Transcript fighting hunger & malnutrition

FIGHTING HUNGER & MALNUTRITION
Undernourishment: global trends
Number of undernourished people
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1 billion people are undernourished in 2009
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The trend in global food security has been reversed in 1996
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Aggravating factors:
“Food crisis” in 2006-08
Global economic slowdown in 2009
Proportion of undernourished in the developing countries
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1970s and 1980s: in spite of relatively rapid population growth, the
number of undernourished in the world was actually declining.
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Since the mid-1990s: the number of undernourished has risen,
despite the benefit of slower population growth.
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2008: the proportion of undernourished eventually increased.
Source: FAO, 2009
Rising hunger: a global phenomenon
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All world regions have been affected by the increase
in food insecurity
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Strongest prevalence of undernourishment:
Sub-Saharan Africa (32 %)
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Strongest percentage increase in the developing
world: Near East and North Africa (+13.5%).
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Latin America and the Caribbean: +12.8%,
(this was the only region in recent years with signs of
improvement)
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Undernourishment has also become a growing
concern in developed countries.
Source: FAO, 2009
Hunger: prevalence
Hunger at a glance
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World hunger tops one billion
This is the highest number since the statistics are available.
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Even before the food and economic crises, hunger was on the rise
The World Food Summit target of halving the number of undernourished by 2015 will not be reached if the trends that prevailed before the
crises continue.
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Coping mechanisms severely strained
To cope with crises, poor people reduce dietary diversity and spending on education and health care.
These coping mechanisms were strained during the food crisis, and the poor will now be forced to draw on their meagre assets even
more deeply.
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A healthy agriculture sector can provide an economic and employment buffer in times of crisis.
Experience suggests that the economic crisis may cause investment in agriculture to decline in the short-to-medium term.
This outcome must be avoided so that agriculture, especially in the poorest countries, can serve as an engine of growth and poverty
reduction.
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Safety nets must address the short-term impacts while providing long-term solutions.
Recipients should ultimately graduate from the programmes by gaining access to modern inputs and adopting new technologies.
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A right-to-food approach has an important role to play in eradicating food insecurity.
To lift themselves out of hunger, the food-insecure need better control over resources, access to opportunities, and improved governance.
Source: FAO, 2009
Food prices crisis
Annual average prices in USD per ton (source: FAO)
Impact on public health
MALNUTRITION
Mortality
Undernutrition is an underlying cause of 53% of deaths among children below 5 years of
age
(associated pathologies: diarrhoea, pneumonia, malaria, and measles)
(WHO, 2005)
Morbidity
. 3,5 billion people affected by iron deficiency (main cause of anaemia)
. 2 billion at risk of iodine deficiency (cause of mental impairment)
. 200 million children under 5 suffer from vitamin A deficiency (vision, growth, protection
against infections)
(2006, FAO & NECS)
Millennium Development Goals
1. “Eradicate extreme poverty and Hunger”
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Halve, between 1990 and 2015, the proportion of people whose income is less than $1.25 a day
Achieve full and productive employment and decent work for all, including women and young people
Halve, between 1990 and 2015, the proportion of people who suffer from hunger
4. “Reduce child mortality”
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Reduce by two-thirds, between 1990 and 2015, the under-five mortality rate
“Eradicate extreme poverty and Hunger”
Global Monitoring Report 2009: A Development
Emergency
Source: World Bank
Global projections: from 41.7% (1990) to 15.1% (2015)
Project., China excl.: 35.2% (1990) to 18.2% (2015)
More than half of the countries with available
data are NOT on track
“Reduce child mortality”
“Nearly half of all deaths of children under five occur in Sub-Saharan Africa.
Malnutrition, as well as lack of access to water and sanitation infrastructure,
contributes to the poor health and death of young children.”
Source: World Bank, 2009
Reminders
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“Hunger”
Generally used to describe a calorie deficiency (target: 2100kcal/day)
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Undernourishment
Refers to a continuous quantitative deficiency, insufficient to cover the daily energetic needs.
Can trigger serious physiological & psychological consequence.
Can cause irreversible damage and eventually lead to death.
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Malnutrition
Pathology that results from deficiencies in one or a number of nutrients, but also psychological disorder or
unbalanced diet.
Includes a qualitative dimension.
Broad range of clinical conditions
„...a state in which the physical function is impaired. One can no longer maintain adequate bodily performance
process such as growth, pregnancy, lactation, physical work, and resisting and recovering from disease.“
(Nutrients: protein, carbohydrate, lipid, vitamins, amino acids, minerals, water, etc)
Chronic malnutrition
Chronic inadequate dietary intake (or repeated infections) over a long period
Leads to stunted growth
Irreversible
Anthropometric measures: low height vs age, or low weight vs age
Acute malnutrition
recent rapid weight loss or a failure to gain weight
higher risk of mortality
Reversible
Anthropometric measures: low weight vs height (and or
Examples
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Obesity
Ituri, D.R.Congo (2009): acute malnutrition <5% prevalence ; chronic malnutrition >60% prevalence
Niger (2005): acute 15% ; chronic 50%
Food security
“Food security exists when all people, at all
times, have physical and economic access to
sufficient, safe and nutritious food for a
healthy and active life”
World Food Summit Plan of Action, 1996
Household food security
As women usually assume overall
responsibility for food in the household and
because they are the major recipients of
food aid, it is important to encourage their
participation in the design and
implementation of programmes wherever
possible.
The Sphere Project
WFP 2002
Food insecurity
Periodical food insecurity
Critical period: « période de soudure »
Farmers: stock previous he previous year can run out before the next harvest and market prices are at their highest
level of the year
Stock breeders: dry season jeopardizes the chances to keep all the cattle alive
Food crisis:
Deteriorating access to food due to:
. Natural disasters (drought , floods..)
. epidemics (cattle)
. Particular political or economical event (hyperinflation of staple food)
. economic crisis
. conflict
. massive displacement of population
Most vulnerable populations:
Internal displaced people, Refugees
Non displaced population
Food crisis:
“A situation of unusually severe food insecurity beyond the coping capacity of individuals and the community”
Famine:
“Whenever a population has reduced access to food, associated with actual or threatened increases in severe morbidity and
mortality“
WHO, 1990
Acute malnutrition
2 types of malnutrition:
Marasmus
Kwashiorkor
Acute malnutrition: treatment
Differentiation between moderate and severe malnutrition
Screening
Use of anthropometric measures
1- weight vs height
International reference value (NCHS/WHO), built on Z-score
Moderate malnutrition
-3 SD < Zx <-2SD
Severe malnutrition
Zx <-3SD
2- MUAC (middle upper arm circumference)
+ oedema!!!!!!!
Acute malnutrition: treatment
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Since approximately 2005, most of the malnourished children follow can follow an
ambulatory treatment
Only the severe cases with complications (associated pathologies) are hospitalized
Hospitalization:
Use of therapeutic milk (F-75 then F-100), used since the beginning of the years 1990’s
- Treatment of the of the associated pathologies
Main objective: restore appetition to guaranty a gain of weight
- The child is discharged after disappearance of anorexia or massive reduction of the oedema, and follows the
ambulatory treatment (after approx. 1 week)
Ambulatory treatment:
Use of RUTF (ready-to-use therapeutic food)
Alongside a systematic treatment, the child receives a weekly dose of Plumpy Nut, until he gains enough weight to
leaves the admission criteria (average 3-4 weeks)
F75
F100
Plumpy nut
MALNUTRITION: “prevention”
Main interest of the RUTF innovation:
Multiplication of the number of children under treatment (the hospitalization is
not mandatory anymore for the majority of the malnourished children).
60.000 children treated in 2005 vs 6500 in 2003
Strong reduction of operational cost.
Same quality level (>90%)
“Preventive” actions
Food distributions
Plumpy Doz
Controversial operations (Niger 2005)
Emergency operations and massive (free) distribution to adress a chronic
situation