World Summit for Children Progress Report

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World Summit for Children Progress Report

• Vitamin A Supplementation
• In 2 year period, 1 million child deaths
  prevented
• 43 countries have gt70 children receiving at
  least 1 dose
• Iodine fortification
• 70 of households use iodized salt
• gt90 million newborns/year are protected mental
  impairment
• Iron
• Little change but severe anemia has decreased.

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Overview

• 4 Types Of Malnutrition
• Overall impact of malnutrition
• Vitamin Mineral Deficiency
• Vitamin A, Iodine, Iron
• Protein-Calorie Malnutrition
• Kwashiorkor and Marasmus
• Secondary Malnutrition
• Lack of clean water and sanitation

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Malnutrition

• Over consumption or under consumption of any
  essential nutrient.

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4 Types of Malnutrition

• Over Consumption of Macronutrients
• Vitamin-Mineral (Micronutrient) Deficiency
• Protein-Calorie Malnutrition
• Secondary Malnutrition

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Malnutrition Developed Countries

• Over consumption of nutrients that provide
  calories.
• Carbohydrates/sugar
• Fat
• Protein
• This may lead to health problems such as diabetes
  and heart disease.

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MalnutritionDeveloping Countries

• Under consumption of essential nutrients.
• Carbohydrates (calories)
• Protein
• Fat
• Vitamins
• Minerals
• Water (safe to drink)

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Impact of Malnutrition

• Health
• Malnutrition is single most condition that
  increases the chance for disease
• Infants childrens immune systems are less
  developed than adults -more susceptible to
  diseases
• Growth
• Causes low birth weight, stunting, wasting,
  underweight
• Cognitive Development
• Impacts the rapid brain development up to age 2
• Productivity
• Less productive in jobs and at school

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Vitamin/Mineral Deficiency (VMD)

• A diet lacking in one or more essential
  micronutrients
• VMD is widespread in developing countries
• Iodine - 20 suffer from iodine deficiency
• Vitamin A - 25 of children have sub-clinical
  Vitamin A deficiency
• Iron - 40 of women are anemic
• Vitamin and mineral deficiencies are rare in
  developed countries except for iron deficiency
  anemia.

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Vitamin A Deficiency

• Children
• Leading cause of preventable blindness and visual
  impairment.
• Increases risk of death from diarrhea and measles
• Pregnant women
• Deficiency is common during last trimester when
  need for Vitamin A is highest for the unborn
  child. Mother will experience night blindness.
• Infant will be born with visual damage
• May be associated with elevated mother-to-child
  HIV transmission.

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Vitamin A Interventions

• Breastfeeding. natural source of vitamin A.
• Supplementation during BF Study in Indonesia
  found 1-time supplement given to women shortly
  after birth was effective in raising breast milk
  vitamin A levels and improving vitamin A status
  of the infant for at least 6 months.
• Supplements for children
• Results of several studies (meta-analysis) found
  vitamin A supplementation decreases death from
  diarrhea and measles.
• Nepal Routine vitamin A supplementation.
  Estimated 18,000 child deaths/year have been
  prevented
• Food Fortification. Maintains vitamin A status
• Guatemala sugar
• U.S. milk (cow and soy)

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Vitamin A Supplementation Effect on Mortality
and Morbidity

• 23 less deaths in children under 5 years of age
• Decreased deaths from diarrhea and measles but
  not from respiratory diseases
• Decreases the severity of diarrhea and measles
• Supplements effective where poverty, existing
  vitamin A deficiency, diarrhea or measles
• Effectiveness was not dependent on high potency
  dosing but rather the improvement of vitamin A
  status

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Iodine Deficiency

• Most common cause of preventable mental
  retardation.
• Impairs growth and development children grow up
  stunted, incapable of normal speech and hearing.
  
• Causes goiter enlarged thyroid
• Globally, 2 billion people are at risk
• Tiny amounts must be consumed regularly due to
  the short storage time in body.

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Iodine Interventions

• Food Fortification (iodized salt) has proven
  highly successful and long-term.
• By 2000, iodized salt was available to 70 of the
  worlds population
• Dietary iodized salt, seafood, sea vegetable,
  plants grown in iodine rich soil and animals who
  eat these plants.

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Vitamin/Mineral Fortification

• Probably no other technology available today
  offers as large an opportunity to improve lives
  and accelerate development at such low cost and
  in such a short time.
• The World Bank

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Iron Deficiency Anemia (IDA)

• Not enough iron to carry adequate oxygen to
  cells.
• In children effects growth, development and
  mental performance.
• In pregnant women increases the risk for a
  miscarriage, maternal mortality low-birth
  weight
• Adults lethargy and loss of productivity

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Whos at risk for IDA?

• People with inadequate daily intake
• Women of child-bearing age
• Pregnant lactating women
• Infants, children, teens in rapid growth
• Drinking tea and high fiber foods decreases
  absorption of iron in plants
• Plant-based diet (vegetarians)

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Iron Deficiency Anemia Intervention

• Fortification of grain products
• In U.S. grains supply 1/3 of iron for most people
• Supplementation for pregnant, lactating women and
  women of childbearing age.
• Dietary Diversification
• Foods rich in Vitamin C increase absorption of
  iron from plant sources (beans, lentils, green
  leafy veggies).
• Cooking in iron skillet increases iron content of
  food
• Breast feeding
• Increase rich dietary sources meat, fish,
  poultry, seafood

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Jay Naidoo, Development Bank of South Africa

• Micronutrient deficiency also has many
  invisible economic effects that are widely
  underestimated because they sap the energy of
  working-age people and hurt the learning ability
  of children, causing billions of dollars in lost
  productivity in developing countries who can
  least afford it.

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Protein-Calorie Malnutrition (PCM)

• Insufficient calories and/or protein to support
  normal body functions
• Can only be solved by increasing the amount of
  food eaten.
• Effects growth, health and activity, and is life
  threatening.

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2 Types of Protein-Calorie Malnutrition

• Kwashiorkor develops when there is protein
  deficiency though adequate calories
• Marasmus occurs from a deficiency of both
  protein and calories.

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Kwashiorkor

• Caused by inadequate protein intake
• Prevalent where the diet is mainly starchy
  vegetables
• the evil spirit which infects the first child
  when the second child is born.
• Growth failure, loss of muscle mass, edema and
  decreased immunity occur. Physical indicators
  are bloated abdomen and reddish hair and skin.
• Can leave a child with permanent mental and
  physical disabilities.

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Why do you need protein?

• Main Function
• Growth, repair and maintenance of tissue
• Build muscle, bone, skin and hair
• Protects from illness
• Antibodies made from protein
• Builds enzymes hormones
• Maintains fluid balance
• Edema swelling caused by build up of fluid
  between cells
• Energy (only if low in other energy nutrients)

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Marasmus

• Common amongst the poorest countries Ethiopia,
  Sudan, Nepal
• Inadequate protein and calorie intake. Not enough
  energy for the body, so protein is used for
  energy and a wasting occurs.
• Most common 6-18 months when brain growing - has
  permanent effect on learning ability.
• Often sick because resistance is low.

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Which is bigger problem protein or calorie
deficiency?

• Calorie deficiency is a more widespread problem.
• Need for calories is first priority. When
  shortage of calories the body stops using
  protein for antibodies, transport, hormones,
  enzymes, muscle, bone and uses it for energy.

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Secondary Malnutrition

• It doesnt result directly from the diet.
• Caused by factors such as illness.
• Common causes are diarrhea (dehydration) and
  intestinal parasites
• Difficult for the body to digestion or absorption
  nutrients (vitamin and minerals).

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United Nations World Food Program

• Where both malnutrition and exposure to
  infection are serious, as they are in most
  developing countries, successful control of these
  conditions depends upon efforts directed equally
  against both.

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Secondary Malnutrition

• Lack of clean water and basic sanitation
• Worldwide, over 1 billion people lack access to
  safe drinking water.
• Parasites (guinea worm, hookworm, snail fever) or
  bacteria (ecoli) lead to diarrhea.
• Diarrhea decreases nutrient and water absorption
• Dehydration occurs
• High risk of death

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• Malnutrition is a problem we can resolve at a
  fraction of the cost of ignoring it We need to
  be about that task nowAnyone who looks honestly
  at world hunger and measures the cost of ending
  it for all time will conclude that this is a
  bargain well worth seizing.
• George McGovern
• Former US Senator