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Drivers of Undernutrition

Bruce Cogill Ph.D.Bioversity International

Nutrition and Marketing Diversity Programme LeaderAIFSC Workshop

“Food and nutrition in Eastern and Southern Africa” Nairobi, Kenya

10-11 September

CGIAR Research Program on Agriculture for Nutrition and Health

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Source: Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print)

Mean anthropometric z-scores using the WHO growth standard

Wasting

Underweight

Stunting

Mean WAZ z scores by age using the new WHO standard, according to region (1–59 months)

Source: Victora et al. Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions. Figure 2. Pediatrics 2010;1254

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The conceptual framework of malnutrition

Poor Dietary Quality

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Food security

- Breastfeeding- Complementary feeding - Vitamin A supplementation- Zinc supplementation- Hygiene

INSTITUTIONS

POLITICAL & IDEOLOGICAL FRAMEWORK

ECONOMIC STRUCTURE

RESOURCESENVIRONMENT, TECHNOLOGY, PEOPLE

Food/nutrientintake

Health

Health,Water/

Sanitation Services

Interventions

Immediate causes

Underlying causes at

household/family level

Basic causes at societal

level

SHORT

ROUTES

LONG ROUTES

- Agriculture- Poverty reduction- Income generation- Education- Health systems strengthening- Women’s empowerment

Care Resources

Household Food Access

Adapted from Ruel (2008) & UNICEF (1990)

Nutritional Status

Care Resources

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Iron folate supplementation (reduces maternal deaths by 23%)

Maternal multiple micronutrients (reduces LBW infants by 16% and reduces maternal anemia by 39%)

Calcium supplementation (reduces risk of pre-eclampsia by 52%)

Promotion of breastfeeding (reduces mortality by 13%)

Social and behavior change for improved complementary feeding (reduces stunting)

Maternal supplements of energy, micronutrients, and protein (reduces LBW infants by 32%)

Deworming (reduces anemia and increases growth)

Neonatal vitamin A (reduces infant mortality by 21% in South Asia)

Delayed cord clamping (reduces anemia)

Vitamin A fortification or supplementation (reduces child mortality by 23%)

Universal salt iodization (improves IQ by 13 points)

Conditional cash transfers with nutrition education (reduces stunting)

Iron fortification and supplementation (reduces anemia by 28% and maternal mortality)

Dietary diversification (e.g. reduces anemia and vitamin A deficiency)

Improving diet quality and diversity

1,000 days Nutrition service deliveryTreatment of severe acute malnutrition in facilities (reduces deaths by 55%)

Zinc for management of diarrhea (reduces mortality by 9%)

What we do in Nutrition: Typical Interventions that should work

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Very useful as the conceptual framework is a causal model that mainly focuses on biological factors MORE COMPLEX

In East Africa additional dimensions enhancing undernutrition include:

• Socio-Economical (poverty, inequities, behaviors…)

• Environmental (sizeable proportion of land arid and semi-arid, prolonged droughts followed by floods exacerbated by climate change)

• Political (conflicts, poor governance, rent seeking…) Governance

• Behaviours

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All other countries in Blue had improved nutrition during same period as growth rates

Growth analysis from Radelet (2011) CGDEVNutrition data for Underweight and Stunting for same period from UNICEF UNDP

Comparing Under Five Nutrition with Changes in economic well being

No Change in Wt/Age Ht/AgeBurkina Faso, Mali, Mauritius, Lesotho and South Africa

Changes in Underweight in Blue countries was 1.3% per year (1996-2008) to close to zero

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Food Systems, Food Environments, Econutrition

Interrelationships among nutrition, human health, agriculture and food production, environmental health , and economic production

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Underweight and obesity in women in 36 highest-stunting burden countries*

*Data on both underweight and obesity prevalence for adult women were available for 29 countries. Stunting based on infants and children under-five. Source: WHO Global Database on Body Mass Index (2010) http://apps.who.int/bmi/index.jsp