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The Lancet Series on Maternal and Child Nutrition The Lancet Series on Maternal and Child Nutrition

The Lancet Series on Maternal and Child Nutrition - PowerPoint Presentation

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The Lancet Series on Maternal and Child Nutrition - PPT Presentation

Launch Symposium 6 June 2013 Imperial College St Marys Campus Rothschild Lecture Hall School of Medicine Norfolk Place London Maternal and Child Undernutrition and Overweight in Lowand MiddleIncome Countries ID: 708108

maternal deaths nutrition child deaths maternal child nutrition 000 deficiencies growth stunting fetal vitamin million risk series children mortality

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Slide1

The Lancet Series on Maternal and Child Nutrition

Launch Symposium

6 June, 2013

Imperial College – St Mary’s Campus

Rothschild Lecture Hall, School of Medicine

Norfolk Place, LondonSlide2

Maternal and Child Undernutrition and Overweight in Low-and Middle-Income Countries:

Prevalences

and

Consequences

Robert E Black

1

, Cesar G Victora2, Susan P Walker3, Zulfiqar A Bhutta4

, Parul Christian1, Mercedes de Onis5, Majid Ezzati6, Sally Grantham-McGregor3,7

, Joanne Katz1, Reynaldo Martorell8, Ricardo Uauy9 and the Maternal and Child Nutrition Study Group

1 Johns Hopkins University 2 Universidad de Federal de Pelotas3 The University of the West Indies4

The Aga Khan University and Medical Center

5 World Health Organization6 Imperial College of London7 University College London8 Emory University9 London School of Hygiene and Tropical Medicine Slide3

Series Background

2008 Series identified need to focus on critical period during pregnancy and first two years of life, the 1,000 days in which good nutrition and healthy growth have lifelong

benefits2008 Series also called for greater priority for national nutrition programmes, stronger integration with health programmes, enhanced inter-sectoral approaches and more focus and coordination in the global nutrition system

Five years on, we re-evaluate problems of maternal and child undernutrition, consider growing problem of overweight and obesity for women and children and assess the current and needed national and global response

2008 Series Executive Summary

3Slide4

Series Overview

Paper 1: prevalence and consequences of nutritional conditions during life course from adolescence (for girls) through pregnancy to childhood and implications for adult health

Paper 2: evidence supporting nutrition-specific interventions, health impact and cost of scaling upPaper 3: nutrition-sensitive interventions and approaches and their potential to improve nutrition

Paper 4: the features of an enabling environment for nutrition and how they can be favourably influenced

Comment: examines what is currently being done, and what should be done nationally and internationally

Insert Series cover/exec summary

2013 Series Executive Summary

4Slide5

Framework for

Actions to Achieve Optimum Fetal and Child Nutrition and Development

5Slide6

Adolescent NutritionSlide7

Adolescent Nutrition: Important for Girls,

and for the Future Generation

As many as half of all adolescent girls in some countries are stunted, increasing risk of

complications in pregnancy and delivery and of poor fetal growth 7Slide8

Maternal

NutritionSlide9

9

Trends in

Thinness

and Obesity for Women Aged 20-29

Years in UN Regions and Globally (

1980-2008)

Prevalence of low

BMI

in adult women has decreased in Africa/Asia since 1980, but remains higher than 10%

Maternal overweight and obesity has increased steadily since 1980;

resulting in increased maternal morbidity and infant mortalitySlide10

Prevalence of V

itamin A and Iodine Deficiencies, Inadequate Zinc Intake, and Iron Deficiency Anaemia

10Slide11

Iron and Calcium Deficiencies Contribute to Maternal Deaths

Series confirms anaemia is a risk factor for maternal deaths, most likely due to haemorrhage, the leading cause of maternal deaths (23% of total deaths)

Calcium deficiency increases the risk of pre-eclampsia, currently the second leading cause of maternal death (19% of total deaths)11

Addressing these deficiencies could result in substantial reduction of maternal deathsSlide12

Evidence

Highlights Importance of Nutritional Status in Women Before and During PregnancyShort maternal stature may lead to obstructed labour and maternal and fetal or neonatal deathMaternal

stunting and low Body Mass Index increases the risk of fetal growth restriction (small for gestational age)Maternal obesity leads to gestational diabetes, pre-eclampsia, haemorrhage and higher risk of neonatal and infant death

12Slide13

Prevalence of SGA Births

32.4 million babies were born SGA in 2011; 27% of all births in LMICs

13Slide14

Risks of SGA for Mortality and Preterm Birth for Neonatal Mortality

14

Reductions in child mortality could be achieved by targeting interventions to reach babies born too small or too soonSlide15

Risk of SGA for Stunting

15

20% of stunting by

24 months can be attributed to being SGASlide16

Child NutritionSlide17

Stunting Rate is Slowly Decreasing

Figure 417

165 million children under five are stunted (25.7%)

2.1%

annual rate of reduction is not fast enough to reach WHA target Slide18

Prevalence of Wasting and Severe Wasting in Children <5 Years Old by UN Regions, 2011

52 million children under 5 are

wasted,

19 million severely wasted

18Slide19

Child Obesity on the Rise

19Slide20

Micronutrient Deficiencies

Deficiencies of essential vitamins and minerals continue to be widespread and have significant adverse effects on child survival and development, as well as maternal healthDeficiencies of vitamin A and zinc adversely affect child health and survival, and deficiencies of iodine and iron, together with stunting, contribute to children not reaching their developmental potential

Significant progress has been made in addressing vitamin A deficiency but efforts must continue at current coverage levels to avoid backsliding because dietary intake of vitamin A is still inadequate

20Slide21

When

Coupled with Infectious Diseases, Wasting Increases Hazard of Death21

NEED TO INSERT

 Weight-for-Length

Z-ScoreAll Deaths

HR (95% CI)

Pneumonia DeathsHR

(95% CI)Diarrhoea Deaths

HR (95% CI)

Measles Deaths HR

(95% CI)Other Infectious DeathsHR

(

95% CI)< -311.6 (9.8, 13.8)

9.7(

6.1, 15.4

)

12.3

(

9.2, 16.6)

9.6

(

5.1, 18.0)

11.2

(

5.9, 21.3)

-3 to < -2

3.4

(

2.9, 4.0

)

4.7

(

3.1, 7.1)

3.4

(

2.5, 4.6)

2.6

(

1.3, 5.1)

2.7

(

1.4, 5.5)

-2 to < -1

1.6

(1.4

, 1.9

)

1.9

(

1.3, 2.8)

1.6

(

1.2, 2.1)

1.0

(

0.6, 1.9)

1.7

(

1.0, 2.8)

-

1

1.0

1.0

1.0

1.0

1.0Slide22

When

Coupled with Infectious Diseases, Stunting Increases Hazard of Death22

NEED TO INSERT

 Height/Length-for-Age

Z-ScoreAll Deaths

HR (95% CI)

Pneumonia DeathsHR (95% CI)

Diarrhoea Deaths HR

(95% CI)

Measles Deaths HR (

95% CI)Other Infectious DeathsHR (95% CI)

< -3

5.5 (4.6, 6.5) 6.4

(4.2, 9.8) 6.3

(

4.6, 8.7)

6.0

(

3.0, 12.0)

3.0

(

1.6, 5.8)

-3 to < -2

2.3

(

1.9, 2.7)

2·2

(

1.4, 3.4)

2.4

(

1.7, 3.3)

2.8

(

1.4, 5.6)

1.9

(1.0

, 3.6)

-2 to < -1

1.5

(1.2, 1.7)

1.6

(

1.0, 2.4)

1.7

(

1.2, 2.3)

1.3

(

0.6, 2.6)

0.9

(

0.5, 1.9)

> -1

1.0

1.0

1.0

1.0

1.0Slide23

Prevalence of Stunting and Overweight for Highest and Lowest Wealth Quintiles in Selected Countries

23Slide24

Breastfeeding Practices by UN Region During 2000-2010

24

Exclusive

breastfeeding only about 30% or less in major UN regionsSlide25

Child Mortality Due to Nutritional Disorders

25

Nutritional Disorders

Attributable deaths with UN prevalences*

Proportion of total deaths of children younger than 5 years

Fetal growth restriction (<1 month)

817,000

11.8%

Stunting (1-59 months)

1,017,000*

14.7%

Underweight (1-59 months)

999,000*

14.4%

Wasting (1-59 months)

Severe

Wasting (1-59 months)

875,000*

516,000*

12.6%

7.4%

Zinc deficiency (12-59 months)

116,000

1.7%

Vitamin A deficiency (6-59 months)

157,000

2.3%

Suboptimum breastfeeding (0-23

months)

804,000

11.6%

Joint effects of fetal growth restriction and

suboptimum breastfeeding in neonates

1,348,000

19.4%

Joint effects of fetal growth restriction, suboptimum

breastfeeding, stunting, wasting, and vitamin A and zinc deficiencies (<5 years)

3,097,000

44.7%

Data are to the nearest thousand. *Prevalence estimates from the UN.Slide26

Child Deaths Attributed to Nutritional Conditions

Undernutrition (fetal growth restriction, sub-optimal breastfeeding, stunting, wasting and deficiencies of vitamin A and zinc) is responsible for 45% of all under five child deaths, representing more than 3 million deaths each year (3.1 million of the 6.9 million child deaths in 2011)

Fetal growth restriction and sub-optimal breastfeeding together are responsible for more than 1.3 million deaths, or 19.4% of all under five child deaths, representing 43.5% of all nutrition-related deaths Deficiencies of vitamin A and zinc are responsible for nearly 300,000 child deaths

26Slide27

Paper 1 Key Messages

Short stature, low BMI and vitamin and mineral deficiencies in pregnancy contribute to maternal morbidity and mortality, fetal growth restriction, infant mortality and stunted growth and development Stunting of growth in the first 2 years of life affects 165 million children who have elevated risk of mortality, cognitive deficits and increased risk of adult obesity and non-communicable diseases

Vitamin A and zinc deficiencies in young children increase the risk of death from infection and other micronutrients have important developmental consequencesThis new evidence strengthens the case for a continued focus on the critical 1,000 day window during pregnancy and the first two years of life, highlighting the importance of intervening early in pregnancy and even prior to conception

27