Mat Nut Slideshow English With Notes

8/6/2019 Mat Nut Slideshow English With Notes

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Maternal Nutrition

Issues and

Interventions

The Linkages Project

Academy for Educational Development



UN

ICEF/C-79-15/G

oodsmith

Maternal

Nutrition

Issues



Major Issuesin Maternal Nutrition

• Inadequate weight and height

• Micronutrient deficiencies



Maternal Malnutrition: A Life-Cycle Issue (1)

• Infancy and early childhood (0-24 months)

–Suboptimal breastfeeding practices

– Inadequate complementary foods

– Infrequent feeding

– Frequent infections

•

Childhood (2-9 years) – Poor diets

– Poor health care

– Poor education




• Adolescence (10-19 years)

– Increased nutritional demands– Greater iron needs

– Early pregnancies

• Pregnancy and lactation

– Higher nutritional requirements

– Increased micronutrient needs

– Closely-spaced reproductive cycles




Throughout life

– Food insecurity

– Inadequate diets

– Recurrent infections

– Frequent parasites

– Poor health care– Heavy workloads

– Gender inequities



Women Giving Birthbefore the Age of 18

18

21

28

0

10

20

30

Asia LAC Africa

UN, World Fertility Survey, 1986

Percent



Chronic Energy Deficiencyin Women 15-49 Years Old

41.1 40.5

18.722.4

14.6

7.2

0

25

50

S Asia SE Asia China SS Africa C Amer. S. Amer.

ACC/SCN, 1992

Percent Women

BMI<18.5 kg/m2



Consequences of Maternal Chronic Energy Deficiency

• Infections

• Obstructed labor

• Maternal mortality

• Low birth weight

• Neonatal and infant mortality



Determinants of IntrauterineGrowth Retardation

Low pre-pregnancy weight

Short stature

Low caloric intake

Maternal low birth-weight

Non nutritional factors

Kramer, 1989



The Intergenerational Cycle of Malnutrition

Child growthfailure

Early

pregnancy

Small adultwomen

Low birth

weight babiesLow weight andheight in teens

ACC/SCN, 1992



Iron Deficiency

• Most common form of malnutrition

• Most common cause of anemia

• Other causes of anemia:

−Parasitic infection

−Malaria



Dietary Iron RequirementsThroughout the Life Cycle

0

2

4

6

8

10

12

0 10 20 30 40 50 60 70

Men

Women

Required iron intake(mg Fe/1000 kcal)

Stoltzfus, 1997

Age (years)

Pregnancy



Causes of Dietary Iron Deficiency

•

Low dietary iron intake• Low iron bioavailability

− Non-heme iron

− Inhibitors



Parasitic Infection

• Causes blood loss

•

Increases iron loss



Malaria

•

Destroys red blood cells• Leads to severe anemia

• Increases risk in pregnancy



Prevalence of Anemiain Women 15-49 years old

ACC/SCN, 1992

Percent



Anemic Women(15-49 years old) Worldwide

215

56 56

248

278 11 4 0.5

0

125

250

S/SE Asia Africa China LAC E Asia

Non-PregnantPregnant

ACC/SCN, 1992

DeMaeyer, 1985

Millions



Severity of Anemiain Pregnant Women

0

50

100

Nepal China

Mild anemia (90<Hb<110 g/L)

Moderate to severe anemia (Hb<90 g/L)

Stoltzfus, 1997

Percent



Severity of Anemiain Non-Pregnant Women

0

50

100

Zanzibar Indonesia

Mild anemia(90<Hb<120 g/L)

Mod-severe anemia (Hb<90 g/L)

Stoltzfus, 1997

Percent



Consequencesof Maternal Anemia

• Maternal deaths

• Reduced transfer of iron to fetus• Low birth weight

•

Neonatal mortality• Reduced physical capacity

• Impaired cognition





Pregnancy Hemoglobinand Low Birth Weight

13.8

11.59.7

8.9 911.4 11

0

5

10

15

80 90 100 110 120 130 140

Lowest pregnancy hemoglobin concentration (g/L)

%

L o w b i r t h w e i g h

t

Garn et al., 1981



Consequences of Anemiaon Women’s Productivity

UNICEF/9

1-029J/S

chytte

Reduced

productivity

Reduced

roductivit



Consequences of Anemiaon Children’s Education

UNICEF/C

-72-15/S p

raguei

Reduced learning capacityReduced learning capacity



Causes of Maternal Vitamin A Deficiency

• Inadequate intake

• Recurrent infections

• Reproductive cycles

U

NICEF/C-16-8/Isa a

c



Consequences of Vitamin A Deficiency in Pregnancy (1)

Increased risk of:• Nightblindness• Maternal mortality

• Miscarriage

• Stillbirth




Consequences of Vitamin A Deficiency in Pregnancy (2)

•

Reduced

transfer of

vitamin A to

fetusUNICEF



Consequences of Maternal Vitamin A Deficiency on Lactation

UNICEFC

-92-18/S

prague

Low

vitamin A

concentrat

ion



Consequences of Vitamin A Deficiency in Childhood

Increased risk of:

• Occular problems

• Morbidity and mortality

• Anemia



Iodine Deficiency in Women

UNICEF/9

5-0065

Shadid

GoiterGoiter



Consequences of Iodine Deficiency on Intelligence

Spectrum of Intellectual Impairment:

• cretinism

•

severe mental impairment

• mild mental impairment

Spectrum of Intellectual Impairment:

• cretinism

•

severe mental impairment

• mild mental impairmentUNICEF/C-79-39



Consequences of Iodine Deficiency on Education

• Educability

• Drop-out rates

• Under utilizationof school facilities

UN

ICEF/C-56-19/M

urray-Lee



Consequences of Maternal Malnutrition on Productivity

Chronic EnergyDeficiency

Iron Deficiency

IodineDeficiency



Consequences of Maternal Zinc Deficiency

• Rupture of membranes

• Prolonged labor

• Preterm delivery


• Maternal and infant mortality



Consequences of Maternal Folic Acid Deficiency

•

Maternal anemia

• Neural tube defects




Consequences of Maternal Vitamin B-6 and B-12 Deficiency

• Maternal anemia

• Impaired development of infant’s brain

• Neurological disorders in infants



Maternal

Nutrition

Interventions

U

NICEF/C

-79-15/G

oo

dsmith



Major Interventionsin Maternal Nutrition

• Improve weight and height

• Improve micronutrient status



Improving Maternal Weight

• Increase caloric intake

• Reduce energy expenditure

• Reduce caloric depletion



Improving Maternal Height

• Increase birth weight

• Enhance infant growth

• Improve adolescent growth



Optimal Behaviorsto Improve Women’s Nutrition

Early Infancy: Exclusive

breastfeedingto about

six months of age U

NICEF/C

-79-10




Late Infancyand

Childhood: Appropriate

complementaryfeeding from

about six

UNICEF/C

-55-3

F/Watson




UNICEF/C-56-7/M

urray-Lee

Late Infancyand Childhood: Continue frequenton-demand

breastfeeding to 24months and beyond




Pregnancy:

• Increase food intake

• Take iron+folic acid

supplements daily

• Reduce workload

UNICEF/C

-55-10/Watson




UNICEF/C-88-15/G

oodsmith

Lactation:• Increase food intake

• Take a high dose

vitamin A at delivery

• Reduce workload



Vitamin A PostpartumSupplementation

Recommendations

Current (WHO):200,000 IU in 1 dose, as soon as possible

after delivery

Proposed (IVACG):400,000 IU in 2 doses of 200,000 IU at

least 1 day apart, as soon as possibleafter delivery




UNICEF9

0-070/Lem

oyne

•

Delay

firstpregnancy

•

Increase




At all times:

•Increase food intake if underweight•Diversify the diet

•Use iodized salt

•Control parasites• Take micronutrient supplements if needed



Improving Women’sMicronutrient Status

• Dietary modification

• Parasite control

•

Fortification• Supplementation



Dietary Modification to ImproveWomen’s Micronutrient Status

Increase:

•Micronutrient intake

•Bioavailability of micronutrient intake



Parasite Control to ImproveWomen’s Micronutrient Status

Reduce parasite transmission:

• Improve hygiene

•

Increase access to treatments



Fortification to ImproveWomen’s Micronutrient Status

Medium-term strategy:

•

Improves micronutrient intake• Without changing food habits

Requires:

• Appropriate nutrient fortificant

• Appropriate food vehicle



Examples of Micronutrient Food Fortification

• Vitamin A in sugar

• Iron in wheat flour

• Iodine in salt

• Multiple fortification- iron + iodine in salt

- iron + vit B in wheat flour

l



Supplementation to ImproveWomen’s Micronutrient Status

• Preventive or therapeutic

• Daily or periodic

• Targeted to groups

• Mass distribution

l A d S l



Iron+ Folic Acid Supplementation for Women of Reproductive Age

Prior to and between pregnancies:

Periodic supplementation (60 mg of iron and 400 μg

folic acid) daily for 3 months for:

●Girls before puberty and during adolescence

●Women of childbearing age

I F l A d S l



Iron+ Folic Acid Supplementationduring Pregnancy

•Daily supplementation

•Start as soon as possible

•Continue for 6 months

M l l M



Multiple Micronutrient Maternal Supplementation

Targeted to:

− Pregnant women

− All women of reproductive age

Iron+folic acid+other micronutrients

Addition increases:− Costs

− Benefits

El f S f l



Elements of a Successful Supplementation Program

•

Supplement supply• Delivery system

• Women’s demand and compliance

• Monitoring and evaluation



Supplement Supply

•

Data-based ordering

• Timely procurement process

• Timely distribution to delivery points



Supplement Delivery System

• Accessible to target population

• Appropriate Staff:− Motivated

− Approachable

− Supportive

− Adequately trained



Women’s Demand and Compliance

• Communications component

− Community awareness

− Information on side effects

• Good quality supplements



Monitoring and Evaluation

• Monitor at all levels:

− Supply

− Coverage

− Compliance

−

Communications component

• Evaluate impact on prevalence



Produced by

The Linkages Project

Documents

Mat Nut Slideshow English With Notes