The Nutrition Factor: Basic for Child survival and development in CA and CEE/CIS

1. The Nutrition Factor: Basic for Child survival and development in CA and CEE/CIS MCH Forum8 April 2008 Arnold Timmer, Nutrition Specialist UNICEF Regional Office CEE/CIS, Geneva

2. CEE/CIS Region

3. Child Nutrition Challenges in CEE/CIS • Nutrition crucial in child survival • Vitamin A, breastfeeding, acute malnutrition (wasting) • Nutrition crucial in child development • Chronic malnutrition (stunting, low height-for-age) • Iodine deficiency • Iron deficiency • Overweight  increasing rapidly in < 5, poverty related • Populations of concern • Children < 2 years  window of opportunity • Pregnant, lactating women and women of child bearing age • Disparities  children in rural areas, families of lower wealth and lower maternal education • Direction • Communicate comprehensive nutrition typology, advocate integrated approach (nutrition investment policy) • Action at community, systems and policy level • Opportunities for Central Asia

4. Successes in Central Asia • IDD elimination through USI close to completion • Flour fortification going to scale • Vitamin A supplementation achieved high coverage • BFHI successful but alone is insufficient • Time has come to look ahead and use momentum created • Invest wisely and ensure optimum child survival and development • Invest in quality of children  future of the nation • “engage” available funding and actors (private sector, civic groups, community) • Communicate in understandable language: school performance, economic productivity, reduced health care costs

5. Child nutrition  child development-Lancet series- • First few years of life are crucial, development of  brain  motor skills  social-emotional skills • Poor child development  poor school achievement  maternal care, stress  under-nutrition  poverty

6. Child nutrition review - outcome • Nutrition typology  chronic and hidden  stunting and micronutrient deficiencies • Children < 2 years particularly affected  caused by poor infant and young child nutrition • Large disparities : national averages seem fine, but worrisome for low income households, low maternal education, and rural areas. • Double burden of malnutrition: rapidly increasing trend of overweight  poverty driven  health care burden, risk chronic disease, reduced productivity/wellbeing • In countries with rapid economic growth lack of progress and rates disproportionate with health care, mortality and income

7. Stunting among children 6-11 and 12-23 months

8. Stunting by maternal education

9. critical serious poor acceptable Overweight emerging as serious public health problem affected by poverty(weight-for-height > +2 SD)

10. Double burden – overweight and stunting (children < 5 years)

11. severe moderate mild normal Anaemia: youngest children are most affected

12. severe moderate mild normal Anaemia (<12 g/dl) among non-pregnant women

13. East Asia & Pacific  43% World  36% Exclusive breastfeeding rate (< 6 months)

14. Strategic directionChild development compromised in CEE/CIS • Children suffer irreversible damage to physical growth, brain development and health. Youngest children in poor, rural families with lower education are hardest hit • Assumed main causes • Diet deficient in vitamins, minerals & protein  low exclusive breastfeeding, complementary foods not available or accessible • Behaviour related: insufficient knowledge and inappropriate practices  external factors: health care advice, counselling, commercial, workplace, traditions & believes

15. Selecting evidence-based interventions and operational strategies using a life-cycle approach Adolescence Adulthood Childhood Newborn Critical Physiological Stage of Health and Nutrition (prenatal-3 years) Pregnancy & birth

16. Child 0 -24 months Community level Systems level Policy level

17. Outdated growth standards Nutrition not seen as education, economic issue Curriculum lacks nutrition Maternity laws weak No counselling skills No nutrition knowledge State-of-art science difficult to access Companies lack understanding importance BF Short maternity leave Outdated growth standards Work - study Health care Economic need to work Low salary commercial influence Policy makers lack understanding of importance of young child nutrition workplace baby friendly? Breastfeed every 3 hours Single parent families information material inadequate Hospital baby friendly? What food to give after 6 months Workplace not baby-friendly No time to BF: work/study Child 0 -24 months Child 0 -24 months Believe breastmilk is not enough Feed infant formula Media not socially oriented Early introduction water, milk needed Weak enforcement of BMS Code stop BF when child is sick or cries Early introduction tea, water, milk No mother support group No legislation to stop marketing IF Mother in law advices on feeding Community does not make BF easy Poor comm network Code BM substitutes weak Family community Weak health system = opportunity for industry Weak community structure Commercial BF alone is not enough Attitude companies is not social Stop BFeeding sick and crying child Commercials influence mother Knowledge women, mothers inadequate Good complementary food not available Consumer groups don’t address nutrition Causal framework poor breastfeeding and complementary feeding practices

18. Strategic Direction – what and how • Focus on children < 2 years and IYCN • Comprehensive approach  advocate as child development • Better understand causes: cultural, labour, economic aspect • Overall protection, promotion and support of infant and young child feeding; expand breastfeeding to community level beyond the BFHI, focus on complementary food & feeding • Micronutrients: supplementation (sprinkles), fortification  also address pre-pregnancy • Address inequities  target specific population groups

19. Strategic Direction – what and how • More attention for overweight • Exclusive and continued breastfeeding • Adequate and timely complementary feeding • Control marketing of foods targeting young children • Use (pre-)schools to launch activities • Private sector role • Strengthen community and family dimension (now health system driven) • Requirements: • Scale up of interventions • Sustainability – ownership, financially feasible • Evidence based • Public health rather than clinical approach

20. Action: policy – systems - community • Poor feeding practices influenced by environment (commercial, work, health care system, community/family)  requires action at community, systems and policy level • Information and Communication: Provision of accurate, objective and consistent information about optimal child feeding practices • Skilled support for mothers to initiate/sustain the optimal feeding practices, prevent/overcome difficulties • Protection from misinformation and inappropriate commercial influences • Create an enabling environment (including the policy/legislative environment) for mothers/families to adequately feed and care for infants and young children

21. Opportunities • Policy • Advocate for comprehensive approach  main problems and interventions combined  budget allocation • Capacity building ‘evidence based policy development’ • Systems • Health system reforms • Update standards, methods, norms, guidelines • Capacity building of scientists  West-East connections • Ensure implementation to peripheral levels • With partners • Community • Innovations, monitoring, documenting and scaling up

22. Costs of Nutrition programming (approximate)

23. Conclusion • Evidence and experience support cost-effective and comprehensive approach • Next steps: • Advocate among broad field of professionals  form working group • Engage high level using political priorities • Formulate comprehensive national nutrition policy and action plan • Go beyond health-spheres  MoFinance, MoEconomic Development, private sector, civic society • Base approach on community level opportunities • Monitor and document in health and economic terms • Organize donors and international agencies around 1 plan

24. THANK YOU