1. Breaking the cycle of poverty early: by Education & Nutrition
D.S Akram Hon. Chairperson Health Education & Literacy Program- Pakistan 19th July 2015 Washington-DC

2. Outline of Presentation
Insight into the issues related to nutrition and ECD in the developing world-Pakistan as an example
UNICEF’s Conceptual Framework for malnutrition
Possible solutions
Scaling up Nutrition
What will we gain
• Nutritional deficiencies limit the intellectual and physical development and growth of the child » growth can be stunted » child does poorly at school.
• Deficiencies in affection and psychosocial stimulation stunt emotional, physical and intellectual development with long term effects » limits potential in school » poor employment chances » lifelong disability » mental problems.
• Nutritional and psychosocial deficiencies interact with short term and long term effects in learning, education and employability.

3. World Map based on Deaths from All Nutritional Deficiencies*
Nutritional deficiencies are due to inadequate amounts of particular categories of food and nutrients in what you have to eat and drink. All of the conditions here involve essential nutrients without which you cannot survive. You need large amounts of protein and carbohydrates, and small amounts of minerals and vitamins. Fats are essential to obtain some vitamins from food. Nutritional deficiencies are the sum of the following (with their contribution to the total nutritional deficiency deaths in 2002):
Starvation [Protein-energy malnutrition], U054 Map 412, (54% of deaths).
Iodine deficiency, U055 Map 413, (1% of deaths).
Vitamin A deficiency, U056 Map 414, (5% of deaths).
Iron-deficiency anaemia, U057 Map 415, (28% of deaths).
Other nutritional disorders, U058 Map 416, (12% of deaths).
Nutritional deficiencies caused 0.85% of all deaths worldwide in 2002, an average of 78 deaths per million people per year.
The ten highest rates of death per million people in 2002 were in:
Sao Tome and Principe, 845
Mali, 834
Sierra Leone, 713
Angola, 694
Liberia, 621 
Haiti, 619
Afghanistan, 454
Guinea-Bissau, 422 
Burkina Faso, 365
Lao People's Democratic Republic, 360
International Classification of Diseases (ICD) codes for all conditions included in category I-E Nutritional deficiencies U053
ICD-9 codes: 243, , , 285.9
ICD-10 codes: D50-D53,D64.9, E00-E02, E40-E46, E50-E64
* Deaths from protein-energy malnutrition, iodine, vitamin A, iron deficiency in 2002.
ICD 10 codes: D50-D53, D64.9, E00-E02, E40-E46, E50-E64.
Accessed at 8/4/08 3

4. What is causing malnutrition (Unicef’s analysis)

5. The “Window of Opportunity” for improving nutrition is very small…pre-pregnancy until months of age
BRAIN DEVELOPMENT STARTS IN 1ST.
Repositioning Nutrition, 2006 5

6. Over 162 million children <5 years are STUNTED
Maximum rates in South Asia are between 40-53%
Proxy indicator for reduced physiological capacity, work output
Decreased educational achievement
Negative employability
(Martorell R; Paper for WB)
Stunting has been taken as a proxy to decreased performance based on lack of appropriate nutrition in the first 2 years of life

7. Pakistan

8. Mountains

9. Plains

10. Desert

11. Scarcity of water

12. Urban Slum

13. Mapping Nutrition

14. Ref: “Mapping of Nutrition Initiatives” DS Akram ,et.al.TRF2013

15. Interventions that Affect Maternal and Child Under Nutrition
(Sufficient evidence for implementation in all 36 countries)
Newborn babies
Promotion of breastfeeding (individual and group counseling)
Infants and children
Promotion of breastfeeding (individual and group counseling).
Behavior change communication for improved complementary feeding*
Zinc supplementation
Zinc in management of diarrhea
Vitamin A fortification or supplementation
Universal salt iodization
Hand washing or hygiene interventions
Treatment of severe acute malnutrition
*Additional food supplements in food-insecure populations.
Vol 371 February 2, 2008

16. Address Intermediate and underlying Causes
Possible Solutions
Address Intermediate and underlying Causes
Infant and Young Child Feeding
Early Child stimulation
Indigenous Hi density foods for children, PLW
Address food insecurity
Micro – Credit / cash transfers
Empower Women – 43% reduction in malnutrition by educating women (Smith and Haddad, 2000)
Land reforms – subsidized agriculture
Alternate sources for power generation
Employment
POLITICAL AND SOCIAL SECURITY

17. Broadening the “nutrition lens”…
Financing envelope
Health sector
Narrow
nutrition lens
Multisectoral
Education sector
Agriculture sector
Private sector
Financial sector
Trade and tax policies sector
Transportation sector
Multiple other sectors
Increasing space for new
sectors & new partners
Environment sector
Governance
Gender
Poverty alleviation 17

18. Scaling Up Nutrition (SUN) September 2010 Coordinated by U.N.
Based on evidence based nutrition strategies from “Lancet Series 2008”
Public-Private Partnership of 102 government and non-government global partners
Based on Three Principles:
Should be Country Based and “Owned”
Focus on “Window of Opportunity” priority to first 1000 days of life.
Multi-Sectoral approach with integration of nutrition in related sectors.

19. Reaching the ‘Unreached’
Conventional methods: face to face, interactive radio, television
Peer counselors and child to child, child to parent teaching
Using technology: alternate sources of power in schools and health centers
Utilizing mHealth, voice messaging and visuals
Using skype for virtual classes and group counseling
CSOs partnering with governments

20. School in Tharparker & Solar Plant

21. What will we Gain?
Investment in Nutrition of children will results in :
Decreased mortality (save 1 million deaths per year or 30 million life years).
Decreased morbidity.
Improved physical & mental growth.
Contribution to achieving ALL MDGs goals.
Increase in lifetime earnings.
Very high rates of return among the top 10 development investments.

22. Convention of the Rights of the Child.
Adopted by UN General Assembly on 20th Nov, 1989.
Total of 10. Principles.
Principle No 4:
The child shall enjoy the benefits of social security. He shall be entitled to grow and develop in health, to this end, special care and protection shall be provided both to him and to his mother, including adequate pre-natal and post-natal care. The child shall have the right to adequate nutrition, housing, recreation and medical services.

23. Our Right – Food Security Good Governance-