Stunting Reduction in Young Children 2nd National Conference on Early Childhood Care and Education ‘Reconstructing Practices to Address Challenges and Trends in ECCE’ May 2-3, 2018

Regional Prevalence of Stunting

Child Stunting in Pakistan Stunting improved from 1965 (48%) to 1994 (36.3%) but deteriorated from 2001 (41.6%) to 2011 (43.7%). NNS: national Nutrition Survey

Provincial comparison of stunting, wasting and severe wasting Newest MICS shows stunting rates above 41% in DI Khan and Bahawalpur 40% severe public health concern

UNICEF

Consequences of malnutrition Physical Increased mortality at all ages Increased morbidity at all ages due to infections Stunted children have more diabetes, cardiac and hypertensive diseases as adults Mental Poor cognitive development Trans generational transfer of poor intellect

Consequences of malnutrition

Consequences of malnutrition Adults who were stunted as children: Earn 20% less as adults Are 30% more likely to live in poverty Children who are stunted: Have on average 13 Points less IQ More likely to drop out of school Poor nations loose 2-11 % of their annual GDP

By Focusing on 1000 Days We can Prevent Stunting The period from pregnancy to 24 months is the crucial window of opportunity to reduce undernutrition - program efforts should focus here UNICEF

Lancet Series 2013 Global and Regional Exposures and Health Consequences Maternal and Child under nutrition is underlying cause of 35% of deaths and disease burden in young children Deaths attributed to stunting, severe wasting and intrauterine growth restriction constitutes the largest risk to children U5 Suboptimal breastfeeding – especially in first 6 months results in 14% of deaths in children Maternal short stature and iron deficiency anemia increases risk of death and accounts for 20% of maternal mortality UNICEF

Thousand Days Approach- Key Nutrition Activities Pregnancy Birth 6 months 1 year 2 years Iron and Folic Acid Supplements Multi micronutrient Supplements Iodized salt Food Supplementation Exclusive Breastfeeding for 6 months Introduction Complementary Feeding Continued Breast Feeding for 2 years Multi micronutrient Supplementation (zinc) Vitamin A ( and deworming) Treatment of Malnutrition Initiation of breastfeeding within one hour UNICEF

Thousand Days Approach- Key Nutrition Sensitive Activities Pregnancy Birth 6 months 1 year 2 years Improved availability, access use of local foods Improved sanitation/hygiene practices Antenatal care Social protection/social safety nets Promote increased marriage age Workplace protection for new mothers Hand washing with soap Improved sanitation and water Early Childhood Development Immunization Treatment of infectious diseases ( diarrhea and pneumonia) Deworming Improved food access/diversity Kangaroo care Birth registration Baby Friendly Hospitals UNICEF

Nutrition Theory of Change UNICEF Black et al, The Lancet 2008 371, 243-260DOI: (10.1016/S0140-6736(07)61690-0

Initiatives to address malnutrition National multi-sectoral nutrition strategy in line with the already developed/endorsed provincial strategies Ten point vision (2015) – RMNCAH and Nutrition strategy (focus on adolescent girls) All PC 1s in provinces (Punjab, resource allocation in Sindh, KP & Balochistan)

Initiatives to address malnutrition (2) Universal Salt iodization – legislation & implementation CMAM and IYCF National Fortification Alliance Flour and vegetable oils fortification – partnership with the chambers of commerce in KPK, Sindh, Punjab, AJ&K SUN (Scaling up Nutrition) Breast feeding - legislation & implementation (Infant feeding boards)

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