Scaling up Nutrition
for sustainable results
Why and how.
A focus on prevention
Trends in stunting prevalence among under-five children
Proportion of children under five years who are stunted (percentage)
60
58
50
52
47
40
49
around 1990
47
45
42
around 2010
40
40
45
42
45
41
35
30
34
30
27
20
26
21
17
10
0
ROSA
ESARO
WCARO
MENA
EAP
TACRO
Note: prevalence estimates calculated according to WHO Child Growth Standards
Source: DHS, MICS and national nutrition surveys, 1990 - 2010, and additional analysis by UNICEF
Least
developed
Sub-Saharan
Africa
Asia
Developing
world
Stunting prevalence
Stunting affects approximately one-third of under-fives in the developing world
Source: UNICEF Global Database, Nov 2009
Compiled from MICS, DHS and other national surveys
• (UN
UNICEF
Lancet 2008: Causal
pathways
in undernutrition,
4
UNICEF 1991
Impact of undernutrition during pregnancy and
early childhood
• Increased risk of dying from infectious diseases (one-third of child
deaths)
• Stunting is associated with reduced school performance equivalent
to 2-3 yrs of schooling
• Stunting associated with reduced income earning capacity (22%
average; up to 45% has been reported!)
• Increased risk of non-communicable diseases in adult life
• Stunted girl is more likely to give birth to undernourished baby
• Reduced GMP by 2-3%
• About 20 million children suffer from severe acute malnutrition
which greatly increases risk of death
Nutrition interventions in the life cycle needed to
reduce stunting and wasting and their coverage rates
Pregnancy
Iron & folic acid supplements
Multi micronutrient supplementation
Iodized salt
Food supplements
71%
-
Birth
Initiation of breastfeeding within 1 hr (Colostrum)
43%
0-6 months
Exclusive breastfeeding
Implementation of the Code on marketing of formula
37%
100 countries
6-24 months
Introduction of complementary feeding
Continued Breastfeeding up to 1 yr
Multi micronutrient supplementation
Vitamin A supplementation (& de-worming)
Zinc supplementation
Treatment of severe malnutrition
Treatment of moderate malnutrition
60%
75%
20 countries
66%
<10%*
-
24-60 months
Vitamin A supplementation (& de-worming)
Treatment of severe malnutrition
Treatment of moderate malnutrition
Social safety net programmes
66%
<10%*
-
Developing country data based on SOWC 2012; * based on estimation
24 countries with increases in exclusive
breastfeeding > 20 percentage points
100
90
baseline circa 1998
80
72
74
76
most recent data circa 2008
70
60
61
63
63
60
54
50
43
40
37
32
30
26
33
39
43
44
46
48
48
50
44
40
39
34
31
29
27
24
23
20
20
19
16
12
10
11
12
10
6
3
3
17
16
11
10
11
10
12
7
1
0
Source: UNICEF database 2011. The baseline is defined as between circa 1998 (1995-2001) and circa 2008 (2005-2011)
7
Status of complementary feeding
Selected countries with data on “minimum acceptable diet” (breastfed
children 6-23 m), and “introduction of complementary foods” (6-8m old, BF
& non BF children)
8
Programme Success Factors
• Situation analysis: The starting point for good programme design
• Political commitment and partnership: Strong and clear government
ownership, leadership and commitment are required
• Evidence based policies and linkages with other sectors: the essential
nutrition package needs to be implemented with key interventions from
other sectors (WASH, HIV, etc)
• Food security.
• Capacity-building: is required at all levels
• Communication for behavioral change: essential and often lacking
• Community based programmmes: essential and often inappropriately done
or not done at all
• Corporate social responsibility: Should increase availability of appropriate
and affordable products (e.g. high-quality complementary foods,
micronutrient-fortified staple foods, etc)
• Resources: Adequate financial investment is required.