1. THE first 1000 DAYS: CHANGE A LIFE, CHANGE THE FUTURE! Provincial Planning Launches

2. Nutrition indicators for children under five Commonly used anthropometric indicators a.Stunting (Low height for age compared to the reference population) b.Underweight (Low weight for age compared to the reference population) c.Wasting (Low weight for height compared to the reference population) d.Low birth weight (below 2.5 kg)

3. Stunting: A silent emergency!

4. Implication for Zambia Zambia is at 45 % stunting in children under five (2007 ZDHS). According to WHO, the severity of the situation is very high when stunting is above 40% Zambia is classified as a country with high burden of stunting which requires immediate actions

5. Stunting in Zambia 45% of children under five are stunted!

6. What is stunting? Stunting is being short for one’s age if compared to the reference population (healthy and well nourished children of the same age) Normal height/age Low height/age Chanda, 5 years old, stunted Nawa, 5 years old

7. Consequences of Stunting (1) Stunting does not affect only the skeletal system, short stature is just one feature of a complex syndrome, “the stunting syndrome”, which includes: Developmental delay (retarded milestones such as walking) Impaired immune function (increased morbidity and mortality) Reduced cognitive function (Decreased school performance and future earning) Metabolic disturbance (Increased risk of chronic diseases in adulthood e.g. obesity and hypertension)

8. Consequences of Stunting (2) A small adult has also some functional limitations compared to a taller one (referring to direct effects of small size) Short stature in women results in intra-uterine growth retardation (inter-generational cycle of stunting) Shorter adults have a reduced working capacity (perpetration of poverty in labor- intensive societies)

10. Is the stunting syndrome reversible? Growth catch-up is possible in later childhood with sustained improvement in living conditions. Children, who remain in poor living condition, in which they became stunted, experience little or no catch-up in growth later in life. Mental and cognitive impairment are often permanent and irreversible after the age of 24 months.

11. The concept of 1000 days Stunting commonly occurs during fetal life, and soon after birth up to until the second year of life. The development of stunting follows the same pattern in all the regions of the world This critical period is equivalent to first 1000 days of life = 270 days (9 months of pregnancy) + 365 days (1st year of life) + 365 days (2 nd year of life).

12. Cont’d The first 1000 critical days is a period of critical nutritional needs and key days for physical growth, motor and intellectual development. Prevention should occur during this critical period using the life cycle approach which includes: adequate maternal nutrition appropriate age-specific IYCF practices a healthier environment (sufficient care, good hygiene etc.)

13. Tackling malnutrition requires a multi-sectoral approach!

14. Zambia National Food & Nutrition Strategic Plan (2011-2015) 8 priority areas for the country 1. Prevention of stunting in children under two years of age: 1 st 1000 most critical days. 2. Increasing micronutrient and macronutrient availability, accessibility and utilization. 3. Early identification, treatment and follow-up of acute malnutrition. 4. Improving nutrition education and nutritious feeding through schools.

15. Zambia National Food & Nutrition Strategic Plan (2011-2015) 5.Increasing linkages among hygiene, sanitation, infection control and nutrition. 6.Food and Nutrition and Mitigation of HIV and AIDS. 7. Food and nutrition actions to prevent and control non-communicable diseases. 8. Improving preparedness and response to needs for food and nutrition during environment.

16. What is the 1000 days Programme? 1. Scaling up an integrated package of high- impact cost-effective interventions and proven nutrition actions focusing on the first 1,000 Most Critical days (window of opportunity from pregnancy to 24 months of age). 2. High-impact cost-effective interventions have been identified in the Lancet series on Maternal and Child Under-nutrition, 2008.

17. I RON & F OLIC A CID U SE I ODIZED SALT C ORRECT FEEDING OF A SICK CHILD S LEEP UNDER TREATED BED NETS S AFE B IRTH & N ORMAL B IRTH W EIGHT B ABY D EWORMING V ACCINATIONS E XTRA MEAL / DIVERSE DIET C ORRECT COMPLEMENTARY FEEDING & FOODS V ITAMIN A A NTENATAL CARE S AFE W ATER & C AREFUL H YGIENE G ROWTH M ONITORING & P ROMOTION E XCLUSIVE B REASTFEEDING C ONTINUED B REASTFEEDING F ORTIFIED STAPLES 1,000 C RITICAL D AYS PMTCT ( NUTRITION AND B REASTFEEDING OPTIONS )

19. Examples of interventions to be focussed on Direct Nutrition Interventions Promote Breastfeeding Promote Complementary feeding Vitamin A supplementation Deworming Home fortification micronutrients powder Zinc supplementation Nutrition sensitive Interventions Food security and agriculture. Cash and food voucher transfers Water, sanitation and hygiene promotion Health 19

20. Phase 1 districts 1. Mbala 2. Kasama 3. Kaputa 4. Chinsali 5. Chipata 6. Lundazi 7. Samfya 8. Mansa 9. Mumbwa 10. Chongwe 11. Zambezi 12. Mongu 13. Shangombo 14. Kalabo Note: Selected based on high levels of stunting and poverty in addition to donor presence

21. Launching of the 1000 Days Programme 25/04/2013

22. Thank you

23. Other Direct intervention Adolescent health and preconception nutrition Maternal dietary supplementation. Micronutrient supplementation and fortification. Breastfeeding & complementary feeding. Dietary supplementation for children. Feeding behaviour and stimulation. Treatment of severe malnutrition, disease prevention.