Tackling global nutrition challenges – a WHO perspective

F.Branca

DirectorDepartment of Nutrition

for Health and DevelopmentWHO

Stunting prevalence and number affected in developing countries

Achievement of MDG 1

178 million children under 5are stunted

Prevalence of Stunting

Source: WHO Global database on Anaemia, 2006

293 million children under 5are anemic

Category of public health significance(anaemia prevalence)

Normal (<5.0%)

Mild (5.0-19.9%)

Moderate (20.0-39.9%)

Severe (≥40.0%)

No Data

Exclusive breastfeeding rates in children <6 months are stalling

12

2025

141624

38

14

43

3238

18

3542

21

46

2936

0

10

20

30

40

50

60

70

80

90

100

AFR AMR EMR EUR SEAR WPR GLOBAL

1986-1990

1991-1995

1996-2002

Global Trend

Major causes of death in children under 5 with disease-specific contribution of undernutrition,

2004

Over 500 million adultsare obese

!!

!!

BMI Adult Both Sexes (≥30%)

No data

≥50.00

40.00 - 50.00

30.00 - 40.00

20.00 - 30.00

10.00 - 20.00

5.00 - 10.00

0.00 - 5.00

Why little progress?

• Inadequate investments• Inadequate coordination

among players• Inadequate coverage• Inadequate responses• Life course not addressed• Social determinants not

considered

Implementation of the Code of Marketing Breast milk substitutes

– 63 Member States reported as having Code legislation or regulations in place (65%);

– 22 Member States reported as having adopted only voluntary measures (23%);

– 9 Member States did not complete the questionnaire sent (12%).

Different policy and operational support needed

FACTOR 1:Better Health System Capacity, variable Nutrition Governance

FACTOR 2: Poorest Health System Capacity,

Consistent Good Nutrition Governance

FACTOR 3:Poor Health System Capacity, Variable Nutrition Governance

(High PH Expenditure)

Strong Nutrition Governance

Medium/weak Nutrition

Governance

Strong Nutrition Governance

Medium/weka Nutrition

Governance

MCU 1Best for reduction of both child stunting and maternal anemia

Vietnam Angola (-)Indonesia

KenyaPakistan

South Africa

BangladeshIndia

CambodiaMozambique

MCU 2Best for reduction of child

stunting, and worst for reduction of maternal anemia

EgyptPeru

Philippines

DR Congo* (-) Ethiopia

MCU 3Worst for reduction of child

stunting, and best for reduction of maternal anemia

GhanaYemen (-)

CameroonMyanmarNigeriaSudan*

Burkina Faso GuatemalaMali

NigerZambia

MCU 4Worst for reduction of both child stunting and maternal

anemia

BurundiCote D’Ivoire (-)

MadagascarNepal

Uganda

Malawi U R Tanzânia

* emergency countriesNOTE: countries with good coverage (>70%) of at least 4 antenatal care visits are in bold type; those with medium coverage (30-70%) are shown as underlined text; and those with low coverage (<30%) of at least 4 antenatal care visits are shown as italicised text.

MCU groups(from stunting

and anemia level and trend)

Readiness Factor

Sharp improvements in exclusive breastfeeding rates are possible

8 616

7

383828

34

61

41

54 56

67

43

83

44

23

1010 10

36

88

0102030405060708090

100

Mal

i

Tog

o

Sen

egal

Leso

tho

Zam

bia

Tan

zani

a

Gha

na

Mal

awi

Mad

agas

car

Ben

in

Rw

anda

% o

f in

fan

ts <

6 m

os

ex

clu

siv

ely

bre

as

tfe

d

around 1996 around 2006

Source: UNICEF database; current EBF >25 and increase >10 percentage points; OR EBF >80%

A new political environment

"Given the importance of nutrition to maternal, newborn and child health and other broader development programming, Ministers stressed that nutrition needs to be better integrated in development efforts. Ministers recognized that investments in nutrition could have a catalytic impact on making progress towards the Millennium Development Goals (MDGs)."

G8 Development Ministers' Meeting

28 April 2010, Halifax

Donors' nutrition strategies

• Canadian initiative on maternal and child health

• US Global Health Initiative

• nutrition strategies (France, UK, European Commission, Ireland).

Scaling up nutrition – a framework for action

• focus on country level action;• scale up evidence-based cost-effective interventions to

prevent and treat undernutrition, with highest priority to the minus 9 to 24 months;

• take a multi-sectoral approach that includes integrating nutrition in related sectors;

• provide substantially scaled up domestic and external assistance for country owned nutrition programmes and capacity;

• support major efforts at the national and global levels for strengthening the evidence base through better data, monitoring and evaluation, and research.

Evidenced Based Direct Interventions toPrevent and Treat Undernutrition

• Promoting good nutritional practices ($2.9 billion):– breastfeeding – complementary feeding for infants after the age of six months– improved hygiene practices including handwashing

• Increasing intake of vitamins and minerals ($1.5 billion)• Provision of micronutrients for young children and their mothers:

– periodic Vitamin A supplements – therapeutic zinc supplements for diarrhoea management– multiple micronutrient powders – de-worming drugs for children (to reduce losses of nutrients)– iron-folic acid supplements for pregnant women to prevent and treat anaemia– iodized oil capsules where iodized salt is unavailable

• Provision of micronutrients through food fortification for all: – salt iodization – iron fortification of staple foods

• Therapeutic feeding for malnourished children with special foods ($6.2 billion):– Prevention or treatment for moderate undernutrition – Treatment of severe undernutrition (“severe acute malnutrition”) with ready-to-use therapeutic foods

(RUTF).

Call for action

WHO is calling the attention of MSs to the need of scaling up interventions to address infant and young child nutrition and to increase the investment in nutrition through comprehensive approaches, as part of a global action plan on nutrition.

Draft resolution

A Draft resolution (EB126.R5) on Infant and Young Child Nutrition was proposed by Peru and endorsed by the EB with minor modifications.

Member States commitments(1) to increase political commitment to reducing malnutrition in all its forms;(2) to strengthen and expedite the implementation of the Global Strategy for Infant

and Young Child Feeding with emphasis on giving effect to the International Code of Marketing of Breast-milk Substitutes, adopted in resolution WHA34.22;

(3) to develop or review current policy frameworks addressing the double burden of malnutrition and allocate adequate human and financial resources to ensure its implementation;

(4) to scale up interventions to improve infant and young child nutrition, including the protection and promotion of breastfeeding and timely, safe and appropriate complementary feeding; the implementation of supplementary and therapeutic feeding interventions for severe malnutrition; and the control of vitamin and mineral deficiencies;

(5) to include these strategies in comprehensive maternal and child health services and supporting to the aim of universal coverage and principles of primary health care, including strengthening health systems as outlined in WHA62.12;

(6) to strengthen nutrition surveillance systems and improve use and reporting of agreed Millennium Development Goals indicators to monitor progress;

(7) to implement the WHO Child Growth Standards by their full integration into child health programmes;

Requests to WHO(1) to strengthen the evidence base on effective and safe nutrition actions to

counteract the public health effects of the double burden of malnutrition and describe good practices for successful implementation;

(2) to mainstream nutrition in all WHO’s health policies and strategies and confirm the presence of essential nutrition actions in the context of the reform of primary health care;

(3) to continue and strengthen collaboration with other United Nations agencies and international organizations involved in the process of ensuring improved nutrition including clear identification of leadership, division of labour and outcomes;

(4) to support Member States, on request, in expanding nutritional interventions related to the double burden of malnutrition, monitoring and evaluating impact, strengthening or establishing effective nutrition surveillance systems, and implementing the WHO Child Growth Standards;

(5) to develop a comprehensive implementation plan on infant and young child nutrition as a critical component of a global multisectoral nutrition framework for preliminary discussion at the Sixty-fourth World Health Assembly and for final delivery at the Sixty-fifth World Health Assembly, through the Executive Board and after broad consultation with Member States.

http://www.who.int/nutrition/en/index.html