slide1 l.
Download
Skip this Video
Loading SlideShow in 5 Seconds..
How is DOHaD affecting policy? Dr. Chessa Lutter Principal Advisor Santiago de Chile, November 19-22, 2009 PowerPoint Presentation
Download Presentation
How is DOHaD affecting policy? Dr. Chessa Lutter Principal Advisor Santiago de Chile, November 19-22, 2009

Loading in 2 Seconds...

play fullscreen
1 / 28

How is DOHaD affecting policy? Dr. Chessa Lutter Principal Advisor Santiago de Chile, November 19-22, 2009 - PowerPoint PPT Presentation


  • 435 Views
  • Uploaded on

. . How is DOHaD affecting policy? Dr. Chessa Lutter Principal Advisor Santiago de Chile, November 19-22, 2009 What does it take for DOHaD to influence policy? Is there a clear measure of population attributable risk (PAR) for health and the development of human capital ?

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'How is DOHaD affecting policy? Dr. Chessa Lutter Principal Advisor Santiago de Chile, November 19-22, 2009' - niveditha


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
slide1
.
  • .

How is DOHaD affecting policy?

Dr. Chessa Lutter

Principal Advisor

Santiago de Chile, November 19-22, 2009

what does it take for dohad to influence policy
What does it take for DOHaD to influence policy?
  • Is there a clear measure of population attributable risk (PAR) for health and the development of human capital?
  • Have interventions been identified that are efficacious and effective when delivered through existing health and social service platforms?
  • Do the interventions address social inequities in health and human capital?
  • Has there been an effective advocacy strategy to influence relevant technical and political agendas?
  • Was the strategy successful?
slide3

Epigenetics? Concordant developmental changes in DNA methylation across chromosome 2 in two P21 vs P0 mouse hypothalamus MSAM cohybridizations

Cohybridization 1

Cohybridization 2

Wenjuan Zhang courtesy of Robert Waterman

it s a fat fat world
It’s a FAT FAT WORLD

FAT Kids

Urban dog: too fat to walk?

Urban black bear behind fast-food restaurant: the new couch potato?

FAT Daddys

slide5
What proportion of adult disease is explained by DOHaD versus the environment in which we live and eat and move (or don’t move enough)?

Developmental origins of adult disease

Obesigenic environment

Interaction ?

Wenjuan Zhang courtesy of Robert Waterman

slide6

Severe acute malnutrition

Stunting

8.1 cm

Marasmas

Kwashiorkor

Age: 2 y 9 m

Weight: 10.7 kg.

Height: 78.3 cm

2 y 6 m

11.6 kg

86.4 cm

Photo credit: Lancet

Photo credit: UNICEF, Perú

slide7

Critical period to prevent linear growth retardation

0.5

0.5

0

0

-0.5

-0.5

-1

-1

-1.5

-1.5

-2

-2

-1 + 2 years

-1 y + 2

Z

-2.5

0

3

5

7

9

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

53

55

57

59

Age (months)

Africa

Latin America and Caribbean

Asia

Source: Shrimpton, R. et al, 2001. http://www.pediatrics.org/cgi/content/full/107/5/e75

prevalence of stunting to low weight for age 2 ds in children 5 years
Prevalence of stunting to low weight for age (<-2 DS) in children < 5 years

%

3.0

6.2

4.5

Source: OPS. Desnutrición en Infantes y Niños Pequeños en América Latina y El Caribe:

Alcanzando los Objetivos del Desarrollo del Milenio. Washington: 2008

slide9

Distribution of Z scores of Guatemalan children

< 5 years (2002)

Weight/age

Weight/length

Length/age

Obese

Stunted

tendencies in the prevalence of stunting by country and year of survey
Tendencies in the prevalence of stunting, by country and year of survey

2008

1989

1994

1998

2003

1986

1995

2000

2005

1986

1991

1996

2002

1987

1995

1999

2002

1995

2000

2005

1986

1996

2000

2007

Source: OPS. Malnutrición en infantes y niños pequeños en América Latina y El

Caribe: Alcanzando los Objetivos de Desarrollo del Milenio. Washington DC. 2008

slide11

Prevalence of stunting by year of survey

and maternal education

=59.3%

=62.3%

Source: OPS. Malnutrición en infantes y niños pequeños en América Latina y El

Caribe: Alcanzando los Objetivos de Desarrollo del Milenio. Washington DC. 2008

slide12

Short-term consequences

Mortality, morbidity, disability

Long-term consequences:

Adult size, intellectual ability, economic productivity, reproductive performance, metabolic CHD

Maternal and child undernutrition

Immediate

causes

Inadequate dietary intake

Disease

Household food

insecurity

Unhealthy hh environment & lack of health services

Inadequate care

Income poverty:

Employment, self-employment, dwelling, assets, remittances, pensions, transfers, etc

Underlying

causes

Lack of capital: financial, human, physical, social, and natural

Basic

causes

Social, economic,

and political context

UNICEF Conceptual model

slide13

The role of infectious disease in child growth

Source: Mata L. The Children of Santa Maria Caique, 1983.

policy driver the effect of malnutrition and human capital
Policy driver: The effect of malnutrition and human capital

The causal relationship between poverty and malnutrition

The causal relationship between malnutrition and poverty

INCAP longitudinal study and work of Reynaldo Martorell

slide16

Decline in the prevalence of stunting in Brazil,

1996-2006

50%

1996

2006

Source: Monteiro et al., Causes for the decline in child undernutrition in Brazil, 1996-2007 Rev Saude Pública 2009;43(1)

slide17

Explanatory factor for the decline in stunting in Brazil, 1996-2006

=63.3%

Source: Monteiro et al., Causes for the decline in child undernutrition in Brazil,

1996-2007 Rev Saude Pública 2009;43(1)

breastfeeding
Breastfeeding

Photo credit: João Aprigio Guerra de Almeida, Fundación Fiocruz, Brasil

slide19
Breastfeeding promotion cited as the most effective preventive intervention to prevent under-5 mortality

From Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS, Bellagio Child Survival

Study Group. How many child deaths can we prevent this year? The Lancet 2003;362:65-71.

the importance of health worker training and counseling on exclusive breastfeeding
The importance of health worker training and counseling on exclusive breastfeeding

3 months

5 months

10-180

days

6 months

%

Source: OPS. Malnutrición en los niños pequeños en América Latina y el Caribe: Alcanzando los Objetivos de Desarrollo del Milenio. Washington 2008.

slide22

Effects on human capital development

Washington Post 2002;

Mortenson et al., 2002

WHO. Horta et al., Geneva 2007.

www.who.int/child_adolescent_health/documents/9241595230/en/index.html

policies and programs to support breastfeeding
Policies and programs to support breastfeeding
  • International Code of Marketing of Breast-milk Substitutes (WHO 1981)
  • Innocenti Declaration (1990) and approval at the 45th World Health Assembly
  • Baby Friendly Hospital Initiative (WHO/UNICEF,1992)
  • Capacity development in clinical management of common BF problems (USAID financed Wellstart International, 1983-1998)
  • Global Strategy for Infant and Young Child Feeding and approval by the World Health Assembly (2003)
  • WHO Child Growth Standards (2006)
changes in medium duration of breastfeeding latin american and caribbean countries 1986 2004
Changes in medium duration of breastfeeding:Latin American and Caribbean countries, 1986-2004

17.3

17.3

21.6

21.6

20.6

20.6

14

14

19.6

19.6

20.3

20.3

Months

19.9

19.9

16.2

16.2

20.6

20.6

11.8

11.8

21.6

21.6

9

9

Country

slide25

Porcentaje de gasto total (%) y gasto (US$) en la promoción de LM

comparado a otros temas en nutrición materno-infantil, 1999-2005

Fuente: Academy for Educational Development. LINKAGES Final Report. Washington DC: 2006. (Expenditures are adjusted for inflation using the Gross Domestic Product Implicit Price Deflator of 2000).

slide26

What have we learned and what do we still

need to know?

0.5

0.5

0

0

-0.5

-0.5

-1

-1

-1.5

-1.5

-2

-2

Maternal nutrition ?

-1 y + 2

-1 + 2 years

Z

-2.5

0

3

5

7

9

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

53

55

57

59

Age (months)

Africa

Latin America and Caribbean

Asia

Source: Shrimpton, R. et al, 2001. http://www.pediatrics.org/cgi/content/full/107/5/e75

what does it take for dohad to influence policy27
What does it take for DOHaD to influence policy?
  • Is there a clear measure of population attributable risk (PAR) for health and the development of human capital?
  • Have interventions been identified that efficacious and effective when delivered through existing health and social service platformsor by addressing fundamental political and social inequities?
  • Do the interventions address social inequities in health and human capital?
  • Has there been an effective advocacy strategy to influence relevant technical and political agendas?
  • Was it successful?