Transcript section 5.9 International nutrition

International Nutrition
International Nutrition
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When was the problem of undernutrition
first recognized as a global concern?
Which 3 UN bodies deal with nutrition
issues?
How does the focus of each differ?
UNICEF
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United Nations Children’s Emergency
Fund
Infant Health & Survival Program
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GOBI - Growth/development, Oral
rehydration, Breastfeeding promotion,
Immunization
Which deficiency problem has UNICEF
addressed?
FAO
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Food and Agriculture Organization
Collaboration of agriculture & health
sectors
World leader in fight against food
insecurity
Strong advocate for nutrition policy
development
FAO
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World Food Program (WFP)
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Largest humanitarian agency
Strives to eradicate hunger
Distributed 4.2 million tons of food to 96.7
million people in 82 countries
Funded by world governments, corporations,
private donations
WHO
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World Health Organization
1948
Emphasizes prevention of nutrition
problems
What nutrition issues has WHO programs
addressed?
UN Agencies
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Which other UN agencies have become
involved in international nutrition issues?
How has The World Bank assisted with
nutrition issues of countries?
United Nations University?
SCN?
International Nutrition Programs
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Strengthen institutions
Supplementary foods
to vulnerable groups
Targeted financial
assistance
Health & nutrition
services
Nutrition education
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Treatment of anemia
Small scale food
production
Food technology
Water supply &
sanitation control
Food
commercialization
Is International Work for you?
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Entrepreneurial spirit needed
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“We can create the jobs” (Stacia Nordin in Aase, p.
1509)
“requires some thinking out of the box about your
career” (Camella Rising in Aase, p. 1509)
“Adapting to a new culture demands
flexibility, resilience, patience, openness,
confidence, and the willingness to learn
(Aase, p. 1510)
Careers in International Nutrition
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Undergraduate degree in Nutrition or
Agriculture
International internship
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Graduate degree
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e.g., Coady, CIDA, Healthbridge
An advantage
Development
Second language helpful
To Breastfeed or Not
The Dilemma of HIV Positive Women
HIV and Breastfeeding
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Child mortality rates are increasing
5 million children have died from AIDS
2.7 million children are living with AIDS
800,000 children where infected in 2001
90+% of HIV infected children live in subSaharan Africa
HIV and Breastfeeding
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Mother-to-child transmission of HIV
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Pregnancy
Childbirth
Breastfeeding
Breast Milk Without HIV
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Best food for infants
Prevents ~ 6 million infant deaths
Provides optimum nutrition
Protection against common childhood
diseases (diarrhea and respiratory
infections)
Promotes child spacing
Transmission of HIV during
Breastfeeding Stats
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1985 first case
Results in ~ 200,000 – 300,000 infant HIV
infections
MechanismsComposition of breast milk
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Undergoes several changes
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Increased leukocyte numbers and
immunoglobulin concentrations found in
colostrum
Therefore it is suggested that colostrum has a
greater concentration of cell-associated HIV
Timing of Breast Milk
Transmission
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Depends on when the mother acquired the
infection
Infected just before delivery or during
breastfeeding =  Rate of transmission
Summary of Transmission Rates
Type of HIV Transmission Estimate
Overall risk of breastfeeding
Risk of transmission by a mother who
acquired transmission just before or
during breastfeeding period
Risk of transmission by a mother with a
preexisting HIV infection
Estimated
Risk
12-14%
29%
(range 1553%)
7-10%
The Decision
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The risk of HIV transmission through
breastfeeding is substantial
The risks of morbidity and mortality from
diarrhea & respiratory disease in non
breastfed infants is also substantial
Possible Alternatives
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Oral antiretroviral (ARV) therapy
Banked donor human milk
Mothers own modified milk (heat
treatment inactivates virus)
Commercial infant formula
Current Recommendations
“When children born to women living with HIV can
be ensured uninterrupted access to nutritionally
adequate substitutes that are safely prepared and
fed to them, they are at less risk of illness and
death if they are not breastfed. However, when
these conditions are not fulfilled, in particular in
an environment where infectious diseases and
malnutrition are the primary causes of death
during infancy, artificial feeding substantially
increases children’s risk of illness and death.”
WHO
HIV and Breast Feeding
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Ethical concerns arising from recommendation to
not breastfeed if HIV-positive?
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Increased diarrheal disease
ID mother as HIV positive (Stigma)
Factors policy makers must take into account
when setting guidelines?
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Transmission rates
Finances
Clean water supply
Social stigma / norms
Required Readings
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Maillet, 2008. Ethical and legal issues in
nutrition, hydration and feeding.
Knowles, & Gilmore, 1994. Discontinuation
of Total Parenteral Nutrition.
Duester, 1997. Building your business –
Setting your fees: A cost-based approach.
Gross, & Ostrowski, 2008. Getting started
in private practice.