Malnutrition in Asia Promoting Child Nutrition in Asia Vientiane November 4-6 2014 Christiane Rudert, Regional Advisor Nutrition UNICEF East Asia Pacific Regional Office
Stunted 3 Year Old Stunted Adult Average growth from 3-18 years 77 cm Height at 18 y 81.2 Height at 3 y 11/11/2014 Severe Moderate Mild Well-nourished (Guatemala, INCAP Oriente Study)
Global picture of malnutrition Over 162 million children under 5 are stunted (too short for their age) 51 million children are wasted, 17 million severely wasted (too thin) -and require special treatment; they are at high risk of death At the same time, 44 million children are overweight and at risk of chronic illness such as diabetes 2 billion people are deficient in key vitamins & minerals.
Very high rates of stunting in South Asia 60 Prevalence of stunting in children under 5 50 40 34 41 41 41 43 48 30 20 19 10 0
Stunting prevalence still of public health significance (>20%) in 12 East Asia-Pacific countries 70 % of under five children 60 50 40 30 20 10 10 10 15 16 17 20 23 24 26 28 33 34 35 36 40 44 44 50 0 Ref: UNICEF database reflecting national surveys in the year shown such as DHS, MICS, national nutrition surveys or living standards surveys. WHO categories of public health significance: WHO. Physical status: the use & interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Series No 854. Geneva, WHO 1995
How many stunted children are there in Asia? 106 million, two-thirds of developing world total of 162 million Afghanistan (59%); 2'928'760 Bangladesh (41%); 6'180'340 Nepal (41%); 1'223'440 Sri Lanka (17%); Bhutan 318'580 (34%); 24'140 Pakistan (44%); 9'678'240 India (48%); 57'878'880 78 million stunted children in South Asia Source: UNICEF 2014, State of the World s Children (brackets refer to the prevalence of stunting)
How many stunted children are there in Asia? Malaysia (17%); 412'250 Laos (44%); 391'160 Timor-Leste (50%); DPRK (28%); 473'200 PNG (44%); 432'080 110'200 Mongolia (16%); 45'900 Thailand Cambodia (16%); 592'960 (40%); 667'600 Myanmar (35%); 1'551'900 China (10%); 8'893'400 Viet Nam 23%); 1'652'320 Philippines (34%); 3'572'800 Indonesia (36%); 8'863'920 28 million stunted children in East Asia-Pacific Source: UNICEF 2014, State of the World s Children (brackets refer to the prevalence of stunting)
How fast are countries reducing stunting? South Asia 3.0 Percentage points 2.5 2.0 1.5 1.0 1.1 1.3 1.4 1.7 1.8 2.1 2.2 2.5 0.5 0.0 Pakistan India Afghanistan Bangladesh Global average Bhutan Sri Lanka Nepal 3.9 % annual reduction required to achieve the global target of 40% fewer stunted children
How fast are countries reducing stunting? East Asia 3.00 2.50 2.28 2.57 Percentage points 2.00 1.50 1.00 0.50 0.33 0.34 0.46 0.50 0.52 0.75 0.83 1.01 1.03 1.34 1.8 0.00
How many children are expected to suffer from severe wasting each year? Almost 24 million in 6 countries in South Asia Afghanistan ; 494'709 Bangladesh; 1'600'000 Nepal ; 178'245 Sri Lanka ; 101'245 Pakistan ; 3'105'704 India ; 18'127'548 Coverage of treatment was 1.4% in 2013 (340,000 children): huge gap!
How many children are expected to suffer from severe wasting each year? 4.3 million annual cases in the 10 countries with treatment programmes in East Asia Cambodia; 99'505 Laos; 136'406 PNG; 138'234 Timor-Leste; DPRK; 23'918 30'911 Mongolia; 5'048 Vietnam; 201'475 Myanmar; 216'335 Philippines; 528'531 Indonesia; 2'995'379 Reported coverage of treatment only ~ 0.8% in 2013 (33,000 children) in the 10 countries
Anemia in selected Asian countries (sorted by children <5) Percentage of target population (%) 80 70 60 50 40 30 20 10 15 30 22 Children < 5 years Pregnant women RAW, non-preg 4.9% - No public health problem 5.0-19.9% - Mild public health problem 20.0-39.9% - Moderate public health problem 40.0% - Severe public health problem 27 43 21 33 4544 48 46 47 47 48 35 33 56 46 55 53 44 70 59 55 75 71 45 0 Sri Lanka Philippines Indonesia Nepal Bangladesh Laos Cambodia India Myanmar Anemia has multiple causes, not limited to inadequate iron and other micronutrient intake. Other causes of anemia include worm infestation, malaria, other infections and genetic blood disorders.
Breastfeeding practices in South Asia Percentage of infants (%) 100 90 80 70 60 50 40 30 20 Global target = 50% 37 46 EBF <6 months) 49 64 70 76 10 0 Ref: UNICEF database. Source of data is national surveys such as DHS, MICS, national nutrition surveys. Date of survey is shown; if different surveys for the two indicators, first date is for early initiation and second is for EBF.
Percentage of infants (%) 100 90 80 70 60 50 40 30 20 10 0 Breastfeeding practices in East Asia: only 4 countries have met global target Global target = 50% 16 17 24 Exclusive breastfeeding <6 months) 28 34 40 42 52 65 66 74 Ref: UNICEF database. Source of data is national surveys such as DHS, MICS, national nutrition surveys. Date of survey is shown; if different surveys for the two indicators, first date is for early initiation and second is for EBF.
Success story: Stunting reduction in Maharashtra State, India Success factors: Improvement in infant and young child feeding, care for women before and during pregnancy, & access to health and sanitation, focus on most deprived High level political commitment Continuity of leadership: 10 years Multi-sectoral response Addressing child malnutrition cannot be the agenda of one department-it should have political buy in, through citizens alliance with MPs from all parties, business leaders, media, NGOs, activists and development partners. 50 41.4 39.0 25 23.3 0 1999 2006 2012 Annual average rate of reduction: 6.7%
Maharashtra: Findings from the stakeholder analysis Perceptions about why stunting has declined Strong economic growth Improved social, nutrition and health programming (especially the NRHM ANC, skilled birth attendant, early initiation of breastfeeding) State s Nutrition Mission seen as a key way of making nutrition visible Increased state budget allocations to nutrition Strong media and civil society Strong focus on frontline worker strengthening in nutrition and health Introduction of community management of severe acute malnutrition in Village Child Development Centres Yet to be resolved: poor access to sanitation and improved water, tribal inequalities, urban poverty
Success story: Stunting reduction in Nepal Combining health and nutrition interventions at facilities and in communities: Delivery of interventions through community-based programming facilitated by the nation s cadre of female community health volunteers (FCHVs) located throughout the country. Improved coverage of safe motherhood programmes, ironfolic acid supplementation to all pregnant women and breastfeeding mothers, deworming, maternal care and child survival interventions. 100 90 80 70 60 50 40 30 20 10 0 57 41 2001 2011
Success story: Breastfeeding in Cambodia 2000 2004 Annual breastfeeding event now one month each year Baby-friendly community initiative now covers over 2,500 villages in 12 provinces 100.0 90.0 80.0 70.0 60.0 50.0 60.0 66.0 73.5 2004 Broadcast of TV & radio spots focusing on early initiation & exclusivity; continuing promotion 40.0 30.0 20.0 10.0 11.7 2005 Sub-decree banning promotion of formula for children < 2 years 0.0 2000 2005 2008 2010
Bangladesh: change in breastfeeding is evident when efforts intensified Modalities for intensification Household level Home visits to support mothers Community level Groups, forums Dialogue National level Coordination Mass media Advocacy Partnerships 100 90 80 70 60 50 40 30 20 10 0 46% 45% 46% 42% 43% 64% 21% 93-94 96-97 99-00 2004 2007 2011 ACF Exclusive breastfeeding rate Source: BDHS 2011
Key messages Prevalence of stunting remains unacceptably high despite economic and development progress Largest burden of stunting and wasting is in Asia Stunting reduction is possible to accelerate in a relatively short time And success is possible in improving breastfeeding rates. Strong political commitment is essential to scaling up effective programmes
THANK YOU!