Why nutrition matters, Ethiopia - Linkages Project

PPT2.2
Why nutrition
matters?

Presentation 2.2…
Overview of malnutrition today…
• What progress has been made?
• View of malnutrition.
• Why nutrition matters?
The ways forward…
• Macroeconomic policies
• Sectoral policies
• Direct nutrition programs Essential Nutrition Actions

Declaration of the
1974 World Food Summit
‘… all governments and the international
community as a whole …. eliminate within a
decade hunger and malnutrition’
(Resolution V)

Malnutrition today – what progress
have we achieved today,
nearly 30 years later?

Malnutrition today – what progress
have we achieved today,
nearly 30 years later?
Some global trends
in malnutrition…

Focus on levels of stunting (low ht/age)
Child stunting level good indicator of socio-economic
conditions
• malnutrition can ‘cost’ a young child up to 11 cm of height by the age of
two years
Much better reflection of human development than
economic indicators

Trends in stunting
(low height for age) in children < 5 yrs,
by region and year
75
% stunted
50
25
0
1980 1990 1995 2000
4 th Report on World Nutrition Situation, ACC/SCN
SS Africa Asia South America

Rates of stunting in children < 5 years have
increased or remained high in Africa
60
%
40
20
0
1980 1990 2000
East and Southern West North
De Onis et al, 2000 - WHO Global Databank

The number of stunted children is rising
dramatically in Africa
Number of children in millions
60
40
20
0
1980 1990 2000
East and Southern West North Total
De Onis et al, 2000 - WHO Global Databank

Prevalence of stunting in children under
five years, in selected east African
countries
100
75
Percentage
50
51
43
38
33
25
0
Ethiopia Tanzania Uganda Kenya

Some problems with dealing with malnutrition:
In the past there was a lack of
consensus on the:
• nature of the malnutrition problem
• causes of the problem…
• what actions to take…

Two extreme schools of thought…
Technologists:
•technological interventions (eg.
magic bullets) can solve the
problem
Structuralists:
•eradicating poverty will solve the
problem

Past problems dealing with malnutrition:
Too many viewpoints led to
CONFUSION
and
a lack of agreement on
how to tackle malnutrition…

Today a much greater consensus exists…
a mix of both
technologist and structuralist
elements

Conceptual Framework of Malnutrition
Nutritional Status
Manifestations
Diet
Health
Immediate
Causes
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Underlying
Causes
Human, Economic, and
Institutional Resources
Political and Ideological Structure
Ecological Conditions
Root
Causes
Adapted from UNICEF
Potential Resources

Conceptual Framework of Malnutrition
Nutritional Status
Manifestations
Diet
Health
Immediate
Causes
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Underlying
Causes
Human, Economic, and
Institutional Resources
Political and Ideological Structure
Ecological Conditions
Root
Causes
Adapted from UNICEF
Potential Resources

Conceptual Framework of Malnutrition
Nutritional Status
Manifestations
Diet
Health
Immediate
Causes
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Underlying
Causes
Human, Economic, and
Institutional Resources
Political and Ideological Structure
Ecological Conditions
Root
Causes
Adapted from UNICEF
Potential Resources

Conceptual Framework of Malnutrition
Nutritional Status
Manifestations
Diet
Health
Immediate
Causes
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Underlying
Causes
Human, Economic, and
Institutional Resources
Political and Ideological Structure
Ecological Conditions
Root
Causes
Adapted from UNICEF
Potential Resources

Some myth-information on nutrition…
• Increasing food production will reduce malnutrition
• Protein deficiency is the cause of malnutrition
• Children in developing countries are genetically short
• Malnutrition should be left in the hands of nutritionists

Why nutrition matters?
Human and
Economic Costs

Ethical Imperative
Nutrition is
a human right…

Negative functional consequences
Illness & Mortality
Intelligence loss
Reduced productivity

Consequences of Malnutrition
Current scientific data
Profiles
Computer model
Functional Consequences

Quantifying the human & economic losses
• Some assumptions:
• Period: over six years
• UN Medium Population Projections
• E-DHS 2000, National Surveys & MOH Reports

Malnutrition
&
Child Survival

Major causes of death
among children under five, world, 2000
Other
29%
Pneumonia
20%
Deaths
associated with
undernutrition
60%
Diarrhoea
12%
Malaria
8%
Perinatal
Measles
HIV/AIDS
22%
5%
4%
EIP/WHO; Caulfield et al, forthcoming
5

Child Mortality
(six year period)
UNICEF/C-56-19/Murray-Lee
1,030,000 child deaths due to PEM
(470 deaths every day)

Underweight and Mortality
… the majority of these deaths, as
much as 80%, are associated with
mild and moderate malnutrition
… invisible to ‘see’ as nearly all
Ethiopian children are
malnourished

Breastfeeding Practices
In Ethiopia,
70%
of infants are
sub-optimally
breastfed
UNICEF/93-COU-0173/Lemoyne

Deaths of Ethiopian infants due to suboptimal
breastfeeding practices
(six year period)
412,000 infants deaths linked to PEM

Vitamin A Deficiency
• Night blindness
• Ulceration of the cornea
• Permanent blindness

Vitamin A Deficiency and Mortality
Improving vitamin A status can
reduce child mortality by 23-34%

VAD: Associated Mortality
(over six year period)
298,000 deaths of Ethiopian children
UNICEF/ Pirozzi

Human Losses
(over six year period)
Over 1,000,000
child lives lost due
to protein-energy
malnutrition and
vitamin A
deficiency
UNICEF/HQ91-0031/Eritrea/Sprague

Malnutrition
&
Education

Malnutrition and Education
Reduced:
• Intellectual development
• School performance
• Economic productivity

Malnutrition and Education
Iron deficiency anemia lowers IQ by about 9 points
Mild iodine deficiencies lowers IQ by about 10 points
Severe stunting associated with IQ loss of 5-10 points
Low birth weight babies have IQs 5 points lower

Iodine Deficiency in Ethiopia
Total Goiter Rate = 22%
(over six year period)
124,000 Severe mental retardation
416,000 Moderate mental retardation
3,620,000 Mild intellectual disability
4,160,000 All grades of mental disability
UNICEF/Ethiopia

Malnutrition
&
Economic Development

Productivity losses in Ethiopia due
to iodine deficiency
(over six year period)
Present value = US $936 million

Stunting & Productivity
Inadequate nutrients in
quantity and quality in
first two years of life

Stunting & Productivity
Height deficit as much as
11cm by 24 months of
age
…stunted children
become stunted adults

Stunting & productivity
1.4% decrease in productivity for every
1% decrease in height
(Haddad & Bouis, 1990)

Stunting (0-24 Months)
(EDHS - 2000)
55%
stunted

Economic losses due to stunting
(over six year period)
• Present value = US $2,031 million

Total economic losses
(over six year period)
3000
US $2,967 million
Economic Losses (US$ million)
0
2,031
936
Stunting
Iodine Deficiency

In summary, the functional consequences
of malnutrition are immense
Deficiency
Reduces

In summary, the functional consequences
of malnutrition are immense:
Deficiency
Vitamin A
Reduces
survival

In summary, the functional consequences
of malnutrition are immense:
Deficiency
Vitamin A
PEM
Reduces
survival
productivity

In summary, the functional consequences
of malnutrition are immense:
Deficiency
Vitamin A
PEM
Iron
Reduces
survival
productivity
intelligence

In summary, the functional consequences
of malnutrition are immense:
Deficiency
Vitamin A
PEM
Iron
Iodine
Reduces
survival
productivity
intelligence

Impact is significant
Human costs
Economic costs

Improved nutrition is an essential input
into human & national development
Key word is
“input”
Can’t afford to wait for improved nutrition to be an
output of overall ‘trickle-down’ development

Planners from each sector need to address:
impact of nutrition on their sector
impact of their sector on nutrition

In Ethiopia
Where can we focus our efforts?

Conceptual Framework of Malnutrition
Nutritional Status
Manifestations
Diet
Health
Immediate
Causes
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Underlying
Causes
Human, Economic, and
Institutional Resources
Political and Ideological Structure
Ecological Conditions
Root
Causes
Adapted from UNICEF
Potential Resources

1. Macroeconomic Policies
2. Sectoral Policies
3. Direct Nutrition Interventions

Macroeconomic Policies
… Trade and exchange rate policies
… Price policy (real income)
… Allocation of public expenditure
… Social safety nets (subsidies, public works &, feeding
programs, targeting…)

Sectoral Policies
… agriculture: availability, access, and stability
… health (especially primary)
… education (especially primary)
… environment
… commerce
… etc

Special focus on roles &
situation of women as:
…farmers
…wage earners
…child caretakers
…home providers

Key issues related to women and nutritional outcomes
Nutritional Status
Diet
Health
Household
Food Security
Care of Mother
and Child
Environ. Health,
Hygiene & Sanitation
Women’s
control of:
•Income
•Decisions
•Physical
capital
•Food
resources
Women’s
access to:
•Land
•Credit
•Technology
•Information
•Physical capital
•Employment
Women’s time
constraints:
•Farm work
•Off-farm work
•Family care
•Child care
Women’s
knowledge:
•Self esteem
•Education
•Beliefs
Women’s health
and nutritional
status:
•Labor
productivity
•Fertility
•Child
caretaking
•Maternal-infant
malnutrition
cycle

Direct Nutrition Interventions
… maternal and child health programs
… supplementary feeding programs
… fortification
… etc

Direct nutrition interventions,
… when should we intervene?
Majority of growth
faltering occurs during
first year of life

When should we intervene?
Many babies are
born malnourished
due to poor maternal
nutrition before &
during pregnancy

Where should we intervene?
Focus on:
• infant & young child feeding,
especially 0-24 months
• nutrition of girls & women

One way to move forward is
The Essential
Nutrition Actions:
An Action Oriented
Approach
for all Sectors

One way to move forward is
The Essential
Nutrition Actions:
An Action Oriented
Approach
for all Sectors

Thank you
Prepared by Victoria Quinn (AED/LINKAGES) based on materials from:
Agnes Guyon, AED/LINKAGES
Ethiopia Profiles Team and AED/FANta, 2000