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Heather Grieve, Women Deliver 29 May 2013


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Nutrition – the emerging issues
Heather Grieve- Nutrition Team Leader Women's and Children's Knowledge Hub

Published in: Health & Medicine, Technology
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Heather Grieve, Women Deliver 29 May 2013

  1. 1. Nutrition – the emerging issuesHeather Grieve- Nutrition Team Leader, Womensand Childrens Health Knowledge Hub
  2. 2. Inadequate food intake DiseaseHealth careFood security Water security Hygiene & sanitationFamily planningGender equityTransport Infrastructure Social protectionClimate EducationIncome & employmentGovernance SecurityTradeImmediatecausesUnderlyingcausesBasiccausesSource: Adapted from UNICEF 1991Conceptual framework for the causes of undernutritionCaring practices
  3. 3. Undernutrition - The immediate effectsRepeated infections,persistent undernutritionDiseaseUndernutritionIncreased durationand severity ofillnessIncreased nutrientrequirementsIntestinal damageMalabsorption and/ orloss of nutrientsSystemic infections, e.g.malaria, pneumonia,measlesFever and illnessIncreased nutrientrequirementsDiarrhoea & other gutinfections
  4. 4. Frequent infectionsLow birth weightand or pre-termbabyStunted childStuntedadolescentSmall pregnantwomanImpaired mental developmentInadequate growthReduced mentalcapacityReduced mental capacityBirth complicationsMaternal mortalityIntra-uterine growth restrictionGreater risk of developingchronic disease such as heartdisease, hypertension anddiabetesUndernutrition - The long term effects
  5. 5. Macrosomia( birth weight >4000g)Overweight/obeseadolescentOverweight /obesepregnant womanGreater risk of developing chronicdisease such as non-insulindependent diabetesPregnancycomplications (e.g.preeclampsia andgestational diabetes)Birth complicationsOverweight/obese childGreater risk of developing chronicdisease such as non-insulindiabetesOvernutrition -The long term effects
  6. 6. 40%22%16%9%6%42%17%47%41%12%6%14%7%13%6%17%9% 10%Indonesia Vietnam Mongolia China Tuvalu Pakistan Kazakhstan Malawi NigeriaStunting OverweightPrevalence of stunting (HAZ < -2) and overweight (WHZ > 2) in children underfive years by countryThe double burdenSource: Country demographic and health surveys; World Bank Data; UNICEF State of theWorld’s Children report; WHO data tables
  7. 7. The nutrition transitionTrends in nutritional status among women aged 15 – 49 years, CambodiaSource: Cambodia DHS 2010
  8. 8. 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013The nutrition landscape in the 21st CenturyUnderJune 6 2013 New SeriesMaternal and ChildNutrition with greaterattention to the doubleburden, the role of othersectors and the enablingenvironment required toscale up nutritionSeries on Maternal andChild UndernutritionWHA endorsed CIPmaternal, infant andyoung child nutrition(6 global targets2025)WHO The Landscape Analysisin-depth Country Assessments
  9. 9. Scaling up nutrition, what are countries being asked to do?MobiliseresourcesScale upnutritionspecificinterventionsAddress thedouble burdenAlign andcoordinateactionsacrosssectors
  10. 10. Asia Pacific - regional profileAsia• High prevalence ofundernutrition (stuntingand micronutrientdeficiencies)• ‘Nutrition transition’• More current nutritionplans with a focusmostly on underweightPacific• ‘Double burden ( highrates ofoverweight/obesity, stunting and micronutrientdeficiencies)• Nutrition plan mostly outdated or directedtowards overweight andobesity
  11. 11. Source: Timor Leste DHS 2010; WHO Micronutrient Data Base, UNDP Human Development IndexTimor LesteChildren < 5 years• IMR: 64/1000 livebirths• Wasting: 19%• Stunting: 58%• Underweight: 45%• Anaemia : 38%• Vit A deficiency:48.5%• Overweight: 0.7%Non- pregnant women• Underweight :27%• Short stature: 15%• Overweight: 5%• Anaemia :21%Pregnant women• TFR: 5.7• Anaemia :28%• MMR: 557/100,000live births• Vitamin A deficiency:2%• 8/10 women birth athome• Median age of firstbirth: 22.4 yearsNutrition capacity• No pre-service and limited in-service nutrition training• New nutrition assistantpositions in some districtsNational nutrition plansand policies• Comoro Declaration• National NutritionStrategy (2013-2018)waiting endorsement• National NutritionSurvey 2013Food security• 60% of thepopulation live on< US$1/day• 40% live belowthe poverty line(55c/day)• 20% of thepopulation arefood insecure• 44% are at risk offood insecurityEducationMean years ofschooling (adults):4.4 yearsPopulation: 1.12 million
  12. 12. Source: PNG National Nutrition Survey 2005;UNDP Human Development Index ;State of the Worlds Midwifery 2011Children < 5 years• IMR: 69/1000 livebirths• Wasting: 5%• Stunting: 43%• Underweight: 18%• Anaemia : 48%• Vit A deficiency: ?• Overweight : no dataNon- pregnant women• Underweight : nodata• Short stature: no data• Overweight: 46%• Anaemia: 36%Pregnant women• TFR: 4.1• Anaemia : 55%• MMR: 250-530/100,000 live births• Adolescent birth rate(births/1000 womenaged 15-19):70• Median age of firstbirth:20.5 yearsNutrition capacity• No pre-service and limited in-service nutrition training• Four nutrition staff at centrallevel and very limited nutritionstaff in the 22 provincesNational nutrition plansand policies• National NutritionPolicy (1995)• IYCF Strategy (draft)Food security• 36% of thepopulation live on< US1.25/day• 28% live belowthe poverty line(% of populationfood insecure: nodata• % of populationrisk of foodinsecurity: no dataEducation• 40% of women(15-49 yrs.)haveno education• Average years ofschooling :3.9years• Female literacyrates : 56%Population: 6.5 millionPapua New Guinea
  13. 13. Nutrition capacity development -The Nutrition Critical Appraisal Tool• Stakeholder consultations in 2009/10 supported the 2008 Lancet Series onMaternal and Child Undernutrition indicating a need to:o build capacity of governments to prioritise and plan nutritionprograms effectivelyo move away from vertical programming and scale up nutrition programsusing integrated approaches based on best practice• The format is based on 1000 days ‘window of opportunity’ from preconception (including adolescents ) to two years of age• The content is based on:o Interventions outlined in the 2008 Lancet Series on Maternal and ChildUndernutritiono WHO Evidence of Nutrition Actions (eLENA)o Globally endorsed nutrition frameworks, policies and procedureso Principles of the Scaling Up Nutrition (SUN) strategy 2012-2015o Best practice case studies from the region• Guides users through current evidence and best practice, and provide links tokey documents, resources and relevant case studies.• Currently being pre-tested
  14. 14. Nutrition capacity development- The Nutrition Critical Appraisal Tool
  15. 15. Nutrition capacity development- Nutrition and Food Security-Approaches to improving the health of women and children short course• Evidence about the ‘what and how’ for nutrition is rapidly changing• Lack of relevant comprehensive in-service training that covers;o nutrition across the 1000 days lifecycleo under and over nutritiono the role of nutrition specific and the nutrition sensitive approaches innutrition programming• Nutrition and Food Security- Approaches to improving the health of womenand children short course developed Nutrition planning and programming Nutrition for infants and young children Nutrition for adolescent girls and women of reproductive age Food security for families and communities• Each module uses local data and where possible local case studies asexamples• 2012/13 adapting the course for district and sub district health and agriculturalextension workers in Timor Leste
  16. 16. Knowledge Hubs for Health are a strategic partnership initiative funded by theAustralian Agency for International DevelopmentThank you