The Nutrition Factor: Basic for Child survival and development in CA and CEECIS

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The Nutrition Factor Basic for Child survival
and development in CA and CEE/CIS
MCH Forum8 April 2008

• Arnold Timmer, Nutrition Specialist
• UNICEF Regional Office CEE/CIS, Geneva

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CEE/CIS Region
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Child Nutrition Challenges in CEE/CIS

• Nutrition crucial in child survival
• Vitamin A, breastfeeding, acute malnutrition
  (wasting)
• Nutrition crucial in child development
• Chronic malnutrition (stunting, low
  height-for-age)
• Iodine deficiency
• Iron deficiency
• Overweight ? increasing rapidly in lt 5, poverty
  related
• Populations of concern
• Children lt 2 years ? window of opportunity
• Pregnant, lactating women and women of child
  bearing age
• Disparities ? children in rural areas, families
  of lower wealth and lower maternal education
• Direction
• Communicate comprehensive nutrition typology,
  advocate integrated approach (nutrition
  investment policy)
• Action at community, systems and policy level
• Opportunities for Central Asia

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Successes in Central Asia

• IDD elimination through USI close to completion
• Flour fortification going to scale
• Vitamin A supplementation achieved high coverage
• BFHI successful but alone is insufficient
• Time has come to look ahead and use momentum
  created
• Invest wisely and ensure optimum child survival
  and development
• Invest in quality of children ? future of the
  nation
• engage available funding and actors (private
  sector, civic groups, community)
• Communicate in understandable language school
  performance, economic productivity, reduced
  health care costs

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Child nutrition ? child development-Lancet
series-

• First few years of life are crucial, development
  of
• ? brain
• ? motor skills
• ? social-emotional skills
• Poor child development ? poor school achievement
• ? maternal care, stress
• ? under-nutrition
• ? poverty

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Child nutrition review - outcome

• Nutrition typology ? chronic and hidden ?
  stunting and micronutrient deficiencies
• Children lt 2 years particularly affected ? caused
  by poor infant and young child nutrition
• Large disparities national averages seem fine,
  but worrisome for low income households, low
  maternal education, and rural areas.
• Double burden of malnutrition rapidly increasing
  trend of overweight ? poverty driven ? health
  care burden, risk chronic disease, reduced
  productivity/wellbeing
• In countries with rapid economic growth lack of
  progress and rates disproportionate with health
  care, mortality and income

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Stunting among children 6-11 and 12-23 months
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Stunting by maternal education
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Overweight emerging as serious public health
problem affected by poverty(weight-for-height gt
2 SD)
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Double burden overweight and stunting
(children lt 5 years)
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Anaemia youngest children are most affected
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Anaemia (lt12 g/dl) among non-pregnant women
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Exclusive breastfeeding rate (lt 6 months)
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Strategic directionChild development compromised
in CEE/CIS

• Children suffer irreversible damage to physical
  growth, brain development and health. Youngest
  children in poor, rural families with lower
  education are hardest hit
• Assumed main causes
• Diet deficient in vitamins, minerals protein ?
  low exclusive breastfeeding, complementary foods
  not available or accessible
• Behaviour related insufficient knowledge and
  inappropriate practices ? external factors
  health care advice, counselling, commercial,
  workplace, traditions believes

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Selecting evidence-based interventions and
operational strategies using a life-cycle
approach
Adolescence
Adulthood
Childhood
Newborn
Critical Physiological Stage of Health and
Nutrition (prenatal-3 years)
Pregnancy birth
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(No Transcript)
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Causal framework poor breastfeeding and
complementary feeding practices
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Strategic Direction what and how

• Focus on children lt 2 years and IYCN
• Comprehensive approach ? advocate as child
  development
• Better understand causes cultural, labour,
  economic aspect
• Overall protection, promotion and support of
  infant and young child feeding expand
  breastfeeding to community level beyond the BFHI,
  focus on complementary food feeding
• Micronutrients supplementation (sprinkles),
  fortification ? also address pre-pregnancy
• Address inequities ? target specific population
  groups

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Strategic Direction what and how

• More attention for overweight
• Exclusive and continued breastfeeding
• Adequate and timely complementary feeding
• Control marketing of foods targeting young
  children
• Use (pre-)schools to launch activities
• Private sector role
• Strengthen community and family dimension (now
  health system driven)
• Requirements
• Scale up of interventions
• Sustainability ownership, financially feasible
• Evidence based
• Public health rather than clinical approach

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Action policy systems - community

• Poor feeding practices influenced by environment
  (commercial, work, health care system,
  community/family) ? requires action at community,
  systems and policy level
• Information and Communication Provision of
  accurate, objective and consistent information
  about optimal child feeding practices
• Skilled support for mothers to initiate/sustain
  the optimal feeding practices, prevent/overcome
  difficulties
• Protection from misinformation and inappropriate
  commercial influences
• Create an enabling environment (including the
  policy/legislative environment) for
  mothers/families to adequately feed and care for
  infants and young children

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Opportunities

• Policy
• Advocate for comprehensive approach ? main
  problems and interventions combined ? budget
  allocation
• Capacity building evidence based policy
  development
• Systems
• Health system reforms
• Update standards, methods, norms, guidelines
• Capacity building of scientists ? West-East
  connections
• Ensure implementation to peripheral levels
• With partners
• Community
• Innovations, monitoring, documenting and scaling
  up

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Costs of Nutrition programming (approximate)
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Conclusion

• Evidence and experience support cost-effective
  and comprehensive approach
• Next steps
• Advocate among broad field of professionals ?
  form working group
• Engage high level using political priorities
• Formulate comprehensive national nutrition policy
  and action plan
• Go beyond health-spheres ? MoFinance, MoEconomic
  Development, private sector, civic society
• Base approach on community level opportunities
• Monitor and document in health and economic terms
• Organize donors and international agencies around
  1 plan

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THANK YOU