capsules(400mg) for women of reproductive age and children 5 to14
years of age
259. Key Messages for
Prevention of IDD…
1/28/2024 Melese.S 259
3. Increased consumption of sea food and decrease
consumption of goiterogens
260. Key Messages for Prevention of
Iron deficiency Anemia
1/28/2024 Melese.S 260
Supplementation of iron and folic acid
Treatment of severe anemia
Deworming
Bed net distribution
Dietary diversification – increased
production and consumption of locally available
iron rich foods
Dietary modification -Fortification of foods
with iron Supplementation of iron and folic acid
261. Key Messages for Prevention of
IDA
1/28/2024 Melese.S 261
Universal Supplementation for Pregnant and Lactating Women
262. Key Messages for
Prevention of IDA
1/28/2024 Melese.S 262
In areas where anemia prevalence in young children is 40% or
more, delivery of iron supplements should continue through
the second year of life, to adolescent girls
Iron and Folic Acid Doses For Universal Supplementation for Children and
Adolescents
263. Key Messages for Prevention
of IDA
1/28/2024 Melese.S 263
Therapeutic doses
267. Lesson Objectives
Understand the current global recommendations for infant
feeding in context of HIV/AIDS.
Understand importance of optimal infant and young child feeding
for child health, nutrition, growth, and development.
Define main options for infant feeding and benefits and risks.
Describe steps for counselling HIV-positive mothers about infant
feeding.
Understand importance of postnatal follow-up and support in
infant feeding.
1/28/2024 Melese.S 267
270. Prophylaxis Regimens for Pregnant
Women & Their Infants - Option A
1/28/2024 Melese.S 270
MATERNAL ANTIRETROVIRAL PROPHYLAXIS
Initiate as early as 14 weeks gestation through delivery
REGIMENS
INFANT ANTIRETROVIRAL PROPHYLAXIS
Breastfeeding Infant: Once daily NVP from birth through duration of
breastfeeding until one week after last exposure to breast milk**
Non-breastfeeding Infant: Once daily NVP or sd-NVP + twice daily AZT
from birth to 4-6 weeks of age
Antepartum Intrapartum Postpartum
Daily AZT from
14wks
sd-NVP, AZT +
3TC*
AZT + 3TC for 7
days*
*sd-NVP and AZT+3TC intra- and post-partum can be omitted if mother
receives > 4 wks AZT during pregnancy
WHO
1-23
274. Infant Feeding Recommendations, 2010
ONE NATIONAL infant feeding strategy
1-28
BREASTFEEDING IN THE PRESENCE OF ARV INTERVENTIONS
• Exclusive breastfeeding for the first 6 months of life
• Introduce complementary foods at 6 months
• Continued breastfeeding up to 12 months of life (Breastfeeding should
then only stop once a nutritionally adequate and safe diet, without
breastmilk, can be provided
OR
AVOID ALL BREASTFEEDING
• Formula provision at national level – NO AFASS Assessment
1/28/2024 Melese.S 274
275. Cont….
oComplexity of Option A
–Different treatment and prophylaxis regimens
through pregnancy and breastfeeding
–Difficulty of long-term NVP dosing for infants
–Requirement for CD4 to determine eligibility
–Follow up along the PMTCT cascade is very low
1/28/2024 Melese.S 275
277. Option B+
• Supplementary 2012 guidelines-In 2012, the WHO released a
programmatic update to the 2010 HIV and AIDS guidelines on
PMTCT.
• The update outlined a third additional option for preventing
mother-to-child transmission of HIV - Option B+.
• This approach is similar to Option B, but suggests giving the
mother triple ARVs as soon as they are diagnosed, continuing for
life, regardless of CD4 count.
• The decision to adopt either the Option A, B or B+ approach should
be made at a country level.
• The Option B+ approach has a number of advantages,
1/28/2024 Melese.S 277
278. The advantages of Option B+
• The advantages of Option B+ are the
Simplification of PMTCT and
ART treatment regimens and service delivery;
strengthening of linkages between reproductive
health and
ART programmes at all service delivery levels;
protection against MTCT in future pregnancies and
between discordant couples; and avoiding
stopping and re-starting ARVs, which allows for
one public health message, namely “ART is for
life”.
1/28/2024 Melese.S 278
282. Option B+ in Ethiopia
• On February 20, 2013, Ethiopia’s State Minister of Health,
launched the Option B+ implementation in the presence of
different partners working in the area of Preventing Mother to
Child Transmission of HIV (PMTCT), HIV, and Maternal New-
born and Child Health
In Ethiopian, Option B+ PMTCT was adopted in 2013 as a
national policy to prevent MTCT of HIV/AIDS [EFMOH,
2013].
• The Federal Ministry of Health developed an operational plan
to phase in Option B+ services in all PMTCT facilities by the
end of 2013
1/28/2024 Melese.S 282
283. Cont….
• Ethiopia has been implementing the one year
accelerated PMTCT plan for Option A since
December 2011.
• The lessons learned from implementing the
accelerated PMTCT plan for Option A will be
a major input while moving towards Option
B+ implementation.
• In Ethiopia, where half of new HIV infections
are the result of mother to child transmission,
effective implementation of Option B+ could
be an important step toward an HIV free
generation.
1/28/2024 Melese.S 283
285. Rationale: Shift from
Option A to B+ or B
Major issue now is not “when to start” or “what to start” but
“whether to stop”
BENEFITS FOR MOTHER AND
CHILD
BENEFITS FOR PROGRAM
DELIVERY & PUBLIC HEALTH
Ensures all ART eligible women
initiate treatment
Reduction in number of steps along
PMTCT cascade
Prevents MTCT in future
pregnancies
Same regimen for all adults (including
pregnant women)
Potential health benefits of early
ART for non-eligible women
Simplification of services for all adults
Reduces potential risks from
treatment interruption
Simplification of messaging
Improves adherence with once
daily, single pill regimen
Protects against transmission in
discordant couples
Reduces sexual transmission of
HIV
Cost effective
1/28/2024 Melese.S 285
286. Programmatic
considerations for B+
• Initiate all HIV+ pregnant and breastfeeding women on
ART
• Operational and programmatic advantages to lifelong ART
for pregnant and breastfeeding women (“B+”), particularly
in settings with:
– Avoid start – stop –start approach
– Generalized epidemics
– High fertility (though need to strengthen FP)
– Long duration of breastfeeding
– Limited access to CD4 to determine ART eligibility
– High partner serodiscordance rates
• National programs need to decide B or B+
1/28/2024 Melese.S 286
Programmatic considerations for B+
287. 2013 (no change from 2010)
National agencies should decide between promoting mothers
with HIV to either breastfeed and receive ARV interventions or
to avoid all breastfeeding
Where the national choice is to promote BF, mothers whose
infants are HIV uninfected or of unknown HIV status should:
1. Exclusively breastfeed their infants for the first six months of
life
2. Introduce appropriate complementary foods thereafter, and
continue breastfeeding for the first 12 months of life
3. Breastfeeding should then only stop once a nutritionally
adequate and safe diet without breast-milk can be provided
(strong recommendation, high-quality evidence for the first 6 months;
low-quality evidence for the recommendation of 12 months)
1/28/2024 Melese.S 287
288. PMTCT Prophylaxis Options Used by Selected
Countries in Africa & Asia, 2012
1/28/2024 Melese.S 288
Option A & mixed
Cameroon India( A&B)
Lesotho Zimbabwe
DRC Myanmar
Ethiopia Malaysia
Kenya(A&B) Vietnam
Mozambique Swaziland(A& B+)
South Africa* Tanzania
Uganda* Zambia*
Nigeria(A&B)
Namibia*
Option B
Bangladesh
Afghanistan
Bhutan
Maldives
Nepal
Pakistan
Sri Lanka
Chad
Burundi
Botswana
Cote D’Ivoire
Ghana
Rwanda
South Africa*
Option B+
Malawi
Ethiopia
Lesotho
Uganda
Zambia
Angola
DRC
Cameron
Namibia
Tanzania
Zimbabwe
Mozambique
Burundi
289. Infant-Feeding Counselling
and Support
• Infant-Feeding Counselling Steps
• STEP 1: Explain risks of MTCT
•
• STEP 2: Explain advantages and disadvantages of
different feeding options, starting with mother’s initial
preference
•
• STEP 3: Explore mother’s home and family situation
• STEP 4: Help mother choose an appropriate option
1/28/2024 Melese.S 289
290. Infant-Feeding Counselling
and Support
• Infant-Feeding Counselling Steps (continued)
• STEP 5: Demonstrate how to practice
chosen feeding option
» Replacement feeding
» Exclusive breastfeeding
» Other breast milk options
• STEP 6: Provide follow-up counselling and
support
1/28/2024 Melese.S 290
291. Multisectoral approach
• Nutrition-specific interventions address the
– Immediate causes - inadequate dietary intake food.
– underlying causes - feeding practices
• Nutrition-sensitive interventions
– can address underlying and basic causes of malnutrition
by incorporating nutrition goals and actions from a wide
range of sectors.
– They can also serve as delivery platforms for nutrition-
specific interventions
1/28/2024 291
Melese.S
295. Nutrition Specific Intervention contact
points
1/28/2024 Melese.S 295
DELIVERY: safe delivery, vitamin
A, iron/folic acid, diet, FP, STI
prevention, Optimal delivery,
VCT, ARVs, Infant Feeding
Options
PREGNANCY : TT, antenatal
visits, iron/folic acid, de-
worming, anti-malarial, diet,
risk signs, FP, STI prevention,
safe delivery, iodized salt,
VCT, Infant Feeding Options,
Safe Sex, ARVs
POSTNATAL AND FAMILY
PLANNING: , diet,
iron/folic acid, diet, FP,
STI prevention, child’s
vaccination, VCT,
Support IF options, Safe
Sex
WELL CHILD AND GMP: monitor
growth, assess and counsel on
infant feeding, iodized salt,
check and complete vaccination,
VCT, Safe Sex
SICK CHILD: monitor growth,
assess and treat per IMCI, counsel
on infant feeding, assess and treat
for anemia, check and complete
vitamin A /immunization/ de-
worming, VCT, Support IF options
IMMUNIZATION:
vaccinations, vitamin A, de-
worming, assess and treat
infant’s anemia, FP, and STI
referral, VCT, Safe Sex,
Support IF options
Critical contacts for infant feeding,
women’s nutrition and PMTCT
296. Integration of Nutrition Specific interventions
with other programs
1/28/2024 Melese.S 296
Child Survival
EPI+
Community IMNCI
Health facilities IMNCI
Reproductive Health
Women’s Nutrition
Lactation Amenorrhea Method
Infectious Diseases
Control of Malaria
Mosquito net & Treatment
Tuberculosis
HIV/AIDS (PMTCT)
National
Immunization Days
Polio
Measles
ENA
Essential Nutrition Actions expands
nutrition coverage within the health sector…
298. 4. Safe disposal of adult and
child feces
1. Clean Play Spaces 2. Wash hands with soap
before feeding the child
4. Safe disposal of
adult and child feces
The Clean Household Approach (CHA)
3. Treatment of
drinking water
before giving it to
children
nutrition-sensitive behaviors
& demand stimulation
1/28/2024 Melese.S 298
299. Feeding Practices & Behaviors:
Encouraging exclusive breastfeeding
up to 6 months of age and continued
breastfeeding together with
appropriate and nutritious food up to
2 years of age and beyond
Fortification of foods: Enabling
access to nutrients through
incorporating them into foods
Micronutrient supplementation:
Direct provision of extra nutrients
Treatment of acute malnutrition:
Enabling persons with moderate and
severe malnutrition to access
effective treatment
Agriculture: Making nutritious food
more accessible to everyone, and
supporting small farms as a source of
income for women and families
Clean Water & Sanitation: Improving
access to reduce infection and disease
Education & Employment: Making
sure children have the nutrition needed
to learn and earn a decent income as
adults
Health Care: Access to services that
enable women & children to be healthy
Support for Resilience: Establishing a
stronger, healthier population and
sustained prosperity to better endure
emergencies and conflicts
Nutrition-Sensitive Strategies
Specific Actions for Nutrition
Nutrition-sensitive strategies increase the impact of
specific actions for nutrition
1/28/2024 Melese.S 299
301. Questions
1. What do we mean by the term 'adolescents ' ?
2. What are the main health problems of adolescents ?
3. What do adolescents need to grow & develop in good health ?
4. Who needs to contribute to meeting these needs & fulfilling these rights ?
5. Why should we invest in the health and development of adolescents ?
6. Frameworks for addressing the health and development of adolescents ?
1/28/2024 Melese.S 301
302. The second decade:
No longer children, not yet adults !
Adolescents 10 - 19 years
Youth 15-24 years
Young people 10-24 years
Source: A picture of health? A review and annotated bibliography of the
health of young people in developing countries (WHO, UNICEF, 1995).
1/28/2024 Melese.S 302
303. Adolescents are a diverse
population group
Different needs
Changing needs
1/28/2024 Melese.S 303
305. Phases of Adolescence
Early 11–12 to 14
years
Rapid pubertal change
Middle 14 to 16
years
Pubertal changes nearly
complete
Late 16 to 18
years
Full adult appearance,
assumption of adult
roles
1/28/2024 Melese.S 305
306. Adolescence
• Physical growth and development
– Height:
• For girls: begins between 10-11yrs
– 6 inches in height, 35 lbs in weight (1 pound (lb) is equal to
0.45359237 kilograms)
1. Peak one year before menarche
2. 2-4 inches during the remainder of adolescence
• For boys: begins between 12-13 yrs
– 8 inches in height, 45 lbs in weight(1 inch = 2.54 cm )
– Thus, an malnourished adolescent may not achieve
his/her full potential height when growth period is
over.
1/28/2024 Melese.S 306
307. Adolescence
• Physical growth and development
–Changes in body composition
• Boys: increase in lean body mass
• Girls: increase in body fat
–Changes in emotional maturity
• Psychological development affects food choices,
eating habits, body images.
1/28/2024 Melese.S 307
308. Nutrient Needs of Adolescents
• Energy and protein
– Highest total calories and
protein grams per day than
at any other time of life
(exception of pregnancy
and lactation)
• Vitamins and minerals
– Nutrients of concern:
1/28/2024 Melese.S 308
309. Trends in Malnutrition in Ethiopia
309
Melese.S
58
51
44
38 37
Stunted
Percentage
of
children
<5
years
2000 EDHS 2005 EDHS 2011 EDHS 2016 EDHS Mini EDHS 2019
Today at least 51% of 14-19 year olds are
suffering from the effects of stunting
1/28/2024
310. Status of adolescent girls in Ethiopia
310
12.5% of
adolescent are
already mothers**
Median age of 1st
marriage is 17
years*
** -EDHS 2019, ~Mixed evidence,
*** KAP survey
29% are chronically
undernourished**
~30% of girls are
Anemic~
32.8% of adolescent
moms received
assisted delivery **
13% of adolescent
moms received
PNC**
One in five
adolescent girl
death
50% increase
in neonatal
mortality
28% of girls
consumed less than 3
meals***
1/28/2024 Melese.S
311. Factors affecting adolescent’s nutritional
behaviors.
Outside influences such as lack of access to food in general - under
nutrition.
Availability and access to fast food outlets, school tuck-shops, food stores
& vendors
Individual factors such as the psychological and biological factors
immediately drive to certain behavior.
Family factors such as parental food preferences.
Social environment - in terms of peers (a strong role) & community
perception.
The macro - environment which needs to be understood in terms of the
society in which the adolescent finds himself/herself (food taboos and
other social norms).
Mass media and advertising, etc.
1/28/2024 Melese.S 311
312. Media access and exposure of adolescent 15-19 yrs
0
10
20
30
40
50
60
70
80
90
Owns mobile phone Used internet last yr Reads newspaper Listens radio Watches television
URBAN MALES URBAN FEMALES URBAN FEMALES RURAL MALES RURAL FEMALES
Source: Adolescent and Youth Strategy Baseline
1/28/2024 Melese.S 312
313. Delivery platform for adolescent nutrition
services
313
Youth Centres
Platform
Health Facilities
Platform
School
Platform
• Support the provision of youth responsive nutrition
services
• Integration of nutrition in Life Skills Training
• Nutrition Assessment, Counseling and
Support
• School-based Deworming
• Promotion of Sanitation and Hygiene
(WASH)
• Weekly Iron folate supplementation
• Link with youth friendly services
• Support the provision of youth responsive nutrition
services
• Provision of deworming tablets
• Nutrition assessment and counseling
• Care of Adolescent Pregnancy and Childbirth
• Improve Nutrition-PSNP linkages
• Weekly Iron folate supplementation
Out of school adolescents
In school adolescents
1/28/2024 Melese.S
314. The Factors That Influence Our Food Choices
1.Major determinants of food choice
• The key driver for eating is of course hunger but what we choose to eat
is not determined solely by physiological or nutritional needs. Some of
the other factors that influence food choice include:
Biological determinants such as hunger, appetite, and taste
Economic determinants such as cost, income, availability
Physical determinants such as access, education, skills (e.g.
cooking) and time
Social determinants such as culture, family, peers and meal
patterns
Psychological determinants such as mood, stress and guilt
Attitudes, beliefs and knowledge about food
1/28/2024 Melese.S 314
316. Nutrition during Adolescence
1.Increased Nutrient Requirement
Adolescents also undergo a very rapid growth
during their puberty (called the pubertal
growth spurt).
• During the pubertal growth spurt, they increase
rapidly both in weight and height.
• Therefore, they need a nutrient intake that is
proportional with their rate of growth.
• Increased requirements of energy, protein,
calcium, phosphorus, Iron and zinc.
1/28/2024 Melese.S 316
317. 2. Behavioral challenges
• Eating disorders
–Bulimia nervosa
–Anorexia nervosa
• Substance abuse
–Khat
–Smoking
–Alcohol
• Out of home eating (fast foods)
–School
–university
1/28/2024 Melese.S 317
ABC’s or three basic types of
eating disorders…
A=Anorexia
B=Bulimia
C=Compulsive Eating
319. Eating Disorders of
Adolescence
• Two important periods of adolescence for
eating disorders
– Early passage into adolescence
– Transition from later adolescence to young
adulthood
• Childhood risk factors (eating problems,
dieting patterns, and negative body image)
– May cause teens to exert excessive control
over their eating as a way to manage stress
and physical changes
1/28/2024 Melese.S 319
320. Types of eating disorders
The main types of eating disorder include:
• Anorexia nervosa – characterised by restricted eating, loss of weight and
a fear of putting on weight
• Bulimia nervosa – periods of binge eating (often in secret), followed by
attempts to compensate by excessively exercising, vomiting, or periods of
strict dieting. Binge eating is often accompanied by feelings of shame and
being 'out of control'
• Binge eating disorder – characterised by recurrent periods of binge
eating (can include eating much more than normal, feeling uncomfortably
full, eating large amounts when not physically hungry). Feelings of guilt,
disgust and depression can follow binge eating episodes. Binge eating
does not involve compensatory behaviours
• Other specified feeding or eating disorder (OSFED) – feeding or eating
behaviours that cause the individual distress and impairment, but do not
meet criteria for the first three eating disorders.
1/28/2024 Melese.S 320
321. A Dynamic Perspective on the Determinants
of Eating Disorders
● Sociocultural factors (mass
media, friends, occupations,
athletics)
● Psychological factors
(perfectionist, need for
control, “all or none”
thinking, low self-esteem,
difficulty expressing
negative emotion, difficulty
resolving conflict, mood
disorders, personality
disorders, substance abuse,
sexual trauma)
● Family factors (perfectionist,
controlling, repress anger,
rigid)
● Biological factors (serotonin,
genetic predisposition)
1/28/2024 Melese.S 321
322. Risk factors for eating disorders
• Psychological risk factors
• Personality factors that make a person more at risk of
developing an eating disorder may include:
low self-esteem
perfectionism
difficulties expressing feelings like anger or anxiety
being a 'people pleaser'
difficulties being assertive with others
fear of adulthood.
1/28/2024 Melese.S 322
323. Cont …
• Social or environmental risk factors
• Social or environmental risk factors in the development of an
eating disorder may include:
being teased or bullied
a belief that high expectations from family and others must be met
major life changes such as family break-up, or the accumulation of many
minor stressors
peer pressure to behave in particular ways
a parent or other role model who consistently diets or who is unhappy
with their body
media and advertising images of the ideal body size and shape as slim
and fit
1/28/2024 Melese.S 323
324. • Biological factors
• Contributing biological factors may include:
adolescence and its associated physical changes
genetic or familial factors – for example, families that are
overly focused on food, weight, shape and appearance.
1/28/2024 Melese.S 324
