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Strategies for Addressing Chronic Malnutrition in Infants and Young Children

Strategies for Addressing Chronic Malnutrition in Infants and Young Children. Mary Arimond, IFPRI and Judy Canahuati, USAID. IFAC, Tuesday, April 15. Photo: CARE USA. Outline. Window of opportunity: conception- 24 months Why does growth falter? Prevention vs. cure

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Strategies for Addressing Chronic Malnutrition in Infants and Young Children

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  1. Strategies for Addressing Chronic Malnutrition in Infants and Young Children Mary Arimond, IFPRI and Judy Canahuati, USAID IFAC, Tuesday, April 15 Photo: CARE USA

  2. Outline • Window of opportunity: conception- 24 months • Why does growth falter? • Prevention vs. cure • Guiding Principles for feeding • “Problem” nutrients; nutrient gaps • Options for filling the gaps • Indicators for measuring progress

  3. Chronic malnutrition begins early* *Lancet series on Nutrition 2008 www.GlobalNutritionSeries.org, WB Repositioning Nutrition as Central to Development, 2006 http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf

  4. Period of most rapid growth and vulnerability to growth faltering • Age (months) Shrimpton et al. 2001

  5. Greatest benefits from nutrition interventionsin first 2-3 years (Guatemala) Annual change in length by age, with consumption of an additional 100 kcal/d of high-energy/protein supplement Age 0-36 mo 36-84 mo Annuallength gain (mm) Schroeder, D., Martorell, R., Rivera, J., Ruel, M.T. and Habicht, J.P. Age differences in the impact of supplementation on growth J. Nutr. 125 (suppl):1060S-1067S, 1995

  6. P=0.10 4pp P<0.05 6pp 4pp P<0.05 Prevention can be more effective than “cure” Random effects logit models (adj. for cluster effects and controlling for age, sex) Ruel et al., 2008

  7. Guiding Principles for Feeding Infants and Young Children • Provide a framework for understanding, assessing, and improving infant and young child feeding • Developed first for breastfed children (PAHO/WHO, 2001) and then for non-breastfed (WHO, 2005) • Cover age range of 0-24 months

  8. Multiple dimensions of infant and young child feeding If breastfed: • Breastfeed exclusively to 6 months, then introduce complementary foods • Continue on-demand breastfeeding until 24 months or beyond If not breastfed: • Meet child’s fluid needs with safe fluids, including clean water Both: • Practice responsive feeding • Practice good hygiene and food handling • Ensure that energy needs are met Continued…….

  9. Multiple dimensions of infant and young child feeding, cont. Both breastfed & non-breastfed: • Gradually increase consistency and variety as infant develops • Feeding frequency: 2-3 times plus snacks (BF), 4-5 times (non-BF) plus snacks • Sufficient energy density of foods (e.g. “thick” vs.watery gruels) • Feed a variety of foods to ensure all nutrient needs are met • Feed specially fortified foods and/or give supplements to fill gaps • Feed appropriately during and after illness

  10. “Problem” nutrients for infants & young children* Vitamin A Calcium Thiamin Iron Riboflavin Zinc Vitamin B6 Folate Non-BF: B12** * Vitamin C **Dewey, 2005, GP Non-BF, pp.15, 20

  11. Nutrient gaps for 6-24 mo • 10-site (9-country) study identified gaps in nutrient intakes for non-BF and in nutrient density of complementary food for BF • Multiple micronutrient gaps in all sites • Gaps were greatest for youngest (6-8 mo) • Some nutrients (e.g. vitamin A) were problematic in some sites but not others • Some were problematic in most or all sites (e.g. iron; size of gap between desired and actual also greatest for iron) Working group on Infant and Young Child Feeding Indicators, 2006

  12. Filling the gap • Fortified commodities have a role to play • As currently formulated, don’t fill the gaps for iron and zinc in infancy (6-12 mo)1 • Micronutrient fortified “sprinkles” and spreads have shown promise in filling some micronutrient gaps • New efforts underway to define standards for micronutrient content of both foods specially fortified for IYC and for micronutrient powders2 1 Ruel et al, 2004 • 2 GAIN. Proposed products and formulations for GAIN’s IYCN Program support, draft, February, 2007

  13. How can we measure progress? • Using framework of Guiding Principles… • Multi-year collaborative project to develop indicators for quality of infant and young child feeding • New indicators to be published by WHO and partners (IFPRI, UC Davis, FANTA Project) in 2008* * http://www.who.int/child_adolescent_health/documents/pdfs/iycf_indicators_for_peer_review.pdf

  14. To sum up… • Chronic malnutrition develops very early, in some places, even before birth. • Pregnancy and the period up to 2 years of age is a critical period for addressing chronic malnutrition. • A combination of programmatic strategies supporting adequate nutrition and care and a reconsideration of nutrient delivery for mothers and infants are showing promise in addressing chronic malnutrition, the most widespread type of malnutrition in the developing world.

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