The PepsiCo Foundation Meeting March 31, 2008

1. Toby Stillman Advisor, Emergency Health and Nutrition The PepsiCo Foundation Meeting March 31, 2008 The PepsiCo Foundation Addressing Malnutrition

2. Review measures of undernutrition Review causes and consequences of undernutrition Introduce Save the Children’s operational approach to nutrition programming Children under the age of five School aged children Outline

3. Measures of Undernutrition Review

4. Measures of Undernutrition Stunting:Height For Age

5. Measures of Undernutrition Stunting:Weight For Age

6. Kwashiorker (oedema) Measures of Undernutrition Wasting:Weight for Height Marasmus (wasting)

7. Measures of UndernutritionMid-upper Arm Circumference

8. Measures of Undernutrition:Micronutrient deficiencies • Vitamin A • Zinc • Iron • Iodine

9. Under-nutrition UndernutritionWhat are the Consequenses? • 35% to 55% of Child Mortality (children <5) • Adult Size • Intellectual Ability • Economic Productivity • Reproductive Performance • Metabolic and Cardiovascular Disease Is build right? Why first bullet alone?

10. UndernutritionWhen does it Happen? First 2 years of life

11. UndernutritionWhere does it Happen?

12. Undernutrition Where does it Happen? ¾ of the world’s underweight children reside in just 10 countries

13. Inadequate Dietary Intake Immediate Causes Disease Underlying Health /Nutrition Causes InsufficientAccess to Food Inadequate Care for Mothers and Children Lack of health services & unhealthy environment UndernutritionHow does it Happen? Under-Nutrition Outcome

14. Addressing UndernutritionInterventions (1)

15. The Coverage Gap Addressing UndernutritionInterventions (2) Source: Lancet Volume 362, PP. 65-71

16. Addressing UndernutritionSC Results Framework Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intended Impact: Children are Healthy and Well-Nourished

17. Addressing UndernutritionSC Priority Interventions

18. Addressing UndernutritionSC Results Framework Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Behaviors Intended Impact: Children are Healthy and Well-Nourished

19. Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 2: Increased Quality Of Services Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Addressing UndernutritionSC Results Framework Intended Impact: Children are Healthy and Well-Nourished Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Behaviors

20. Time Longer Term Medium Term Shorter Term # of community health workers trained in BCC Inputs & Outputs Addressing UndernutritionMonitoring our Progress Impacts % children <5 stunted % children with diarrhea Children are healthy and well nourished % women exclusively breastfeeding % children receiving timely care for illness Increased use of key health and nutrition practices and services Outcomes % population within 5 km of health care facility Improved Access Improved Quality % children diagnosed and treated according to protocol Improved KA&S % husbands supporting exclusive breastfeeding Improved Policies National policy on management of acute malnutrition in place Strategies Activities

21. Addressing UndernutritionSC Priority Interventions (1)

22. Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 2: Increased Quality Of Services Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Addressing UndernutritionSC Priority Interventions (1) Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intervention: Timely introduction of appropriate complementary foods Intended Impact: Children are Healthy and Well-Nourished

23. Complementary FeedingIR 3: Knowledge, Attitudes, and Skills • Formative Research (E.g. TIPS, PD) • Mother to mother support groups • Growth monitoring and promotion • Mass Communication • PD/Hearth Why does IR3 come before IR1 on next page?

24. Complementary FeedingIR 1: Access to Food • Resource transfers for the most vulnerable • Food and/or nutrient supplements • Micro-credit programs • Food production and income generation (sustainable agriculture) • Inputs and services: agricultural inputs, financial services, access to markets • Improved practices: training and entrepreneurship What should be under sustainable ag—you trailed off, see word in green

25. Addressing UndernutritionSC Priority Interventions (2) Why isn’t 2nd last bullet on bottom left—home care for diarrhea Bolded under this intervention?

26. Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 2: Increased Quality Of Services Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Addressing UndernutritionSC Priority Interventions (2) Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intervention: Timely appropriate care for ARI, Diarrhea, Malaria, and Malnutrition Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intended Impact: Children are Healthy and Well-Nourished

27. Timely, Appropriate CareIR 1: Access to Treatment Take services closer to the population • The community health worker as prescriber for pneumonia, diarrhea, and malaria “Community Case Management” • Front-line health workers as providers of first choice for severe acute malnutrition Community-based Management Of Acute Malnutrition

28. SC Child Nutrition ProgramsProducing Results • Mozambique (2002 – 2007) • Exclusive breastfeeding increased from 5% to 74% • Months of adequate food provisioning from 7.9 to 10.7 months • Bangladesh (2005 – 2007) • Underweight reduced from 52% to 44% in first 2 years of program • Vietnam • Immediate breastfeeding increased from 74% to 92% • Exclusive breastfeeding increased from 39% to 52% • Bolivia (2002 – 2007) • Reduced stunting from 37% to 30.2% • Exclusive breastfeeding increased from 75% to 83% • Nicaragua (2002 – 2007) • Reduced stunting from 20.5% to 9.6% • Exclusive breastfeeding increased from 37% to 84%

29. The School-aged ChildOutcomes of Interest Growth Educational Attainment The equivalent of 200 million school years are lost each year in low income countries as a result of poor health and nutrition – World Bank Is the build on this right—why words at top come in later?

30. The School Aged ChildSC Results Framework Strategic Objective Increased Use of Key Health and Nutrition Practices and Services Intended Impact: Children are well educated

31. The School Aged ChildSC Priority Interventions • Micronutrient supplementation: Vitamin A, Iron, Iodine • De-worming • Proper disposal of excreta and hand washing at appropriate times • Health and Nutrition education • Alleviation of short-term hunger

32. Intermediate Result 1: Increased Access to, & Availability of, Services and Supplies Intermediate Result 2: Increased Quality Of Services Intermediate Result 3: Increased Knowledge, Attitudes, and Skills Intermediate Result 4: Enabling Social & Policy Environment Nutrition in the School-aged Child Intended Impact: Children are well educated Strategic Objective Increased Use of Key Health and Nutrition Practices and Services