Transcript Response to child malnutrition Arun Gupta MD FIAP One Asia Breastfeeding Partners Forum 14-16 September 2011 Ulaanbaatar, Mongolia.

Response to child malnutrition
Arun Gupta MD FIAP
One Asia Breastfeeding Partners
Forum 14-16 September 2011
Ulaanbaatar, Mongolia
Conceptual framework: Causes of child
malnutrition
Child malnutrition,
death and disability
Manifestations
of a problem
Inadequate dietary intake
Insufficient
access
to food
Inadequate and/or inappropriate
knowledge and discriminatory
attitudes limit household access to
actual resources
Disease
Poor water/
sanitation and
inadequate health
services
Inadequate
maternal and childcare practices
Immediate causes
Underlying causes
at household/family
level
Quantity and quality of actual resources — human,
economic and organisational — and the way they are
controlled
Basic causes at
societal level
Potential resources: environment,
technology, people
Political, cultural, religious, economic and
social systems, including women’s status, limit
the utilisation of potential resources
Source: The State of the World's Children, 1998.
How 9.7 million U-5
children die in 42 countries
Other
AIDS
Diarrhoea
Malaria
Measles
Pneumonia
Unknown
Neonatal
disorders
Three Major Killers
Neonatal sepsis
Diarrhoea
Pneumonia
Breastfeeding is No. 1
intervention for all the three
Source: Robert et al. LANCET 2003;361:2226-34
First year is critical!
Well over two-thirds of these deaths, which are often
associated with inappropriate feeding practices,
occur during the first year of life. (Global Strategy)
Brain development
4 million (Approx)
Children die
during first month,
5.8 million (Approx) by
1 year and 8.8 million
by 5 years
Over 186 million are stunted
Years of life
Major Causes of Death among
Children around the World
Pneumonia
20%
Other
29%
Deaths associated
with undernutrition
60%
Diarrhoea
12%
Malaria
8%
Perinatal
22%
Measles
HIV/AIDS 5%
4%
Sources:
EIP/WHO, Caulfield LE, Black RE.
Year 2000
WHO 2009. Global health risks: mortality and burden of disease
attributable to selected major risks.
WHO 2009. Global health risks: mortality and burden of disease
attributable to selected major risks.
How a child should grow?
 WHO Growth Study showed that children
any where in the world can grow remarkably
similar, provide they get an environment that
supports
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How should we respond ?
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Progress in low and high income countries
Measles Vac.
1990/2000
2009
High
84
93
Low
58
75
High
98
99
Low
39
40
High
99
100
Low
57
67
High
100
100
Low
27
42
SBA
Drinking water
Sanitation
What are the gaps in low income
countries?
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Health care
Water and sanitation
Feeding practices
Support to women for maternity
Food security
GAPS become BIGGER during emergency
situations?
Status of IYCF policies and programmes in 40 countries
Grade A
Grade B
Grade C
Status in 14 countries
in SEARO and WPRO
regions
Grade A
Status of policies and programmes in selected indicators 14
countries in SEARO and WPRO regions
Grade A
Grade B
Grade C
Grade A
Let’s take e.g. Diarrhea
 According to WHO: 88% is due to poor water and
sanitation; 73 deaths due to diarrhea are due to Child
undernutrition.
 Each episode 3-5% weight loss..more undernutrition
 Major cause of child mortality
 What should we do? YOUR response
 What are we doing , FOCUS IS SHIFTING FROM normal
response to one virus…Rotavirus vaccine….even though
its 40% effective in reducing severe disease and no study
to show reduction of community virus.
Broader picture…malnutrition
 How should we respond?
 But what is the current response !
Women in lines !
CNN speaks ..calls Plumpy’nut a
life saver
UNICEF makes a HUGE effort
Next level of malnutrition !
 You have the solution
Plumpy’doz
Reaching families with Plumy’doz
 Introducing the magic
food
Promos from Africa
Message of the manufacturer !
Global Response
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WHA Resolution 63.23
A WHO plan in the making
SUN: Scaling Up Nutrition
PPPs
GAIN, GAVI, BOND, MI etc and new ones in the
making projected as UN or Civil Society
organisations approved by UN
 Ready to use commercial foods/ Vaccines
What should we do?
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Aim at undernutrition free children
Work on 100 food security, water and sanitation programmes
Invest is support for women to enhance optimal breastfeeding rates
Follow up 63.23 Bring legislations to end promotions of baby food and
children's foods
 Raise the voice to stop unethical, and flawed response as well as
conflicts of interests
 Call for independent research
 Malnutrition /child undernutrition ask for food based response with use
of local indigenous foods
IBFAN Statement on the Promotion and Use of Commercial
Fortified Foods as Solutions for Child Malnutrition
IBFAN strongly supports the right to adequate food for
ALL and therefore calls upon governments, and
all others concerned, globally and regionally:
1.
To take immediate steps to
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Enhance rates of optimal breastfeeding and IYCF.
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Provide adequate drinking water
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Make health care accessible
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Provide adequate child care support systems
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Support sustainable food systems that improve local
food production, availability and affordability
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Include women and gender perspective in food
security
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Implement WHA resolution 63.23 to end inappropriate
promotion of foods for infants and young children,
including nutrition and health claims.
2. To ensure that the primary treatment of all types of acute
malnutrition is based on local foods and supervised by
a trained health professionals without undue
commercial influence.
3. To re-evaluate the use of commercial ready-made foods
in the prevention and treatment of child malnutrition in
emergencies such as man-made and/or natural
disasters and to advocate the use, wherever possible,
of diverse indigenous /local foods.
4. To ensure that international, regional and local policies
and plans of action for the prevention of child
malnutrition are based on independent research and
include impact evaluations.