STUNTING BY REGION, 1980-2000

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Translating Research Results Into Policy and
Action
Nutrition Comes of Age
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The menu

• The Scientific Basis for Intervening in Nutrition
• Nutritional Status in the Region
• The Latest Scientific Findings in Nutrition
• USAID Program Initiatives

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The Scientific Basis for Intervening in Nutrition
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MALNUTRITION, AN UNDERRLYING CAUSE OF CHILD
MORTALITY
Malnutrition 55
Source UNICEF, The State of the Worlds
Children, 1998
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STUNTING (CHRONIC MALNUTRITION) IN CHILDREN, BY
REGION, 1980-2000
Source 4th Report on The World Nutrition
Situation, January 2000
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PREVALENCE OF CLINICAL VITAMIN A DEFICIENCY IN
CHILDREN, BY REGION, 1980-2000
Source The Micronutrient Report, 2001
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ANEMIA IN CHILDREN BY REGION, 1998
Source 4th Report on The World Nutrition
Situation, January 2000
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Evidence of Immediate Health Impact Change in
mortality among pre-schoolers in five countries
due to increased vitamin A intake
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-34
-30
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1988 Aceh
1988 Java
1990 T. Nadu
1990 A. Prad
1991 Sarlahi
1991 Jumla
1992
1992
Indonesia
India
Nepal
Sudan
Ghana
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Benefits Costs of Intervention
DALYs Disability adjusted life years
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The Latest Research Findings in Nutrition
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DGLVs, THEY AINT WHAT THEY USED TO BE

• Conversion rate of ß-carotene in fruits and
  vegetables to retinol dramatically reduced.
• Importance of Finding huge amounts of fruits and
  vegetables need to be consumed/ supplementation
  and vitamin A fortification need is greater than
  originally thought.

Clive E. West and Ans Eilander, Bioefficacy of
carotenoids in the SIght and Life Newsletter,
February, 2000.
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FOLIC ACID AND NEURAL TUBE DEFECTS

• The incidence of neural tube defects in the
  United States has declined by almost 20 since
  the mandatory addition of folic acid to bread and
  pasta in 1998.

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IMPORTANCE OF FINDING

• A major impact on the rate of birth defects in
  developing countries can be achieved through the
  delivery of folic acid
• How? a combination of supplementation and
  fortification interventions.

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VITAMIN A SUPPLEMENTATION OF NEW-BORNS

• Early results from India suggest vitamin A
  supplements given to new-borns reduce mortality
• IMPORTANCEsupplements could be given to
  new-borns within the first 48 hours/ lactating
  women given post-partum supplementation/
  fortification
• Stay tuned for further results

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EXCLUSIVE BREASTFEEDING AND MTCT

• A prospective study of HIV-infected pregnant
  women showed that infants who are exclusively
  breastfed have no excess risk of HIV infection
  over 6 months than those never breastfed.

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IMORTANCE OF FINDINGS

• The promotion of exclusive breastfeeding in high
  HIV prevalence areas is a more feasible
  intervention than the distribution of alternative
  foods to replace breastfeeding.

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ZINC IS AN EFFECTIVE ANTI-DIARRHEA MEDICINE

• WHO declared zinc safe and efficacious in the
  treatment of acute watery diarrhea in children.
• 20 mg doses given over 7 to 10 days to reduce the
  severity and duration.
• Programmatic implications the supply and use of
  zinc in public health programs

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USAID Programmatic Initiatives
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Periodic Vitamin A Supplementation

• Periodic every 6 months
• Active an effort is made to reach out to mothers
  to assure their participation
• Institutionalized the concept of regularized
  periodic distribution is incorporated into health
  sector plans of action
• Integrated the vitamin A distribution is
  complemented with other preventive services of
  similar periodicity

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Essential Child Survival Nutrition Actions
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The New Growth Promotion

• Monitor monthly weight gain of children under 2
• Focus on preventive nutrition basic health
  services/ practices at community level

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Essential Maternal Nutrition Actions

• Adequate food intake during pregnancy lactation
• Adequate micronutrient intake during pregnancy
• Reduction of malaria infection in pregnant women
  in women in endemic areas
• Birth spacing of 3 years or longer

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Essential Nutrition ActionsPromoted at 6 Key
Contacts
PREGNANCY TT, antenatal visits, iron/folic
acid, de-worming, anti-malarial, diet, EBF, risk
signs, FP, STI prevention, safe delivery, iodized
salt
DELIVERY safe delivery, EBF, vitamin A,
iron/folic acid, diet, FP, STI prevention
POSTNATAL AND FAMILY PLANNING EBF, diet,
iron/folic acid, diet, FP, STI prevention,
childs vaccination
IMMUNIZATION vaccinations, vitamin A,
de-worming, assess and treat infants anemia, FP,
and STI referral
SICK CHILD monitor growth, assess and treat per
IMCI, counsel on feeding, assess treat for
anemia, check and complete vitamin
A/immunization/de-worming
WELL CHILD GM/P monitor growth, assess and
counsel on feeding, iodized salt, check and
complete vaccination/ vitamin A /de-worming
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Looking Ahead

• GAIN Global Alliance for Improved Nutrition -
  multi donor
• PAID - Vitamin A beyond NIDS
• Zinc Preventive and Therapeutic
• Postpartum/newborn vitamin A
• Intersectoral linksag,food security,ID

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