Nutrition in Developing Countries Jonathan Gorstein

Causes of Malnutrition Malnutrition is a complex condition that involves multiple, overlapping deficiencies of protein, energy and micronutrients A child becomes malnourished because of illness in combination with inadequate food intake Insufficient access to food, poor health services, the lack of safe water and sanitation, and inadequate child and maternal care are underlying causes

Causes of Mortality among Preschool Children, 2002 Source: WHO (2003) Deaths associated with malnutrition 54% Other HIV/AIDS Measles Malaria Diarrhea Acute Respiratory Infection Perinatal

Intergenerational Cycle of Malnutrition The cycle of poor nutrition perpetuates itself across generations - supported by scientific evidence Child growth failure Low weight and height in adolescents Early pregnancy Small adult woman Low birthweight baby

Classification of Malnutrition WHO recommends three anthropometric indicators for assessment of nutritional status –Wasting (Low weight-for-height) –Stunting (Low height-for-age) –Underweight (Low weight-for-age) Classification based on International Growth Reference

Consequences of Malnutrition: Economic costs Malnutrition leads to reduced productivity, hampering economic growth and effectiveness of investments in health and education Vitamin and mineral deficiencies are estimated to cost some countries the equivalent of more than 5 per cent of their GNP in lost lives, disability and productivity

Role of Caring Practices Inadequate care for children and women is an underlying cause of malnutrition Good hygiene in and around the home and in handling food reduces risk of illness Care includes all interaction between parent and child that helps children develop emotionally and physically

Micronutrients Micronutrients are needed by the body only in minute amounts, are critical for: –Regulation of growth, activity, development –Immune and reproductive function Three primary micronutrient deficiencies include: –Iodine –Vitamin A –Iron

Population at Risk of Deficiency - Global Source: UNICEF (2002)

Iodine Deficiency Disorders (IDD) Single most important cause of preventable brain damage and mental retardation Significantly raises the risk of stillbirth and miscarriage in pregnant women 43 million people worldwide suffer from varying degrees of brain damage and physical impairment due to iodine deficiency – Concept of IDD (Spectrum of disability) The primary intervention for the control of IDD is through salt iodization

Today Some 70 per cent of households in the developing world are using iodized salt, compared to less than 20 per cent at the beginning of the decade. As a result, 91 million newborns are protected yearly from significant loss in learning ability Iodine Deficiency Disorders (IDD) Unfinished Business There are still 35 countries where less than half the households consume iodized salt

Coverage of Iodized Salt – by Region Source: UNICEF (2002)

90% or more 50% to 89% Less than 50% No recent data Levels of Iodized Salt Coverage Source: UNICEF (2002)

Major Increases in Iodized Salt Coverage Source: UNICEF (2004)

41 Million Newborns Still Unprotected from Learning Disabilities Source: UNICEF (2002)

Vitamin A Deficiency Contributing factor in 2.2 million deaths each year from diarrhea and 1 million deaths from measles among preschool children under five Severe deficiency can also cause irreversible corneal damage, leading to partial or total blindness Results of field trials indicate that VA supplementation of children with can reduce deaths from diarrhea. Four studies showed deaths were reduced by per cent. VA can reduce by half the number of deaths due to measles

Magnitude of Vitamin A Deficiency Pre-school children Clinically deficient: 3 million (Asia and Africa) Subclinically deficient (low serum retinol): million 250, ,000 become blind each year 90 % case fatality among those who become blind Pregnant women 25%-30% cases of night blindness reported in some Asian countries

Interventions to Control VAD In 1999, only 10 countries provided two rounds of VA supplementation with high coverage, this has increased to over 50 countries by Between 1998 and 2004, UNICEF estimates that about two million child deaths may have been prevented from vitamin A supplementation Food Fortification - A number of countries are successfully fortifying staple foods with vitamin A (e.g. sugar, maize flour, wheat) reaching large populations.

1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months Vitamin A Supplementation Coverage 1 : Developing world Source: UNICEF (2000)

Rapid Progress – Number of countries with high VA supplementation coverage 1 1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months Source: UNICEF (2000)

70% or more 30 to 69% Less than 30%No data available VA Supplementation Coverage Where VAD is a public health problem (U5MR>70) 1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months Source: UNICEF (2000)

Iron Deficiency and Anaemia Most common nutritional disorder in the world Lowers resistance to disease and weakens a child's learning ability and physical stamina Significant cause of maternal mortality, increasing the risk of hemorrhage and infection during childbirth. Nearly 2 billion people estimated to be anemic and millions more are iron deficient, the vast majority are women.

Global Prevalence of Anaemia: Pregnant Women Source: WHO (1999)

Global Prevalence of Anaemia: Preschool Children Source: WHO (1999)

Main Factors Contributing to Anaemia Iron deficiency –Poor bioavailability of consumed iron –Insufficient dietary iron intake Chronic and recurrent infections that interfere with food intake and absorption/utilization of iron –Helminth infections, primarily Hookworm –Chronic diarrheal disease –HIV –Malaria

Interventions to Control Anaemia Depends on etiology –For iron deficiency: supplementation and fortification –For parasitic disease control: appropriate measures for prevention and presumptive treatment

Proposed New Goals: Micronutrient deficiencies Achieve sustainable elimination of iodine deficiency disorders by 2005 and vitamin A deficiency by 2010, Reduce by one third the prevalence of anaemia, including iron deficiency, by 2010; and Accelerate progress towards reduction of other micronutrient deficiencies, through food fortification and supplementation

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