Transcript Salad Bowl of the Pacific – Yet the Double Burden

Salad Bowl of the Pacific
– Yet the Double Burden
PROFAV Workshop
Nadi, Fiji
20-23 October 2014
Ateca Kama
NFNC, MoHMS Fiji
Fiji
 Pop 837,271
 18,333 sq km
 2 major islands
 333 islands
Introduction
 Abundance of fruits and vegetables
 MPI estimates
 Yet beset with serious but preventable nutrition-
related diseases
 Burden the economy with excessive medical costs
 Significant loss of human development potential and
work productivity
 Major cause of preventable NCDs, in particular
childhood obesity and nutrient deficiency diseases
– change to poorer quality diet and lifestyle
Low birth weight (LBW)
(Birth weight <2,500g)
 Higher incidence of LBW amongst Indo-Fijian
children
18.8
20
18
16
Percent
14
10.2
12
10
7.7
8
6
4
2
0
Fijians
Indo-Fijians
ALL
4
Underweight
 High rate of underweight amongst Indo-fijian children
28.8
30
0-4 years
5-9 years
25
Percentages
20
15.9
15
11.5
10
5
7.1
3.9
3.7
0
Fijians
Indo-Fijians
All
5
Growth Faltering
 Growth faltering amongst Fijian children
Fijians
NCHS
Indo-Fijians
145
140
% of the NCHS Median
135
130
125
120
115
110
105
100
95
90
85
80
75
At
bi rth
0-2m
3-5m
6-8m
9-11m
12-23m 24-59m
5-9y
10-14y
15-17y
Age (months/years)
6
Overweight and Obesity
(Overweight: BMI 25-29.9, Obese: BMI ≥30)
 56% of the population surveyed was overweight and
obese.
Obese
Underweight
23.9%
6.1%
Normal
37.6%
Overweight
32.3%
Source: NNS 2004
Anaemia
(Under 5 years: Haemoglobin <11g/dl)
 High rates of anaemia in children <5 years.
78.8
80
1993
2004
68.3
64
70
58.8
51.5
Percentages
60
50
40.4
40.2
40
29.9
25
30
22.1
20
10
0
6-11m
12-23m
24-35m
36-47m
Months
Source: NNS 2004
48-59m
Iron Deficiency in Women
(Serum Ferritin = <15µg/L)
43
45
40
Percentages
35
30
23
25
20
15
11.5
10
5
0
Fijians
Indo-Fijians
All Women
9
Anaemia in Women and Men
(Haemoglobin = Women <12g/dl, Men <13g/dl)
 Higher rates in women especially Indo-Fijian
women.
60
Percentages
Indo-Fijians
All
50
40
Fijians
51
40
33
30
21
18
20
10
0
Women
Men
Source: NNS 2004
21
Vitamin A Deficiency
(Serum Retinol = <30µg/dl)
 Rates are higher in Indo-Fijian Women
25
21
Percentages
20
13
15
10
8
5
0
Fijians
Indo-Fijians
All
11
Changes in Dietary Pattern
 Traditional diets have evolved in the past decade
 More prominent amongst iTaukei than Indo-fijians
 Shifted from traditional dalo to more cheaper cassava
and rice, bread and biscuits
 Intake of animal protein has increased substantially
compared to fish
 Food choice determined mainly by
 Value for money
 Ease of preparation
 Personal preference
 ACIAR Report 2002
Nutrition Transition
 The dietary changes observed in the 2004 NNS
typify the “nutrition transition” that included both
quantitative and qualitative changes (WHO, 2003)
 The adverse changes include:
 shifts in the diet towards a higher energy density with
more fat and sugary foods
 greater saturated fat (from animal sources)
 reduced consumption of complex carbohydrates and
dietary fibre
 reduced fruit and vegetable consumption
 The dietary pattern found in the 2004 is consistent
with the diet characteristic of nutrition transition
FBS Trends
 A total of 3,421 kilocalories/capita/day
 54% in excess of the FAO nutrient requirement YET 47% of
population is unable to meet minimum Energy requirement
 Total nutrient availability showed a steady increase over
the years
 1985 - 2,819 kcals
 1995 - 2,939 kcals
 2005 - 3,663 kcals
 Calories from imported foods have increased
 2006 - 51%
 2007 - 62%
 2008 - 69%

High importation of sugar, cereals, oil and butter
 Import dependent
Source: FBS 2009
Other Trends
 Low consumption of:
 Vegetables and fruits - 25%
 Green leafy vegetables - 21%
 Exclusive Breastfeeding - 40%
 Major sources of:
 Fat - vegetable and meat
 Cholesterol - fish and seafood
 Sugar - consumed >2 times/day
 Anaemia in Women of Child Bearing Age
 NNS 2004 - 40%; IS Iron Fortified Flour 2010 - 28%
 Anaemia in Children <5 years
 NNS 2004 - 50%; MNS 2008 - 37%
Source: NNS 2004
OPIC Study - Fruits
 Consumption of fruits amongst Fijian
adolescents
 59% iTaukei consume 1 or less serve/day
 68% Indo-fijians consumed 1or less serve/day
 6% iTaukei consumed > 4 serves/day
 3% Indo-fijians consumed > 4 serves/day
 Frequency of fruit consumption after school higher
in males than females.
OPIC Study - Vegetables
 Consumption of vegetables amongst Fijian
adolescents
 42% iTaukei eat 1or less serve per day
 47% Indo-fijians eat 1or less serve per day
 39% males eat 1 or less serve per day
 48% females eat 1 or less serve per day
 Fruit availability at home more for Indo-fijians
than iTaukei
NCD STEP Survey
 Fiji has now repeated its second NCD STEPS
survey (in adults), and the findings indicate that the
underlying causes and risk factors of these
diseases have greatly increased (from 2002 to
2011).
 Overweight increased from 23.6% to 32.1%
 Consumption of fruits and vegetables - very low



1.2 % Males and 0.6% Females - consume 5 or more
servings of fruits/day
26.4% eat less than 1 serving of vegetables/day
2.9% Males and 2.2% Females - consume 5 or more
servings of fruit and vegetables per day
NCD STEP 2002
Fruit & Vegetable Intake
(Fiji NCD STEPS 2002)
Servings of fruits
<1 serving per day
1 serving per day
2-4 servings per day
5+ servings per day
0
10
20
30
40
50
60
70
Percentage
19
Value Chain Study
 Applicability of VC approaches to address low FV
consumption in Fiji
 Identify strength, limitations and potential to inform
PH action to increase FV intake
 Amaranthus, Papaya and Tomatoes
 Price and Quality important to food choice
 Quality - taste, appearance, perceived health
properties, freshness and convenience
 Barriers to consumption - inconsistent availability
and high prices
VC Study
 Challenges
 Access to agricultural input, limited transportation and
market infrastructure
 Consumers driven by price, so focus on costminimization rather than value-addition
 Farmers received little information on supply and
demand trends
 High vulnerability to natural disasters impaired the
delivery of consumer-defined value
 Findings identified opportunities to enhance FV
availability, affordability and acceptability by
promoting the qualities of FV that consumers value
Government Effort
 ICN 1 Recommendations
 National Plans of Action for Nutrition
 Bula 5:30 Campaign
 5 servings of fruits and vegetables
 30 minutes of physical activity
 Fiji Food and Nutrition Policy 2008
 9 policy areas
 Fiji Plan of Action for Nutrition 2010-2014
 Programs and Activities
 SHC Plan for Fruits and Vegetables
 Green Growth Framework
 Food Security
Policies, Regulations and SPs
 Policies:
 Food and Nutrition Policy 2008


Fiji Plan of Action for Nutrition 2010-14
Food and Health Guidelines
 National Baby Friendly Hospital Initiative [BFHI] Policy
 Regulations:
 Marketing Controls - Foods for Infants and Young
Children
 The Advertising and Promotion of Unhealthy Foods and
Non Alcoholic Beverages to Children
 Strategic Plans
 NCD, IYCF, FPAN, MOH, Government, Agencies
FPAN 2010-2014
1.
2.
3.
4.
5.
6.
7.
8.
9.
Advocate nutritional issues and mainstreaming into the
Government decision-making systems
Promote and sustain household food security
Improve national nutrition status
Protect consumers through quality and safety of food and
water
Improve nutritional status of the socio-economically
disadvantaged and the nutritionally vulnerable
Nutrition policy for schools
Promote healthy diets and lifestyles
Establish and promote nutrition surveillance and monitoring
system
Strengthen collaboration with development partners
Oversight of the FPAN Steering Committee
Evaluation
 The Fiji Plan of Action for Nutrition 2010-2014 will
be evaluated though the National Nutrition Survey
2014
 Effect of the nutrition intervention strategies
contained in FPAN
 Determine whether the strategies have had impact
on the nutritional health of Fiji’s population
 Findings will be used to inform future evidence
informed policies, surveillance and nutrition
interventions
 Fiji Food and Nutrition Policy 2015
 Fiji Plan of Action for Nutrition 2016-2020
 NCD Strategic Plan 2015-2019
Visit our website for more information:
www.nutrition.gov.fj
Email us at:
[email protected]
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