Update on the nutrition situation in the Asia Pacific region Mike Toole 13 th National Rural Health Conference, Darwin, 24-27 May 2015 Source: DFAT, Port Moresby, Papua New Guinea
Conceptual framework of malnutrition Malnutrition Undernutrition Overnutrition Overweight & obesity Micronutrient undernutrition Protein energy undernutrition
Types and consequences of undernutrition Protein energy undernutrition Acute undernutrition: wasting (thinness) Chronic undernutrition: stunting (short stature) Premature death Poor educational and employment outcomes Undernutrition Vitamin A deficiency Micronutrient undernutrition Iron deficiency Specific clinical syndromes Other micronutrient deficiencies Barker s Hypothesis: Adults who were born with a low weight for gestational age are more likely to experience high blood pressure and obesity, and associated chronic diseases including diabetes and cardiovascular disease
Why is child under nutrition important? Recent estimates suggest that poor nutrition accounts for some 45% of child deaths globally and 11% of the total global disease burden Of those children that survive undernutrition, more than a quarter or 165 million children are stunted While the highest rates of stunting are in South Asia and sub Saharan Africa, some countries in Southeast Asia and the Pacific have very high rates, including Timor Leste (50%) Papua New Guinea (44%) Cambodia (41%) Laos (40%) Indonesia (39%) Myanmar (35%) Solomon Islands (33%) Kiribati (33%)
The Lancet s Series on Maternal and Child Undernutrition. June, 2013. http://thousanddays.org/wp content/uploads/2013/06/nutrition_exec_summ_final.pdf
Prevalence of stunting by country, 2013
Trends in stunting, by region 1990 2010 Source: Sixth World Nutrition Situation Report, 2011
This is what stunting looks like Two 12 year olds in Bangladesh. The line on the wall shows the normal height for that age (Source: UNICEF)
Causes of undernutrition Immediate causes Inadequate food intake Infectious diseases Inappropriate care failure to Breastfeed until 6 months Give complementary feeding after 6 months diverse nutrients Effectively treat undernutrition Underlying causes Lack of access to safe water, sanitation and basic hygiene practices Inadequate household access to food Low agricultural productivity Low status of women Basic causes poverty, poor governance, inadequate policies, illiteracy especially among women, etc.
Inter generational influences on child nutrition Low pre pregnancy body mass index (BMI) and small stature Low female adolescent BMI and small stature Low birthweight Child undernutrition
Low birthweight is associated with 2.5 3.5 fold higher odds of wasting, stunting and underweight* Prevalence (%) of small forgestational age births, by UN regions Source: Sixth World Nutrition Situation Report, 2011 * Parul Christian et al. Int J Epidemiol. 2013. doi:10.1093/ije/dyt109.
Interventions that address child undernutrition Nutrition specific interventions address the immediate causes of child undernutrition They target the 1000 day window of opportunity covering pregnancy and the first two years of life Nutrition sensitive interventions address the underlying causes of child undernutrition and can be incorporated into a range of sectoral programs agriculture, water & sanitation, education, women s affairs, etc. Nutrition governance interventions address the basic causes of child undernutrition, such as laws, policies and the promotion of economic growth, operate at the societal level The Lancet s Series on Maternal and Child Undernutrition Executive Summary. June, 2013. http://thousanddays.org/wp content/uploads/2013/06/nutrition_exec_summ_final.pdf
The Lancet s Series on Maternal and Child Undernutrition Executive Summary. June, 2013. http://thousanddays.org/wp content/uploads/2013/06/nutrition_exec_summ_final.pdf
Effect of scale up on child deaths
Strategies to address micronutrient deficiencies Dietary diversity Fortification Supplementation
Agriculture programs can focus on producing high nutritional value crops For example, iron bio fortified beans Orange fleshed sweet potato (high in Vitamin A) GM modified high Vitamin A containing rice (golden rice) Australian Acacias for food in West Africa
Scaling Up Nutrition: the SUN Movement The Movement came into being in September 2010, with the establishment of a Framework and a Road Map Coordinated by a UN Special Representative for Food Security and Nutrition Australia joined the donor network in 2013 Countries that join the SUN Movement are committed to: ensuring that programs in all sectors of government are sensitive to nutrition; and increasing coverage of proven interventions that improve nutrition during the 1,000 day period between a mother s pregnancy and her child s second birthday
Of the ten most overweight nations in the world, nine are in the Pacific (% overweight or obese)
Prevalence of diabetes by country, 2013
Lingering under nutrition, rising over nutrition (Children <5 years of age) Source: UNICEF, 2013
The double burden in the Pacific Stunting in children Overweight /obese in men Overweight/ obese in women Papua New 44% 40% 46% Guinea Kiribati 33% 76% 82% Solomon 33% 60% 69% Islands Vanuatu 26% 46% 55% Nauru 24% 67% 82% Regional prevalence of childhood overweight or obesity: (Source: de Onis, 2010) 17% in Northern Africa 7.6% in Southern Africa 6.9% in Latin America 4.6% in SE Asia 3.5% in the Pacific region Reducing undernutrition in young children may contribute to reducing overweight and obesity in adults
Thank you Source: Burnet Institute, Myanmar Source: Asian Development Bank, 2007