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shiree │

shiree │. nutrition. Bangladesh Demographic and Health Survey – 2011 Summary Output 23 rd April 2012. Fertility and Family Planning Bangladesh Demographic and Health Survey – 2011. Trends in Fertility. Total Fertility Rate (Births per woman). 2016 Aim: 2.0.

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shiree │

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  1. shiree│ nutrition

  2. Bangladesh Demographic and Health Survey – 2011 Summary Output 23rd April 2012

  3. Fertility and Family Planning Bangladesh Demographic and Health Survey – 2011

  4. Trends in Fertility Total Fertility Rate (Births per woman) 2016 Aim: 2.0

  5. Trends in Use of Contraception Percentages of married women age 15-49 currently using a methods of family planning 2016 Aim: 72

  6. Unmet Need for Family Planning Percentages of married women age 15-49 who wish to spare or limit births but are not using contraception 2016 Aim: 9%

  7. Maternal Health Bangladesh Demographic and Health Survey – 2011

  8. 2016 Aim: 50% for all three indicators Trends in Maternal Health Among births three years before the survey Source: BDHS 2011 Source: BDHS 2011

  9. Trends in Delivery in Health Facilities by Wealth Percentages of births delivered in health facilities in the three years before the survey 2016 Aim: <1:4 for percentage of deliveries of deliveries in health facilities among the poorest and wealthiest women Source: BDHS 2011

  10. Child Survival and Health Bangladesh Demographic and Health Survey – 2011

  11. Trends in Child Mortality 2016 Aim: 31 2016 Aim: 48 Deaths per 1,000 live births Source: BDHS 2011 Source: BDHS 2011

  12. Childhood Care Percent of children under age five 2016 Aim: 90% 2016 Aim: 50% 2016 Aim: 90% Source: BDHS 2011 Source: BDHS 2011

  13. Nutrition Bangladesh Demographic and Health Survey – 2011

  14. Trends in Exclusive Breastfeeding Percent of children under 6 months who are exclusively breastfeed 2016 Aim: 50% Source: BDHS 2011 Source: BDHS 2011

  15. Trends in Vitamin A Supplementation Percent of children age 9-59 months receiving Vitamin A supplementation in the six months preceding the survey 2016 Aim: 90% Source: BDHS 2011 Source: BDHS 2011

  16. IYCF Practices Percent of children age 6-23 months 2016 Aim: 52% Source: BDHS 2011

  17. Trends in Children’s Nutritional Status Percent of children under age five 2016 Aim: 38% WHO threshold for 'very high‘ prevalence of underweight (30%) WHO threshold for 'very high‘ prevalence of stunting (40%) Source: BDHS 2011 Source: BDHS 2011

  18. Nutrition Status at shiree shiree Change Monitoring System (CMS) - 3

  19. Stunting, wasting and underweight amongst under 5s (shiree BHH) with data CMS3 surveys WHO threshold for 'very high‘ prevalence of stunting (40%) WHO threshold for 'very high‘ prevalence of underweight (30%) WHO threshold for 'very high‘ prevalence of wasting (15%)

  20. Adult nutrition status of shiree beneficiaries WHO threshold for 'very high‘ prevalence of CED (BMI<18.5 is 40%) WHO threshold for Severe public health problem (Adult anaemia= 40.0 %) WHO threshold for 'high‘ prevalence of CED (BMI<18.5 is 20%)

  21. Why Nutrition is important? • Foundation to development contributing to MDG’s • Economic benefit • Low Birth Weight (LBW) perpetuates intergenerational cycle of undernutrition and disease • Economic growth – unlikely to yield Nutrition results

  22. Nutrition’s Impact on Poverty • 20% of the world’s deaths and disabilities are due to undernutrition. • Loss of GDP from undernutrition can be as high as 3% (year in, year out). • Better nutrition empowers people and communities through: • improved intellectual capacity • income generation and access to assets • poverty reduction; and • rapid development

  23. Modified from WB,2004 Income Poverty Low Food Intake Frequent Infections Hard physical labour Frequent pregnancies Large families Malnutrition Indirect loss in productivity from poor cognitive development and schooling Direct loss in productivity form poor physical status Direct loss in productivity from poor physical status Indirect loss in productivity from poor cognitive development and schooling Loss in resources from increased health care costs of ill-health Loss in resources from increased health care costs of ill-health

  24. Nutrition contribution to MDGs

  25. Economic Benefit • 2-3 % GDP lost as a result of undernutrition – most developing countries including Bangladesh • >10% reduction in life time earning of each malnourished individual • Bangladesh – loses over USD700 million in vitamin and mineral deficiencies • Scaling up core micronutrient interventions cost less than US$65 million peryear

  26. Figure : GDP Loss Due To Iron Deficiency Source: Horton 1999, web-link: http://www.unscn.org/files/Publications/Briefs_on_Nutrition/Brief8_EN.pdf

  27. What are the causes of Malnutrition then?

  28. Long-term consequences: Adult size, Intellectual ability, Economic productivity, Reproductive performance, Metabolic and cardiovascular diseases Short-term consequences: Mortality, Morbidity, Disability Maternal and child undernutrition Immediate Cause Inadequate dietary intake Disease Household food insecurity Inadequate care Unhealthy household environment and lack of health services Underlying Cause Income poverty: employment, self-employment, dwelling, assets, remittances, pensions, transfers etc. Lack of capital: financial, human, physical, social, and natural Basic Cause Social economic and political context

  29. When should we intervene? The “Window of Opportunity” for Improving Nutrition is very small …pregnancy until 18-24 months of age Beyond two years stunting is largely irreversible

  30. Window of Opportunity” for Improving Nutrition

  31. key interventions

  32. Shiree nutrition intervention • Scale up proven intervention • Innovation Fund • Research and Monitoring • Advocacy

  33. SF Target Groups: Pregnant  women  Breastfeeding women Children < 2 years Children 2-5 years Adolescent girls All family members (deworming only !)

  34. Major Scale Fund Interventions: • Behavior change interventions (Individual counselling and group meetings) • Breastfeeding promotion and support • Early initiation of breastfeeding • Exclusive breastfeeding for six months and continued breastfeeding until two years of age • Complementary feeding promotion • Behavior change promotion to follow international best practices Proven Interventions • Handwashing with soap and promotion of hygiene behaviors • Delivery of educational messages • Micronutrient and deworming interventions • Multiple micronutrient supplements (MNS - 5 components) • Deworming (Albendazole Tablets and suspensions) • Iron-folic acid supplements (IFA tablets)

  35. Expected results An improvement in adolescent and maternal nutritional status as defined by changes in weight (and concomitant body mass index) and haemoglobin concentration An improvement in child growth (i.e. reduction of stunting, wasting and underweight infants and young children) and improvement in haemoglobin concentration Beneficiaries are better placed to sustainably transition out of extreme poverty

  36. Activity Details – Individual counselling Step 1: survey community and list eligible shiree beneficiary households Step 2: Allocation of responsibility to community volunteers Step 3: Hands on training Step 4: Supportive Supervision Step 5: Monthly meetings Step 6: Performance Incentives Step 7: Accountability, Monitoring, Learning and Evaluation

  37. Social Mobisation V Doc, Religious Leaders, Adolescents, TBAs, School Teachers Mass media Campaign Video show; Tea stall 1. Listing all PW to 24m in catchment area 7. Monitoring for data based decision 2. Allocate Staff, volunteers of 1 (CPKs/V): 20 and 1 (sup): 10 ratios Central Coordination,Management, Exchange Lessons 3. Basic Hands on Training 6. Reward, recognition, or performance based incentives 4. Observed supervisional support 5. Monthly review, feedback, micro-planning Supply IFA Tab; Deworming drugs; MNS Performance Improvement Cycle

  38. Training Materials

  39. BCC Materials Job aid Training Manuals Social Mobilisation Brochure Social Mobilisation Manual, FlipChart Brochure for Adolescent Girls Advocacy brochure Observation Checklist and Social Mobilization Guidelines Illustrated comic books on maternal and child nutrition for adolescent groups DVDs on IYCF TVCs, RDCs and Meena film

  40. Technical support & consultation will be provided by A&T (Alive and Thrive) Existing training materials developed by A&T on IYCF and micronutrient supplementation will be used Modules for group meetings will be reviewed and adopted – shiree partners and A&T Master trainers will be trained by A&T

  41. Logistics

  42. Procurement & Supply Procurement of IFA for pregnant women and adolescent girls Procurement of MNPs for children under 2 Procurement of deworming drugs for children and other family members will be centrally procured and distributed to the SF NGOs

  43. Monitoring & Evaluation

  44. Used for: • Reporting to Donor and GoB • Progress against log-frame • Achievements of quarterly/monthly targets • Programme Management • Track the changes • Feeding back to the implementing partners • Exchange and sharing with other stakeholders

  45. Impact Indicators • 1. % point of targeted U-2 children: • stunted • underweight • wasted • anaemic. • 2. % point of targeted pregnant and breastfeeding mothers and adolescent girls: • chronic energy deficient (CED) • anaemic

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