Child Nutrition and Feeding in the Sahel

Child Nutrition and Feeding in the Sahel: Understanding and Responding UNICEF/Pirozzi 2006 CAP 2007 Workshop for West Africa Victor M. Aguayo, PhD Regional Nutrition Adviser, UNICEF Outline of the presentation  Nutrition situation of children → How much do we know for sure?  Trends in child undernutrition 1995 → 2006 → Is the situation worsening?  Ending child undernutrition in the Sahel → What are we up against? → Integrated response 2 Outline of the presentation  Nutrition situation of children → How much do we know for sure?  Trends in child undernutrition 1995 → 2006 → Is the situation worsening?  Ending child undernutrition in the Sahel → What are we up against? → Integrated response 3 Sahel: A very young region … with the highest child mortality rates worldwide Annual infant deaths Annual child deaths Total population B.Faso Chad Mali Mauritania Niger SAHEL Population underfives Annual births IMR U5MR 12,822,000 2,393,000 601,000 97 9,448,000 1,804,000 456,000 117 13,124,000 2,540,000 647,000 121 2,980,000 513,000 123,000 78 13,499,000 2,775,000 734,000 152 51,873,000 10,025,000 2,561,000 121 192 58,297 115,392 200 53,352 91,200 219 78,287 141,693 125 9,594 15,375 259 111,568 190,106 216 311,098 553,766  > 10 million under-fives = 19.3% of the total population  U5MR = 216 = 1 in 5 → > 550,000 child deaths annually  56% of child deaths happen in the first year of life 4 Sahel: Some of the highest child undernutrition rates in the world 50 Prevalence of underweight in children 0-59 months old (2000-2005) 37.7 39.7 36.7 33.1 31.8 36.6 Percentage 25 0 B.Faso Chad Mali Mauritania Niger SAHEL 5 Sahel: Chronic undernutrition in children is widespread 50 Prevalence of stunting in children 0-59 months old (2000-2005) 40.9 38.8 38.2 34.5 39.9 39.1 Percentage 25 0 B.Faso Chad Mali Mauritania Niger SAHEL 6 Sahel: Chronic undernutrition in children is widespread… and severe Population underfives B.Faso Chad Mali Mauritania Niger SAHEL 2,393,000 1,804,000 2,540,000 513,000 2,775,000 10,025,000 Prevalence of stunting 38.7 40.9 38.2 34.5 39.8 39.1 Children stunted 926,091 737,836 970,280 176,985 1,104,450 3,915,642 Prevalence of severe stunting 19.5 23.2 19.2 16.5 19.5 19.9 Children severely stunted 466,635 418,528 487,680 84,645 541,125 1,998,613  4 million under-fives with chronic undernutrition  2 million of them with severe chronic undernutrition 7 Sahel: Acute undernutrition rates in children among the highest in the world 20 Prevalence of wasting in children 0-59 months old (2000-2005) 18.6 13.5 Percentage 14.1 12.8 10.6 14.1 10 0 B.Faso Chad Mali Mauritania Niger SAHEL 8 Sahel: Acute undernutrition rates in children among the highest in the world Population underfives B.Faso Chad Mali Mauritania Niger SAHEL 2,393,000 1,804,000 2,540,000 513,000 2,775,000 10,025,000 Prevalence of wasting 18.6 13.5 10.6 12.8 14.1 14.1 Children wasted 445,098 243,540 269,240 65,664 391,275 1,414,817 Prevalence of severe wasting 5.1 3.1 1.6 3.3 3.2 3.2 Children severely wasted 122,043 55,924 40,640 16,929 88,800 324,336 At any point in time during the year;  An average 1.4 million under-fives with acute undernutrition  An average 324.000 under-fives with severe acute undernutrition 9 Sahel: Acute undernutrition rates are over emergency thresholds Prevalence of undernutrition in children 6-59 months old (2000-2004) Prevalence of Prevalence wasting of stunting B. Faso Chad 19.1 14.1 42.9 46.3 Prevalence of underweight 41.7 41.5 Mali Mauritania Niger SAHEL  <5%  5-9%  10-14%  ≥ 15% 11.3 13.3 15.2 14.8 42.8 38.2 44.2 43.6 37.4 35.1 44.4 41.0 Internationally agreed upon emergency thresholds: → Situation = under control → Situation = of concern → Situation = serious → Situation = critical 10 Sahel: Some of the highest child undernutrition rates in the world 11 Sahel: Acute undernutrition starts very early in life Prevalence Prevalence Prevalence Prevalence Prevalence Prevalence wasting wasting wasting wasting wasting wasting children children 0-5 children 6-11 children 12-23 children 36-47 children 48-59 24-35 mo old mo old mo old mo old mo old mo old B.Faso Chad Mali Mauritania Niger SAHEL 15.1 9.5 5.4 8.9 5.1 8.7 34.3 20.8 14.1 16.3 19.3 21.8 31.1 23.8 20.4 14.9 35.0 27.1 18.7 13.4 10.7 14.0 14.1 14.2 11.0 9.6 6.2 11.9 6.5 8.4 8.7 6.7 6.2 10.3 4.8 6.8 20.4% children under-two with acute undernutrition 18.4% children under-three with acute undernutrition  65% of U5s with acute undernutrition are under-twos  85% of U5s with acute undernutrition are under-threes 12 Sahel: Acute undernutrition affects primarily infants and young children Prevalence of undernutrition in children 6-59 months old (2000-2004) All Sahelian countries combined 50 Wasting Stunting Percentage 0 0-5 mo 6-11 mo 12-23 mo 24-35 mo 36-47 mo 48-59 mo 13 Sahel: Undernutrition is the major cause of child mortality Sahel. Major causes of child mortality Neonatal 26% Malaria 21% Measles 6% HIV/AIDS 4% Malnutrition 55% Pneumonia 21% Diarrhea 17% WHO 2006/Lancet 2003/SOWC 2005 14 Outline of the presentation  Nutrition situation of children → How much do we know for sure?  Trends in child undernutrition 1995 → 2006 → Is the situation worsening?  Ending child undernutrition in the Sahel → What are we up against? → Integrated response 15 Sahel: Trends in stunting in children 0-35 months old (1995-2004) 50 Prevalence of stunting in children 0-35 months old (1995-2005) 41.1 33.7 31.0 34.9 35.3 30.1 33.8 34.7 34.4 34.3 Percentage 25 0 B.Faso Chad Mali 1995-1999 2000-2004 Niger SAHEL 16 Sahel: Trends in wasting in children 0-35 months old 30 Prevalence of wasting in children 0-35 months old (2000-2005) 24.6 23.3 20.7 19.5 20.1 17.7 17.9 18.7 17.1 13.3 Percentage 15 0 B.Faso Chad Mali 1995-1999 2000-2004 Niger SAHEL 17 Niger: Trends in wasting and stunting in children 6-35 months old 60 Prevalence of wasting and stunting in children 6-35 months old (2000-2005) 49.5 41.3 50.0 40 Percentage 32.3 24.1 23.1 22.4 22.5 20 0 1992 1998 Wasting 2000 Stunting 2005 18 Outline of the presentation  Nutrition situation of children → How much do we know for sure?  Trends in child undernutrition 1995 → 2006 → Is the situation worsening?  Ending child undernutrition in the Sahel → What are we up against? → Integrated response 19 What are we up against? (1/3) We are up against a region:  With 10 million U5s (20% population)  Where 1/5 children die before age 5 yrs old  With some of the highest child mortality rates in the world  With some of the highest child undernutrition rates in the world  Where a major nutrition crisis in children is underway  Acute undernutrition rates reach emergency levels (15%)  Chronic undernutrition rates are over critical levels (>40%)  1.4 million underfives with acute malnutrition  4.0 million underfives with chronic malnutrition 20 What are we up against? (2/3) We are up against a nutrition crisis:  That is affecting primarily very young children (< 3yrs)  1.2 million are under-threes  Acute undernutrition: 15-20% under-threes throughout the year  Increasing poverty levels are widening the ‘hunger season’  Chronic undernutrition: 33% under-threes throughout the year  Double burden: 1/2 to 1/3 of under-threes are both acutely and chronically malnourished  A nutrition crisis that is killing 300,000 children annually  Food security - as currently measured - is neither sensitive nor specific in predicting risk of undernutrition in children 21 What are we up against? (3/3) We are up against a nutrition crisis:  That has five main underlying causes: Children are nutrition insecure because:  They lack access to age-appropriate foods  They lack access to age-appropriate feeding practices  They lack access to essential health services  They lack access to safe water and hygiene practices  They are born with a low birth weigh 22 Our choices, our focus  Where acute undernutrition in children 6-59 mo > 10% → there is a nutrition crisis that requires:  Treatment and prevention  Through facility-based and community-based programs  For the same communities and at the same time  With food interventions where food access is a problem  Prioritize young (0-35 months old) children’s:  Access to age-appropriate foods  Access to age-appropriate feeding practices  Access to essential health services  Access to safe water and key hygiene practices 23  Support pregnant women and lactating mothers  To prevent LBW  To prevent maternal depletion  To prevent lactation failure Essential Nutrition and Child Survival package (1/2) Prevention of acute and chronic undernutrition  Early initiation of breastfeeding (< 1 hr after birth)  Exclusive BF 0-6 mo  Continued BF 6-23 mo  Adequate complementary foods 6-23 mo (+ fortified)  Adequate complementary feeding and hygiene practices  Bi-annual vitamin A supplementation  Bi-annual deworming  Access to essential health services: (immunization+)  Access to impregnated bednets Through facility-based, outreach and community-based services 24 Support to pregnant women and lactating mothers  Through prenatal/postnatal care services  Focus on the control of Maternal Anemia to reduce LBW  With food support where access to food is a problem  Girl’s and women’s education Essential Nutrition and Child Survival package (2/2) Treatment of acute undernutrition  Facility-based therapeutic feeding → For children with SAM and medical complications  Community-based therapeutic care → For children with SAM without medical complications → Using ready-to-use therapeutic foods (RUFTs) → to the extent possible locally produced  Community-based supplementary feeding → Using age-appropriate supplementary foods → to the extent possible locally produced 25 Essential Nutrition and Child Survival package (2/2 cont) Treatment of acute undernutrition 1. Child-centered Nutrition and Child Survival information systems  Regular and reliable collection, analysis and interpretation  Children’s anthropometry  Children’s access to adequate foods  Children’s access to adequate feeding practices  Children’s access to essential health services 2. Harmonized protocols for the management of acute malnutrition  National consensus building  Evidence-based, state-of-the-art protocols  Facility-based care  Community-based care  Human resource capacity  Training, supervision, and quality assurance 26 Essential Nutrition and Child Survival package (2/2 cont) Treatment of acute undernutrition 3. Uninterrupted supply of food and non-food items  Therapeutic foods  Supplementary foods  Anthropometric material  Essential drugs and micronutrients  Monitoring and evaluation 4. Coordinated action  IASC Cluster leadership agreements  Inter Agency MOUs  Agency’s mandate and core commitments  UNICEF → Nutrition and Feeding  WFP → Food Aid  WHO → Health 27 A call to action  Focus on youngest children → Low-cost + high-impact → Preventive + curative → Nutrition and child survival interventions → Delivered at national scale  One coordinated effort → With additional resources → To support governments → To work for children’s nutrition and survival rights 28 Child Nutrition and Feeding in the Sahel: Understanding and Responding UNICEF/Pirozzi 2006 CAP 2007 Workshop for West Africa Victor M. Aguayo, PhD Regional Nutrition Adviser, UNICEF