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Water and Food Safety are Essential to Nutrition Goals for Women and Children: A Health Sector Perspective Rebecca Stoltzfus Program in International Nutrition.

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Presentation on theme: "Water and Food Safety are Essential to Nutrition Goals for Women and Children: A Health Sector Perspective Rebecca Stoltzfus Program in International Nutrition."— Presentation transcript:

1 Water and Food Safety are Essential to Nutrition Goals for Women and Children: A Health Sector Perspective Rebecca Stoltzfus Program in International Nutrition College of Agriculture and Life Sciences Cornell University Division of Nutritional Sciences

2 Outline Child stunting as a priority in global health and development Timing: the 1000 days The importance of food safety and gut health to overcoming child malnutrition Relevance to food security initiatives Key Interventions

3 Together with micronutrient deficiencies, responsible for 1/3 of child deaths globally

4 Stunting: Invisible Malnutrition 105 cm 125 cm 100 cm 7 years 4 years 30% increase in risk of death from infectious disease 10% decrease in lifetime earnings 7 month delay in starting school 0.7 years loss of schooling Increased risk of NCD’s in later life

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6 What is causing all this stunting and wasting?

7 Cause #1: Poor Diet Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries – Dewey & Adu-Afarwuah, 2008 – 42 studies/programs, most published Children who received interventions gained: – 0.0 – 0.76 Z scores weight-for-age – 0.0 – 0.64 Z scores length-for-age The best studies caused a 0.7 Z score improvement. BUT: the average growth deficit of African and Asian children is -2.0 Z At best, diet solved 1/3 of the problem.

8 Cause #2: Diarrhea Between 6-18 months of age, children in developing countries have around 9 episodes of diarrhea. Many authors reported that diarrhea accounts for 10-80% of growth faltering But others contend that children grow at “catch-up rates” between episodes, and thus recover these deficits The Lancet Nutrition Series (2008) concluded that by implementing sanitation and hygiene interventions with 99% coverage, child malnutrition would be reduced by only 2.4%

9 Cause #3: EE Environmental Enteropathy A subclinical condition of the small intestine, called environmental enteropathy (EE) Characterized by: – Flattening of the villi of the gut, reducing its surface area – Thickening of the surface through which nutrients must be absorbed – Increased permeability to large molecules and cells (microbes) Likely causes: – Too many microbes in the gut—worms may also play a role – Effects of toxins on the gut Decreased nutrient absorption + Infiltration of microbes

10 Toxins (mycotoxins) Microbes & Worms (fecal-oral) Liver Toxicity Enteropathy Diarrhea Liver Cancer Stunting & Wasting Illness & Death The dual contributions of food safety to child malnutrition

11 #1 risk factor for all child deaths (malnutrition) #2 cause of all child deaths (diarrhea) Together: about 2 million child deaths / year Toxins (mycotoxins) Microbes & Worms (fecal-oral) Liver Toxicity Enteropathy Diarrhea Liver Cancer Stunting & Wasting Illness & Death The dual contributions of food safety to child malnutrition

12 An unknown fraction of 700,000 adult deaths/year #1 risk factor for all child deaths (malnutrition) #2 cause of all child deaths (diarrhea) Together: about 2 million child deaths / year Toxins (mycotoxins) Microbes & Worms (fecal-oral) Liver Toxicity Enteropathy Diarrhea Liver Cancer Stunting & Wasting Illness & Death The dual contributions of food safety to child malnutrition

13 Safe Food and Nutritious Food are both essential to meet child nutrition goals Nutritious food is essential to provide nutrients needed for growth and development – Food Aid targeting – Quality of food: nutrients – Quantity Safe food is essential to prevent diarrhea and promote healthy gastro-intestinal function (prevent enteropathy) – Quality of food: free from toxins and microbes – Household technologies and behaviors – Prioritizing those behaviors in the feeding of young children Just a reminder: (Breastmilk is the fundamental safe and nutritious food)

14 Relevance to food security initiatives

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16 Foods safe from Microbes and Toxins Household Hygiene behaviors

17 Food safety interventions, focusing on microbes and soil- transmitted helminths (worms)

18 Source: World Bank, accessed

19 Playing in the dirt makes kids smart Letitia Rowlands From: The Daily TelegraphThe Daily Telegraph November 24, :00AM Good dirty fun... Bronte Good and Sebastian Livisianos Pic: Nic Gibson. Source: The Daily Telegraph Maybe in Australia.... But not if the dirt contains pathogens and helminth eggs! 100% of household soil samples in rural Zimbabwe contained E. Coli Ngure et al., unpublished % of infants 5-11 months old were infected with helminths in rural coastal Tanzania. Goodman et al., Am J Trop Hyg 2007;76(4):

20 Feeding young children in rural Zimbabwe, M Mbuya

21 If allowed, toddlers consume poultry feces Peruvian shantytown families: – Households who owned free-range poultry: Average ingestion of poultry feces by toddlers per 12-hour observation period was 3.9 times – Marquis GM et al., Am J Public Health 1990 Rural Zimbabwe: – Not selected for poultry ownership: 3 of 7 toddlers directly ate chicken feces during a 6-hour observation period. – Ngure F et al., unpublished observations, 2011

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23 Case Study: Pilot testing of a fortified instant porridge designed for complementary feeding of infants in Tanzania Food insecure population High prevalence of stunting Feeding frequency of infants too low Micronutrient deficiencies common “This food relieves my problems. In the past the baby was crying of hunger, and I did not have any food to feed her. But nowadays, if my baby is hungry, I prepare the food and feed her and she does not demand eating other foods after eating the new baby food.” “I like its preparation very much as you do not get in the kitchen to cook it; even her father can prepare it. Also its taste has impressed me; it is like groundnuts, beans, sour taste and maize.” Paul KH et al., J Nutr 2008; 138:1963-8Instant porridge designed by Instalife, Inc.

24 Microbial contamination of infant foods in coastal Tanzania Proportion of food samples with choliform counts exceeding acceptable limit Kung’u et al., J Health Pop Nutr :41-52

25 Food safety and hygiene interventions: Microbial Water treatment – At source – At household Handwashing with soap after fecal contact and before preparing/serving food Avoid feeding leftovers, or reheat Separate young children from poultry and household soil Safe disposal of feces—especially of children

26 Forthcoming randomized trial in rural Zimbabwe, highly food insecure Outcome: stunting in infants from 0-18 months Control Infant Feeding: Education + Nutributter WASH: Integrated Water, Hygiene & Sanitation WASH + Infant Feeding Principal Investigator: J Humphrey Funders: Gates, DFID, NIH, UNICEF Grantees: Zvitambo, Johns Hopkins, Cornell


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