Malnutrition and child survival Prof Dr Patrick Kolsteren
- Slides: 27
Malnutrition and child survival Prof Dr. Patrick Kolsteren Nutrition and Child Health Unit Institute of Tropical Medicine Antwerp
Malnutrition and mortality • Malnutrition is the underlying cause of 3. 5 million deaths • 35 % of the disease burden in children under five due to malnutrition • 11 % of the total mortality and disability
Major Causes of Death among Children around the World Deaths associated with undernutrition 60% Sources: EIP/WHO, Caulfield LE, Black RE. Year 2000
Expression of malnutrition • Thinness or acute severe/ moderate malnutrition • Sub-optimal growth: stunting or short stature • Micronutrient deficiencies – – Vitamin A Zinc Iron Iodine
Stunting Lancet series maternal and child nutrition 19 January 2008
Vitamin A deficiency Lancet series maternal and child nutrition 19 January 2008
Zinc deficiency Lancet series maternal and child nutrition 19 January 2008
Health effects • Decreased immunity “nutritional immune deficiency syndrome” • Frequent infections • Psycho-motor development delays • School performance • Lower IQ • Blindness • Neurological malformations • Short adults pregnancy complications
Immediate causes of malnutrition • Low birth weight / maternal nutrition • No breastfeeding or non exclusive breastfeeding • Complementary feeding: – Low quantity – Low energy density – Low quality: diversity, fruit and vegetables • Low quality diet : family dish • Micronutrient deficiencies • Infection pressure
DANGERS WITH COMPLEMENTARY FOODS 1. Diarrhea 2. Food allergies and atopic (in particular before 4 months of age) 3. Not enough: - Composition (Fat = 40 %) - Poor density (150 CC /meal ) - Time and frequency 4. Too salty
DANGERS WITH COMPLEMENTARY FOODS 5. Low quality - Poor in micronutrients - Low-bioavailability - Low fat : ADEK - Little variation - Qualilty of proteins ( 2/3 cereals and 1/3 tubers) cereals are rich in lysine, poor in methionine and cysteine) - No fruits and vegetables - No animal protein
DANGERS WITH COMPLEMENTARY FOODS 6. Contamination Mycotoxine: aflatoxine and fumonisins Little research : In tanzania 20 % of infant in the Kilimanjaro region have intakes above the recommended safety levels. Large seasonal variation. CF is largely cereal based.
Infection pressure • Drop in maternal immunological protection at 6 months • Environmental sanitation : – Diarrhoea – Worm infections – Parasites : vector borne diseases (malaria) • Cause of malnutrition and a result of malnutrition
What works? • Promotion of exclusive breastfeeding • Improve complementary feeding and nutrition support • Hand-washing and hygiene interventions
How to improve complementary feeding? • Food based approach: food diversity, accept new food sources in CF • Increase fat content • Role of ω3 and ω6 fatty acids is not clear. • Invest in toxine analyses
What works ? • Treatment of malnutrition, severe and moderate • Focus on identification of malnourished children • Vitamin A fortification • Iodisation of salt • Zinc supplementation • Improve maternal nutritional status pregnancy
How to get there in operational terms? • Coverage means access to infrastructures • Infrastructures exist : health care system • Most interventions can be delivered through health system if they focus on child health • Health systems needs to be supported with a particular emphasis on child health and health promotion
Way forward • • Accept that we know what to do Focus on what works and increase coverage Use existing structures Find ways to deliver the interventions in a local context. Support local initiatives in research and development. Who drives the agenda? ? ? • 99 % grants for “new solutions” that can reduce mortality by 22% • 1 % for solutions that increase coverage that can reduce mortality by 66 %
Thank you
- Patrick kolsteren
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