Transcript Health Sector Overview

The
ThePepsiCo
PepsiCoFoundation
FoundationMeeting
March 31, 2008
Addressing Malnutrition
Toby Stillman
Advisor, Emergency Health and Nutrition
Page 1
Outline
•
Review measures of undernutrition
•
Review causes and consequences of undernutrition
•
Introduce Save the Children’s operational approach
to nutrition programming
– Children under the age of five
– School aged children
2
Page 2
Measures of Undernutrition Review
Stunting
(Chronic)
Underweight
(Both)
Wasting
(Acute)
Height for
Age
Weight for Age
Moderate < -2 SD
< -2 SD
Weight for
Height or
MUAC
< -2 SD
< - 3 SD
< - 3SD
< - 3SD
Index
Severe
Page 3
Measures of Undernutrition Stunting:
Height For Age
Page 4
Measures of Undernutrition Stunting:
Weight For Age
Page 5
Measures of Undernutrition Wasting:
Weight for Height
Marasmus (wasting)
Page 6
Kwashiorker (oedema)
Measures of Undernutrition
Mid-upper Arm Circumference
Page 7
Measures of Undernutrition:
Micronutrient deficiencies
• Vitamin A
• Zinc
• Iron
• Iodine
Page 8
Undernutrition
What are the Consequenses?
Pneumonia
•
35% to 55% of Child
Mortality (children <5)
•
Adult Size
•
Intellectual Ability
•
Economic Productivity
•
Reproductive
Performance
19%
Newborn
36%
Under-nutrition
Diarrhea
17%
Other
Malaria
InjuriesAids Measles 8%
4%
3% 3%
10%
Is build
right? Why first
•
Metabolic and
Cardiovascular
bullet
alone? Disease
9
Page 9
Undernutrition
When does it Happen?
Page 10
First 2 years
of life
Undernutrition
Where does it Happen?
Page 11
Undernutrition
Where does it Happen?
Page 12
¾ of the
world’s
underweight
children reside
in just 10
countries
Undernutrition
How does it Happen?
Outcome
Immediate
Causes
Underlying
Health /
Nutrition
Causes
Page 13
Under-Nutrition
Inadequate
Dietary Intake
Insufficient
Access to Food
Disease
Inadequate
Care for Mothers
and Children
Lack of health services &
unhealthy environment
Addressing Undernutrition
Interventions (1)
Page 14
Addressing Undernutrition
Interventions (2)
100
90
80
70
60
50
40
30
20
10
0
The Coverage Gap
39
47
55
40
30
20
Exclusive BF
Water,
Treatment
Treatment
Oral
Sanitation,
(pneumonia)
(diarrhea)
rehydration
Hygiene
Source: Lancet Volume 362, PP. 65-71
Page 15
therapy
Vitamin A
Addressing Undernutrition
SC Results Framework
Intended Impact:
Children are Healthy and Well-Nourished
Strategic Objective
Increased Use of Key Health and Nutrition Practices and Services
Page 16
Addressing Undernutrition
SC Priority Interventions
Practices
Nutrition
• Immediate Breastfeeding
• Exclusive Breastfeeding through 6
months of age
• Timely introduction of appropriate
complementary foods (Frequency of
Services
• Vitamin A supplementation
(Maternal and Child)
• Iron supplementation
• Iodine supplementation
feeds, quality of feeds, etc.)
Health
• Proper disposal of feces
• Measles immunization
• Hand washing at appropriate times • Timely appropriate treatment of
ARI, diarrhea, malaria, and
• Appropriate home care for Illness,
malnutrition including zinc
including oral rehydration therapy for
children with diarrhea
therapy for diarrhea
• Timely referral of seriously ill
children
Page 17
Addressing Undernutrition
SC Results Framework
Intended Impact:
Children are Healthy and Well-Nourished
Strategic
Objective
Behaviors
Increased Use of Key Health and Nutrition Practices and Services
Page 18
Addressing Undernutrition
SC Results Framework
Intended Impact:
Children are Healthy and Well-Nourished
Strategic
Objective
Behaviors
Increased Use of Key Health and Nutrition Practices and Services
Intermediate
Result 1:
Increased Access
to, & Availability
of, Services and
Supplies
Page 19
Intermediate
Result 2:
Increased
Quality
Of Services
Intermediate
Result 3:
Increased
Knowledge,
Attitudes, and Skills
Intermediate
Result 4:
Enabling Social
& Policy
Environment
Addressing Undernutrition
Monitoring our Progress
Time
Children
are<5healthy
and
% children
stunted
well nourished
% children with diarrhea
Impacts
% women
Increased
exclusively
use of breastfeeding
key health and
nutrition practices and services
% children receiving timely care for illness
%
Improved
Access
population
within 5
km of
health
care
facility
Page 20
% children
Improved
Quality
diagnosed
and
treated
according
to protocol
%
Improved
KA&S
husbands
supporting
exclusive
# Strategies
of
community
breastfeed
health
workers
ing
trained in BCC
Activities
National
Improved
Policies
policy
on
managem
ent of
acute
malnutriti
on in
place
Outcomes
Inputs &
Outputs
Longer
Term
Medium
Term
Shorter
Term
Addressing Undernutrition
SC Priority Interventions (1)
Practices
Services
Nutrition
• Immediate Breastfeeding
• Vitamin A supplementation
(Maternal and Child)
• Exclusive Breastfeeding through 6
months of age
• Iron supplementation
• Timely introduction of appropriate • Iodine supplementation
complementary foods (Frequency
of feeds, quality of feeds, etc.)
Health
• Proper disposal of feces
• Hand washing at appropriate times
• Appropriate home care for Illness,
including oral rehydration therapy for
children with diarrhea
• Timely referral of seriously ill
children
Page 21
• Measles immunization
• Timely appropriate treatment
of ARI, diarrhea, malaria, and
malnutrition including zinc
therapy for diarrhea
Addressing Undernutrition
SC Priority Interventions (1)
Intended Impact:
Children are Healthy and Well-Nourished
Strategic
Objective
Intervention:
Increased
of Key Health
and Nutrition
Practices and foods
Services
Timely Use
introduction
of appropriate
complementary
Intermediate
Intermediate
Result 1:
Result
1:
Increased
Access
Increased
to,
& Availability
Access
to, &
of,
Services and
Availability
of,
Suppliesand
Services
Supplies
Page 22
Intermediate
Result 2:
Increased
Quality
Of Services
Intermediate
Intermediate
Result 3:
Result
3:
Increased
Increased
Knowledge,
Knowledge,
Attitudes,
andand
Skills
Attitudes,
Skills
Intermediate
Result 4:
Enabling Social
& Policy
Environment
Complementary Feeding
IR 3: Knowledge, Attitudes, and Skills
• Formative Research (E.g. TIPS, PD)
• Mother to mother support groups
• Growth monitoring and promotion
• Mass Communication
• PD/Hearth
Why does IR3 come before IR1 on next page?
Page 23
Complementary Feeding
IR 1: Access to Food
• Resource transfers for the most vulnerable
• Food and/or nutrient supplements
• Micro-credit programs
• Food production and income generation
(sustainable agriculture)
– Inputs and services: agricultural inputs, financial
services, access to markets
– Improved practices: training and entrepreneurship
What should be under sustainable ag—
you trailed off, see word in green
Page 24
Addressing Undernutrition
SC Priority Interventions (2)
Practices
Nutrition
• Immediate Breastfeeding
• Exclusive Breastfeeding through 6
months of age
• Timely introduction of appropriate
complementary foods (Frequency of
Services
• Vitamin A supplementation
(Maternal and Child)
• Iron supplementation
• Iodine supplementation
feeds, quality of feeds, etc.)
Health
• Proper disposal of feces
• Hand washing at appropriate times
• Appropriate home care for Illness,
including oral rehydration therapy for
children with diarrhea
• Measles immunization
• Timely appropriate
treatment of ARI, diarrhea,
malaria, and malnutrition
including zinc therapy for
diarrhea
• Timely referral of seriously ill
Whychildren
isn’t 2nd last bullet on bottom
Bolded under this intervention?
Page 25
left—home care for diarrhea
Addressing Undernutrition
SC Priority Interventions (2)
Intended Impact:
Children are Healthy and Well-Nourished
Strategic
Objective
Intervention:
Increased
Use of care
Key Health
andDiarrhea,
NutritionMalaria,
Practicesand
andMalnutrition
Services
Timely
appropriate
for ARI,
Intermediate
Intermediate
Result 1:
Result
1:
Increased
Access
Increased
to,
& Availability
Access
to, &
of,
Services and
Availability
of,
Suppliesand
Services
Supplies
Page 26
Intermediate
Result 2:
Increased
Quality
Of Services
Intermediate
Result 3:
Increased
Knowledge,
Attitudes, and
Skills
Intermediate
Result 4:
Enabling Social
& Policy
Environment
Timely, Appropriate Care
IR 1: Access to Treatment
Take services closer to the population
• The community health worker as prescriber for
pneumonia, diarrhea, and malaria
“Community Case Management”
• Front-line health workers as providers of first choice for
severe acute malnutrition
Community-based Management Of Acute
Malnutrition
Page 27
SC Child Nutrition Programs
Producing Results
• Mozambique (2002 – 2007)
– Exclusive breastfeeding increased from 5% to 74%
– Months of adequate food provisioning from 7.9 to 10.7 months
• Bangladesh (2005 – 2007)
– Underweight reduced from 52% to 44% in first 2 years of program
• Vietnam
– Immediate breastfeeding increased from 74% to 92%
– Exclusive breastfeeding increased from 39% to 52%
• Bolivia (2002 – 2007)
– Reduced stunting from 37% to 30.2%
– Exclusive breastfeeding increased from 75% to 83%
• Nicaragua (2002 – 2007)
– Reduced stunting from 20.5% to 9.6%
– Exclusive breastfeeding increased from 37% to 84%
Page 28
The School-aged Child
Outcomes of Interest
Growth
Educational Attainment
The equivalent of 200 million school years are lost each year in low income
Is the build
on this
right—why
top come
countries
as a result
of poor
health and words
nutritionat
– World
Bank in later?
Page 29
The School Aged Child
SC Results Framework
Intended Impact:
Children are well educated
Strategic Objective
Increased Use of Key Health and Nutrition Practices and Services
Page 30
The School Aged Child
SC Priority Interventions
• Micronutrient supplementation: Vitamin A, Iron, Iodine
• De-worming
• Proper disposal of excreta and hand washing at
appropriate times
• Health and Nutrition education
• Alleviation of short-term hunger
Page 31
Nutrition in the School-aged Child
Intended Impact:
Children are well educated
Strategic Objective
Increased Use of Key Health and Nutrition Practices and Services
Intermediate
Result 1:
Increased
Access to, &
Availability of,
Services and
Supplies
Page 32
Intermediate
Result 2:
Increased
Quality
Of Services
Intermediate
Result 3:
Increased
Knowledge,
Attitudes, and
Skills
Intermediate
Result 4:
Enabling Social
& Policy
Environment