Nutrition Profile of the WHO South-East Asia Region
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2 Nutrition Profile of the WHO South-East Asia Region
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4 Table of Contents iii
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6 Foreword v
7 WHO Vision and Mandate* Department of Nutrition for Health and Development VISION vi
8 MANDATE vii
9 WHO South-East Asia Region
10
11 Introduction introduction ICN goals Elimination of: 1. Famine & famine-related deaths; 2. Starvation & nutritional deficiency diseases in communities affected by natural & man-made disasters; 3. Iodine & Vitamin A deficiency. Reduction of: 4. Starvation and widespread chronic hunger; 5. Undernutrition, especially among children, women and the aged; 6. Other important micronutrient deficiencies, including iron; 7. Diet-related communicable & noncommunicable diseases; 8. Social & other impediments to optimal breast-feeding; 9. Inadequate sanitation & poor hygiene, including unsafe drinking water. T International Conference on Nutrition World Summit for Children 1
12 nutrition in south-east asia ICN Plan of Action Strategies: 1. Incorporating nutritional objectives, considerations and components into development policies and programmes; 2. Improving household food security; 3. Protecting consumers through improved food quality and safety; 4. Preventing and managing infectious diseases; 5. Promoting breast-feeding; 6. Caring for the socio-economically deprived, and the nutritionally vulnerable; 7. Preventing and controlling specific micronutrient deficiencies; 8. Promoting appropriate diets and healthy lifestyles; 9. Assessing, analysing and monitoring nutrition situations. st Data Sources and Methodology 2
13 introduction Since the data relating to trends in prevalence of undernutrition are subject to many limitations, a note of caution is necessary in interpretation of the analysis as well as inter-country comparisons. 3
14 nutrition in south-east asia WHO South-East Asia Region 4
15 Regional Profile S National Plans of Action for Nutrition All SEAR countries except DPR Korea have developed national plans of action for nutrition with a multi-sectoral approach following the declaration in ICN. At present, implementation of these plans is receiving due attention from the highest level in the respective Governments. National nutrition and food policies have been adopted in most countries and interventions are being redesigned keeping in view past experiences and future needs. Table 1 Basic indicators of the SEA Region Indicators * Life expectancy at birth (yrs) IMR (per live births) Under 5 MR (per 1000 live births) * Future projections regional profile 5
16 nutrition in south-east asia Table 2 Demographic Profile of the SEA Region Country Population Life IMR (1) <5 MMR (2) GNP HDI (3) in millions Expectancy 1998 Mortality ( ) Capita Value (1998) (1998) Ratio (US$) (1994) (1997) (1995) M F Bangladesh Bhutan India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Average (References: 1, 2, 3, 5 & 8) (1) Infant Mortality Rate (Per 1000 live births) (2) Maternal Mortality Ratio (Per 100,000 live births) (3) Human Development Index 6
17 Table 3 Trends in Per Capita Energy, Protein and Fat Supplies in the SEA Region from to Country Per Capita Energy Supply Total Protein Total Fat (Kcal/Day) (g/day) (g/day) Regional Profile Bangladesh Bhutan India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Average regional profile (Reference: 6) 7
18 nutrition in south-east asia Protein-Energy Malnutrition TWHO Global Database * Note : x axis is not to scale. 8
19 Protein-Energy Malnutrition regional profile 9
20 nutrition in south-east asia 10
21 Protein-Energy Malnutrition low birth weight (LBW) < regional profile growth monitoring 11
22 nutrition in south-east asia Feeding Practices in Young Children I )LJXUH 3HUFHQWDJHRIFKLOGUHQZKRDUHEUHDVWIHGLQ6($5FRXQWULHV È Ã H J W D Q H U F H 3 Exclusively breast-fed frombirth up to 4-6 months Breast-fed and complementary food from4-6 months up to 9 months %DQJODGHVK,QGLD,QGRQHVLD 1HSDO 0\DQPDU 6ULÃ/DQND 0DOGLYHV 7KDLODQG 12
23 Iron Deficiency Anaemia I regional profile 600 million people 13
24 nutrition in south-east asia 14
25 Iodine Deficiency Disorders I regional profile 172 million people 15
26 nutrition in south-east asia 16
27 Vitamin A Deficiency V regional profile 17
28 nutrition in south-east asia 125 million children 18
29 Diet-Related Chronic Diseases I regional profile 19
30 nutrition in south-east asia 20
31 Nutritional Achievements in South-East Asia Major Nutritional Achievements in the South-East Asia Region* regional profile l l l l l l l l l l l Infant mortality reduced. Life expectancy increased. Literacy rate increased in both men and women. Severe forms of protein-energy malnutrition have declined. Increased trends in per capita dietary energy and protein supplies. Nutritional blindness and Vitamin A deficiency have declined substantially. Iodine deficiency disorders have shown a declining trend in children in most countries. Coverage of iodised salt has increased at the household levels. Legislation of salt iodisation is in place in almost all countries. Most countries have adopted and are following the International Code of Marketing Breast Milk substitutes. All countries have developed National Plans of Action for Nutrition which are in different stages of implementation as appropriate to each country s priority. *See also Appendices 3 & 4 21
32 nutrition in south-east asia Conclusions and Recommendations Recommendations 1. Growth monitoring & Promotion; 2. Nutrition Surveillance; 3. Promotion, protection and support of breast-feeding and caution against early introduction of complimentary foods; 4. Food security and Safety net; 5. Revised strategy for anaemia prevention and control; 6. Control of parasitic and other infections; 7. Monitoring of iodine content in salt; 8. Assessment of subclinical Vitamin A deficiency; 9. Encouragement of community participation; 10. Strengthening of the Information, Education and Communication (IEC) component; 11. Development of human resources for health (HRH); 12. Nutrition for the elderly; 13. Undertaking of expenditure surveys; 14. Need for sustainable health & nutrition programmes; 15. Prevention of diet-related noncommunicable diseases. B 1. Growth monitoring and promotion (GMP) 2. Nutrition surveillance 22
33 Conclusions & Recommendations 3. Promotion, protection and support of breast-feeding and caution against early introduction of complimentary foods regional profile 4. Food security and safety net 5. Revised strategy for anaemia prevention and control 23
34 nutrition in south-east asia adolescent girls 6. Control of parasitic infections 7. Monitoring of iodine content in salt 24
35 Conclusions & Recommendations 8. Assessment of the subclinical Vitamin A deficiency regional profile 9. Encouragement of community participation 10. Strengthening of the Information, Education and Communication (IEC) component 11. Development of human resources for health (HRH) 25
36 nutrition in south-east asia 12. Nutrition for the elderly 13. Undertaking of expenditure surveys 14. Need for sustainability It is necessary to identify strategies whereby the improvement of nutritional status is adapted as both a specific goal of development and as an indicator of socio-economic progress. 15. Prevention of diet-related non-communicable diseases 26
37 Challenges for the 21 st Century l l l l l l l l Continuing challenges in the South-East Asia Region Low birth weight continues to be a problem in most countries and increasingly so amongst infants born to undernourished and adolescent mothers. Undernutrition continues as a major problem with unacceptably high levels of moderate to severe stunting. Iron deficiency anaemia is a major problem in the region particularly in women of childbearing age and children less than five years. Iodine deficiency disorders are still a public health problem in most countries. Vitamin A deficiency, while generally lessening, is still a major public health problem. Other nutritional deficiencies of emerging global public health importance include, for example, zinc deficiency associated with growth retardation and impaired immune function, folate deficiency which causes widespread megaloblastic anaemia of pregnancy and is associated with neural tube defects in high risk groups; and calcium deficiency associated with osteoporosis. The non-communicable diseases are now becoming major causes of death in some countries of the region. This reflects demographic changes as well as changes in diet and lifestyles, especially in newly industrialised countries. A future concern is the epidemiologic transition where countries must develop multi-faceted nutrition programmes which address both undernutrition and infectious diseases as well as diet-related chronic diseases like diabetes, obesity, cardiovascular diseases and certain diet-related cancers. regional profile 27
38 nutrition in south-east asia 28
39 Country Profiles country profiles 29
40 nutrition in south-east asia 30 Nutritional Situation Bangladesh
41 31 country profiles Bangladesh
42 nutrition in south-east asia 32
43 Bangladesh country profiles 33
44 nutrition in south-east asia 34
45 35 country profiles Bhutan Nutritional Status
46 nutrition in south-east asia 36
47 Bhutan country profiles 37
48 nutrition in south-east asia 38 Nutritional Status India
49 39 country profiles India
50 nutrition in south-east asia 40
51 India country profiles 41
52 nutrition in south-east asia 42
53 India country profiles 43
54 nutrition in south-east asia 44
55 45 country profiles Nutritional Status Indonesia
56 nutrition in south-east asia 46
57 Indonesia country profiles 47
58 nutrition in south-east asia 48
59 49 country profiles Maldives Nutritional Status
60 nutrition in south-east asia 50
61 Maldives country profiles 51
62 nutrition in south-east asia 52
63 53 country profiles Myanmar Nutritional Status
64 nutrition in south-east asia 54
65 Myanmar country profiles 55
66 nutrition in south-east asia 56
67 57 country profiles Nepal Nutritional Status
68 nutrition in south-east asia 58
69 Nepal country profiles 59
70 nutrition in south-east asia 60
71 61 country profiles Sri Lanka Nutritional Status
72 nutrition in south-east asia 62
73 Sri Lanka country profiles 63
74 nutrition in south-east asia 64
75 65 country profiles Thailand Nutritional Status
76 nutrition in south-east asia 66
77 Thailand country profiles 67
78 nutrition in south-east asia 68
79 References references country profiles 69
80 nutrition in south-east asia 70
81 References references country profiles 71
82 nutrition in south-east asia Appendix 1 Abbreviations 72
83 Appendix 1 appendices country profiles 73
84 nutrition in south-east asia Appendix 2 Definitions 74
85 Appendix 2 appendices country profiles 75
86 nutrition in south-east asia 76
87 Appendix 2 appendices country profiles 77
88 nutrition in south-east asia 78
89 Appendix 2 appendices country profiles 79
90 nutrition in south-east asia Appendix 3 Regional Objectives & Ongoing Programmes Objectives 80
91 Ongoing Programmes Appendix 3 appendices country profiles 81
92 nutrition in south-east asia Appendix 4 Regional Workshops and Consultations from
93 Appendix 4 appendices country profiles 83
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