Prevention of stunting a development challenge food nutrient based approaches the way forward
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Prevention of stunting - a development challenge; food/nutrient based approaches, the way forward. Dr. Khizar Ashraf United Nations, World Food Programme. Intended Discussion. Nutrition Status of Under 5 Children in Pakistan and the issue of food insecurity Why Malnutrition Matters

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Dr. Khizar Ashraf United Nations, World Food Programme

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Prevention of stunting- a development challenge;food/nutrient based approaches, the way forward

Dr. Khizar Ashraf

United Nations, World Food Programme

Intended Discussion

  • Nutrition Status of Under 5 Children in Pakistan and the issue of food insecurity

  • Why Malnutrition Matters

  • The window of opportunity (1000 days)

  • Prevention of Stunting possible food based approaches

  • Ongoing Evidence building in Pakistani context

Malnutrition -

  • responsible for about 1500 deaths globally, mostly women, infants and children, during this presentation!

  • These deaths are preventable!

Some Major World Risk Factors Causing Deaths

Malnutrition accounts of ≈ 30 million

deaths per year (about 1 death per second)


Figure from WHO, 2000

The Issue < 5 Indicators NNS 2011

  • 32.7%, 30.3% and 40 % are suffering from Iron, Vitamin A and Zinc deficiency respectively, where as 62.5% are anemic

Anemia Vitamin A Vitamin D Zinc

Micro-nutrient Deficiency: Iodine

Adequate level of iodine status at national level documented in NNS 2011.

Significant improvement in the use of Iodized Salt in 2011 compared to the result of 2001 NNS.

Yet Pakistan lags behind the international USI target coverage of 90% and above.

Why Malnutrition Matters

Why Malnutrition Matters

The Outcome: Vicious Cycle of Poverty and Malnutrition- Estimated effect on Pakistan

Income poverty

Low food intake

Frequent infections

Hard physical labor

Frequent pregnancies

Large families


Direct loss in productivity from poor physical status

Indirect loss in productivity from poor cognitive development and schooling

Loss in resources from increased health care costs of ill health

Overall loss to the economy of 2-3% of GDP annually

Evidence shows the “window of opportunity” is small…with a large part of the damage happening before and shortly after birth…

Mean height for age z-scores by age By region (0-59 months)

Source: Victora CG, et al. Worldwide timing of growth faltering: revisiting implications for interventions using the World Health Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print)

Why Malnutrition Matters

Nutrition and Early Childhood Development

Abnormal Brain Development Following Sensory Neglect in Early Childhood.

Source: Perry (2004)

Major contributing factors in Pakistan

  • Inappropriate IYCF practices; late initiation breast feeding - only 37% exclusively breastfed.

  • Household food insecurity is 58% country wide, 72% in Sindh

  • Household income minimal - subsistence

  • Poor quality and insufficient amount clean water

  • Poor sanitation - 48 million people practice open defecation

  • Early and frequent childbearing (50% of girls are married by the age of 18 years, 15% by the age of 15, PDHS 2006-07)

  • Low literacy rate - 47%

  • Frequent emergencies


Why to engage in Prevention of Stunting

How to move towards prevention of stunting

Prevention of stunting project Thatta- Sajawal:utilizing the window of opportunity for addressing stunting in children under 5

Objectives of the Project

  • To reduce stunting in children 6-23 months using a locally produced LNS type (Wawamum) and promoting appropriate IYCF practices (including promotion of exclusive breast feeding until 6 months).

  • To reduce micronutrient deficiencies in children 24-59 months using multi micronutrient powders, MNP,, along with appropriate behavior change communication.

  • To improve maternal/PLW nutritional status and to have an impact on the birth outcome (reduce low birth weight),

  • To study effectiveness of food based approach to address stunting Lipid- based nutrient supplement

Evidence Building in Pakistani Context: Research component

  • To assess the effectiveness of the food/nutrient -based interventions on reduction of stunting among children under two.

  • To assess the design and operational factors at the different stages of the programme cycle that may have affected the outcome.

  • To determine unintended consequences of the interventions, both positive and negative.

  • To determine cost-effectiveness.

  • To provide recommendations for improved programme design and evaluation.

  • To know the optimal length of preventive intervention.

  • To compare the use of specialized nutritious foods over other interventions, such as conditional cash transfers for stunting prevention.

Thank you

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