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Theme. Poor maternal and child health and malnutrition as a cause for structural damage of the brain and cognitive development. Prepared and delivered by Leena Rammah. Rationale.

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Theme

Theme

Poor maternal and child health and malnutrition as a cause for structural damage of the brain and cognitive development

Prepared and delivered by Leena Rammah


Rationale

Rationale

  • Evidence shows - good health, nutrition of pregnant women and young children, along with an appropriate stimulation during the early years have an important positive effect on cognitive development.

  • Deeper analysis shows maternal health and nutrition affects child’s health right from fetus brain development till later stages.


Maternal health

Maternal health

A concept that includes:

Family planning

Prenatal, and postnatal care

Education provision

Health promotion


Theme

Let us look at Health, Nutrition and Cognitive Development during two major phases:

  • Prenatal phase

  • Postnatal phase


Factors that affect mother s and child s health prenatal

Factors that affect mother’s and child’s health (prenatal)

  • Studies prove women with proper prenatal care have better health results than women who miss PNC during pregnancy.

  • The health and the well being of women and their children are inter-linked. This process requires a substantial strengthening of the health system (DFID)


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Factors that affect mother’s and child’s health and can damage brain development (prenatal)

Early or late age pregnancies

Premature delivery

Contact with potentially toxic substances (e.g. alcohol tobacco, and drug abuse, etc.

Existence of certain diseases (maternal measles,

toxoplasmosis,..)


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Exposure to Radiation

Maternal attitudes and behaviors

Absence of skilled health personnel during delivery

High blood pressure (pre-eclampsia)

Intake of certain medication due to illness

Poor education

Factors that affect mother’s and child’s health and can damage brain development (prenatal)


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Factors that affect mother’s and child’s health and can damage brain development (perinatal)

  • Intrauterine position

  • Obstructed labor and asphyxia

  • Prolonged labor

  • Obstetrical trauma

  • Pelvic fetus incompatibility


Maternal factors that affect child s health and brain development prenatal

Maternal factors that affect child’s health and brain development (prenatal)

  • The younger the age at pregnancy, the greater the health risks for mother and child and the higher risk of infant mortality (60%)

  • Children who survive are more likely to suffer from low birth weight, under nutrition and delayed cognitive development.(Lawn et al., 2006;UNICEF, 2008b; WHO, 2005).


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Postnatal care is likewise important and includes:

Child birth

Newborn’s care

ECD’s education

Factors that affect child’s health and can damage brain development (postnatal)


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Factors that affect child’s health and can damage brain development (postnatal)

  • Poor disease prevention and vaccination

  • Exposure to accidents

  • Lack of physical activity

  • Improper stimulation


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Factors that affect child’s health and can damage brain development (postnatal)

  • Lack of early education

  • Lack of psychological and social care

  • Lack of love and parents’ care, (bonding)

  • Existence of Infectious diseases (Meningitis,..)

12


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Maternal nutrition deficiency that affect brain and cognitive development (prenatal)

  • Folic Acid deficiency

  • Iron deficiency anemia (IDA)

  • Iodine deficiency

  • Omega 3 deficiency


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Iron deficiency and its effect upon brain and cognitive development.

Iodine deficiency and its affects

Vitamin A deficiency.

Lack of exclusive breastfeeding till the age of six months.

Insufficient supplementary food and of micronutrients introduced after the age of six with continuation of breast feeding well into the second year.

Child’s nutrition deficiency that affect brain and

cognitive development (postnatal)


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Iron deficiency has been clearly linked to cognitive deficits

in young children. Iron is critical for maintaining an adequate

number of oxygen-carrying red blood cells, which in turn are

necessary to fuel brain growth.(http://www.zerotothree.org/brainwonders).

How do poor maternal and child’s malnutrition affect cognitive development? (Postnatal)


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Children who are malnourished usually:

are fussy eaters

are deprived of adequate calories

are deprived of protein in their diet

experience insufficient growth in early years

suffer from lasting behavioral and cognitive deficits,

including slower language and fine motor development, lower

IQ, and poorer school performance. (www.zerotothree.org/brainwonders)


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How do poor maternal and child’s malnutrition affect

cognitive development? (Postnatal)

Breast milk contains all the amino and fatty acids needed for brain development. Research has shown that babies who are breast-fed as compared to babies who are formula fed score higher on IQ tests.


Effects of malnutrition

Effects of malnutrition

Child illness / malnutrition reduce cognitive development and intellectual performance, school enrolment and attendance.

Intrauterine growth retardation and malnutrition during early childhood have long term effects on body size and strength with implication on productivity in adulthood (WHO 2006)


Micronutrient deficiency

Micronutrient Deficiency

Micronutrient deficiencies can severely affect early cognitive

development, including a loss of up to fifteen points on IQ test

even in moderate forms.

Children are also affected by Vitamin A deficiency which

causes blindness, poor health and concentration(Victoria et al., 2008).


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Intervention with stunted children

IQ

non-stunted

Both

control

stimulated

supplemented

Grantham-McGregor et al, 1991


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What is brain development in prenatal phase?

Average Brain Weights at

Different Times of Development:

AGE BRAIN WEIGHT

(grams)

20 weeks of gestation 100

Birth 400

18 months old 800

3 years old 1100

Adult 1300-1400


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Brain development in prenatal phase

The brain grows at an amazing rate during this period. From the 3rd week of Intrauterine life 250,000 neurons proliferateevery minute.


Brain and cognitive development postnatal

Brain and Cognitive development (postnatal)

Neurons which are continuously firing or activated, through stimulation will consolidate and strengthen over time.


Brain and cognitive development in postnatal phase

Brain and Cognitive development in postnatal phase

  • The child has by birth 100 Billion Neurons. For the brain to function in

  • proper way, these neurons have to be connected by synapses.

  • These synapses can be developed by:

  • Appropriate nutrition, especially breast feeding, that helps to form myelin that cover the synapses and can allow the impulse to pass.

  • Early stimulation for the brain through interaction with the child.

  • Through ECD, a child may form and reinforce over 1 trillion connections.


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Combination between nutrition and stimulation that can affect cognitive development

Study on level of intelligence among orphaned Vietnamese girls according to the level of nutrition.

American Journal of clinical nutrition 1977, 30


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Poor maternal health is associated with poverty

Poverty reduction

Lancet Paper 1, S Grantham-McGregor 2007


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1. The value of women and children’s health.

2. Inexpensive ways to save lives of women and children

3. The economic soundness.

4. The political soundness, including social stability and human security

5. The improvement of the health system.

Why invest in maternal health, newborn and

child health?


Healthy children are the core of the formation of human capital

Healthy children are the core of the formation of human capital

A key to beat poverty

Integration of disease prevention and care for mothers

newborns and children makes economic sense as it

maximizes benefits and minimizes costs for mothers,

newborns and children. Indeed high under 5 mortality and

morbidity and high level of malnutrition have a serious

economic and development cost.(DFID)


Why to consider poor maternal health as an emergency in education

Why to consider poor maternal health as an emergency in education

Short-term distress in the form of rising malnutrition will have negative long-term consequences for education.


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Situation analysis of health, education

Many countries lack programs addressing health, nutrition, care, and education of children under 3, a critical period in life.

Countries with at least one formal program for children under 3 in 2005 (%)

Source: EFA Global Monitoring Report 2007.


Strategic benefits of education evidences

Strategic benefits of education (evidences)

  • 10% of worldwide disease is caused by under nutrition(WHO 2005)

  • According to 2007 MDG report, 84% of women who have completed secondary or higher education are attended by skilled personnel during child birth, more than twice the rate of mothers with no formal education(UNICEF 2008)

  • Children of educated mothers are 50% more likely to survive until the age of 5 and beyond than those whose mothers who didn’t receive or complete schooling(UNICEF 2008)


Recommendations

Recommendations

To advocate for services that should include:

  • Education on safe motherhood.

  • Promotion of maternal nutrition.

  • Supplementation of micronutrient and tetanus toxoid, where appropriate.

  • Prenatal care and counseling.

  • Delivery assistance in all cases by a skilled professional


Recommendations1

Recommendations

  • Care for obstetric emergencies, including referral for pregnancy, childbirth, and abortion complications.

  • Postnatal care.

  • Promotion of longer intervals between births through family counseling.


Theme

Recommendations

  • Postnatal care, including exclusive breast-feeding.

  • Early stimulation for the brain of the child through interaction.

  • ECD as Holistic approach on policy level


Acknowledgments for experts inputs

Acknowledgments for experts inputs

  • Mrs. Lara Hussain

  • Dr. Mahendra Sheth

  • Dr. Malak Zalouk

  • Mr. Moncef Moalla


Theme

Thank you


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