Stunting Reduction in Young Children

1. 2nd National Conference on Early Childhood Care and Education ‘Reconstructing Practices to Address Challenges and Trends in ECCE’ May 2-3, 2018 Stunting Reduction in Young Children

3. Regional Prevalence of Stunting

4. Child Stunting in Pakistan Stunting improved from 1965 (48%) to 1994 (36.3%) but deteriorated from 2001 (41.6%) to 2011 (43.7%).

5. Provincial comparison of stunting, wasting and severe wasting Newest MICS shows stunting rates above 41% in DI Khan and Bahawalpur 40% severe public health concern

7. Consequences of malnutrition • Physical • Increased mortality at all ages • Increased morbidity at all ages due to infections • Stunted children have more diabetes, cardiac and hypertensive diseases as adults • Mental • Poor cognitive development • Trans generational transfer of poor intellect

8. Consequences of malnutrition

9. Consequences of malnutrition • Adults who were stunted as children: • Earn 20% less as adults • Are 30% more likely to live in poverty • Children who are stunted: • Have on average 13 Points less IQ • More likely to drop out of school • Poor nations loose 2-11 % of their annual GDP

10. By Focusing on 1000 Days We can Prevent Stunting • The period from pregnancy to 24 months is the crucial window of opportunity to reduce undernutrition - program efforts should focus here

11. Lancet Series 2013 Global and Regional Exposures and Health Consequences • Maternal and Child under nutrition is underlying cause of 35% of deaths and disease burden in young children • Deaths attributed to stunting, severe wasting and intrauterine growth restriction constitutes the largest risk to children U5 • Suboptimal breastfeeding – especially in first 6 months results in 14% of deaths in children • Maternal short stature and iron deficiency anemia increases risk of death and accounts for 20% of maternal mortality

12. Thousand Days Approach- Key Nutrition Activities 2 years Birth 6 months 1 year Pregnancy Iron and Folic Acid Supplements Multi micronutrient Supplements Iodized salt Food Supplementation Exclusive Breastfeeding for 6 months Introduction Complementary Feeding Continued Breast Feeding for 2 years Multi micronutrient Supplementation (zinc) Vitamin A ( and deworming) Treatment of Malnutrition Initiation of breastfeeding within one hour

13. Thousand Days Approach- Key Nutrition Sensitive Activities 2 years Birth 6 months 1 year Pregnancy Improved availability, access use of local foods Improved sanitation/hygiene practices Antenatal care Social protection/social safety nets Promote increased marriage age Workplace protection for new mothers Hand washing with soap Improved sanitation and water Early Childhood Development Immunization Treatment of infectious diseases ( diarrhea and pneumonia) Deworming Improved food access/diversity Kangaroo care Birth registration Baby Friendly Hospitals

14. Nutrition Theory of Change Black et al, The Lancet 2008 371, 243-260DOI: (10.1016/S0140-6736(07)61690-0

15. Initiatives to address malnutrition • National multi-sectoral nutrition strategy in line with the already developed/endorsed provincial strategies • Ten point vision (2015) – RMNCAH and Nutrition strategy (focus on adolescent girls) • All PC 1s in provinces (Punjab, resource allocation in Sindh, KP & Balochistan)

16. Initiatives to address malnutrition (2) • Universal Salt iodization – legislation & implementation • CMAM and IYCF • National Fortification Alliance • Flour and vegetable oils fortification – partnership with the chambers of commerce in KPK, Sindh, Punjab, AJ&K • SUN (Scaling up Nutrition) • Breast feeding - legislation & implementation (Infant feeding boards)

17. Thank You