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Chapt8Slides.pptxNutrition and Global Health
Chapter 8
Chapter 8: Nutrition and Global Health
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The Importance of Nutrition
Nutritional status is intimately linked with health status
Fundamental to growth Physical
Mental
Intimately linked with school enrollment and performance
Profound effect on labor productivity and income
Inadequate nutrition is the leading risk factor for loss of health in low- and middle-income countries.
Low-cost, highly-effective interventions are available to improve nutrition status.
The status of nutrition is fundamental for both physical and mental health. It is very coherently related with cognitive development and thereby with school enrollment, school performance, and school completing. This later translates into the productivity and income generation in life. Nutrition is the leading risk factor for the loss of health for low and middle income countries. In low and middle income countries, 26% of the children under 5 are underweight, and 30% of the all the children are stunted. These nutritional issues could be very easily solved with low cost and highly effective intervention programs. For instance, in high income countries salt was fortified with iodine almost 50 years back, whereas in many low income countries salt is still not iodized.
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Definitions and Key Terms
Malnutrition - refers to those who do not get proper nutrition, whether too little, too much, or the wrong kind
Undernourished - refers to those who lack sufficient energy or nutrients
Underweight - refers to those who have low weight for their height or age
Overweight or obese - refers to those who are nourished to the point of being too heavy for their height or age
We need to familiarize ourselves with a number of key terms for better understanding of nutrition in global health perspective and they are listed in this slide and the table in next slide.
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Table: Key Terms and Definitions
This table displays key terms and definitions as defined within nutrition and global health.
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The Determinants of Nutritional Status
Immediate causes of malnutrition:
Inadequate dietary intake- weakens the body and opens it up to infection.
Illness- makes it harder for people to eat, absorb the nutrients they take in, and raises the need for some nutrients.
Inadequate intake
Illness
Infection
The two immediate cause of malnutrition are inadequate intake and illness. Inadequate intake causes weakness in the body and makes health vulnerable for infection. Inadequate intake becomes part of a vicious cycle as it leads to illness and infection. When people become ill because of inadequate intake, they become more unable to eat which makes them further ill and thereby more vulnerable to infection.
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Determination of Nutritional Status : The UNICEF Framework
Adapted with permission from UNICEF. State of the World’s Children, 1998, Figure 5. Available at: http://www.unicef.org/source98/silent4.htm. Accessed January 17, 2007.
UNICEF has frame worked a set of underlying causes of inadequate intake and infection. Inadequate food access, insufficient health service, unhealthful environment and inadequate care for children and women are some basic underlying causes of in adequate intake.
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Gauging Nutritional Status
Nutritional status of infants and children is gauged by measuring and weighing them, then plotting weight and height on a growth chart.
Child’s position on growth curve indicates if they are developing normally.
Large share of nutritional deficits are mild, but still have negative consequences on development.
The Nutritional status of infants and children is gauged by measuring and weighing them, then plotting weight and height on a growth chart. These growth charts have been standardized. The place of the child on the growth chart indicates whether the child is growing normally or not. The large share of nutritional deficits in the world fall under the category of “mild “or “moderate” but they could have negative consequences on the biological development.
In this picture, a female health worker measures a newborn in a Bangladeshi village.
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Key Nutritional Needs
Undernutrition
Outcome of insufficient food intake and repeated infectious disease.
Includes underweight, stunted, wasted, and micronutrient malnutrition.
Raises risk of illness and decreased intellectual capacity in children.
Raises risk of pregnancy-related death and delivering prematurely in women.
Undernutrition accounts for 11% of the global burden of disease and is considered the number one risk to health worldwide.
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)
Under nutrition is defined as the outcome of inadequate intake and repeated infectious disease. It includes being underweight for one’s age, too short for one’s age (stunted), thin for one’s age (wasted) or having deficiencies in vitamins and minerals. Under nutrition accounts for 11% of the global burden of disease and is considered the number one risk to health worldwide
In this picture, this little boy in India eats a plate of rice but little else. He may not be getting all the nutrients that his growing body needs.
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One in every three malnourished children in the world lives in India. The percentage of children under 5 years old who are:
wasted (too thin for their height) = 20%
underweight (too thin for their age) = 43%
or stunted (to short for their age) = 48%.
Malnutrition in early childhood has serious, long-term consequences because it impedes motor, sensory, cognitive, social and emotional development. Malnourished children are less likely to perform well in school and more likely to become malnourished adults.
In addition, malnutrition makes children more vulnerable to diarrhea, which remains a leading cause of death among children. Unhygienic practices and unsafe drinking water are some of the other main factors that contribute to diarrhea.
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Micronutrient Deficiency
Micronutrients are vitamins and minerals that are absolutely essential to good health.
Causes lower IQ, stunting, and blindness in children, low immunity for adults and children and endanger the life of mother and infant during childbirth.
Micronutrients are vitamins and minerals that are absolutely essential to good health. Deficiency in micronutrients causes lower IQ, stunting, and blindness in children, low immunity for adults and children and endanger the life of mother and infant during childbirth.
The International Micronutrient Malnutrition Prevention and Control (IMMPacCt) Program works with CDC to contribute CDC skill to combat the problem.
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Global Prevalence of Micronutrient Deficiencies
This map details worldwide severity of the most common micronutrient deficiencies—vitamin A, anemia, and zinc—using World Health Organization (WHO) children under 5 prevalence data. Source: http://www.harvestplus.org/content/nutrients
As you can see from the map, micronutrient deficiencies are higher in sub-Saharan Africa and South East Asia.
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Key Nutritional Needs
Vitamin A
Deficiency associated with “night blindness” and eventually, permanent blindness.
Important to growth and the proper functioning of the immune system.
Impact on severity of illness and chance of survival from several causes, including diarrhea, malaria, and pneumonia.
An estimated 250,000 to 500,000 vitamin A-deficient children become blind every year. Half of these children die within a year of becoming blind (source:GAIN)
Vitamin A can be found in plenty of plants and animal products. Deficiency of Vitamin A is associated with “night blindness” and eventually, permanent blindness. It is also important to growth and the proper functioning of the immune system. It has impact on severity of illness and chance of survival from several causes, including diarrhea, malaria, and pneumonia.
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Key Nutritional Needs
Iodine
Iodine deficiency is the greatest single cause of mental retardation and brain damage.
Deficiency associated with a growth on the thyroid called goiter and the failure to develop full intellectual potential.
Occurs in people who live in mountainous regions where less seafood is consumed and the soil is deficient in iodine.
Iodine deficiency is the greatest single cause of mental retardation and brain damage. Deficiency associated with a growth on the thyroid called goiter and the failure to develop full intellectual potential. It occurs in people who live in mountainous regions where less seafood is consumed and the soil is deficient in iodine. Iodine deficiency is the most common form of preventable mental illness in the world
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Eighteen million children per year are born with impaired mental abilities because of iodine deficiencies. Nearly two billion individuals have insufficient iodine in their diets, including one third of all school age children
Source (GAIN)
Iodine
Eighteen million children per year are born with impaired mental abilities because of iodine deficiencies. Nearly two billion individuals have insufficient iodine in their diets, including one third of all school age children.
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Key Nutritional Needs
Iron
Globally, anemia affects almost 25% of the population.
According to WHO, one out of every two preschool children and pregnant women in developing countries have iron deficiency anemia.
Deficiency causes iron deficiency anemia which is associated with fatigue and weakness.
Iron-deficient pregnant women have an increased risk of giving birth to a premature or low birth weight baby or hemorrhaging and dying in child birth.
The Miller’s Tale
More than half the population of Middle Eastern countries are iron deficient - yet fortifying flour with iron costs just US$2 per person, per lifetime. This Life episode looks at progress on introducing fortified flour in Egypt and Yemen, two of the worst affected countries. - http://www.youtube.com/watch?v=AvC0jpwIA-I
Globally, anemia affects almost 25% of the population. According to WHO, one out of every two preschool children and pregnant women in developing countries have iron deficiency anemia. The outcome of iron deficiency anemia is fatigue and weakness. Iron-deficient pregnant women have an increased risk of giving birth to a premature or low birth weight baby or hemorrhaging and dying in child birth. Most absorbable form of iron comes from fish, meat, and poultry. Less absorbable form comes from fruits, nuts, dried beans and vegetables.
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Key Nutritional Needs
Zinc
Deficiency is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction.
Deficiency is a major risk factor for morbidity and mortality from diarrhea, pneumonia, and malaria.
Zinc and ORS
In June 2012, the Ghana Health Service and SHOPS launched a major communication campaign to increase the awareness about the new WHO/UNICEF-recommended diarrhea treatment with zinc and ORS and to promote correct use of those treatments.
http://www.youtube.com/watch?v=i8ncm3o-NLo
Deficiency in Zinc is associated with growth retardation, impaired immune function, skin disorders, hypogonadism, and cognitive dysfunction .it is also a major risk factor for morbidity and mortality from diarrhea, pneumonia, and malaria.
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Iron fortified pearl millet
Vitamin A cassava
Vitamin A rich sweet potato
Zinc fortified rice and wheat
Breeding Crops for Better Nutrition
Source: HarvestPlus, available at http://www.harvestplus.org/content/zinc-wheat
These are couple of approaches that have been adopted in low income country to cost effectively face the challenges of nutrient deficiencies.
Iron Pearl Millet : Pearl millet is an important cereal grown in many harsh environments in the arid and semi-arid tropical regions of Asia and Africa. It is a significant source of dietary energy and nutritional security of poor farmer-consumers in several highly populated regions of India. Pearl millet, biofortified with iron, will be targeted to those populations in India that rely on it as a staple food crop.
Vitamin A Cassava: An estimated 70 million people rely on cassava for basic sustenance. Cassava is a hearty crop able to withstand disease, drought and pests. It will also grows on poor marginal soils and is thus cultivated and eaten where both poverty and malnutrition is widespread. Biofortifying cassava with provitamin A (converted in the body to vitamin A) will have a significant positive impact on nutrition and overall health, especially among poorer communities.
Sweet Potato: More then 95% of sweet potato is grown in the developing world which is an excellent source for Vitamin A
Zinc fortified Rice and Wheat: Rice is the staple food for more than half the world’s population. In several Asian countries, rice provides 50 to 80 percent of the energy intake of the poor. Because of the high daily consumption of rice in Asia, it is an ideal staple crop to biofortify with zinc
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Nutritional Needs Throughout the Life Cycle
Pregnancy and Birth weight
Pregnant women need a sufficient amount of protein and energy as well as iron, iodine, folate, zinc, and calcium.
Fetuses that do not get sufficient nutrition from the mother may suffer from stillbirth, mental impairment or birth defects.
Infancy and Young Childhood
Children need sufficient protein and energy as well as iodine, iron, vitamin A, and zinc.
Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection.
Grow best and stay healthiest if exclusively breastfed for first 6 months.
“Window of opportunity” is in utero to two years of age.
TED Talk: Improving childhood nutrition in Kenya
https :// www.youtube.com/watch?v=nTBGwTAls6w
Pregnant women need a sufficient amount of protein and energy as well as iron, iodine, folate, zinc, and calcium for herself and for her baby in utero. It is extremely important that the fetus get enough nutrition from the mother because fetuses that do not get sufficient nutrition from the mother may suffer from stillbirth, mental impairment or birth defects.
A child’s biological development depends largely on the time between conception and two years of age. Children need sufficient protein and energy as well as iodine, iron, vitamin A, and zinc. Nutritional gaps during this time can cause problems with stature and mental development, and frequent infection. A large number of research has suggested that infants grow best and stay healthiest if exclusively breastfed for first 6 months. Complimentary feeding should also starts around 6 months of age in addition to breast milk. Suboptimal breastfeeding is associated with about 10% of burden of disease in children worldwide.
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Nutritional Needs Throughout the Life Cycle
Adolescents
Adolescents need protein and energy to grow as well as iron, iodine, folic acid, and calcium
Adolescent girls who are poorly nourished are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls
Adulthood and Old Age
Adults need a well-balanced diet with protein, energy, and iron
Foods that contain too much fat, cholesterol, sugar, or salt can be harmful
Older adults need calcium to reduce risk of osteoporosis
Well- nourished adolescent girls grow faster than who are not well nourished. Poorly nourished girls are much more likely to give birth to an underweight child and experience complications during pregnancy than well-nourished girls. Adults need a well-balanced diet with protein, energy, and iron. Foods that contain too much fat, cholesterol, sugar, or salt can be harmful. Older adults are the vulnerable portion of the society with special nutritional need that is related with their effective functionality. Calcium is one of the nutrients that older adults need to take regularly to reduce risk of osteoporosis.
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Nutritional State of the World
26% of under-5 children are underweight according to most recent estimates
Rates of underweight vary considerably by region.
Only about 0.5% of total deaths in low- and middle-income countries are directly due to undernutrition.
Deaths are usually “nutrition related.”
26% of under-5 children are underweight according to most recent estimates and this rates of underweight vary considerably by region. Only about 0.5% of total deaths in low- and middle-income countries are directly due to under nutrition.
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Prevalence of chronic undernutrition in developing regions
| Region | Percentage of population | Number (millions) | ||||
| 1969-1971 | 1979-1981 | 1990-1992 | 1969-1971 | 1979-1981 | 1990-1992 | |
| Latin America and the Caribbean | 18 | 13 | 14 | 51 | 46 | 61 |
| Near East and North Africa | 25 | 10 | 10 | 44 | 24 | 32 |
| Sub-Saharan Africa | 36 | 39 | 41 | 96 | 140 | 204 |
| East and Southeast Asia | 41 | 27 | 16 | 468 | 371 | 262 |
| South Asia | 33 | 33 | 22 | 233 | 297 | 250 |
| Continental Africa | 34 | 33 | 34 | 116 | 148 | 211 |
| Developing regions | 35 | 27 | 20 | 893 | 878 | 809 |
Source: http://www.fao.org/docrep/w0073e/w0073e03.htm
Here is table displaying the prevalence of chronic undernutrition in developing regions. As you can see, the number in millions over decades has increased in Sub-Saharan Africa, but has decreased in South Asia.
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Nutritional State of the World
Low Birth weight
11% of babies in low- and middle-income countries are born low birth weight according to recent estimates.
About 3% of DALYs lost in low- and middle-income countries are attributable to low birth weight.
11% of babies in low- and middle-income countries are born low birth weight according to recent estimates. 2.5% of total death under 5 years of age occurs in low and middle income countries because of low birth weight. About 3% of DALYs lost in low- and middle-income countries are attributable to low birth weight.
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Nutritional State of the World
This table displays the prevalence of low birth weight in low and middle income countries in 2001.
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Prevalence of underweight children under five years of age, by region
| Region | Percentage underweight | Number underweight (millions) | ||||
| 1980 | 1985 | 1990 | 1980 | 1985 | 1990 | |
| Sub-Saharan Africa | 28.9 | 29.9 | 29.9 | 19.9 | 24.1 | 28.2 |
| Near East/North Africa | 17.2 | 15.1 | 13.4 | 50 | 5.0 | 4.8 |
| South Asia | 63.7 | 61 1 | 58.5 | 89.9 | 100.1 | 101,2 |
| Southeast Asia | 39,1 | 34 7 | 31.3 | 22.8 | 21.7 | 19.9 |
| China | 23.8 | 21,3 | 21.8 | 20,5 | 21,1 | 23,6 |
| Central America/Caribbean | 17.7 | 15.2 | 15.4 | 3 1 | 2.8 | 3.0 |
| South America | 9.3 | 8.2 | 7.7 | 3.1 | 2.9 | 2.8 |
| Global (average percentage/total number) | 37.8 | 36.1 | 34.3 | 164 | 178 | 184 |
Source: http://www.fao.org/docrep/w0073e/w0073e03.htm
Here is the prevalence of underweight children under five years of age by region from 1980 to 1990.
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Nutritional State of the World
Nutrition impacts health and human development. It has direct link to what people learn and their productivity. Nutritional deficits impacts maternal health, affects household income and health of children. It affects children’s ability to learn in school, which impacts their future prospects.
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Vitamin A
About 250 million children suffer from vitamin A deficiency worldwide.
6.5% of all deaths of children under-5 in low- and middle-income countries are due to vitamin A deficiency.
Iodine
About 70 million people worldwide are affected by iodine deficiency.
Associated with substantial DALYs lost in low- and middle-income countries.
Iron
About 1.6 billion people were affected by anemia between 1993 and 2005.
Substantial public health problem for children under 5 and pregnant women, especially in low- and middle-income countries.
0.7% of DALYs lost in low- and middle-income countries is related to iron deficiency anemia.
Zinc
Second most important micronutrient responsible for death and DALYs in children under 5.
About 4% of DALYs lost in children under 5 years of age are due to zinc deficiency.
Nutrition, Health, and Economic Development
Nutrition impacts health and human development.
Link to what people learn and their productivity.
Poor nutrition:
Impacts maternal health, which affects household income and health of children.
Affects children’s ability to learn in school, which impacts their future prospects.
Leads to lower productivity in adult workers.
Video : The Power of Nutrition (3:31)
This video illustrates the importance of early childhood nutrition in strengthening the future for children, communities and nations.
http ://www.youtube.com/watch?v=QHIZyYAsSFY
Nutrition impacts health and human development and there is a link to what people learn and their productivity based on nutrition level. Poor nutrition impacts maternal health, which affects household income and health of children, affects children’s ability to learn in school, which impacts their future prospects and leads to lower productivity in adult workers. Watch this video called The Power of Nutrition.
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