1. Human Development Europe & Central Asia The World Bank Europe & Central Asia Tamer Rabie Senior Health Specialist The World Bank Europe & Central Asia Building Tomorrow Through Better Nutrition

2. Human Development Europe & Central Asia The World Bank Europe & Central Asia Irrefutable Evidence for Nutrition

3. Human Development Europe & Central Asia The World Bank Europe & Central Asia

4. Human Development Europe & Central Asia The World Bank Europe & Central Asia Impact of Undernutrition Interventions on the MDGs MDGImpact of Undernutrition Intervention 1.Eradicate poverty & hunger Target is to reduce prevalence of underweight children < 5 years 2.Achieve universal primary education Reducing undernutrition increases cognitive development, contributes to learning & school completion rates 3.Promote gender equality Maternal education and empowerment lead to better nutrition and health practices. Reduces discrimination against girls in family feeding practices.

5. Human Development Europe & Central Asia The World Bank Europe & Central Asia Impact of Undernutrition Interventions on the MDGs cont’d MDGImpact of Undernutrition Intervention 4.Reduce child mortality Enormous impact of reducing undernutrition on decreasing child mortality. 5.Improve maternal health Reduced maternal mortality by reducing anemia with IFA or multiple MN supplementation.

6. Human Development Europe & Central Asia The World Bank Europe & Central Asia Background for KG Nutrition Report Joint World Bank/UNICEF report Objective to calculate the potential human & economic benefits from increasing nutrition investments Situational Analysis Epidemiology of undernutrition Physical & economic consequences Systems for delivering nutrition interventions Coverage of nutrition interventions Economic gains

7. Human Development Europe & Central Asia The World Bank Europe & Central Asia Three Domains for Nutrition Analysis DomainContent EpidemiologicalNutrition burden, evidence for efficacy & effectiveness of interventions Operational Coverage, quality & utilization of nutrition - related programs, capacities, opportunities, & constraints to improving them Economic and sociopolitical Factors from community, national & international levels that may enhance or inhibit efforts and strengthen policies & programs

8. Human Development Europe & Central Asia The World Bank Europe & Central Asia (A) Physical Burden of Undernutrition

9. Human Development Europe & Central Asia The World Bank Europe & Central Asia Deaths Resulting from Undernutrition PrevalenceAnnual Deaths Low birth weight 1,500–1,999 g0.6 139 2,000–2,499 g4.4 249 Vitamin A deficiency < 5 months18.0146 6–59 months32.0 105 Stunting <-3 SD 3.7442 <-2 SD 13.7326 Wasting <-3 SD 0.4140 Total1,547

10. Human Development Europe & Central Asia The World Bank Europe & Central Asia DALYs Caused by Undernutrition MaleFemaleTotal All causes DALYs171,190145,648316,839 Growth deficiencies Low birth weight23,73818,688 42,426 (13.4%) Stunting3,1093,032 6,141 (1.9%) Micronutrient deficiencies Iron-deficiency anemia1,027963 1,990 (0.6%) Iodine deficiency9781,012 1,990 (0.6%) Vitamin A deficiency12 24 (0.01%)

11. Human Development Europe & Central Asia The World Bank Europe & Central Asia (B) Economic Burden of Undernutrition

12. Human Development Europe & Central Asia The World Bank Europe & Central Asia Cost of Lost Workforce Number of deaths Value (US$ millions) Low birth weight3881.28 Vitamin A deficiency2510.97 Stunting7681.86 Wasting1400.34 Total1,5474.45

13. Human Development Europe & Central Asia The World Bank Europe & Central Asia Cost of Future Productivity Losses NPV at 3% discount rate (US$ million/year) Iodine deficiency disorders15.30 Stunting (< 5 years)5.25 Low birth weight1.30 Childhood anemia6.09 Total27.94

14. Human Development Europe & Central Asia The World Bank Europe & Central Asia Iodine Sufficient Brain Iodine Deficient Brain Source: From Legrand, 1967

15. Human Development Europe & Central Asia The World Bank Europe & Central Asia Total Economic Losses Attributable to Undernutrition US$ 32 million Annually

16. Human Development Europe & Central Asia The World Bank Europe & Central Asia (C) Benefits from Scaling Up Nutrition Interventions

17. Human Development Europe & Central Asia The World Bank Europe & Central Asia Future Gain in Productivity, Million US$/Year InterventionLBWStuntingIDD Childhood Anemia Maternal MMN or IFA supplements0.18 Maternal/energy protein supplements0.42 Use of IPT/ITN during pregnancy0.47 Complementary feeding promotion (food-secure pop.) 1.35 Complementary feeding promotion (food-insecure pop.) 1.59 Zinc for diarrhea treatment 1.71 Iodized salt 0.52 Micronutrient supplements (Sprinkles) 1.21 Deworming of child 0.45 Package0.781.930.521.58

18. Human Development Europe & Central Asia The World Bank Europe & Central Asia Future Gain in Workforce, Million US$/Year Intervention Low Birth Weight Stunting Maternal MMN or IFA supplements0.17 Maternal energy/protein supplements0.39 Use of IPT/ITN in pregnancy0.44 Complementary feeding promotion (food-secure pop.) 0.45 Complementary feeding promotion (food-insecure pop.) 0.53 Zinc for diarrhea treatment 0.57 Package0.750.64

19. Human Development Europe & Central Asia The World Bank Europe & Central Asia (D) Choosing Priorities

20. Human Development Europe & Central Asia The World Bank Europe & Central Asia Prioritization Method Three criteria used to rank interventions 1.Deaths averted 2.Economic return on investments 3.Feasibility of implementation at scale Two ranking systems developed a.Operational priority -- weight to feasibility of implementation at scale b.Evidence for interventions – weight to the “evidence base” set out in The Lancet series

21. Human Development Europe & Central Asia The World Bank Europe & Central Asia Highest Priority Interventions Early initiation of breastfeeding, exclusive breastfeeding until six months of age, and timely and appropriate complementary feeding Supplementing pregnant women with iron folic acid or multiple micronutrients Expand salt iodization and flour fortification programs

22. Human Development Europe & Central Asia The World Bank Europe & Central Asia Second Priority Interventions Maintain twice-annually vitamin A supplementation Expand deworming program Zinc for the management of diarrhea Severe acute malnutrition treatment Address underlying and basic causes of undernutrition through other sectors Promoting handwashing and hygiene

23. Human Development Europe & Central Asia The World Bank Europe & Central Asia Conclusions Undernutrition costs the Kyrgyz Republic more than US$ 32 million annually Scaling up proven interventions could save over US$ 6 million annually SUN Framework brings global consensus on implementing two complementary approaches addressing: ▫Immediate causes: a set of direct public health interventions focusing on the minus 9 to 24- month window of opportunity ▫Underlying causes: a broader set of longer-route interventions in agriculture & social protection

24. Human Development Europe & Central Asia The World Bank Europe & Central Asia Building Tomorrow Through Better Nutrition