1. STUNTING AND ITS IMPACT ON CHILD SURVIVAL IN ODISHA
Odisha Development Conclave
20th Sep 2015

2. Stunted bodies Stunted brains Stunted lives
Stunted Children
Stunted bodies Stunted brains Stunted lives
+ Intergenerational

3. Effects of Stunting on Brain Development
Normal
Typical brain cells
extensive branching
Severe malnutrition early in life causes changes to brain cell development and reduction in the “connectivity” or “branching” between brain cells.
In humans, this process of brain development happens in the first 2 years of life, which is a critical period of vulnerability.
This slide shows microphotographs of the deep layers of the developing brain (cortex) of infants a few months old, at different levels of magnification.
On the top, are normal brain cells, which have greater connectivity, both in number and span of branches
[this is from a well nourished, 2.5 month old girl who ]
On the bottom, are damaged brain cells that have developed in the context of STUNTING.
there are fewer branches (dendrites)
each of these branches is significantly shorter (amplitude of dendrites)
the proportion of these damaged cells is higher
At higher magnification, the branches are abnormal - the projections (called spines) are fewer, and abnormal in shape and size
[this is from a severely stunted 2.6 month old girl]
Extra supporting information:
Context: Chile (disadvantaged area)
Human study: infants, children who died of pnuemonia, aged 3-4 months, 5 were well-malnourished and 5 were underweight/some were stunted.
Primary motor cortex
Malnutrition: “moderate” protein calorie malnutrition; we recalculated stunting
Controls: well nourished
Stunting
Impaired brain cells
- limited branching
-abnormal branches
Source: Cordero E et al, 1985 (Adapted from Figure 2 & Figure 4), Benıtez-Bribiesca et al (Adapted from Figure 4)

4. Multiple Benefits of Eliminating Malnutrition in Young Children
Prevent more than 1/3 of child deaths per year (Health)
Improve school attendance by at least one year (Education)
Increase wages by 5-50%
Reduce poverty as well-nourished children are 33% more likely to escape poverty as adults (Protection)
Empower women to be 10% more likely to run their own business (Gender equality)
Boost gross national product by 11% in Africa and Asia
Break the inter-generational cycle of poverty
Source Haddad L. Child Growth =Sustainable Economic Growth: Why we should invest in nutrition. May 2013.

5. 1,000+ DAYS The Critical “Window of Opportunity”
Stunting: The Critical Window
Source: Victora et al 2010
The Critical “Window of Opportunity”
1,000+ DAYS
Pre-pregnancy (+), Pregnancy: 9*30 = 270 days
2 years after birth: 365*2 = 730 days
Source: Victora et al 2010

6. Reduction of Stunting in Odisha - Trends
Stunting reduced by 15.1% over the last 8 years
Decline in Stunting among SCs and STs more rapid % and 19.4% respectively
Overall rate of decline is lower than the national average (19.4%)
Rate of decline is not rapid enough to reach the WHA target of 40% reduction over the coming 10 years

8. Causes of Undernutrition and Multi-sector Actions
Health & Family Welfare
W & Child Dev.
Agriculture
Food & Civil Supplies
Drinking Water & Sanitation
Education
Rural Dev.

9. Known Solutions: 10 Essential Interventions
Infant and Young Child Feeding Practices
Access to
health services and healthy environment
Care for women before and during pregnancy
Immunization and Vitamin A
Appropriate feeding in illness
Therapeutic feeding for severe acute malnutrition
Improve hygiene and sanitation and safe drinking water
Delay in marriage, first pregnancy
Adolescent and women’s nutrition
Breastfeed in 1 hour of birth
Exclusive breastfeed for 6 months
Complementary foods at 6 months
Age-appropriate foods for children six months to two years
1. Girls are born, protected; delay in marriage, first pregnancy and repeated pregnancies
2. Adequate food, nutrition and support for women (before, during and after pregnancy) to prevent anemia, undernutrition and care for those at risk
Initiation of breastfeeding within 1 hour of birth
Exclusive breastfeeding during the first six months of life
Timely introduction of complementary foods at six months
Age-appropriate foods for children six months to two years (quality, quantity an frequency and hygiene)
Immunization and bi-annual Vitamin A supplementation with deworming
Appropriate feeding for children during and after illness
Therapeutic feeding for children with severe acute malnutrition
Improve hygiene and sanitation practices and access to safe drinking water and sanitation commodities.

10. Access to some Essential Nutrition Interventions in Odisha
Source: NFHS and RSOC state factsheet
IYCF
Micronutrients
Health & WASH
Adolescent and maternal nutrition

11. Key Actions
Multi-sector convergent actions – GoO, community, PRI, media, CSO
Equity: Focus on marginalized groups
Community awareness, especially in tribal communities
About optimal nutrition for women before, during and after pregnancy
About optimal child nutrition, especially complementary feeding
Support to obtain information