The emerging double burden of malnutrition in Timor Leste: a time to act?

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1 The emerging double burden of malnutrition in Timor Leste: a time to act? Heather Grieve Senior Nutrition Specialist, Australian Embassy Timor Leste and the Office of his Excellency the President of the Republic of Timor Leste

2 Presentation outline 1. A bit about Timor Leste 2.The nutrition situation: Timor Leste 3.The nutrition transition and the double burden of malnutrition (DBM): an example from Indonesia 4.The nutrition transition and the emerging DBM in Timor Leste 5. A time to act? 6. Current activities

3 A bit about Timor Leste Population:1.178 million (42% less than 15 years of age) Independence: Portuguese colony from 1642, became independent 1975 (9 days) Referendum supporting independence; regained independence in 2002 following Indonesian occupation and unrest. Official Languages: Portuguese, Tetum Religion: Catholic (97%) Currency:US Dollar Life expectancy: 68 years Main labour force: agriculture (81%) Least developed country (UNCTAD)

4 A bit about Timor Leste

5 A bit about Timor Leste

6 A bit about Timor Leste

7 A bit about Timor Leste Changes in infant mortality rate (IMR), under 5 mortality rate (U5MR) and maternal mortality ratio (MMR) U5MR 1400 Deaths /1000 live births IMR NMR Deaths/100,000 live births MMR (Deaths/100,000 live births) * Source: WHO (2014), UNICEF (2012) DHS 2003 /2009/10

8 A bit about Timor Leste Coverage of key interventions during the first 1000 days % Contraceptive prevalence rate Iron folic acid 90 days ANC 4+ Skilled attendant at birth Delivery at health facility PNC within 2 days Early initiation of breastfeeding Exclusive breastfeeding Continued breastfeeding to months

9 Nutrition situation: Timor Leste

10 Nutrition situation: Timor Leste

11 Nutrition situation: Timor Leste

12 The global evidence base The Lancet Series on Maternal and Child Undernutrition (2008) The Lancet Maternal and Child Nutrition Series, 2013 MIYCN Global Nutrition Targets (2025) Global NCD risk factor reduction targets (including reduction of salt intake by 30% and halting further increases in adult obesity) 2014 Rome Declaration on Nutrition & Framework for Action

13 Interface between under and overnutrition in early years Source;WHO (2002), Black etal (2013) Menzies School of Health Research

14 The nutrition transition The traditional diet in LMICs was mostly plant based foods which were low in fat and sugar. A nutrition transition is occurring, in which diets are becoming higher in processed foods which are high in fats and sugars Receding famine Nutrition related noncommunicable disease Policy and behaviour change Many LMICs are in the receding famine/ nutrition related noncommunicable disease (NCDs) phase. The change in diet and lifestyles is associated with an increase in the prevalence of overweight, obesity and NCDs and in many countries the double burden of malnutrition Many high income countries are in the policy/behaviour change phase and are promoting healthy food and physical activity environments Source; Popkin et al (2001)

15 The nutrition transition: Indonesia Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( ) KCal per person per day GDP per capita Kcal GDP/ capita Source: World Bank and FAOSTAT 92014)

16 The nutrition transition: Indonesia Changes in energy supply (Kcal per day per person) Kcal per day per person Alcoholic beverages and stimulants Fruits, vegetables, pulses and treenuts Animal products Sugar crops, sugar and sweeteners Starchy Roots Oil crops and vegetable oils Cereals Excluding Beer Source :FAOSTAT (2014)

17 The double burden of malnutrition: Indonesia Changes in the prevalence of malnutrition in children (< 5 years) Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;

18 The double burden of malnutrition: Indonesia Changes in the prevalence of malnutrition in women of reproductive age (aged years) Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;

19 The nutrition transition: Indonesia Estimated NCD risk factors (2008) Source :WHO (2011)

20 The nutrition transition: Indonesia In 2008 an estimated 582,000 men and 481,700 women died from NCD related deaths. NCDs are now the main cause of disability and death Estimated age standardised NCD deaths per 100,000 people, Indonesia (2008) Men Cardiovascular diseases and diabetes Chronic respiratory disease Cancers Other Women Source: WHO (2011), Shrimpton, and Rokx (2013)

21 The nutrition transition: Timor Leste Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( ) Kcal/capita /day Kcal/capita/day (food supply) GDP/capita Source: World Bank and FAOSTAT (2015)

22 The nutrition transition: Timor Leste

23 The emerging double burden of malnutrition: Timor Leste Changes in the prevalence of malnutrition in children (0 59 months) Prevalence of under and overweight (%) / Stunting (HAZ< 2)Timor Leste Overweight (WHZ>+2) Timor Leste Source; Tiimor Leste DHS 2003 and 2009/10 Timor Leste FNS, 2013

24 The emerging double burden of malnutrition: Timor Leste Changes in the prevalence of malnutrition in women of reproductive age Prevalence of under and overweight (%) / Underweight (BMI<18.5)Timor Leste Overweight (BMI 25) Timor Leste Source; Timor Leste DHS 2003 and 2009/10 Timor Leste FNS, 2013

25 The nutrition transition: Timor Leste Estimated NCD risk factors (2008) Source :WHO (2011)

26 The nutrition transition: Timor Leste In 2008 an estimated 1400 men and 1000 women died from NCD related deaths. NCDs are now a significant cause of disability and death in Timor Leste Estimated age standardised NCD deaths per 100,000 people, Timor Leste (2008) All NCDs Cardiovascular diseases and diabetes Cancers Chronic respiratory disease Men Women Source: WHO (2011

27 The nutrition transition: Timor Leste Whilst deaths from communicable, maternal, perinatal and nutrition related conditions make up the bulk of deaths, NCDs are now estimated to account for 34% of all deaths. Proportional mortality (% of total deaths, all ages) Source: WHO (2011),

28 A time to act? 1. The Strategic Development Plan ( ) 2. National Health Sector Strategic Plan ( ) 3. Action Plan for a Hunger and Malnutrition Free Timor Leste ( ) 4. Draft National Nutrition Strategy ( ) 5. RMNCH Strategy ( ) 6. Draft National Nutrition and Food Security Policy

29 A time to act?

30 A time to act?

31 A time to act?

32 A time to act? Cigarettes sold in packets and as singles Pop mee or Super mee 2 minute noodles Lollies

33 What are we doing? High level advocacy through the Presidents Office and the cross ministerial nutrition and food security council Promoting improved complementary feeding and dietary diversity Integrated nutrition programming Promoting and rewarding success at the community level

34

35 Obrigada wain

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