4th National Seminar on Food Security and
Nutrition
Nutrition
a critical investment in human and economic development
Institut de Recherche pour le Développement (IRD)
Frank Wieringa MD PhD
A Nutritionist view of Development
MALNUTRITION
STUNTING
PREVENTION
FORTIFICATION
SANITATION
MORBIDITY / MORTALITY
HEALTH
REPRODUCTIVE HEALTH
Mother Child Health
CHRONIC DISEASE
Diabetes/ Hypertension
ECONOMIC
DEVELOPMENT
CULTURE / BELIEFS
GENDER ISSUES
FISHERY
AGRICULTURE
NUTRITION
FOOD SAFETY
HUMAN RIGHTS
EDUCATION
HOUSEHOLD
ECONOMICS
POVERTY
HUMAN DEVELOPMENT
HUMAN POTENTIAL
MILLENIUM DEVELOPMENT GOALS
A NON- Nutritionist view …….
MALNUTRITION
STUNTING
CULTURE / BELIEFS
GENDER ISSUES
SANITATION
MORBIDITY / MORTALITY
FOOD SAFETY
HEALTH
AGRICULTURE
REPRODUCTIVE HEALTH
Mother Child Health
CHRONIC DISEASE
Diabetes/ Hypertension
ECONOMIC
DEVELOPMENT
PREVENTION
FORTIFICATION
FISHERY
NUTRITION
POVERTY
EDUCATION
HOUSEHOLD
ECONOMICS
HUMAN RIGHTS
HUMAN DEVELOPMENT
HUMAN POTENTIAL
MILLENIUM DEVELOPMENT GOALS
Problems/Challenges
So how to get Nutrition on the Agenda of
Human and Economic Development…..
Nutrition and Human Development
NUTRITION in relation to:
1. HEALTH
2. EDUCATION
3. POVERTY
Nutrition and Human Development:
HEALTH
SOME SOBERING FACTS......
Malnutrition accounts for 50% of the
deaths from infectious diseases......
or ⅓ of all-cause child mortality......
Causing 2.6 million child-deaths / year
Annex Table 14 Major burden of disease -- 10 selected risk factors and 10 leading diseases and injuries, 2000
Developing countries with high child and high or very high adult mortality (AFR-D, AFR-E, AMR-D, EMR-D, SEAR-D)
Risk factor
% DALYs
Disease or injury
% DALYs
Underweight
14.9
HIV/AIDS
9.0
Unsafe sex
10.2
Lower respiratory infections
8.2
Unsafe water, sanitation and hygiene
5.5
Diarrhoeal diseases
6.3
Indoor smoke from solid fuels
3.7
Childhood cluster diseases
5.5
Zinc deficiency
3.2
Low birth weight
5.0
3.1
Malaria
4.9
Vitamin A deficiency
3.0
Unipolar depressive disorders
3.1
Blood pressure
2.5
Ischaemic heart disease
3.0
Tobacco
2.0
Tuberculosis
2.9
Cholesterol
1.9
Road traffic injury
2.0
Iron deficiency
a
1-24% population attributable fraction
25-49% population attributable fraction
50%+ population attributable fraction
a
Underweight contributes to
15% of ‘DALY’s’ in DC...
Micronutrient deficiencies
(Vit A, zinc, iron)
another 9% .......
Nutrition and Human Development:
HEALTH
SOME SOBERING FACTS .......
 Vitamin A + zinc deficiency alone account > 1 million
child deaths / yr
 Iodine deficiency in pregnancy acounts for ~20,000,000
mentally retarded infants / yr
 Folate deficiency is causing ~200,000 severe birth
defects / yr
 Severe iron deficiency causes ~50,000 maternal death / yr
Nutrition and Human Development:
HEALTH
Vitamin & Mineral Deficiency – Global Damage Assessment Report
Micronutrient Initiative & UNICEF, 2004
Nutrition and Human Development:
EDUCATION
Learning is difficult when you are hungry:
Not only because you cannot concentrate, but
also because your learning capability is reduced
and you are more often ill
SOME SOBERING FACTS......
 Iodine deficiency lowers IQ by 10 – 15 points
 Iron deficiency in 6 – 24 mo old children impairs
mental development in 40 – 60% of developing world’s
children
Nutrition and Human Development:
EDUCATION
Prevalence of stunting
is directly related to
female enrollment in
secondary education....
And maternal nutritional
status affects learning
capabilities of their
children..... for their
whole life.......
Nutrition and Human Development:
POVERTY REDUCTION
Malnutrition during the first 2 years of life is
associated with ~20% lower income in adulthood
 in Guatamala, a nutritional intervention during the first
3 years of life resulted in 46% higher wages 15 yrs later
Nutrition and Economic Development
Iron deficiency lowers the productivity of workforces
with estimated losses of up to 2% of GDP
 World Bank: “Micronutrient deficiencies impose high
economic costs on virtually every developing nation.”
Nutrition and the MDG’s
NUTRITION
Nutrition and Economic Development
FOR EVERY $1 SPEND ON NUTRITION.......
 $15 IN RETURN...
Problems/Challenges
So how to get Nutrition on the Agenda of Human
and Economic Development…..

√ YES!
Problems/Challenges
So how to get Nutrition on the Agenda of Human
and Economic Development…..

√ YES!
Are there solutions?
What is the best way forward for Cambodia?
Solutions …YES!
…many
Solutions
Integrated, multi-sectorial approach
 life-cycle approach
Life cycle approach…..
Adoloscent girls
School children
Young Children
Women of Reproductive Age
Pregnant women
Infants
Lactating women
Life cycle approach…..
FOOD FORTIFICATION: OIL, FISH SAUCE, RICE
NUTRITION EDUCATION
Adoloscent girls
Women of Reproductive Age
WEEKLY IRON / FOLATE SUPPLEMENTS
SCHOOL MEALS /
DEWORMING
School children
Pregnant women
DAILY IRON / FOLATE SUPPLEMENTS
EXCLUSIVE BREAST
DELAYED CORD FEEDING FOR 6
CLAMPING
MONTHS
Young Children
Infants
Lactating women
HIGH QUALITY
COMPLEMENTARY
FOODS
Is (fast) progress feasible?
Is fast progress feasible? YES!
COMPARISON OF STUNTING PREVALENCE
Is (fast) progress feasible? YES!
Prevalence of underweight per province Vietnam
1999
2010
National plans of Action for Nutrition
NPAN 1995-2000
NNS 2001-2010
Conclusions and way forward
• Nutrition and Development go hand-in-hand
Conclusions
អរគុណ់
thank you
អរគុណ់