Mejorando sistemas para empoderar comunidades

Overview: Malnutrition, a clinical and public health problem; understanding its

causes, measuring it and effective interventions

Collaboratives Improvement in Adolescence and Child Health Workshop

Belize June 21st 2013.

MA Hinojosa-Sandoval - URC.

Malnutrition the facts

• Children have the same growth potential up to age five, irrespective of where they are born.

• In a healthy, well-nourished population onlyaround 2% of children would naturally beshort enough to be classed as stunted.

J L Smith and S Brooker, 2010, ‘Impact of hookworm infection and deworming on anaemia in non-pregnantpopulations: a systematic review’, Tropical Medicine & International Health, 15(7): 776–795

R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 243–60

Estado nutricional de los niños y las niñas menores de cinco años del Ecuador

Fuente: INEC - ECV 2005-2006 Quinta Ronda Realizado por M. A. Hinojosa-Sandoval. Junio 2007

1,19 1,19

1,15

0,90,9

0,83

0,74

0,55

0,4

0,5

0,6

0,7

0,8

0,9

1

1,1

1,2

1,3

Z s

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TENDENCIA DEL DIFERENCIAL Z CON LOS DATOS DE REFERENCIA INTERNACIONAL

T/E

Evaluación del estado nutricional de los niños y las niñas

Fuente: INEC - ECV 2005-2006 Quinta Ronda Realizado por M. A. Hinojosa-Sandoval. Junio 2007

Prevalencia de Desnutrición por edad

Desnutrición crónica (T/E)

Desnutrición global (P/E)

Desnutrición aguda (P/T)

0 Meses 3,1 3,1 3,9

0-5 Meses 3,4 1,6 1,5

6-11 Meses 7,9 5 1,8

0-11 Meses 5,9 3,5 1,7

12-23 Meses 24,8 13,7 4,2

24-59 Meses 19,8 8,6 1

0-59 Meses 18,1 8,6 1,7

0

5

10

15

20

25

30

0 Meses 0-5 Meses 6-11 Meses 0-11 Meses 12-23 Meses 24-59 Meses

% D

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TENDENCIA DE LA DESNUTRICION DURANTE LA NIÑEZ

The smallest

• El hombre mas pequeño del mundo visita al pastor chino Bao Xishun de 2,36 m, ese momento el mas alto del mundo

• The shortest man in the world, He Pingping, 0,73 m – 19 years old, with the longest legs’ woman of the world

Malnutrition the facts

• Globally, 165 million children are stunted; undernutrition underlies 3·1 million deaths in children younger than 5 years

• As in Belize (22% EMI-UNICEF 2013 ), one in four of the world’s children are stunted,. Thatmeans their body and brain has failed todevelop properly because of malnutrition.

• Moreover, malnutrition is underlying cause of one-third of the global children’s deaths.

• Evidence-based interventions for improvement of maternal and child nutrition: what can be done and at what cost? Zulfi qar A Bhutta, Jai K Das, Arjumand Rizvi, Michelle F Gaff ey, Neff Walker, Susan Horton, Patrick Webb, Anna Lartey, Robert E Black. PublishedOnline June 6, 2013. http://dx.doi.org/10.1016/S0140-6736(13)60996-4

Malnutrition the facts

• Stunting, or chronic malnutrition, isa result of a child having a poor diet(too few calories or too littlenutritious food, or both) for a number of years, or an infectionleading to a deficient absorption of nutrients.

M de Onis, M Blossne and E Borghi, (2011) ‘Prevalence of stunting among pre-school children 1990-2020’, Growth Assessment and Surveillance Unit, Public Health Nutrition, 2011, Jul 14:1–7 2 R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 43–60R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 243–60

Malnutrition the facts• The first 1,000 days of life, beginning

with conception, through a mother’spregnancy and up until the age of two, isthe most critical period in a child’sdevelopment.

• Even if a child’s diet improves later in lifeand any health issues are resolved, damage done during this period is largelyirreversible.M de Onis, M Blossne and E Borghi, (2011) ‘Prevalence of stunting among pre-school children 1990-2020’, Growth Assessment and Surveillance Unit, Public Health Nutrition, 2011, Jul 14:1–7 2 R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 43–60R E Black, L H Allen, Z A Bhutta, et al (2008) ‘Maternal and child undernutrition: global and regional exposures and health consequences’, The Lancet, 2008, Jan 19, 371 (9608), 243–60

Malnutrition the facts• Stunting can have an intergenerational effect:

a mother who is stunted may in turn give birthto a small baby, because the fetus’s growth in the womb may have been restricted.

• Besides, a long-term lack of nutritious food, orhaving an infection such as worms, can resultin a lack of micronutrients (vitamins and minerals) in a child’s diet.

• Nearly all deaths linked to micronutrientdeficiency are due to a lack of vitamin A, zinc or iron.

UN Inter-agency Group for Child Mortality Estimation (2011) Levels & Trends in ChildMortality: Report 2011, New York: UNICEF N S Scrimshaw and J P San Giobanni (1997) ‘Synergism of nutrition, infection, and immunity: an overview’, American Journal of ClinicalNutrition, Vol 66, 464S–477SSee 1,000 Days Partnership website: http://www.thousanddays.org/about/M H N Golden (1988) ‘The role of individual nutrient deficiencies in growth retardation of children as exemplified by zinc and protein’, In: J C Waterlow (ed) (1988) Linear Growth Retardation in Less Developed Countries, New York: Raven press

Malnutrition the facts

• The presentation of Kwashiorkor is no different from septicemia, often affects multiple organ systems

Kwashiorkor

YEAR U5MR LBW% BBF% EBF<6M% BFU2% Stunting%

2013 106 14 51 10 27 222012 113 14 51 10 27 222009 97 8 10 27 182007 125 6 24 23

2005 79 6 24 23

2003 84 4 24 23

2000 83 4 24

SOURCE: EMI UNICEF 2000 TO 2013. Published June 2013

EVIDENCE BASED INTERVENTIONS TO TACKLE

UNDERNUTRITION

Malnutrition the options• There are many examples of success in reducing the

prevalence of chronic malnutrition (Brazil 1996-2006 1998-2006 Mexico, Peru 1990) . These experienceshave had in common interventions such as educationof women, an increased purchasing power of thepoorest families, increasing access and improvedquality of health services, health care models forfocalizing beneficiaries and the establishment of a surveillance system and evaluation on the impact. Allof these interventions are considered as nationalpriorities, for public health in Belize.

50º CONSEJO DIRECTIVO, 62ª SESIÓN DEL COMITÉ REGIONAL. Washington DC ESTRATEGIA Y PLAN DE ACCION PARA REDUCIR LA DESNUTRICIÓN CRÓNICA, EUA del 27 de septiembre al 1 de octubre de 2010. Punto 4.9 del orden del día provisional. CD 50/13

Standards nutrition update 2011

Malnutrition the options

• Besides, recommendations to tackle thechronic malnutrition in children undertwo are in the following scheme, mainlyfrom the electronic library on nutritionactions (eLENA) and existing evidenceused by WHO for development of guidelines and policies for actionOPS/OMS

Standards nutrition update 2011

Zulfi qar A Bhutta, Jai K Das, Arjumand Rizvi, Michelle F Gaff ey, Neff Walker, Susan Horton, Patrick Webb, Anna Lartey, Robert E Black, TheLancet Nutrition Interventions Review Group, and the Maternal and Child Nutrition Study GroupEvidence-based interventions forimprovement of maternal and child nutrition: what can be done and at what cost? www.thelancet.com Pubished online June 6, 2013 http://dx.doi.org/10.1016/S0140-6736(13)60996-4

Malnutrition the options

RESEARCH

RESEARCH

HEALTH SYSTEM OF BELIZE, AWARE OF THE NEED FOR TACKLING CHRONIC MALNUTRITION, CONSIDER: 1. PREVENTIVE & EARLY

INTERVENTION2. COMMUNITY

EMPOWERMENT3. QUALITY IN

IMPROVEMENT HEALTH CARE SERVICES

4. ASSURE SUSTAINABILITY THROUGH QUALITY IMPROVEMENT PROCESS

Collaborative Improvement in Child Health

Belize June 21st 2013.

MA Hinojosa-Sandoval - URC.

Collaborative Improvement in Child Health

Belize June 21st 2013.

MA Hinojosa-Sandoval - URC.