bruce cogill (bioversity) - drivers of undernutrition
DESCRIPTION
Presentation to the AIFSC-ILRI Nutrition WorkshopTRANSCRIPT
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Drivers of Undernutrition
Bruce Cogill Ph.D.Bioversity International
Nutrition and Marketing Diversity Programme LeaderAIFSC Workshop
“Food and nutrition in Eastern and Southern Africa” Nairobi, Kenya
10-11 September
CGIAR Research Program on Agriculture for Nutrition and Health
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Source: Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print)
Mean anthropometric z-scores using the WHO growth standard
Wasting
Underweight
Stunting
Mean WAZ z scores by age using the new WHO standard, according to region (1–59 months)
Source: Victora et al. Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions. Figure 2. Pediatrics 2010;1254
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The conceptual framework of malnutrition
Poor Dietary Quality
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Food security
- Breastfeeding- Complementary feeding - Vitamin A supplementation- Zinc supplementation- Hygiene
INSTITUTIONS
POLITICAL & IDEOLOGICAL FRAMEWORK
ECONOMIC STRUCTURE
RESOURCESENVIRONMENT, TECHNOLOGY, PEOPLE
Food/nutrientintake
Health
Health,Water/
Sanitation Services
Interventions
Immediate causes
Underlying causes at
household/family level
Basic causes at societal
level
SHORT
ROUTES
LONG ROUTES
- Agriculture- Poverty reduction- Income generation- Education- Health systems strengthening- Women’s empowerment
Care Resources
Household Food Access
Adapted from Ruel (2008) & UNICEF (1990)
Nutritional Status
Care Resources
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Iron folate supplementation (reduces maternal deaths by 23%)
Maternal multiple micronutrients (reduces LBW infants by 16% and reduces maternal anemia by 39%)
Calcium supplementation (reduces risk of pre-eclampsia by 52%)
Promotion of breastfeeding (reduces mortality by 13%)
Social and behavior change for improved complementary feeding (reduces stunting)
Maternal supplements of energy, micronutrients, and protein (reduces LBW infants by 32%)
Deworming (reduces anemia and increases growth)
Neonatal vitamin A (reduces infant mortality by 21% in South Asia)
Delayed cord clamping (reduces anemia)
Vitamin A fortification or supplementation (reduces child mortality by 23%)
Universal salt iodization (improves IQ by 13 points)
Conditional cash transfers with nutrition education (reduces stunting)
Iron fortification and supplementation (reduces anemia by 28% and maternal mortality)
Dietary diversification (e.g. reduces anemia and vitamin A deficiency)
Improving diet quality and diversity
1,000 days Nutrition service deliveryTreatment of severe acute malnutrition in facilities (reduces deaths by 55%)
Zinc for management of diarrhea (reduces mortality by 9%)
What we do in Nutrition: Typical Interventions that should work
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Very useful as the conceptual framework is a causal model that mainly focuses on biological factors MORE COMPLEX
In East Africa additional dimensions enhancing undernutrition include:
• Socio-Economical (poverty, inequities, behaviors…)
• Environmental (sizeable proportion of land arid and semi-arid, prolonged droughts followed by floods exacerbated by climate change)
• Political (conflicts, poor governance, rent seeking…) Governance
• Behaviours
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All other countries in Blue had improved nutrition during same period as growth rates
Growth analysis from Radelet (2011) CGDEVNutrition data for Underweight and Stunting for same period from UNICEF UNDP
Comparing Under Five Nutrition with Changes in economic well being
No Change in Wt/Age Ht/AgeBurkina Faso, Mali, Mauritius, Lesotho and South Africa
Changes in Underweight in Blue countries was 1.3% per year (1996-2008) to close to zero
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Food Systems, Food Environments, Econutrition
Interrelationships among nutrition, human health, agriculture and food production, environmental health , and economic production
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Underweight and obesity in women in 36 highest-stunting burden countries*
*Data on both underweight and obesity prevalence for adult women were available for 29 countries. Stunting based on infants and children under-five. Source: WHO Global Database on Body Mass Index (2010) http://apps.who.int/bmi/index.jsp