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Page 1 The PepsiCo Foundation Meeting March 31, 2008 The PepsiCo Foundation Addressing Malnutrition Toby Stillman Advisor, Emergency Health and Nutrition
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Page 2 2 Review measures of undernutrition Review causes and consequences of undernutrition Introduce Save the Children’s operational approach to nutrition programming –Children under the age of five –School aged children Outline
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Page 3 Measures of Undernutrition Review Stunting (Chronic) Underweight (Both) Wasting (Acute) IndexHeight for AgeWeight for AgeWeight for Height or MUAC Moderate< -2 SD Severe< - 3 SD
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Page 4 Measures of Undernutrition Stunting: Height For Age
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Page 5 Measures of Undernutrition Stunting: Weight For Age
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Page 6 Measures of Undernutrition Wasting: Weight for Height Marasmus (wasting)Kwashiorker (oedema)
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Page 7 Measures of Undernutrition Mid-upper Arm Circumference
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Page 8 Measures of Undernutrition: Micronutrient deficiencies Vitamin A Zinc Iron Iodine
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Page 9 9 Undernutrition What are the Consequenses? Under-nutrition 35% to 55% of Child Mortality (children <5) Adult Size Intellectual Ability Economic Productivity Reproductive Performance Metabolic and Cardiovascular Disease Is build right? Why first bullet alone?
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Page 10 Undernutrition When does it Happen? First 2 years of life
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Page 11 Undernutrition Where does it Happen?
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Page 12 Undernutrition Where does it Happen? ¾ of the world’s underweight children reside in just 10 countries
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Page 13 Undernutrition How does it Happen? Outcome Under-Nutrition Immediate Causes Inadequate Dietary Intake Disease Underlying Health / Nutrition Causes Inadequate Care for Mothers and Children Insufficient Access to Food Lack of health services & unhealthy environment
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Page 14 Addressing Undernutrition Interventions (1)
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Page 15 Addressing Undernutrition Interventions (2) Source: Lancet Volume 362, PP. 65-71 The Coverage Gap
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Page 16 Intended Impact: Children are Healthy and Well-Nourished Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Addressing Undernutrition SC Results Framework
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Page 17 Addressing Undernutrition SC Priority Interventions PracticesServices Nutrition Immediate Breastfeeding Exclusive Breastfeeding through 6 months of age Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.) Vitamin A supplementation (Maternal and Child) Iron supplementation Iodine supplementation Health Proper disposal of feces Hand washing at appropriate times Appropriate home care for Illness, including oral rehydration therapy for children with diarrhea Timely referral of seriously ill children Measles immunization Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea
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Page 18 Intended Impact: Children are Healthy and Well-Nourished Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Behaviors Addressing Undernutrition SC Results Framework
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Page 19 Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Behaviors Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services Intended Impact: Children are Healthy and Well-Nourished Addressing Undernutrition SC Results Framework
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Page 20 Addressing Undernutrition Monitoring our Progress Increased use of key health and nutrition practices and services Improved Access Strategies Activities Impacts Outcomes Time Longer Term Medium Term Shorter Term Children are healthy and well nourished % children <5 stunted % children with diarrhea % women exclusively breastfeeding % children receiving timely care for illness % population within 5 km of health care facility Inputs & Outputs # of community health workers trained in BCC Improved Quality % children diagnosed and treated according to protocol Improved KA&S % husbands supporting exclusive breastfeed ing Improved Policies National policy on managem ent of acute malnutriti on in place
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Page 21 Addressing Undernutrition SC Priority Interventions (1) PracticesServices Nutrition Immediate Breastfeeding Exclusive Breastfeeding through 6 months of age Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.) Vitamin A supplementation (Maternal and Child) Iron supplementation Iodine supplementation Health Proper disposal of feces Hand washing at appropriate times Appropriate home care for Illness, including oral rehydration therapy for children with diarrhea Timely referral of seriously ill children Measles immunization Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea
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Page 22 Intended Impact: Children are Healthy and Well-Nourished Addressing Undernutrition SC Priority Interventions (1) Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intervention: Timely introduction of appropriate complementary foods
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Page 23 Complementary Feeding IR 3: Knowledge, Attitudes, and Skills Formative Research (E.g. TIPS, PD) Mother to mother support groups Growth monitoring and promotion Mass Communication PD/Hearth Why does IR3 come before IR1 on next page?
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Page 24 Complementary Feeding IR 1: Access to Food Resource transfers for the most vulnerable Food and/or nutrient supplements Micro-credit programs Food production and income generation (sustainable agriculture) –Inputs and services: agricultural inputs, financial services, access to markets –Improved practices: training and entrepreneurship What should be under sustainable ag— you trailed off, see word in green
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Page 25 Addressing Undernutrition SC Priority Interventions (2) PracticesServices Nutrition Immediate Breastfeeding Exclusive Breastfeeding through 6 months of age Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.) Vitamin A supplementation (Maternal and Child) Iron supplementation Iodine supplementation Health Proper disposal of feces Hand washing at appropriate times Appropriate home care for Illness, including oral rehydration therapy for children with diarrhea Timely referral of seriously ill children Measles immunization Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea Why isn’t 2 nd last bullet on bottom left—home care for diarrhea Bolded under this intervention?
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Page 26 Intended Impact: Children are Healthy and Well-Nourished Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intervention: Timely appropriate care for ARI, Diarrhea, Malaria, and Malnutrition Addressing Undernutrition SC Priority Interventions (2)
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Page 27 Take services closer to the population The community health worker as prescriber for pneumonia, diarrhea, and malaria “Community Case Management” Front-line health workers as providers of first choice for severe acute malnutrition Community-based Management Of Acute Malnutrition Timely, Appropriate Care IR 1: Access to Treatment
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Page 28 SC Child Nutrition Programs Producing Results Mozambique (2002 – 2007) –Exclusive breastfeeding increased from 5% to 74% –Months of adequate food provisioning from 7.9 to 10.7 months Bangladesh (2005 – 2007) –Underweight reduced from 52% to 44% in first 2 years of program Vietnam –Immediate breastfeeding increased from 74% to 92% –Exclusive breastfeeding increased from 39% to 52% Bolivia (2002 – 2007) –Reduced stunting from 37% to 30.2% –Exclusive breastfeeding increased from 75% to 83% Nicaragua (2002 – 2007) –Reduced stunting from 20.5% to 9.6% –Exclusive breastfeeding increased from 37% to 84%
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Page 29 The School-aged Child Outcomes of Interest GrowthEducational Attainment The equivalent of 200 million school years are lost each year in low income countries as a result of poor health and nutrition – World Bank Is the build on this right—why words at top come in later?
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Page 30 Intended Impact: Children are well educated The School Aged Child SC Results Framework Strategic Objective Increased Use of Key Health and Nutrition Practices and Services
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Page 31 The School Aged Child SC Priority Interventions Micronutrient supplementation: Vitamin A, Iron, Iodine De-worming Proper disposal of excreta and hand washing at appropriate times Health and Nutrition education Alleviation of short-term hunger
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Page 32 Nutrition in the School-aged Child Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 2: Increased Quality Of Services Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intended Impact: Children are well educated
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