The emerging double burden of malnutrition in Timor Leste: a … · 2015. 6. 15. · Timor Leste...

The emerging double burden of malnutrition in Timor‐Leste: a time

to act?

Heather GrieveSenior Nutrition Specialist,

Australian Embassy Timor‐Leste and the Office of his Excellency the President of the Republic of Timor‐Leste

Presentation outline

1. A bit about Timor‐Leste2.The nutrition situation: Timor‐Leste3.The nutrition transition and the double burden of malnutrition (DBM): an example from Indonesia

4.The nutrition transition and the emerging DBM in Timor‐Leste

5. A time to act?6. Current activities

A bit about Timor‐LestePopulation:1.178 million(42% less than 15 years of age)

Independence: Portuguese colony from 1642, became independent 1975 (9 days). 1999 Referendum supporting independence; regained independence in 2002 following Indonesian occupation and unrest. Official Languages: Portuguese, Tetum

Religion: Catholic (97%)

Currency: US Dollar

Life expectancy: 68 years

Main labour force: agriculture (81%)

‘Least developed country ‘(UNCTAD)

A bit about Timor‐Leste

Changes in infant mortality rate (IMR), under 5 mortality rate (U5MR) and maternal mortality ratio (MMR)

Source: WHO (2014), UNICEF (2012) DHS 2003 /2009/10


171

106

83

6457

129

60

45 4847

21 22 24

0

20

40

60

80

100

120

140

160

180

1990 2000 2003 2009 2012

U5MR

IMR

NMR

Deaths /1

000 live births

1200

1000

680

500570 *

0

200

400

600

800

1000

1200

1400

1990 1995 2000 2005 2013

MMR(Deaths/100,000 live births)

Deaths/100

,000

live births


22

32

55

30

2225

93

62

39

0

10

20

30

40

50

60

70

80

90

100

Contraceptiveprevalence

rate

Iron folic acid90 days

ANC 4+ Skilledattendant at

birth

Delivery athealth facility

PNC within 2days

Early initiationof

breastfeeding

Exclusivebreastfeeding

Continuedbreastfeeding

to 20‐23months

Coverage of key interventions during the first 1000 days

%

Nutrition situation: Timor‐Leste

The global evidence base

• The Lancet Series on Maternal and Child Undernutrition (2008)

• The Lancet Maternal and Child Nutrition Series , 2013

• MIYCN Global Nutrition Targets (2025)

• Global NCD risk factor reduction targets (including reduction of salt intake by 30% and halting further increases in adult obesity)

• 2014 “Rome Declaration on Nutrition” & Framework for Action

Interface between under and overnutrition in early years

Source;WHO (2002), Black etal (2013)‐Menzies School of Health Research

The traditional diet in LMICs was mostly plant based foods which were low in fat and sugar. A “nutrition transition” is occurring, in which diets are becoming higher in processed foods which are high in fats and sugars

The nutrition transition

‘Receding famine’

‘Nutrition related non‐

communicable disease’

‘Policy and behaviour change’

Many LMICs are in the ‘receding famine/’nutrition‐related non‐communicable disease (NCDs) phase. The change in diet and lifestyles is associated with an increase in the prevalence of overweight, obesity and NCDs and in many countries the ‘double burden of malnutrition’

Many high income countries are in the policy/behaviour change phase and are promoting healthy food and physical activity environments

Source; Popkin et al (2001)

0

500

1000

1500

2000

2500

3000

3500

4000

2300

2350

2400

2450

2500

2550

2600

2650

2700

2750

2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

GDP pe

r cap

ita

KCalpe

r person pe

r day

Kcal GDP/ capita

Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( 2002‐2011)

Source: World Bank and FAOSTAT 92014)

The nutrition transition: Indonesia

0

500

1000

1500

2000

2500

3000

1991 2001 2011

Kcal per day per person

Alcoholic beverages and stimulants Fruits, vegetables, pulses and treenutsAnimal products Sugar crops, sugar and sweetenersStarchy Roots Oil crops and vegetable oilsCereals ‐ Excluding Beer

Changes in energy supply (Kcal per day per person)

Source :FAOSTAT (2014)


Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;

Changes in the prevalence of malnutrition in children (< 5 years)

The double burden of malnutrition: Indonesia

Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;

Changes in the prevalence of malnutrition in women of reproductive age (aged 15‐49 years)

The double burden of malnutrition: Indonesia

Source :WHO (2011)

Estimated NCD risk factors (2008)


050100150200250300350400450

Men WomenCardiovascular diseases and diabetes CancersChronic respiratory disease Other

Source: WHO (2011), Shrimpton, and Rokx (2013)

Estimated age standardised NCD deaths per 100,000 people, Indonesia (2008)

In 2008 an estimated 582,000 men and 481,700 women died from NCD related deaths. NCDs are now the main cause of disability and death


Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( 2002‐2011)

Source: World Bank and FAOSTAT (2015)

The nutrition transition: Timor‐Leste

1888

1934

2037

2083

463

876

1002

1105

0

200

400

600

800

1000

1200

1750

1800

1850

1900

1950

2000

2050

2100

1996 2001 2006 2010 2011 2012

Kcal/capita/day(food supply)

GDP/capita

Kcal/capita

/day

Source; Tiimor‐Leste DHS 2003 and 2009/10Timor ‐Leste FNS, 2013

Changes in the prevalence of malnutrition in children (0‐59 months)

The emerging double burden of malnutrition: Timor‐LestePrevalen

ce of u

nder and

overw

eight

(%)

49

58.1

50.2

5

1.50

10

20

30

40

50

60

70

2003 2009/10 2013

Stunting (HAZ<‐2)TimorLesteOverweight (WHZ>+2)Timor Leste

Source; Timor Leste DHS 2003 and 2009/10Timor Leste FNS, 2013

Changes in the prevalence of malnutrition in women of reproductive age

The emerging double burden of malnutrition: Timor‐LestePrevalen

ce of u

nder and

overw

eight

(%)

37.7

27.2

24.8

3.15.1

10.2

0

5

10

15

20

25

30

35

40

2003 2009/10 2013

Underweight(BMI<18.5)TimorLesteOverweight (BMI≥25) Timor Leste

Source :WHO (2011)

Estimated NCD risk factors (2008)


0

100

200

300

400

500

600

700

Men Women

All NCDsCardiovascular diseases and diabetesCancersChronic respiratory disease

Source: WHO (2011

Estimated age standardised NCD deaths per 100,000 people, Timor‐Leste (2008)

In 2008 an estimated 1400 men and 1000 women died from NCD related deaths. NCDs are now a significant cause of disability and death in Timor‐Leste


Source: WHO (2011),

Proportional mortality (% of total deaths, all ages)

Whilst deaths from communicable, maternal, perinatal and nutrition related conditions make up the bulk of deaths, NCDs are now estimated to account for 34% of all deaths.


A time to act ?

1. The Strategic Development Plan (2011‐2030 )

2. National Health Sector Strategic Plan (2011‐2030)

3. Action Plan for a Hunger and Malnutrition Free Timor ‐Leste (2015‐2025)

4. Draft National Nutrition Strategy (2015‐2019)

5. RMNCH Strategy (2015‐2019)

6. Draft National Nutrition and Food Security Policy

A time to act?

A time to act ?

A time to act ?

Cigarettes sold inpackets and as singles

Lollies‘Pop mee or Super mee” 2 minute noodles

• High level advocacy through the Presidents Office and the cross ministerial nutrition and food security council

• Promoting improved complementary feeding and dietary diversity

• Integrated nutrition programming

• Promoting and rewarding success at the community level

What are we doing?

Obrigada wain

The emerging double burden of malnutrition in Timor Leste: a … · 2015. 6. 15. · Timor Leste...

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