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Global health history seminar 60Geneva, 29 February 2012

Improving infant feeding practices

Francesco BrancaDirector, Department of Nutrition for Health and

Development, WHO Geneva

Global History seminar 60


171 million children under 5stunted growth (2010)

Prevalence of Stunting


An impact on mortality

• Childhood malnutrition is the underlying cause of death in an estimated 35% of all deaths among children under the age of five years

• More than two million children die each year as a result of undernutrition before the age of five years

• Maternal and child undernutrition account for 11% of the global burden of disease


An impact on health and wellbeing

• short adult stature • reduced lean body mass • poor cognition and educational performance • lower productivity and adult wages• Increased risk of chronic diseases• women stunted as children deliver lower birth

weight babies


Stunting prevalence and numberaffected in developing countries

1990 2000 2010

010

2030

4050

Stun

ting

(%)

40.3

48.6

23.7

39.337.7

18.1

38.2

27.6

13.5

1990 2000 2010

050

100

150

200

Num

ber o

f stu

nted

(mill

ions

)

45

190

13

51

138

10

60

100

7

AFRICA ASIA LATIN AMERICASource: Department of Nutrition, World Health Organization


Overweight prevalence and number affected in developing countries

1990 2000 2010

02

46

810

Ove

rwei

ght (

%)

4

3.2

6.8

5.7

3.7

6.8

8.5

4.9

6.9

1990 2000 2010

05

1015

20N

umbe

r of o

verw

eigh

t (m

illio

ns)

4

13

4

7

14

4

13

18

4

AFRICA ASIA LATIN AMERICASource: Department of Nutrition, World Health Organization


Some countries have been successful in reducing stunting


Exclusive breastfeeding rates in children <6 months

%


9

Significant increases in EBF …

3 36

16 16

8 710 11 11

712

19

3338

17

2326

34 36 37 38 4043

47 48

54

60 6164

67

76

0

10

20

30

40

50

60

70

80

baseline

most recent dataSource: UNICEF Global Database 2009


…and significant declines

10

7774

63

5047 44

36 35

19 1914

44

53

32 31

6

2317 15

7 84

0

10

20

30

40

50

60

70

80

90

Baseline Most recent dataSource: UNICEF Global Database 2009


…

…


Proposed global Targets1. Reduction of childhood stunting

Target: 40% reduction of the global number of children under five who are stunted

2. Reduction of anaemia in women of reproductive ageTarget: 50% reduction of anaemia in non pregnant women of reproductive age

3. Reduction of low birth weightTarget: 50% reduction of low birth weight

4. No increase in childhood overweightTarget: 0% increase in the prevalence of overweight in children under five

5. Increase exclusive breastfeeding rates in the first six months of life Target: increase of exclusive breastfeeding rates in the first six of life months to at least 50%


Comprehensive action plan on maternal, infant and young child nutrition

ACTION 1 : To create a supportive environment for the implementation of comprehensive food and nutrition policies

ACTION 2 : To include all required effective health interventions with an impact on nutrition in plans for scaling up

ACTION 3: To stimulate the implementation of non health interventions with an impact on nutrition

ACTION 4 : To provide adequate human and financial resources for the implementation of health interventions with an impact on nutrition

ACTION 5 : To monitor and evaluate the implementation of policies and programmes


Action 2 : to include all required effective health interventions with an impact on nutrition in plans for

scaling up

7days

28 days

1 year

Birth

5 years10 years

20 years

Immediate initiation of breastfeeding

Exclusive breastfeeding to 6m

Continued breastfeeding

Adequate complementary feeding from 6m

Micronutrient supplementation as

necessary

Energy and nutrient Adequate CF

Micronutrient supplementation as

necessarySchool meals

Adolescent dietary advice

Pre-pregnancy dietary advice for adolescent

girls and women

Diet and micronutrientsduring pregnancy


• Evidence-based nutrition policy making

• Best practices for implementation

• Effective nutrition interventions

Nutrition Programme Guidance

Maternal and Child Nutrition

Nutrition and the Environment

Nutrition and Growth Surveillance

MicronutrientsNutrition in

Emergencies and Humanitarian

Crisis

Nutrition Care for Groups

with Special Needs

Nutrition in HIV, TB and other

Communicable Diseases

Nutrition and Chronic Disease

Prevention

Undernutrition

WHO E-Library for

Nutrition Programmes Guidance: Recommendations,

Evidence and Best Practices


Development of standards and tools

• Standards for attained growth 0-5 years• Growth velocity standards 0-5 years• Growth reference 5-19 years• Child Growth Standards Software• Postpartum maternal weight loss and

BMI change • Multi-country study to develop

standards for fetal growth, birth weight for gestational age, preterm babies

• Guidelines for nutrition surveillance


!!!!

!

Implementation WHO Child Growth Standards

Implementation StatusImplementing

Adoptation being discussed

Not being discussed

Status unknown


Management of severe acute malnutrition

• Update national protocols• Training of health workers • provision of supplies for inpatient

care• Link inpatient care and outpatient

community-based management:• monitoring and evaluation• Link to preventive activities on

IYCF

Tanzania, Ghana, Burkina Faso, Niger, Senegal, Ivory Coast; Sri Lanka, India, Indonesia; Somalia, Sudan, Pakistan, Iraq, Afghanistan, Yemen


Infant and Young Child Feeding

• Protection, promotion and support of appropriate IYCF

– Exclusive breast feeding for 6 months – Complementary feeding (need

strengthening and support for use of local foods, food fortification, micronutrient supplementation)

– Feeding of IYC in difficult circumstances (HIV, malnutrition, emergencies, LBW)

• Health services – Baby Friendly Hospital Initiative– Pre-service education and in-service

training• Maternity protection• Code of marketing of breastmilk

substitutes• Monitoring and evaluation


!!!!

IYCF Integrated Course Status 2006-2008

Integrated Course Introduced / Repeated

Adapted Integrated Course

Course Not Introduced

Capacity building for IYCF


The Baby Friendly Hospital Initiative

0%

20%

40%

60%

80%

100%

120%

Austria

Chinese Taipei

Finland

Geo

rgia

Greece

Israel

Japan

Year 2010

Year 2008

Year 2006

0%20%40%60%80%100%120%

Lithuania

Malta

New

Zealand

Russian…

Spain

Tajikistan

United…

Uzbekistan

Year 2010

Year 2008

Year 2006


Code : legislative status in countries

RegionFullIn

law

ManyIn

law

FewIn

lawVol Few

vol Draft Study

Action toend freesuppliesonly

Noaction

Noinfo Total

AFRO 13 6 5 9 1 6 3 0 2 2 47

AMRO 8 5 4 (1) 9 2 1 0 0 5 (2) 1 35 (3)

EMRO 7 5 2 2 0 1 1 2 1 (1) 21 (1)

EURO 2 23 6 0 1 2 7 0 1 11 53

SEARO 4 2 0 3 1 0 0 0 0 1 11

WPRO 3 5 (1) 3 8 1 0 0 0 1 6 27 (1)

Total 37 46 (1) 20 (1) 31 6 10 11 2 10 (2) 21(1) 194 (5)


Code : functioning implementation and monitoring system

Region Full/Yes Partial No No information Total

AFRO 10 2 3 32 47

AMRO 6 2 5 22 (3)* 35 (3)

EMRO 1 0 2 18 (1) 21 (1)

EURO 13 10 7 23 53

SEARO 3 0 3 5 11

WPRO 4 (1) 0 3 20 27 (1)

37 (1) 14 23 120 (4) 194 (5)


We know what to do. We can reduce maternal anemia, Low Birth Weight and child stunting and bring down the risk of noncommunicable diseases within a generation. We can achieve this by giving nutrition the attention it deserves.

M.ChanRemarks at the High-level Meeting on Nutrition, New York, 20 September 2011


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

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