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Overview Of UNICEF-assisted Nutrition Programme

UNICEF Nutrition supplier Meeting

Copenhagen, 5-6 October 2009

Flora Sibanda-Mulder

2

Neonatal

37%

HIV/AIDS

3%

Diarrhoea

17%

Measles

4%

Injuries, 3%

Other, 10%

Malaria

8% Pneumonia

19%

Causes of Neonatal Deaths>35%

attributable to

undernutrition

Other – 7%Tetanus – 7%Diarrhoea – 3%

Sepsis/Pneumonia – 26%

Asphyxia – 23%

Congenital – 8%

Preterm – 28%

>35% of under-five deaths are attributable to undernutrition (Lancet Series, 2008)

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Types of malnutrition

Acute malnutrition Marasmus (wasting) Kwashiorkor (oedematous)

Chronic malnutrition Stunting

Growth faltering (underweight) Composite of acute & chronic malnutrition

Specific nutrient (micronutrient) deficiency Anaemia, Iodine, Vitamin A, Zinc etc

Malnutrition secondary to disease HIV and AIDS / TB Any illness (diarrhoea, pneumonia, measles, etc.)

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Differences between acute and chronic malnutrition

Diagnostic indicators

Acute malnutrition - MUAC or weight for height

Stunting - height for age

Underweight - weight for age

Types of intervention

Acute malnutrition – short term treatment

Chronic malnutrition – long term preventative/antenatal care

Different Therapeutic regimes

Acute malnutrition – complete therapeutic diet (200 Kcal/kg/day)

Chronic malnutrition – nutritional supplements (<200 Kcal/day)

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Definition of Severe Acute Malnutrition

Middle Upper Arm Circumference (MUAC) < 115mm in children between 6 – 59 months of age

or

Weight-for-height <70% of median or below -3SD of mean reference values

("wasted")

Bilateral pitting oedema of nutritional origin

("oedematous malnutrition")

Infants who are not

breastfed are far more

likely to get sick and

die

9

Infants (<6mos) exclusively breastfed (%) in selected Asian countries

Source: SOWC 2009, UNICEF

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Protection by breastfeeding is greatest for the youngest infants

WHO Collaborative Study Team. Effects of breastfeeding on infant and child mortality due to

infectious disease in less developed countries: a pooled analysis. The Lancet 2000;355:451-5

Risk of death if

breastfed is

equivalent to

one.

Tim

es m

ore

lik

ely

to

die

if n

ot

bre

astf

ed

Age in months

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Micronutrient Deficiencies and MDGs

The combined effects of micronutrient deficiencies on mortality,

morbidity and productivity are estimated to result in economic losses of billions of dollars.

MDG 1: Eradicate hunger and poverty

Iron and iodine def are related to mental and physical incapacity and this has implications for learning and productivity leading to low earnings

MDG 2: Universal primary education

Iron and iodine nutrition are closely related to cognitive function. Anaemia is also related to low school attendance independent of cognition

MDG 4: Reduction of Child Mortality

Vitamin A and zinc are directly related to child survival. Vitamin A and zinc deficiencies contribute to increased morbidity and mortality.

MDG 5: Improve maternal health

Anaemia is an important cause of maternal deaths. Severe vitamin and mineral deficiencies are associated with pregnancy complication

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Challenges

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Food Prices and Economic Crises: The reality

1. Malnutrition levels in most developing countries are unacceptably high in „normal times‟. A nutrition crisis in children is already underway

2. As the price of staple foods increases beyond the coping capacity of poor households, levels of malnutrition and vulnerability increases

3. The economic downturn has resulted in loss of jobs and wages and reduced purchasing power

4. The current policy, programme, and safety-net responses are inadequate. In the near future, they risk to be driven by political considerations rather than by the needs of the most vulnerable children

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The reality of food prices surge

3. High food prices and economic will affect first the

nutrition situation of the most vulnerable children and

women; however consequences are likely to go beyond

nutrition

4. The current crises open a window of opportunity to

scale up advocacy, policy, programme, and budgetary

action for child nutrition in vulnerable countries

An emergency is extraordinary situation of

natural or political origin that puts the health and

survival of a population at risk.

An emergency can happen

anywhere

USA

hurricane

Associated Press

USA hurricane

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Nutrition in Emergencies

Emergencies have an impact on a whole range of factors that can increase the risk of malnutrition, illness (morbidity) and death (mortality). Unfortunately, high malnutrition and mortality rates continue to occur during emergencies

Causes include: severe shortages of food combined with disease epidemics; poverty, chronic food insecurity and poor infrastructure; HIV and AIDS; climate change; volatile food prices; political and

economic crisises

The main nutritional problems of concern in emergencies are:

Acute malnutrition (wasting) especially in young children -kwashiorkor characterised by oedema (swelling due to fluid retention) and marasmus

Micronutrient deficiencies especially iron, vitamin A, iodine deficiencies and (common in disadvantaged populations). Outbreaks have occurred in emergency-affected populations – vit. C def in Afghanistan, Riboflavin in Uganda (2009)

Poor infant and young child feeding practices, including distribution of infant formula

1. It does not have the protective properties of breastmilk

2. It actively increases

vulnerability

4. Infant formula is not

sterile

5. It increases food

insecurity

3. It carries risks linked to the

methods of feeding

The risks of artificial feeding

Artificially fed infants are highly

vulnerable in emergencies

Even a little artificial feeding carries

risk

25.4

11.5

0

5

10

15

20

25

30

Received Donations Infant Formula Did Not Receive Donations Infant Formula

Prop

ortio

n of

chi

ldre

n w

ith d

iarr

hea

in th

e pa

st 7

day

s

Relation between prevalence of diarrhoea and receipt of donated infant formula, Yogyakarta Indonesia post-2006 earthquake.

The risks of artificial feeding in emergencies

Relation between prevalence of diarrhoea and receipt of donated infant formula, Yogyakarta Indonesia post-2006 earthquake

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Possible to prevent 26% of U5 deaths by scaling up key Nutrition interventions

1%

1%

2%

2%

2%

2%

3%

3%

4%

4%

5%

6%

7%

13%

0% 2% 4% 6% 8% 10% 12% 14%

Antimalarial iPTP

Measles Vaccine

Nevirapine and Replacement Feeding

Newborn Tem. Management

Tetanus Toxoid

Vitamin A Supplementation

Antenatal steroids

Water, sanitation, hygiene

Clean delivery

Hib vaccine

Zinc (preventative)

Appropriate Complementary Feeding

Insecticide Treated Materials

Exclusive and Continued Breastfeeding

Source: Jones et al, Lancet 2003;362:65-71 (Child Survival Series)

Joint Health and Nutrition Strategy

Conceptual framework

Impact on

MDGs

Learning by

doing, and

doing better by

learning

Strategic result 1:

Enhanced

knowledge &

evidence

Strategic result 3:

Effective

coverage

Leveraging

policies,

legislation,

plans and

budgets

through

enhanced

knowledge &

evidence

Translating

policies,

legislation,

plans and

budgets into

large-scale

accelerated

action

Strategic result 2:

Enabling

Policies,

Plan & budgets

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The “Window of Opportunity” for high impact nutrition interventions is very small…pre-pregnancy until 18-24 months of age

-2.00

-1.75

-1.50

-1.25

-1.00

-0.75

-0.50

-0.25

0.00

0.25

0.50

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

Age (months)

Weig

ht

for

ag

e Z

-sco

re (

NC

HS

) Latin America and Caribbean

Africa

Asia

Data Source: Shrimpton et al (2001)

How can we improve nutrition?

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Why is a lifecycle approach important?

It helps in understanding that:

Maximum benefits in one age group can be derived from interventions in an earlier age group

Interventions at several points across the lifecycle are needed to sustain improvements in outcomes and have cumulative effect

There are intergenerational risks and benefits and essential

linkages to managing risks for all age groups

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UNICEF response in Nutrition

Preventing malnutrition in children to promote growth, development and survival, and women

Supporting the treatment of severe acute malnutrition in children in countries with SAM burden

Protecting nutritional status of vulnerable groups affected by emergencies - crucial and a humanitarian right

Breastfeeding

saves lives in

emergencies all

over the world

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Prevention of malnutrition: IYCF

Promotion and Support for breastfed infants

Early initiation (ErBF1)

Exclusive breastfeeding (ExBF6)

Promotion of timely and age-appropriate complementary feeding

Ensure age-appropriate micronutrient fortified blended foods as part of general ration (WFP)

Advocate for additional nutrient-rich foods in supplementary feeding programmes

Support for non-breastfed infants Education of mothers and families on

appropriate use of BMS

Ensure access to safe water and handwashing with soap

Monitor use of BMS

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Provide MMN preparation containing 1 RNI/daily or 2 RNI/weekly of 10-15 vitamins and minerals (depending on availability of fortified food aid)

Preferably with food (in-home fortification)

Continue VAC distribution and Zn as adjunct for diarrhoea treatment

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Additional preventative interventions

Increase and maintain high coverage of vitamin A supplementation

Deworming of all children 1-5 years of age

Promotion of hygienic practices – handwashing with soap (with WASH)

ORT + Zinc for diarrhoea management

Access to essential health services (immunization+)

Access to impregnated bednets (in malaria-prone areas)

Access to safe water

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Facility-based therapeutic feeding

→ For children with SAM and medical complications

Community-based therapeutic management

→ For children with SAM without medical complications

→ Using ready-to-use therapeutic foods (RUTFs)

→ to the extent possible locally produced

Supplementary feeding for management

of moderate acute undernutrition

→ Using age-appropriate supplementary

foods

Management of Acute Undernutrition

Thank You