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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
Opportunities and Challenges for
Achieving Nutrition Security in Low
and Middle Income Countries
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INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
GLOBAL TRENDS IN NUTRITION
Click to edit Master title style 171 million children under 5 are stunted
Source: WHO Global Database on Child Growth and Malnutrition, May 2009 - Mercedes de Onis, BMGF meeting 2010
Click to edit Master title style Stunting ↓ from 44-29% (1990-2010)
1990 2000 2010
010
2030
4050
Stu
ntin
g (%
)
4 0 .3
4 8 .6
2 3 .7
3 9 .3
3 7 .7
1 8 .1
3 8 .2
2 7 .6
1 3 .5
1990 2000 2010
050
100
150
200
Num
ber o
f stu
nted
(mill
ions
)
4 5
1 9 0
1 3
5 1
1 3 8
1 0
6 0
1 0 0
7
AFRICA ASIA LATIN AMERICASource: Department of Nutrition, World Health Organization
Mercedes de Onis, BMGF meeting 2010
%
Click to edit Master title style Overweight children ↑ steadily (1990-2010)
Mercedes de Onis, BMGF meeting 2010
1990 2000 2010
02
46
810
Overw
eig
ht (%
)
4
3 .2
6 .8
5 .7
3 .7
6 .8
8 .5
4 .9
6 .9
1990 2000 2010
05
10
15
20
Num
ber of overw
eig
ht (m
illions)
4
1 3
4
7
1 4
4
1 3
1 8
4
AFRICA ASIA LATIN AMERICASource: Department of Nutrition, World Health Organization
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
Vitamin A: 160 million children affected; ~30%
children (40% in Africa and South Asia); also
prevalent in women
Anemia: (half of which is due to iron deficiency):
Static at ~45% in children (Africa and Asia); 500
million women anemic (highest burden in Asia)
Iodine: widespread deficiency
Low birth weight: 25-33% in Africa and Asia
Slow progress on ↓ micronutrient deficiencies
and low birth weight
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
Coexistence of under and over nutrition
0
10
20
30
40
50
60
70
80
90
100
Egypt Peru Mexico
%
Other
Overweight
Obese
†*, †
Anemia in women
0
5
10
15
20
25
30
35
2003 2005 2008
Stunting
Wasting
Overweight
Egypt
In same country
In same household
In same individual
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INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
WHY DOES NUTRITION MATTER?
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Height
at 18 y 81.2
Severe Moderate Mild Well-nourished
Height
at 3 y
Source: Paul Melgar, INCAP
Stunted child – Stunted adult
Damage is irreversible
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
High risk of illness and mortality (associated with
35% of child deaths)
Poor cognitive development, delays in starting
school, poor school performance
Reduced economic productivity – wages, income,
skilled jobs
Increased risk of obesity and NCD at adulthood
(and premature death)
Small mothers, small babies
Being undernourished in early childhood
= Being handicapped for life
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
GPD losses > 2-3 %
US $80 billion/y (Sridhar 2007)
Huge cost to society & global economy
Malnutrition Poverty
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INTERNATIONAL FOOD POLICY RESEARCH INSTITUTE
WHAT NEEDS TO BE DONE TO
ACCELERATE PROGRESS IN
IMPROVING NUTRITION?
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LAC
Europe &
Central Asia
North Africa &
Near East
SS Africa
South Asia
-9 to 24 mo
1. PREVENT – Focus on 1st 1000 Days
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
2. Scale-up targeted nutrition Interventions
Series of Nutrition Interventions of known
efficacy (Lancet 2008):
• Maternal health and nutrition during pregnancy
(and before)
• Appropriate child feeding practices
• Micronutrient supplementation (e.g. vitamin A,
zinc, iron)
• Immunization
• Hygiene
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15
3. Integrate nutrition into other
relevant sectors
Agriculture &
Food Security
Social
Protection
Poverty
Reduction
Health
Water &
Sanitation
Private
Sector
Trade/Fiscal
Policies
Environment &
Climate Change
GOVERNANCE GENDER
Work
Multi-
Sectorally
Source: World Bank 2011
Click to edit Master title style 4. Use a life cycle approach
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
5. Focus on poor, vulnerable, left
behind, and on reducing inequities
6. Improve data, information,
measurement, documentation,
learning, evaluation
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Marie Ruel ︳ Food Secure Arab World ︳ Beirut, Feb 6-7, 2012
Several new initiatives are following these
principles
How will these translate into actions on the
ground and Improvements in nutrition at scale?
UK DFID