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Evidence Based Interventions for Improving Maternal and Child Nutrition:

Evidence Based Interventions for Improving Maternal and Child Nutrition: What Can be Done and at What Cost?

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Evidence Based Interventions for Improving Maternal and Child Nutrition:

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  1. Evidence Based Interventions for Improving Maternal and Child Nutrition: What Can be Done and at What Cost? Zulfiqar A Bhutta1,2, Jai K Das1, Arjumand Rizvi1, Michelle Gaffey2, Neff Walker3, Sue Horton4, Patrick Webb5, Anna Lartey6, Robert E Black for Lancet Maternal and Child Nutrition & Interventions Review Groups 1 The Aga Khan University and Medical Center, Karachi, Pakistan 2Hospital for Sick Children (Sick Kids), Toronto , Canada 3 Johns Hopkins University, Baltimore, USA 4 University of Waterloo, Canada 5 Tufts University, Boston, USA 6 University of Ghana, Ghana

  2. Nutrition-Specific Interventions and Programs: How can they Help Accelerate Progress in Improving Maternal and Child Nutrition?

  3. Furthering the Evidence Base to Improve Maternal and Child Nutrition • Since 2008 Lancet Series, many nutrition interventions have been successfully implemented at scale, and the evidence base for effective interventions and delivery strategies has grown; coverage rates for other interventions are either poor or non-existent • The evidence base for nutrition specific and sensitive interventions was updated & enhanced • Ten nutrition-specific interventions across the life cycle to address undernutrition and micronutrient deficiencies in women and children were modelled to assess impact and cost of scaling up

  4. Interventions Across the Lifecycle

  5. Nutrition Interventions Reviewed

  6. Delivery Platforms Reviewed

  7. Delivery Platforms Reviewed

  8. Breast Feeding Promotion-Effects on breast feeding rates Effects on exclusive breastfeeding rates Effects on NOT breastfeeding

  9. Behavior Change Communication for Improved Complementary Feeding

  10. Behavior Change Communication for Improved Complementary Feeding

  11. Behavior Change Communication for Improved Complementary Feeding

  12. Micronutrient interventions in childhood • Vitamin A Supplementation: Reduces all-cause mortality (RR 0·76, 95% CI 0·69–0·83), diarrhoea-related mortality (RR 0·72, 95% CI 0·57–0·91), incidence of diarrhoea (RR 0·85, 95% CI 0·82–0·87) and incidence of measles (RR 0·50, 95% CI 0·37–0·67) • Preventive Zinc Supplementation:Reduces incidence of diarrhoea RR: 0.87 (95% CI 81–94) and pneumonia RR: 0.81 (95% CI 0.73–0.90) and improves mean height gain by 0·37 cm (SD 0·25) • Iron Supplementation: Reduces anaemia (RR 0·51, 95% CI 0·37–0·72), increases haemoglobin concentration (MD 5·20 g/L, 95% CI 2·51–7·88) and ferritin concentration (MD 14·17 mcg/L, 95% CI 3·53–24·81). Developmental benefits mainly in school age children. • Micronutrient Powders: Reduce anaemia (RR 0·66, 95% CI 0·57–0·77), retinol deficiency (RR 0·79, 95% CI 0·64–0·98) and improve haemoglobin concentrations (SMD 0·98, 95% CI 0·55–1·40). Further evaluation of safety needed when used at scale

  13. LiST modeling effects on mortality for 34 high burden countries: revised model

  14. Modeling the Impact of Interventions: What’s New?

  15. Countries With High Burden of Malnutrition These 34 countries account for 90% of the global burden of malnutrition

  16. Effect of Scale-up Interventions onCause-specific Deaths

  17. Impacts Mortality in children younger than 5 years could be reduced by 15% (range 9-19%) • 35% (19-43) reduction in diarrhoea-specific mortality • 29% (16-37) reduction in pneumonia-specific mortality • 39% (23-47) reduction in measles-specific mortality • Reduced deaths due to asphyxia and congenital anomalies • Little effect on maternal mortality Stunting overall reduced by at least 20.3% (range 11.1-28.9%) Severe wasting reduced overall by 61.4% (range 35.7-72%)

  18. Effect of Scale-up Interventions on Deaths in Children Younger than 5 Years

  19. Packages of Nutrition Interventions

  20. Effect of Packages of Nutrition Interventions at 90% Coverage

  21. Can community based nutrition programs reach the poor?

  22. All Community Platforms • Maternal mortality (RR 0.81; 95% CI: 0.59 to 1.11) • Maternal morbidity (RR 0.75; 95% CI 0.61 to 0.92) • Neonatal deaths (RR 0.74; 95% CI 0.66 to 0.83) • Stillbirths (RR 0.79; 95% CI 0.70 to 0.90) • Perinatal mortality (RR 0.74; 95% CI 0.66 to 0.84)

  23. All Community Platforms • Maternal mortality (RR 0.81; 95% CI: 0.59 to 1.11) • Maternal morbidity (RR 0.75; 95% CI 0.61 to 0.92) • Neonatal deaths (RR 0.74; 95% CI 0.66 to 0.83) • Stillbirths (RR 0.79; 95% CI 0.70 to 0.90) • Perinatal mortality (RR 0.74; 95% CI 0.66 to 0.84) • Facility births (RR 1.28; 95% CI 1.04 to 1.59) • Breastfeeding rates 125% (RR 2.25; 95% CI 1.70 to 2.97) • Skilled care births (RR 1.59; 95% CI 0.64 to 3.95) • Iron/folate supplementation (RR 1.47; 95% CI 0.99 to 2.17).

  24. Community based Interventions Modeled • Multiple micronutrient supplementation in pregnancy • Promotion of breastfeeding • Promotion of appropriate complementary feeding • Vitamin A supplementation • Preventive zinc supplementation • Treatment of diarrhoea with zinc • Recognition and management of severe acute malnutrition

  25. Equity Analysis of Effect of Scale Up Nutrition Interventions

  26. Potential Impact of Scaling Up 10 Proven Interventions Continued investment in nutrition-specific interventions and delivery strategies to reach poor segments of the population at greatest risk can make a significant difference If these 10 proven nutrition-specific interventions were scaled-up from current population coverage to 90%, we could: • Save an estimated 900,000 lives in 34 high burden countries (where 90% of the world’s stunted children live) • Reduce the number of children with stunted growth and development by 33 million On top of existing trends, the WHA targets for 2025 are reachable

  27. Total Additional Annual Cost of Achieving 90% Coverage with Nutrition Interventions Data are 2010 international dollars, millions.

  28. Paper 2 Key Messages Promising interventions exist to improve maternal nutrition and reduce fetal growth restriction and small-for-gestational age (SGA) births in appropriate settings in developing countries, if scaled up A set of 10 evidence-based interventions if implemented at scale can save at least 15% of under 5 child deaths (i.e. 1 million lives saved) and avert a fifth of all stunting Delivery strategies exist to especially target undernutrition and impact child mortality among the poorest The costs for scaling up these nutrition specific interventions globally is $9.6 billion, affordable given the gains A clear need and opportunity exists to introduce promising evidence-based interventions in the preconception period and adolescents and also address the impact on long-term neurodevelopmental outcomes

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