Nutrition in Developing Countries

Jonathan Gorstein

Causes of Malnutrition

• Malnutrition is a complex condition that involves multiple, overlapping deficiencies of protein, energy and micronutrients

• A child becomes malnourished because of illness in combination with inadequate food intake

• Insufficient access to food, poor health services, the lack of safe water and sanitation, and inadequate child and maternal care are underlying causes

Causes of Mortality among Preschool Children, 2002

23%

18%

15%

10%

5%

25%

4%

Source: WHO (2003)

Deaths associated with malnutrition

54%

Other

HIV/AIDS

Measles

Malaria

Diarrhea

Acute Respiratory

Infection

Perinatal

Intergenerational Cycle of Malnutrition

The cycle of poor nutrition perpetuates itself across generations - supported by scientific evidence

Child growth failure

Low weight and height in

adolescentsEarly pregnancy

Small adult woman

Low birthweight baby

Classification of Malnutrition

• WHO recommends three anthropometric indicators for assessment of nutritional status– Wasting (Low weight-for-height)– Stunting (Low height-for-age)– Underweight (Low weight-for-age)

• Classification based on International Growth Reference

Consequences of Malnutrition:Economic costs

• Malnutrition leads to reduced productivity, hampering economic growth and effectiveness of investments in health and education

• Vitamin and mineral deficiencies are estimated to cost some countries the equivalent of more than 5 per cent of their GNP in lost lives, disability and productivity

Role of Caring Practices

• Inadequate care for children and women is an underlying cause of malnutrition

• Good hygiene in and around the home and in handling food reduces risk of illness

• Care includes all interaction between parent and child that helps children develop emotionally and physically

Micronutrients

• Micronutrients are needed by the body only in minute amounts, are critical for:– Regulation of growth, activity, development – Immune and reproductive function

• Three primary micronutrient deficiencies include:– Iodine– Vitamin A– Iron

0.0

0.5

1.0

1.5

2.0

2.5

Iodine Iron Vitamin A

People(billions)

1.6

2.0

0.8

Population at Risk of Deficiency - Global

Source: UNICEF (2002)

Iodine Deficiency Disorders (IDD)

• Single most important cause of preventable brain damage and mental retardation

• Significantly raises the risk of stillbirth and miscarriage in pregnant women

• 43 million people worldwide suffer from varying degrees of brain damage and physical impairment due to iodine deficiency – Concept of IDD (Spectrum of disability)

• The primary intervention for the control of IDD is through salt iodization

Today• Some 70 per cent of households in

the developing world are using iodized salt, compared to less than 20 per cent at the beginning of the decade.

• As a result, 91 million newborns are protected yearly from significant loss in learning ability

Iodine Deficiency Disorders (IDD)

Unfinished Business• There are still 35 countries where less than half the households

consume iodized salt

69

70

28

55

68

70

80

81

0 20 40 60 80 100

World

Developing Countries

Latin America and the Caribbean

East Asia and Pacific

Middle East and North Africa

Sub-Saharan Africa

South Asia

CEE/CIS

Coverage of Iodized Salt – by Region

Source: UNICEF (2002)

90% or more50% to 89% Less than 50%No recent data

Levels of Iodized Salt Coverage

Source: UNICEF (2002)

19

0

31

1

28

5

28

51

0

83

7073

76 76

87 88 90 919897

0

20

40

60

80

100

1993 2000 1994 1998 1996 2000 1995 2000 1994 2000 1993 2000 1992 2000 1995 1999 1995 1999 1995 1999

Bangladesh Togo Lao PDR MadagascarCentral African

Rep.Jordan Mexico China Eritrea Nigeria

Major Increases in Iodized Salt Coverage

Source: UNICEF (2004)

41 Million Newborns Still Unprotected from Learning Disabilities

Sub-Saharan Africa

CEE/CIS

Latin America/CaribbeanMiddle East/

North Africa

South Asia

East Asia/Pacific

17 million

8 million

7 million

4 million

3 million2 million

Source: UNICEF (2002)

Vitamin A Deficiency

• Contributing factor in 2.2 million deaths each year from diarrhea and 1 million deaths from measles among preschool children under five

• Severe deficiency can also cause irreversible corneal damage, leading to partial or total blindness

• Results of field trials indicate that VA supplementation of children with can reduce deaths from diarrhea. Four studies showed deaths were reduced by 35-50 per cent.

• VA can reduce by half the number of deaths due to measles

Magnitude of Vitamin A Deficiency

• Pre-school children• Clinically deficient: 3 million (Asia and Africa)• Subclinically deficient (low serum retinol): 100-140 million• 250,000-500,000 become blind each year• 90 % case fatality among those who become blind

• Pregnant women• 25%-30% cases of night blindness reported in some Asian

countries

Interventions to Control VAD

• In 1999, only 10 countries provided two rounds of VA supplementation with high coverage, this has increased to over 50 countries by 2004.

• Between 1998 and 2004, UNICEF estimates that about two million child deaths may have been prevented from vitamin A supplementation

• Food Fortification - A number of countries are successfully fortifying staple foods with vitamin A (e.g. sugar, maize flour, wheat) reaching large populations.

7066

35 34

80

50

0

20

40

60

80

100

DevelopingCountries(excluding

China)

LeastDevelopedCountries

Sub-SaharanAfrica

East Asia /Pacific (excl.

China)

South Asia Latin America/ Caribbean

Perc

ent

1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months

Vitamin A Supplementation Coverage1:Developing world

Source: UNICEF (2000)

Rapid Progress – Number of countries with high VA supplementation coverage1

11

27

43

0

10

20

30

40

50

No. o

f cou

ntrie

s

1996 1998 1999

1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months

Source: UNICEF (2000)

70% or more

30 to 69% Less than 30% No data available

VA Supplementation CoverageWhere VAD is a public health problem (U5MR>70)

1 Percent of children aged 6-59 months who received at least one vitamin A supplement within the last six months

Source: UNICEF (2000)

Iron Deficiency and Anaemia

• Most common nutritional disorder in the world• Lowers resistance to disease and weakens a

child's learning ability and physical stamina • Significant cause of maternal mortality, increasing

the risk of hemorrhage and infection during childbirth.

• Nearly 2 billion people estimated to be anemic and millions more are iron deficient, the vast majority are women.

Global Prevalence of Anaemia:Pregnant Women

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10

20

30

40

50

60

70

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Source: WHO (1999)

Global Prevalence of Anaemia:Preschool Children

0

10

20

30

40

50

60

70A

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Am

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Source: WHO (1999)

Main Factors Contributing to Anaemia

• Iron deficiency– Poor bioavailability of consumed iron– Insufficient dietary iron intake

• Chronic and recurrent infections that interfere with food intake and absorption/utilization of iron– Helminth infections, primarily Hookworm– Chronic diarrheal disease– HIV– Malaria

Interventions to Control Anaemia

• Depends on etiology– For iron deficiency: supplementation and

fortification– For parasitic disease control: appropriate

measures for prevention and presumptive treatment

Proposed New Goals:Micronutrient deficiencies

• Achieve sustainable elimination of iodine deficiency disorders by 2005 and vitamin A deficiency by 2010,

• Reduce by one third the prevalence of anaemia, including iron deficiency, by 2010; and

• Accelerate progress towards reduction of other micronutrient deficiencies, through food fortification and supplementation

Thank you