Transcript Conceptual Framework of Malnutrition

SANCADI
Southern African
Nutrition Capacity
Development Initiative
David Sanders
Director: School of Public Health
University of the Western Cape
SANCADI
Global initiative to develop human capacity in nutrition
Spearheaded by UNU and IUNS
Established as the first of the African nutrition capacity
development initiatives.
Developed as a “learning co-operative”, comprised of
institutions in the region, which would provide a
mechanism for mutual transfer of expertise and capacity.
From 2005 funded by USDA and facilitated through University
of the Western Cape (RSA)
Focus:
Botswana, Zambia, Mozambique, Malawi, South Africa
Inform:
Namibia, Swaziland
Rates of childhood stunting
S u b -S a h a ra n Afric a
80
70
Cl VAD
60
SCl VAD
50
A nem N P
40
A nem P
30
A n e m k id s
TGR
20
uwt
10
0
1985
1990
1995
2000
2005
S u b -S a h a ra n A fric a
S o u th A s ia
80
70
70
60
Cl VAD
50
SCl VAD
Cl VAD
60
SCl VAD
50
Anem NP
40
40
Anem P
30
30
A n e m k id s
20
TGR
10
20
Anem NP
Anem P
uwt
A n e m k id s
TGR
uwt
0
10
1985
1990
1995
2000
2005
0
1985
1990
1995
2000
2005
S o u th Am e ric a
S E A s ia
60
70
Cl VAD
50
60
SCl VAD
40
A nem NP
50
30
40
30
20
20
10
A n e m k id s
TGR
10
uwt
0
0
1985
A nem P
1985
1990
1995
2000
2005
1990
1995
2000
2005
N a tio n a l Tr e n d s in U n d e r w e ig h t P r e v a le n c e
35
Les otho
30
M alaw i
25
M oz am bique (6
P rovinc es )
Zam bia
20
P r e v (%)
15
Zam bia (S .
P rov.)
Zim babw e
10
5
S
ep
-9
1
A
ug
-9
2
Ju
n93
M
ay
-9
4
A
pr
-9
5
M
ar
-9
6
Ja
n97
D
ec
-9
7
N
ov
-9
8
S
ep
-9
9
A
ug
-0
0
Ju
l-0
1
M
ay
-0
2
A
pr
-0
3
0
Dat e
Global HIV prevalence
40 million people around the
world live with HIV - more
than the population of
Poland.
Nearly two-thirds of them live in
Sub-Saharan Africa, where
in the two hardest hit
countries HIV prevalence is
almost 40%.
The global HIV/Aids epidemic
killed more than 3 million
people in 2003
there are emerging and growing
epidemics in China,
Indonesia, Papua New
Guinea, Vietnam, several
Central Asian Republics, the
Baltic States, and North
Africa.
The AIDS debate, BBC News
Progress in the area of Infant Feeding and
HIV/AIDS
There has been growing recognition and understanding of the complex
dilemma facing HIV+ mothers re: infant feeding.
In 1998, the perception in the HIV community was that formula milk should be
provided to all HIV+ women to avoid infant transmission – it was a heated
dialogue.
New evidence from programs and research have highlighted the risks (social,
nutritional, health) with this intervention.
In most countries (though not all), the focus has shifted toward promotion of
HIV-free survival & finding ways to make breastfeeding safer.
Numerous guidelines and tools have been developed (HIV & IF Framework for
Action, Global IYCF strategy, policy & program guidelines, counseling
tools, reference guide, training courses) to strengthen infant feeding
counseling in PMTCT program
But there is a LONG way to go – a far more energetic effort and more
resources are needed to seriously make these tools and knowledge
available on the ground to reach affected communities & individuals.
Progress in the area of Nutrition and HIV/AIDS
The role of nutrition in HIV/AIDS has long been recognized but action was limited.
In 1999, most focus was on AIDS-related wasting only. Now there is growing
understanding of that HIV affects nutrition early in the course of infection and that
there are multiple entry points.
Likewise, the important associations between food & nutrition insecurity and HIV are
better understood today.
A comprehensive review of the evidence on nutrition & HIV/AIDS was completed last
year. Two consultations in Durban last year highlighted this issue and charted a
“way forward”.
Many tools and materials for capacity development & implementation have been
developed in Africa and shared between countries.
WHO Executive Board and other resolutions have increased global commitment to
addressing this issue. Several agencies have been actively involved.
But, like with infant feeding, these tools and knowledge must be put into practice.
Implementation lags far behind. Human resources are a serious constraint.
The nutrition community has been slow to respond to this crisis.
CFRs in hospitals: Implementing the WHO guidelines
for severe malnutrition saves lives.
Country
Case fatality (%)
BEFORE
Case fatality (%)
AFTER
Malawi
55
16
South Africa
30
35
46
25
45
6
20
21
18
8
Ghana
20
18
AFRICA
Research, Education and Training Products.
SANCADI Objectives
-
Nutrition and HIV/AIDS
Management of severe malnutrition
Nutrition programming and advocacy
Nutrition and food security
SANCADI Objectives (1)
Nutrition and HIV/AIDS
- Disseminate learning module
- Training of trainers
- Monitor and evaluate use of module
- Support and mentoring of trainees
SANCADI Objectives (2)
Management of severe malnutrition
- Assessment of current practices
- Capacity development where required
SANCADI Objectives (3)
Nutrition programming and advocacy
- Audit
- Identify institutions and organisations to
facilitate support and mentoring
SANCADI Objectives (4)
Nutrition and food security
- Enhance visibility and sustainability
- Strengthen government support through
• evaluating & spreading of WHO/FAO training
course
• advocacy and marketing by SANCADI
Regional capacity building training
courses on
Intersectoral Food & Nutrition Policies
Main Aim:
Providing support to countries in strengthening
and implementing national intersectoral food and
nutrition plans & policies to address emerging &
re- emerging nutrition issues, i.e. the double
burden of malnutrition, through:
► bringing together concerned sectors (health,
agriculture, education, finance/planning)
► incorporating various on-going work and
international commitments (MDGs, poverty
eradication, child survival, FIVIMS, etc.)
Capacity building training courses on
intersectoral food and nutrition plans and policies
Anglophone
Nairobi, February 2002:
Eritrea, Ethiopia, Kenya, Liberia, Seychelles, Sierra Leone,
Zimbabwe (7 countries)
Cape Town, Feb 2003:
Lesotho, Malawi, South Africa, Tanzania, Uganda, Zambia,
Zimbabwe (7 countries)
Cape Town, Oct 2004:
South Africa, Botswana, Zimbabwe, Namibia, Nigeria, Ghana (6
countries)
Francophone
Cotonou, May 2004:
Benin, Burkina Faso, Burundi, Cameroon, RDC, Guinée, Niger,
Togo (8 countries)
Main outcomes of the review meeting
1. Training course to become a WHO/FAO/UNICEF
training course through strengthening food access
concept & incorporating issues related to MDGs and child
survival
2. Further strengthen the sections on advocacy and
partnership (including civil society)
3. Encourage synergy with other existing training courses
aiming to support action at different levels, (i.e. to design
and implement specific programmes & projects at local &
community levels)
Common actions recommended by all Regions
•
strengthen the mechanisms for following up with the course
participants & countries to review their implementation status
after the training courses
•
strengthen communications between regional institutions,
networks and partners involved in food & nutrition issues
•
develop a forum for discussion through internet to allow
exchange of experiences, ask for information/questions on
how to overcome any specific problems encountered, etc.
•
ensure sustained funding for regional/country training
workshops to provide continued support for countries in
strengthening and implementing national food & nutrition
policies and strategies.
NEXT STEPS
• Appoint coordinator
• Undertake rapid audit of CD activities on nutrition programming
and advocacy
• Select institutions/ organisations to facilitate and support ongoing CD (eg using UWC manuals/modules, RCQHC Tanzania)
• Disseminate the learning module developed by RCQHC on
Nutrition and HIV/AIDS
• Evaluate effectiveness of/disseminate current CD approaches to
Food Security challenges (eg WHO/FAO/UNICEF course )
• Assess and improve current practice at 1st level (district)
hospitals on Management of severe malnutrition in selected
countries (eg using WHO 10 steps plus RUTF)
• Develop an advocacy and marketing strategy for SANCADI