Poor maternal and child health and malnutrition
as a cause for structural damage of the brain and
cognitive development
Prepared and delivered by Leena Rammah
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Evidence shows - good health, nutrition of pregnant
women and young children, along with an appropriate
stimulation during the early years have an important
positive effect on cognitive development.
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Deeper analysis shows maternal health and nutrition
affects child’s health right from fetus brain
development till later stages.
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A concept that includes:
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Family planning
Prenatal, and postnatal care
Education provision
Health promotion
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Let us look at Health, Nutrition and Cognitive
Development during two major phases:
1. Prenatal phase
2. Postnatal phase
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Studies prove women with proper prenatal care have
better health results than women who miss PNC during
pregnancy.
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The health and the well being of women and their
children are inter-linked. This process requires a
substantial strengthening of the health system (DFID)
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Factors that affect mother’s and child’s health
and can damage brain development (prenatal)
Early or late age pregnancies
 Premature delivery
 Contact with potentially toxic substances (e.g. alcohol
tobacco, and drug abuse, etc.
 Existence of certain diseases (maternal measles,
toxoplasmosis,..)
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Factors that affect mother’s and child’s health
and can damage brain development (prenatal)
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Exposure to Radiation
Maternal attitudes and behaviors
Absence of skilled health personnel during delivery
High blood pressure (pre-eclampsia)
Intake of certain medication due to illness
Poor education
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Factors that affect mother’s and child’s health
and can damage brain development (perinatal)
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Intrauterine position
Obstructed labor and asphyxia
Prolonged labor
Obstetrical trauma
Pelvic fetus incompatibility
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The younger the age at pregnancy, the greater the health risks for
mother and child and the higher risk of infant mortality (60%)
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Children who survive are more likely to suffer from low
birth weight, under nutrition and delayed cognitive
development. (Lawn et al., 2006;UNICEF, 2008b; WHO, 2005).
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Factors that affect child’s health and can damage
brain development (postnatal)
Postnatal care is likewise important and includes:
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Child birth
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Newborn’s care
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ECD’s education
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Factors that affect child’s health and can damage
brain development (postnatal)
Poor disease prevention and vaccination
 Exposure to accidents
 Lack of physical activity
 Improper stimulation
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Factors that affect child’s health and can damage
brain development (postnatal)
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Lack of early education
Lack of psychological and social care
Lack of love and parents’ care, (bonding)
Existence of Infectious diseases (Meningitis,..)
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Maternal nutrition deficiency that affect brain
and cognitive development (prenatal)
Folic Acid deficiency
 Iron deficiency anemia (IDA)
 Iodine deficiency
 Omega 3 deficiency
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Child’s nutrition deficiency that affect brain and
cognitive development (postnatal)
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Iron deficiency and its effect upon brain and cognitive
development.
Iodine deficiency and its affects
Vitamin A deficiency.
Lack of exclusive breastfeeding till the age of six
months.
Insufficient supplementary food and of micronutrients
introduced after the age of six with continuation of
breast feeding well into the second year.
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How do poor maternal and child’s malnutrition
affect cognitive development? (Postnatal)
Iron deficiency has been clearly linked to cognitive deficits
in young children. Iron is critical for maintaining an adequate
number of oxygen-carrying red blood cells, which in turn are
necessary to fuel brain growth. (http://www.zerotothree.org/brainwonders).
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Children who are malnourished usually:
 are fussy eaters
 are deprived of adequate calories
 are deprived of protein in their diet
 experience insufficient growth in early years
 suffer from lasting behavioral and cognitive deficits,
including slower language and fine motor development, lowe
IQ, and poorer school performance. (www.zerotothree.org/brainwonders)
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How do poor maternal and child’s malnutrition affect
cognitive development? (Postnatal)
Breast milk contains all the amino and fatty acids needed
for brain development. Research has shown that babies
who are breast-fed as compared to babies who are formula
fed score higher on IQ tests.
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Child illness / malnutrition reduce cognitive development and
intellectual performance, school enrolment and attendance.
Intrauterine growth retardation and malnutrition during early
childhood have long term effects on body size and strength
with implication on productivity in adulthood (WHO 2006)
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Micronutrient deficiencies can severely affect early cognitive
development, including a loss of up to fifteen points on IQ test
even in moderate forms.
 Children are also affected by Vitamin A deficiency which
causes blindness, poor health and concentration (Victoria et al., 2008).
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Intervention with stunted children
IQ
110
non-stunted
Both
105
stimulated
supplemented
100
95
control
90
85
Baseline
6 mo
12 mo
18 mo
Grantham-McGregor et al, 1991
24 mo
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What is brain development in prenatal phase?
Average Brain Weights at
Different Times of
Development:
AGE
BRAIN WEIGHT
(grams)
20 weeks of gestation
Birth
18 months old
3 years old
Adult
100
400
800
1100
1300-1400
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Brain development in prenatal phase
The brain grows at an amazing rate during this period.
From the 3rd week of Intrauterine life 250,000 neurons
proliferate every minute.
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Neurons which are continuously firing or activated, through
stimulation will consolidate and strengthen over time.
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The child has by birth 100 Billion Neurons. For the brain to function in
proper way, these neurons have to be connected by synapses.
These synapses can be developed by:
1. Appropriate nutrition, especially breast feeding, that helps to form
myelin that cover the synapses and can allow the impulse to pass.
2. Early stimulation for the brain through interaction with the child.
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Through ECD, a child may form and reinforce over 1 trillion connections.
Combination between nutrition and stimulation
that can affect cognitive development
115
110
105
Adopted before the
age of 2
Adopted after the
age of 2
100
95
90
85
Severe
malnutrtion
Moderate
malntrtion
Well
nourished
Study on level of intelligence among orphaned Vietnamese girls
according to the level of nutrition.
American Journal of clinical nutrition 1977, 30
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Poor maternal health is associated with poverty
Poverty reduction
Intergenerational transmission of poverty
preschool child
low IQ, behaviour problems
poor stimulation,
nutrition & health
National
economy
school
poor school achievement
behaviour problems
adult
low education
low skilled / no work
high fertility
depressed/stressed
Lancet Paper 1, S Grantham-McGregor 2007
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Why invest in maternal health, newborn and
child health?
1. The value of women and children’s health.
2. Inexpensive ways to save lives of women and children
3. The economic soundness.
4. The political soundness, including social stability and
human security
5. The improvement of the health system.
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A key to beat poverty
Integration of disease prevention and care for mothers
newborns and children makes economic sense as it
maximizes benefits and minimizes costs for mothers,
newborns and children. Indeed high under 5 mortality and
morbidity and high level of malnutrition have a serious
economic and development cost. (DFID)
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Short-term distress in the form of rising malnutrition will
have negative long-term consequences for education.
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Situation analysis of health, education
Many countries lack programs addressing health, nutrition,
care, and education of children under 3, a critical period in life.
World
Arab States
Central/East. Europe
Sub-Saharan Africa
East Asia/Pacific
South/West Asia
L. America/Carib.
Central Asia
N. America/W. Europe
0%
50%
100%
Countries with at least one formal program for children under 3 in 2005 (%)
Source: EFA Global Monitoring Report 2007.
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 10%
of worldwide disease is caused by under nutrition
(WHO
2005)
 According
to 2007 MDG report, 84% of women who have
completed secondary or higher education are attended by
skilled personnel during child birth, more than twice the rate
of mothers with no formal education (UNICEF 2008)
 Children
of educated mothers are 50% more likely to survive
until the age of 5 and beyond than those whose mothers who
didn’t receive or complete schooling (UNICEF 2008)
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To advocate for services that should include:
 Education on safe motherhood.
 Promotion of maternal nutrition.
 Supplementation of micronutrient and tetanus toxoid,
where appropriate.
 Prenatal care and counseling.
 Delivery assistance in all cases by a skilled professional
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Care for obstetric emergencies, including referral for
pregnancy, childbirth, and abortion complications.
Postnatal care.
Promotion of longer intervals between births through
family counseling.
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Recommendations
Postnatal
care, including exclusive breast-feeding.
Early stimulation for the brain of the child through interaction
ECD as Holistic approach on policy level
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Mrs. Lara Hussain
Dr. Mahendra Sheth
Dr. Malak Zalouk
Mr. Moncef Moalla
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Thank you
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- World Family Organization