two key issues for development - BVSDE - PAHO/WHO

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two key issues for development - BVSDE - PAHO/WHO

Prevalence estimates of stunting, wastingand overweight using the new WHO ChildGrowth Standard6050403020100Argentina, 2006Argentina, 2006Bolivia, Bolivia, 2003 2003Brazil, Brazil, 1996 1996Colombia, Colombia, 2005 2005Dominican Dominican Republic, Republic, 2002 2002Ecuador, Ecuador, 2002 2002El El Salvador, Salvador, 2003 2003Guatemala, Guatemala, 2002 2002Haiti, Haiti, 2005 2005Honduras, Honduras, 2005 2005Nicaragua, Nicaragua, 2001 2001Peru, Peru, 2004-2006 2004-2006OrganizaciónPanamericanade la SaludStunting Wasting OverweightPercentage


Prevalence of stunting by highest levels ofmaternal education attendedPrevalence of stunting8070605040302010NonePrimarySecundaryHigher0Bolivia Colombia DominicanGuatemala Haiti PeruRep.2003 2005 2002 2002 2005 2004-6OrganizaciónPanamericanade la Salud


Factors that explain stunting in PeruDeterminants% stunting explainedCharacteristics of the mother 46%Characteristics of the house25%Characteristics of the child 14%Contextual Characteristics(social, communitaries)19%OrganizaciónPanamericanade la SaludSource: Valdivia M. Acerca de la magnitud de la inequidad en salud en el Perú(GRADE, 2002)


Prevalence of obesity in under 5 yrs.(De Onis & Blossner, 2000)OrganizaciónPanamericanade la SaludAlgeriaEgyptArgentinaChileMoroccoSouth AfricaBoliviaPeruUruguayJamaicaJordanAustraliaBrazilUSAChinaZimbabweIndonesiaParaguayAzerbaijanKenyaIranPakistanVenezuelaTurkeyUgandaColombiaTanzaniaRomaniaGhanaIndiaMaliBangladeshCentral AfricPhilippinesVietnam0 1 2 3 4 5 6 7 8 9 10%


Overweight and obesity in fertile womenand quintile of poverty 2004 - 20056050% of women403020100obesity 2.2 9.6 16 15.3 14.1overweight 25.6 28.1 33.8 33.7 31.1OrganizaciónPanamericanade la Saludlowerquintilesecondquintilethird quintilefourthquintileupperquintileSource: INEI. ENDES 2004-2005


Coexistence of Stunting andOverweight/Obesity at the samehouseholdOrganizaciónPanamericanade la Salud


Coexistence of children with stunting andmaternal overweight at the same household60% of children and mothers5040302010Children with stuntingMothers with overweightChildren with stunting andmothers with overweight0BoliviaOrganizaciónPanamericanade la SaludBrasilColombiaDominicanRepublicGuatemalaHaitiNicareguaPeruSource: Garret, J, Ruel, Marie T. The coexistence of child undernutricionand maternal overweight: prevalence, hypotheses, and programme andpolicy implications. Maternal and Child Nutrition, 1, 185-196, 2005


OrganizaciónPanamericanade la SaludLa Iniciativacontra ladesnutricióninfantil


Letters sent to all presidential candidates• During the PresidentialCampaign for the period 2006-2011, letters were sent to eachcandidate, inviting them toprioritize the reduction ofstunting as a key issue.• 10 candidates, including thecurrent President of Peru,accepted the challenge.OrganizaciónPanamericanade la Salud


A Press Conference of the“Iniciativa contra laDesnutrición Infantil” tookplace on April 5th , 2006.The commitment of 10Candidates was announced.OrganizaciónPanamericanade la Salud


“Challenges and Opportunities in the Struggleagainst Stunting in Peru”Meeting with the Prime Minister, the First Lady, 6 Ministers ofState, 22/25 Governors, UN Agencies, NGOs and WB.OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


DeterminantsSchool childrenInfants< 6 mInfants6 m-2 m 2 yPre-schoolchildrenIlliteracyDomestic violencePoor access to health servicesDelivery and newbornsUnemploymentFood insecurityPregnant womenDiseases´ vectorsOrganizaciónPanamericanade la SaludAdolescenceInadequate householdsEnvironmental pollutionNo access to safe waterInadequate sanitationMINSA-WHO Workshop:“Intervenciones de impacto paramejorar la salud de la madre y elniño en las zonas críticas dePerú” July 2004


DeterminantsPreschool childrenSchool childrenInfants(< 6 mo)Infants(6 to 12 mo)delivery care andcare of newbornPregnant womenLife course approachOrganizaciónPanamericanade la SaludYoungsters


• Steroids in pre-term babies• Instituional delivery• Adequate clamping of theumbilical chord• Oxitocin when needed• Neonatal IMCI• “Madre canguro”• Household Controls• BF and complementary feeding• G&D Control• Immuniuzation• Micronutrients supplemts• IMCISchoolchildren• Preventionof adolescentpregnanciesPregnancyDelivery & NBInfant2- 6 mo.Child6-24 mo.• Exclusive BF• Immunization• G & D controls• IMCI• Child care• Early StimulationChild2-5 yrs.• G & D Controls• Immunization• Fortified foods• Healthy schoolinitiative• Physical activity• G & D Control• Immunization• Micronutrient supplements• Feeding Counselling• IMCI• Physical Activity• EducationAdolescentsOrganizaciónPanamericanade la Salud• Pre-natal Control• Micronutrients supplements• Immunization DT• Use of MgSo4 in pre-eclampsia• Maternal Homes for ARPBasicInterventions


“MODERNIZATION” and other determinants• Increased access to high energy and low nutrientfoods.• Increased access to health services but stillinsufficient and of poor quality• Chaotic urbanization: Poor quality dwellings, poorwater supply and sanitation, intrahousehold pollution• Increased violence and insecurity• Increased tobacco, alcohol and drugs consumption• Significant reduction of physical activityOrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


TIPOS DE ARTICULACIÓN DE LAESTRATEGIA CRECERARTICULACION HORIZONTAL MULTISECTORIALARTICULACION VERTICAL NACIONAL / LOCALRENIECOrganizaciónPanamericanade la SaludMINAGPRONAMACHCSMIN.VIVIENDAAGUA PARATODOSPRONASARMIMDESPRONAACRECERGOBIERNO REGIONALGOBIERNO LOCALPCMJUNTOSMINEDUPRONAMAORGANIZACIÓN LOCALCENTRO EDUCATIVO - POSTA DE SALUD - IGLESIAS – ONGsAPAFAs - O.S.B. – JAAS – COMITES VECINALESMINSASISPARTICIPACION DE LA COMUNIDAD


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


OrganizaciónPanamericanade la Salud


On track to meet MDG1? PeruStunting60% of stunting5040302040.8%27.3%24.2%18.7%14.4% 13.3%Gap 2009-2015Rural13.5%Total5.5%Urban1.1%1001992 1996 2000 2005 2009 (1T) 2015OrganizaciónPanamericanade la SaludGoal (MDG)Source: INEI. Encuesta Demográfica y de Salud Familiar1992, 1996, 2000 y 2004-2009


Different “faces” of malnutrition in Peru• Intrauterine growth retardation• Anemia• Stunting• Overweight and Obesity• Increasing prevalence of overweight in childhood• Osteoporosis• Vitamin A deficiency in rural areas• Iodine Deficiency Disorders under control• Zinc and folate deficienciesOrganizaciónPanamericanade la Salud

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