Page 1

The PepsiCo Foundation MeetingMarch 31, 2008

The PepsiCo Foundation

Addressing Malnutrition

Toby StillmanAdvisor, Emergency Health and Nutrition

2Page 2

• Review measures of undernutrition

• Review causes and consequences of undernutrition

• Introduce Save the Children’s operational approach to nutrition programming

– Children under the age of five

– School aged children

Outline

Page 3

Measures of Undernutrition Review

Stunting (Chronic)

Underweight(Both)

Wasting (Acute)

Index Height for Age

Weight for Age

Weight for Height or MUAC

Moderate

< -2 SD < -2 SD < -2 SD

Severe < - 3 SD < - 3SD < - 3SD

Page 4

Measures of Undernutrition Stunting:Height For Age

Page 5

Measures of Undernutrition Stunting:Weight For Age

Page 6

Measures of Undernutrition Wasting:Weight for Height

Marasmus (wasting) Kwashiorker (oedema)

Page 7

Measures of UndernutritionMid-upper Arm Circumference

Page 8

Measures of Undernutrition:Micronutrient deficiencies

• Vitamin A

• Zinc

• Iron

• Iodine

9Page 9

UndernutritionWhat are the Consequenses?

Pneumonia

19%

Diarrhea

17%

Malaria

8%Measles

4%

Aids

3%

Injuries

3%

Other

10%

Newborn

36%

Under-nutrition

• 35% to 55% of Child Mortality (children <5)

• Adult Size

• Intellectual Ability

• Economic Productivity

• Reproductive Performance

• Metabolic and Cardiovascular DiseaseIs build right? Why first bullet alone?

Page 10

UndernutritionWhen does it Happen?

First 2 years of life

Page 11

UndernutritionWhere does it Happen?

Page 12

Undernutrition Where does it Happen?

¾ of the world’s

underweight children reside in just 10

countries

Page 13

UndernutritionHow does it Happen?

Outcome Under-Nutrition

ImmediateCauses

InadequateDietary Intake Disease

UnderlyingHealth /NutritionCauses

Inadequate Care for Mothers

and Children

InsufficientAccess to Food

Lack of health services & unhealthy environment

Page 14

Addressing UndernutritionInterventions (1)

Page 15

3947

4030

20

55

0102030405060708090

100

Exclusive BF Water,

Sanitation,

Hygiene

Treatment

(pneumonia)

Treatment

(diarrhea)

Oral

rehydration

therapy

Vitamin A

Addressing UndernutritionInterventions (2)

Source: Lancet Volume 362, PP. 65-71

The Coverage Gap

Page 16

Intended Impact:

Children are Healthy and Well-Nourished

Strategic Objective Increased Use of Key Health and Nutrition Practices and Services

Addressing UndernutritionSC Results Framework

Page 17

Addressing UndernutritionSC Priority Interventions

Practices Services

Nu

trition

• Immediate Breastfeeding

• Exclusive Breastfeeding through 6 months of age

• Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.)

• Vitamin A supplementation (Maternal and Child)

• Iron supplementation

• Iodine supplementation

Health

• Proper disposal of feces

• Hand washing at appropriate times• Appropriate home care for Illness,

including oral rehydration therapy for children with diarrhea

• Timely referral of seriously ill children

• Measles immunization

• Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea

Page 18

Intended Impact:

Children are Healthy and Well-Nourished

Strategic Objective Increased Use of Key Health and Nutrition Practices and

Services

Behaviors

Addressing UndernutritionSC Results Framework

Page 19

Strategic Objective Increased Use of Key Health and Nutrition Practices and

Services

Behaviors

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intermediate Result 3:Increased

Knowledge, Attitudes, and

Skills

Intermediate Result 4:

Enabling Social &

Policy Environment

Intermediate Result 2:

Increased Quality

Of Services

Intended Impact:

Children are Healthy and Well-Nourished

Addressing UndernutritionSC Results Framework

Page 20

Addressing UndernutritionMonitoring our Progress

Increased use of key health and nutrition practices and services

Improved Access

Strategies

Activities

Impacts

Outcomes

Time

Longer Term

Medium Term

Shorter Term

Children are healthy and well nourished% children <5 stunted

% children with diarrhea

% women exclusively breastfeeding

% children receiving timely care for illness

% population within 5 km of health care facility

Inputs & Outputs

# of community health workers trained in BCC

Improved Quality% children diagnosed and treated according to protocol

Improved KA&S% husbands supporting exclusive breastfeeding

Improved PoliciesNational policy on management of acute malnutrition in place

Page 21

Addressing UndernutritionSC Priority Interventions (1)

Practices Services

Nu

trition

• Immediate Breastfeeding

• Exclusive Breastfeeding through 6 months of age

• Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.)

• Vitamin A supplementation (Maternal and Child)

• Iron supplementation

• Iodine supplementation

Health

• Proper disposal of feces

• Hand washing at appropriate times• Appropriate home care for Illness,

including oral rehydration therapy for children with diarrhea

• Timely referral of seriously ill children

• Measles immunization

• Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea

Page 22

Intended Impact:

Children are Healthy and Well-Nourished

Addressing UndernutritionSC Priority Interventions (1)

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intermediate Result 3:Increased

Knowledge, Attitudes, and

Skills

Intermediate Result 4:

Enabling Social & Policy Environment

Intermediate Result 2:Increased

Quality Of Services

Strategic Objective Increased Use of Key Health and Nutrition Practices and

Services

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intermediate Result 3:Increased

Knowledge, Attitudes, and

Skills

Intervention: Timely introduction of appropriate complementary foods

Page 23

Complementary FeedingIR 3: Knowledge, Attitudes, and Skills

• Formative Research (E.g. TIPS, PD)

• Mother to mother support groups

• Growth monitoring and promotion

• Mass Communication

• PD/Hearth

Why does IR3 come before IR1 on next page?

Page 24

Complementary FeedingIR 1: Access to Food

• Resource transfers for the most vulnerable

• Food and/or nutrient supplements

• Micro-credit programs

• Food production and income generation (sustainable agriculture)

– Inputs and services: agricultural inputs, financial services, access to markets

– Improved practices: training and entrepreneurshipWhat should be under sustainable ag—

you trailed off, see word in green

Page 25

Addressing UndernutritionSC Priority Interventions (2)

Practices Services

Nu

trition

• Immediate Breastfeeding

• Exclusive Breastfeeding through 6 months of age

• Timely introduction of appropriate complementary foods (Frequency of feeds, quality of feeds, etc.)

• Vitamin A supplementation (Maternal and Child)

• Iron supplementation

• Iodine supplementation

Health

• Proper disposal of feces

• Hand washing at appropriate times• Appropriate home care for Illness,

including oral rehydration therapy for children with diarrhea

• Timely referral of seriously ill children

• Measles immunization

• Timely appropriate treatment of ARI, diarrhea, malaria, and malnutrition including zinc therapy for diarrhea

Why isn’t 2nd last bullet on bottom left—home care for diarrheaBolded under this intervention?

Page 26

Intended Impact:

Children are Healthy and Well-Nourished

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intermediate Result 3:Increased

Knowledge, Attitudes, and

Skills

Intermediate Result 4:

Enabling Social & Policy Environment

Intermediate Result 2:Increased

Quality Of Services

Strategic Objective Increased Use of Key Health and Nutrition Practices and

Services

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intervention: Timely appropriate care for ARI, Diarrhea, Malaria, and Malnutrition

Addressing UndernutritionSC Priority Interventions (2)

Page 27

Take services closer to the population

• The community health worker as prescriber for pneumonia, diarrhea, and malaria

“Community Case Management”

• Front-line health workers as providers of first choice for severe acute malnutrition

Community-based Management Of Acute Malnutrition

Timely, Appropriate CareIR 1: Access to Treatment

Page 28

SC Child Nutrition ProgramsProducing Results• Mozambique (2002 – 2007)

– Exclusive breastfeeding increased from 5% to 74%– Months of adequate food provisioning from 7.9 to 10.7 months

• Bangladesh (2005 – 2007)– Underweight reduced from 52% to 44% in first 2 years of program

• Vietnam – Immediate breastfeeding increased from 74% to 92%– Exclusive breastfeeding increased from 39% to 52%

• Bolivia (2002 – 2007)– Reduced stunting from 37% to 30.2% – Exclusive breastfeeding increased from 75% to 83%

• Nicaragua (2002 – 2007)– Reduced stunting from 20.5% to 9.6% – Exclusive breastfeeding increased from 37% to 84%

Page 29

The School-aged ChildOutcomes of Interest

Growth Educational Attainment

The equivalent of 200 million school years are lost each year in low income countries as a result of poor health and nutrition – World BankIs the build on this right—why words at top come in later?

Page 30

Intended Impact:

Children are well educated

The School Aged ChildSC Results Framework

Strategic Objective Increased Use of Key Health and Nutrition Practices and Services

Page 31

The School Aged ChildSC Priority Interventions

• Micronutrient supplementation: Vitamin A, Iron, Iodine

• De-worming

• Proper disposal of excreta and hand washing at appropriate times

• Health and Nutrition education

• Alleviation of short-term hunger

Page 32

Nutrition in the School-aged Child

Intermediate Result 1:Increased

Access to, & Availability of, Services and

Supplies

Intermediate Result 3:Increased

Knowledge, Attitudes, and

Skills

Intermediate Result 4:

Enabling Social & Policy Environment

Intermediate Result 2:Increased

Quality Of Services

Strategic Objective Increased Use of Key Health and Nutrition Practices and Services

Intended Impact:

Children are well educated