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Trend and challenges in food and nutrition development in Thailand

Trend and challenges in food and nutrition development in Thailand. Kraisid Tontisirin Professor Emeritus, Mahidol University Presentation at the 2 nd National Health Promotion Meeting, Ministry of Health Thailand 15 June 2007. Overview of presentation. Introduction

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Trend and challenges in food and nutrition development in Thailand

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  1. Trend and challenges in food and nutrition development in Thailand Kraisid Tontisirin Professor Emeritus, Mahidol University Presentation at the 2nd National Health Promotion Meeting, Ministry of Health Thailand 15 June 2007 Kraisid Tontisirin 2007, Mahidol University

  2. Overview of presentation • Introduction • Nutrition and nutrition related chronic diseases (NRCDs) in Thailand • Past achievement of nutrition improvement in Thailand • Major global issues on food and nutrition • Life course approaches in nutrition promotion • Conclusion

  3. Fundamentals for human, animal and plant health • Genetics • Nutrition • Prevention and control of diseases • Environment

  4. Factors influencing health and quality of life • Genetics • Nutrition • Mental well being • Physical activity and exercise • Avoidance of toxicants i.e. smoking, excessive alcoholic consumption

  5. Nutrition -a link between food and health enabling Availability, access, consumption and utilization of food of adequate quality, quantity & safety Meeting human nutrient and non-nutritient requirements during the life cycle Kraisid Tontisirin 2007, Mahidol University

  6. Overview of presentation • Introduction • Nutrition and nutrition related chronic diseases (NRCDs) in Thailand • Past achievement of nutrition improvement in Thailand • Major global issues on food and nutrition • Life course approaches in nutrition promotion • Conclusion

  7. Major food and nutrition problem in Thailand Undernutrition: PEM ( underweight, stunting, wasting), hunger, micronutrient deficiencies ( iron, iodine, vitamin A…) Overnutrition and nutrition related chronic diseases (NRCDs): overweight, obesity, hyperlipidemia, diabetes mellitus, high blood pressure, CVD… Food safety (unsafe from hazards in food) and food high in fat (sat. FA and trans FA) sugar and sodium) Kraisid Tontisirin 2007, Mahidol University

  8. i • ,

  9. ThailandMultiple Indicator Cluster Survey (MICS 2006) • National samples of over 40,000 households (HH) plus over-sampling of an additional 30,000 HH • In 26 focus provinces

  10. Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007* *In 26 focus provinces in 4 regions

  11. Prevalence of Low Birth Weight(LBW) 9 % of infants born weighing less than 2500 grams Top province (%) Weakest Province (%) Phuket (4.89) Mukdahan (16.32) Phangnga (5.510) Yala (17.83) Mae Hong Son (5.911) Ubon (20.4) Satun (7.812) Chiang Rai (27.15) Pattani (7.913) Chiang Mai (27.2) From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  12. Millennium Development Goal 4. (Reduce child mortality) Reduce by two thirds, between 1990 and 2015 the under-five mortality rate. • National Goal: No more than 6% of newborns weighing less than 2,500 grams (NPA, 2005-2014) from 18 % • Indicators available in Thailand MICS3:-Birth weight From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  13. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  14. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  15. Prevalence of undernutrition of children under five years • Underweight (wt/age) 9.3 % • Stunted (ht/age) 11.9 % • Wasting (wt/ht) 4.1 % From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  16. Millennium Development Goal 1.(Eradication extreme poverty and hunger) • Eradicate extreme poverty and hunger. Reduce by half between 1990 and 2015 the proportion of people who suffer from hunger. • National Goal:No more than 5% of children under five years underweight for age(10% in WFFC) • National Status Thailand MICS 2006: • 9.3% of children aged 0-59 months underweight for age

  17. Prevalence of under weight of under five From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  18. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  19. Map: Low Weight for Age of under five From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  20. Malnutrition contributes about 50% of this mortality Kraisid Tontisirin 2007, Mahidol University

  21. Underweight Children in Thailand* 8-12 % in preschool children (rural> urban) 7-9 % in 6-14 years old children (rural>urban) 6-9 % in 15- 18 years old children (rural>urban) ----------------------------------------------------------- * Div of Nutrition, MOPH, 2003 Kraisid Tontisirin 2007, Mahidol University

  22. Stunted children in Thailand* 5-9 % in preschool children (rural> urban) 7-8 % in 6-14 years old children (rural>urban) 11-16 % in 15- 18 years old children (urban>rural) ----------------------------------------------------------- * Div of Nutrition, MOPH, 2003 Kraisid Tontisirin 2007, Mahidol University

  23. Overweight and obesity (Thailand) • National Goal: No more than 10% overweight in every group of 0-5 year old children (NPA 2006, p. 90) • National Status: 6.9% of all children and 10.4% of municipal children under the age of 5 are overweight From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  24. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  25. Childhood overweight and obesity in Thailand* 10-15 % in primary school children Over 50 % of obese children with hyperlipidemia ( high cholesterol and TG) Over 25 % of normal weight children with hyperlipidemia *various sources of data from Dr Ladda, INMU (Dr. Uruwan) and Faculty of Public Health, Mahidol U. (Dr. Chutima); more data in various setting are still needed. Kraisid Tontisirin 2007, Mahidol University

  26. Exclusive breastfeeding • Infants who received only breast milk and vitamins, mineral supplements or medicine in the 24 hours prior to the interview are classed as exclusively breastfed. • Only 5 %of Thai infants benefit from ex.BF (vs. 46% of global figures) • 8/26 focus provinces, no ex.BF was reported

  27. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  28. Salt iodization( 15-29.9 ppm for adequately iodized salt)) • Only 10.4 % of samples of HH found adequate level of iodine • Lowest rate (22.6 %) was found in the Northeast with adequate level • 53.7 % in the Northern, 59.7 % in the Central, and 60.3 in the Southern region From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  29. From Thailand Multiple Indicator Cluster Survey 2006… Unicef May 2007

  30. Ten leading causes of health burden in Thailand(MOPH 1999) Male Female HIV/AID HIV/AIDS Traffic accident Stroke StrokeDiabetes mellitus CA liver Depression Murder/violence Traffic accident Suicide Low birth weight Diabetes mellitus CA liver COPD Osteoarthritis Ischemic HD COPD Low birth weight Ischemic HD

  31. 13 leading causes of DALY in Thailand(Disability adjusted life years … MOPH 1999) Male Female Unsafe sex Unsafe sex Cigarette Smoking Overweight and obesity Alcoholic consumptionHigh blood pressure No helmet protection Cigarette Smoking High blood pressure High blood cholesterol Drug addicts Occupational accident Overweight and obesity No helmet protection Inadequate intake of F&V Physical inactivity High blood cholesterol Poor hygiene Occupational accident Inadequate intake of F&V Poor hygiene Alcoholic consumption Air pollutionDrug addicts Physical inactivity Air pollution

  32. Nutrition situation and NRCDs in Thai adults(MOPH 3rd Physical examination surveys 2004) Male Female BMI (kg/m2) 22.6 23.8 Waist circ. (cm) 78.6 76.6 Waist circ.>90 and 80 cm (%) 15.4 36.1 Thinness (%) 11.6 9.6 Overweight (%) 17.8 25.4 Obesity (%) 4.8 9.0

  33. Nutrition situation and NRCDs in Thai adults(MOPH 5th Food and Nutrition Survey 2003) Male Female High LDL-C >130 (%) 13-33 13-44 LOW HDL-C <40 (%) 6-13 18-32 High TG >150 (%) 6-46 8-37 Prevalence of DM (%) 6.4 7.3 Prevalence of high BP (%) 23.3 20.9 Fruit & veg intake (g/d) 268* 283* *MOPH 3rd Physical examination surveys 2004)

  34. Food, nutrition and life style factors(Dada from various sources 2003-2005) Sugar consumption in 2004 was 30.3 (kg/person/y) or 83 g/d or 16.6 % of energy intake from sugar. Soft drink beverage intake was 102 bottles/person/y( 816 in the US) Increased consumption of sugary drink i.e. fruit juices, sweet tea and coffee Increasing snack consumption particularly in children, 2 packs/person/day Expansion of fast food services

  35. Food, nutrition and life style factors(Dada from various sources 2002-2005) Increasing snack consumption particularly in children, 2 packs/person/day Expansion of fast food services Increased alcoholic beverage intake, 81.7 liter/person/y in 2003 Only 35.7 % of male and 23.7 % female from 6 year onward exercised regularly(2002..Office of National Statistics)

  36. Overview of presentation • Introduction • Nutrition and nutrition related chronic diseases (NRCDs) in Thailand • Past achievement of nutrition improvement in Thailand • Major global issues on food and nutrition • Life course approaches in nutrition promotion • Conclusion

  37. Nutrition interventions • Supplementation with micronutrients/food • Food fortification • Nutrition education/communication • Food based approach: ensuring food security/consumption of safe and nutritious food • Public health measures: basic services, immunization, sanitation, deworming … • Community based (integrated) approaches

  38. Kraisid Tontisirin 2007, Mahidol University

  39. Under the umbrella of the Poverty Alleviation Plan (PAP) targeting to the poor areas to achieving BMN Primary Health Care (PHC) and Food and Nutrition Plan (FNP) have been incorporated in the PAP Nutrition has been used as goals and indicators Multisectoral-community based strategies since 1981

  40. Forging the link between government and community

  41. Componentsof a successful community based program Minimum Basic Services (Health, Education, Agr. Extension) • Supportive System • Training • Funding • Problem Solving • Supervision Facilitators • Menus (Activities) • Food production • Nutrition education • Food sanitation & safety • ANC • GMP • BF/CF • Other activities • Interface • (service providers and • community leaders) • Plan/goals • Implementation • Monitoring/evaluation Mobilizers (1:10 households) Community Leaders Family Individual Basic Minimum Needs Goals/Indicators

  42. Food and nutrition security Food-based dietary guidelines • Health service & • Caring practices • Food & Nutrition Programmes • Prevent & control malnutrition • School meals, etc. Nutrition labelling Consumption Consumer protection Individual/Family & Community as Core Utilization Food processing Food production Monitoring and Surveillance Food combination Fortification Rice/cereals Legumes Fish Chicken Eggs Vegetables Fruits Dairy

  43. Dramatic improvements are possible: • Between 1960 and 2004, Chilecut its underweight rate from 37% to 2.4% • Thailand reduced malnutrition rates from 36% to 13% in the 15 years to 1990 • Brazildecreased its child undernutrition by 67% between 1970 and 2000 • Malnutrition in Indiahas declined by about 30% since 1960 • Between 1980 and 1990, Tanzania reduced reduce child malnutrition from 50% to 30% Common factor: national leadership, focus on nutrition From Ending child hunger and undernutrition initiatives (ECHUI, WFP 2007

  44. Overview of presentation • Introduction • Nutrition and nutrition related chronic diseases (NRCDs) in Thailand • Past achievement of nutrition improvement in Thailand • Major global issues on food and nutrition • Life course approaches in nutrition promotion • Conclusion

  45. Global problem 852 m undernourished people worldwide 400 m undernourished children < 18 149 m underweight children < 5 5-6 m preventable U5 deaths per year, (where undernutrition is a key factor) 85 mfamilies in need (countries where U5 underweight ≥ 10%) * Approximations and estimates, sources: FAO, WFP, WHO/UNICEF, WFP/UNICEF

  46. Prevalence of undernourishment, 2000-2002 Source : FAO, SOFI, 2004

  47. FAO’s Hunger map (2002-2004)

  48. We are not on track to meet the World Food Summit Goal

  49. What will it cost if we do nothing? • Economic and social consequences of approx 45 million preventable child deathsby 2015 (at today’s rate of attrition) • approx.2 to 3 percent of GDPlost annually to undernutrition in high prevalence countries* • $500 billion to $1 trillion in lost productivity and income over the lifetime of today’s undernourished children* • Prospect of achieving other MDGs reduced. • *Sources: UN Standing Committee on Nutrition, World Bank, FAO

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