Nutrition in Developing Countries

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Nutrition in Developing Countries
Jonathan Gorstein
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Causes of Malnutrition

• Malnutrition is a complex condition that involves
  multiple, overlapping deficiencies of protein,
  energy and micronutrients
• A child becomes malnourished because of illness
  in combination with inadequate food intake
• Insufficient access to food, poor health
  services, the lack of safe water and sanitation,
  and inadequate child and maternal care are
  underlying causes

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Causes of Mortality among Preschool Children, 2002
Other
Perinatal
Deaths associated with malnutrition
54
HIV/AIDS
Acute Respiratory Infection
Measles
Malaria
Diarrhea
Source WHO (2003)
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Intergenerational Cycle of Malnutrition

• The cycle of poor nutrition perpetuates itself
  across generations - supported by scientific
  evidence

Child growth failure
Low weight and height in adolescents
Early pregnancy
Low birthweight baby
Small adult woman
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Classification of Malnutrition

• WHO recommends three anthropometric indicators
  for assessment of nutritional status
• Wasting (Low weight-for-height)
• Stunting (Low height-for-age)
• Underweight (Low weight-for-age)
• Classification based on International Growth
  Reference

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Consequences of MalnutritionEconomic costs

• Malnutrition leads to reduced productivity,
  hampering economic growth and effectiveness of
  investments in health and education
• Vitamin and mineral deficiencies are estimated to
  cost some countries the equivalent of more than 5
  per cent of their GNP in lost lives, disability
  and productivity

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Role of Caring Practices

• Inadequate care for children and women is an
  underlying cause of malnutrition
• Good hygiene in and around the home and in
  handling food reduces risk of illness

• Care includes all interaction between parent and
  child that helps children develop emotionally and
  physically

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Micronutrients

• Micronutrients are needed by the body only in
  minute amounts, are critical for
• Regulation of growth, activity, development
• Immune and reproductive function
• Three primary micronutrient deficiencies include
• Iodine
• Vitamin A
• Iron

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Population at Risk of Deficiency - Global
2.0
1.6
0.8
Source UNICEF (2002)
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Iodine Deficiency Disorders (IDD)

• Single most important cause of preventable brain
  damage and mental retardation
• Significantly raises the risk of stillbirth and
  miscarriage in pregnant women
• 43 million people worldwide suffer from varying
  degrees of brain damage and physical impairment
  due to iodine deficiency Concept of IDD
  (Spectrum of disability)
• The primary intervention for the control of IDD
  is through salt iodization

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Iodine Deficiency Disorders (IDD)

• Today
• Some 70 per cent of households in the developing
  world are using iodized salt, compared to less
  than 20 per cent at the beginning of the decade.
  
• As a result, 91 million newborns are protected
  yearly from significant loss in learning ability

• Unfinished Business
• There are still 35 countries where less than half
  the households consume iodized salt

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Coverage of Iodized Salt by Region
Source UNICEF (2002)
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Levels of Iodized Salt Coverage
90 or more
50 to 89

Less than 50
Source UNICEF (2002)
No recent data
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Major Increases in Iodized Salt Coverage
Source UNICEF (2004)
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41 Million Newborns Still Unprotected from
Learning Disabilities
Source UNICEF (2002)
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Vitamin A Deficiency

• Contributing factor in 2.2 million deaths each
  year from diarrhea and 1 million deaths from
  measles among preschool children under five
• Severe deficiency can also cause irreversible
  corneal damage, leading to partial or total
  blindness
• Results of field trials indicate that VA
  supplementation of children with can reduce
  deaths from diarrhea. Four studies showed deaths
  were reduced by 35-50 per cent.
• VA can reduce by half the number of deaths due to
  measles

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Magnitude of Vitamin A Deficiency

• Pre-school children
• Clinically deficient 3 million (Asia and
  Africa)
• Subclinically deficient (low serum retinol)
  100-140 million
• 250,000-500,000 become blind each year
• 90 case fatality among those who become blind
• Pregnant women
• 25-30 cases of night blindness reported in some
  Asian countries

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Interventions to Control VAD

• In 1999, only 10 countries provided two rounds of
  VA supplementation with high coverage, this has
  increased to over 50 countries by 2004.
• Between 1998 and 2004, UNICEF estimates that
  about two million child deaths may have been
  prevented from vitamin A supplementation

• Food Fortification - A number of countries are
  successfully fortifying staple foods with vitamin
  A (e.g. sugar, maize flour, wheat) reaching
  large populations.

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Vitamin A Supplementation Coverage1 Developing
world
1 Percent of children aged 6-59 months who
received at least one vitamin A supplement within
the last six months
Source UNICEF (2000)
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Rapid Progress Number of countries with high VA
supplementation coverage1
1 Percent of children aged 6-59 months who
received at least one vitamin A supplement within
the last six months
Source UNICEF (2000)
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VA Supplementation Coverage Where VAD is a public
health problem (U5MRgt70)

70 or more
30 to 69
Less than 30
No data available
1 Percent of children aged 6-59 months who
received at least one vitamin A supplement within
the last six months
Source UNICEF (2000)
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Iron Deficiency and Anaemia

• Most common nutritional disorder in the world
• Lowers resistance to disease and weakens a
  child's learning ability and physical stamina
• Significant cause of maternal mortality,
  increasing the risk of hemorrhage and infection
  during childbirth.
• Nearly 2 billion people estimated to be anemic
  and millions more are iron deficient, the vast
  majority are women.

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Global Prevalence of AnaemiaPregnant Women
Source WHO (1999)
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Global Prevalence of AnaemiaPreschool Children
Source WHO (1999)
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Main Factors Contributing to Anaemia

• Iron deficiency
• Poor bioavailability of consumed iron
• Insufficient dietary iron intake
• Chronic and recurrent infections that interfere
  with food intake and absorption/utilization of
  iron
• Helminth infections, primarily Hookworm
• Chronic diarrheal disease
• HIV
• Malaria

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Interventions to Control Anaemia

• Depends on etiology
• For iron deficiency supplementation and
  fortification
• For parasitic disease control appropriate
  measures for prevention and presumptive treatment

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Proposed New GoalsMicronutrient deficiencies

• Achieve sustainable elimination of iodine
  deficiency disorders by 2005 and vitamin A
  deficiency by 2010,
• Reduce by one third the prevalence of anaemia,
  including iron deficiency, by 2010 and
• Accelerate progress towards reduction of other
  micronutrient deficiencies, through food
  fortification and supplementation

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Thank you