Improving Child Nutrition: the Achievable Imperative

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Improving Child Nutrition: the Achievable Imperative IMPROVING CHILD NUTRITION The achievable imperative for global progress © United Nations Children’s Fund (UNICEF) April 2013 Permission is required to reproduce any part of this publication. Permission will be freely granted to educational or non-profit organizations. Others will be requested to pay a small fee. For permission please contact: Division of Communication, UNICEF Attention: Permissions, H-6F 3 United Nations Plaza, New York, NY 10017 USA Tel: +1 (212) 326-7434 Email: [email protected] This report and any corrigenda subsequent to printing are available at www.unicef.org/publications/index.html ISBN: 978-92-806-4686-3 eISBN: 978-92-806-4689-4 United Nations Publications Sales No.: E.13.XX.4 Photo credits Cover: © UNICEF/NYHQ2010-3063/Pirozzi Page 1: © UNICEF/INDA2012-00208/Vishwanathan Page 2: © UNICEF/NYHQ2010-3088/Pirozzi Page 3: © UNICEF/NYHQ2010-3087/Pirozzi Page 7: © UNICEF/NYHQ2009-0812/Ramoneda Page 17: © UNICEF/NYHQ2011-0385/Asselin Page 28: © UNICEF/Kyrgyzstan/2009/Gorshkova Page 33: © UNICEF/NYHQ2012-1793/Sokol Page 34: © UNICEF/NYHQ2008-1577/Pirozzi Page 39: © UNICEF/NYHQ2012-0577/Ose Page 40: © UNICEF/NYHQ2008-1373/Pietrasik Page 42: © UNICEF/NYHQ2006-2243/Pirozzi Page 44: © UNICEF/BANA2011-00682/Sujan Page 47: © UNICEF/NYHQ1998-1166/Noorani Page 49: © UNICEF/NYHQ2012-0178/Asselin Page 51: © UNICEF/NYHQ2008-1390/Pietrasik Page 55: © UNICEF/NYHQ2012-0353/Asselin Page 113: © UNICEF/INDA2012-00201/Vishwanathan IMPROVING CHILD NUTRITION The achievable imperative for global progress CONTENTS FOREWORD �������������������������������������������������������������������������������������������������������������������������������������iii KEY MESSAGES �����������������������������������������������������������������������������������������������������������������������������iv CHAPTER 1: INTRODUCTION ���������������������������������������������������������������������������������������������������������1 CHAPTER 2: CAUSES AND CONSEQUENCES OF UNDERNUTRITION ���������������������������������������3 CHAPTER 3: CURRENT STATUS OF NUTRITION ��������������������������������������������������������������������������7 Stunting ���������������������������������������������������������������������������������������������������������������������������������������������8 Underweight ������������������������������������������������������������������������������������������������������������������������������������ 12 Wasting ������������������������������������������������������������������������������������������������������������������������������������������� 13 Overweight �������������������������������������������������������������������������������������������������������������������������������������� 15 Low birthweight ������������������������������������������������������������������������������������������������������������������������������� 16 CHAPTER 4: INTERVENTIONS TO ADDRESS STUNTING AND OTHER FORMS OF UNDERNUTRITION ��������������������������������������������������������������������������������������� 17 Nutrition-specific interventions �������������������������������������������������������������������������������������������������������� 17 Maternal nutrition ����������������������������������������������������������������������������������������������������������������������� 18 Infant and young child feeding ���������������������������������������������������������������������������������������������������� 19 Prevention and treatment of micronutrient deficiencies �������������������������������������������������������������23 Prevention and treatment of severe acute malnutrition ��������������������������������������������������������������25 Water, sanitation and hygiene and access to health services�����������������������������������������������������26 Nutrition-sensitive approaches ��������������������������������������������������������������������������������������������������������26 Maintaining the focus on equity ������������������������������������������������������������������������������������������������������27 CHAPTER 5: IT CAN BE DONE: SUCCESS STORIES IN SCALING UP NUTRITION ������������������28 Ethiopia: Reducing undernutrition with national planning ����������������������������������������������������������������28 Haiti: Expanding nutrition services in an emergency �����������������������������������������������������������������������30 India: Improving nutrition governance to reduce child stunting in Maharashtra ������������������������������31 Nepal: Making steady progress for women and children ����������������������������������������������������������������32 Peru: Reaching the most disadvantaged by concentrating on equity ����������������������������������������������35 Rwanda: Reducing stunting through consolidated nationwide action ���������������������������������������������37 Democratic Republic of the Congo: Scaling up community-based management of severe acute malnutrition ����������������������������������������������������������������������������������38 Sri Lanka: Reducing under-five mortality by expanding breastfeeding ��������������������������������������������40 Kyrgyzstan: Reducing iron deficiency with home fortification of food ���������������������������������������������41 United Republic of Tanzania: Institutionalizing vitamin A supplementation �������������������������������������43 Viet Nam: Protecting breastfeeding through legislation ������������������������������������������������������������������45 CHAPTER 6: NEW DEVELOPMENTS IN GLOBAL PARTNERSHIPS ��������������������������������������������47 CHAPTER 7: THE WAY FORWARD �������������������������������������������������������������������������������������������������49 REFERENCES ���������������������������������������������������������������������������������������������������������������������������������52 NUTRITION PROFILES: 24 COUNTRIES WITH THE LARGEST BURDEN AND HIGHEST PREVALENCE OF STUNTING ��������������������������������������������������������������������������������������������������������55 Infant and young child feeding indicators and area graphs ������������������������������������������������������������ 104 Definitions of indicators ����������������������������������������������������������������������������������������������������������������� 106 Data sources ����������������������������������������������������������������������������������������������������������������������������������111 STATISTICAL TABLES������������������������������������������������������������������������������������������������������������������� 113 Table 1: Country ranking based on number of stunted children �����������������������������������������������������114 Table 2: Demographic and nutritional status indicators ������������������������������������������������������������������116 Table 3: Infant and young child feeding practices and micronutrient indicators ����������������������������� 120 Regional classification and general note on the data ��������������������������������������������������������������������� 124 ii Improving Child Nutrition FOREWORD Poor nutrition in the first 1,000 days of children’s lives More and more countries are scaling up their nutrition can have irreversible consequences. For millions of programmes to reach children during the critical period children, it means they are, forever, stunted. from pregnancy to the age of 2. These programmes are working. Countries that are reaching mothers Smaller than their non-stunted peers, stunted children and children with effective nutrition and related are more susceptible to sickness. In school, they interventions during the first 1,000 days are achieving often fall behind in class. They enter adulthood more results. Stunting and other forms of undernutrition likely to become overweight and more prone to are decreasing. non-communicable disease. And when they start work, they often earn less than their non-stunted co-workers. But we must still reach millions of mothers and their children, especially those in the hardest to reach It is difficult to think of a greater injustice than robbing areas. Urgently. a child, in the womb and in infancy, of the ability to fully develop his or her talents throughout life. The World Health Assembly has set the goal of achieving a 40 per cent reduction in the number of This is a tragedy for the 165 million children under stunted children under 5 years old by 2025, or around the age of 5 afflicted by stunting in the world today. 70 million children saved from the misery of stunting. It is a violation of their rights. It is also a huge burden for nations whose future citizens will be neither as This report shows that we can attain that target. healthy nor as productive as they could have been. Countries like Ethiopia, Haiti, Nepal, Peru and Rwanda are leading the way, quickly scaling up And let us not forget the tens of millions of children equity-focused initiatives. Committed to results, around the world who are vulnerable to the ravages they are achieving progress through advocacy, of life-threatening, severe acute malnutrition. Slowly, better allocation of resources and investments in treatment is expanding but, still, too many children tailored policies and programmes. remain out of its reach. About one third of under-five mortality is attributable to undernutrition. And where progress can be made, we have a moral obligation to do so. At last, the gravity of undernutrition and its
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