NUTRITION AND FOOD SECURITY OF SELECTED SITUATION OF SELECTED ASIAN

COUNTRIES

Md Abdul Mannan

Lalita Bhattacharjee

Nutritionists

Training on “Comparative Review of the Nutrition Situation and Policies in Selected Countries and with particular reference to Bangladesh”

27 March to 6 April 2014

Constitutional obligation• Bangladesh Constitutional and the rights of its

citizen are focused as in article 18 (1) :

The State shall regard the raising of the level of nutrition and the improvement of public health as among its primary duty

Countries with highest burden of malnutrition

These 34 countries account for 90% of the global burden of malnutrition

Source: The Lancet, 2013

Prevalence (%) of child malnutrition in selected Asian countries

4

Bangladesh 2011

India 2006

Nepal 2011

Pakistan 2011

Sri Lanka 2009

Lao PDR 2006

Thailand 2006

0 5 10 15 20 25 30 35 40 45 50

36

43.5

29.1

30.9

21.6

31.6

7

41

47.9

40.5

43

19.2

47.6

15.7

Stunting % Underweight %

Stunting and Underweight in South Asian Countries – Annual Average Change , 1990 -2010

-2.50

-2.00

-1.50

-1.00

-0.50

0.00

Bang

lade

sh

Indi

a

Nepa

l

Paki

stan

Sri L

anka

Bang

lade

sh

Indi

a

Nepa

l

Paki

stan

Sri L

anka

Stunting Underweight

Perc

ent

6

Prevalence (%) of Anaemia in selected Asian countries (recent observation)

Bangladesh

India

Nepal

Pakistan

Sri Lanka

Lao PDR

Thailand

0 10 20 30 40 50 60 70 80 90

47

74.3

78

50.9

29.9

48.2

25.2

Anemia %

Quintile H/A % < - 2SD

STUNTING

W/H % < - 2 SD WASTING

W/A % < - 2SD UNDERWEIGHT

Lowest 53.7 17.5 50.3

Second 45.4 16.2 41.6

Middle 40.7 17.7 36.0

Fourth 35.9 13.6 27.5

Highest 25.7 12.1 20.9

Nutritional status of U5 children by wealth quintile in Bangladesh

Prevalence of undernourishment, S Asia 1999-20; 2011-2013

Country No. (millions) Undernourished

1990-92

No. (millions) Undernourished

2011-13

% pop undernourished

1990-92

% pop undernourished

2011-13

Bangladesh 36.5 24.8 33.9 16.3

India 227.3 213.8 25.5 17.0

Nepal 5.0 5.0 25.4 16.0

Pakistan 31.2 31.0 27.2 17.2

Sri Lanka 5.9 4.8 33.4 22.8

Total South Asia

314.3 294.7 25.7 16.8

Source: FAO, SOFI, 2013

Prevalence of undernourishment in selected South Asian countries and progress towards MDG targets

Bangladesh India Nepal Pakistan Sri Lanka

34.6

26.9 25.9 26.4

33.9

16.8 17.5 18 19.924

-51.4

-34.9-30.5

-24.6-29.2

1990-92 (%) 2010-12 (%) Change so far (%)

Food groups as % of dietary energy supply in selected Asian countries

Bangladesh

Nepal

India

Sri Lanka

Pakistan

Lao PDR

Thailand

Maldives

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

78.9

67.5

57.6

56

46.6

69

48.6

37.4

Cereals

Sugar

Pulses

Oils

Fruits &Veg-etables

Roots & Tubers

Meat, fish, egg and milk

Other foods

Source: FAO RAP 2012, Adapted from FBS 2007 - 2009

Per capita dietary energy (kcal) intake (HIES, 2010)

80% 79%76%

73%70%

60%

80% 80%77%

75%72%

72%69% 69%

67%63%

50%

55%

60%

65%

70%

75%

80%

85%

90%

1991-92 1995-96 2000 2005 2010 2015

National Rural Urban

Dietary energy intake Cereal contribution to dietary energy shows a declining trend Only 3% point decline in 5 years during 2000-05 and 2005-10 DES from cereals should be 60% for better health

Per capita/d intake of major food items (g)

Association between DES Cereal% and % stunting in U-5 children (n = 20, p = 0.000)

y = 0.7634x - 17.671R2 = 0.5154

05

10152025303540455055

35 40 45 50 55 60 65 70 75 80 85

DES Cereal%

% S

tun

tin

g

Source: Authors' own calculation from FAO RAP 2007

FOOD CONSUMPTION SITUATION •Significant + correlations between DES Cer% and child MN rates

The “Window of Opportunity” for Improving Nutrition is very small…pre-pregnancy until 18-24 months of age

(focus on 1st 1000 days –SUN)

-2.00

-1.75

-1.50

-1.25

-1.00

-0.75

-0.50

-0.25

0.00

0.25

0.50

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 57 60

Age (months)

Weig

ht

for

ag

e Z

-sco

re (

NC

HS

)

Latin America and Caribbean

Africa

Asia

Repositioning Nutrition, 2006

1000 days: conception to child’s second birthday

National Food Policy – progress toward the goalOverall goals of the NFP is “to ensure dependable sustained food security and nutrition for all people of the country at all times”

3 indicators focus on nutrition as main outcome of food security: Undernourishment (caloric intakes ):

- FAO: target reached in early 2000s, no significant progress thereafter - HIES: past DCI trend and average intake improving too slowly

Underweight and stunting: targets reachable if progress is sustained

NFP 2007/08(PoA baseline)

2009/10(CIP/SFYP baseline)

2010/11 2011/12 Target 2015 Source

Undernourishment (3year moving average) 15.5% 16.5% 17.1% 16.8% 17%

(MDG -1)FAO, SOFI

Underweight (0 to 59 months) 41.0% na na 36.4% 33%

(MDG -1)BDHS

Stunting (0 -59 months) 43.2% na na 41.3% 38%

(HPNSDP)BDHS

Indicators NFP PoA CIP FSNSP

Infants exclusively breast fed 6 mo + + +

SAM/MAM children < 5 years% + +

ANC coverage at least 4 visits % + + +

Diarrhea in U5 children (last 2 wk + + +

CED prevalence among women ( BMI < 18.5) + + +IDD among women (goiter)/ UIE% ; % HH consuming adequately iodized salt + + -----

Children receiving minimum acceptable diet at 6 -23 mo of age % + + +

IDA (pregnant women) % + + -----

Proportion of population using safe water supply for domestic use % + + +

Access to safe drinking water in arsenic affected areas (% population) + + -----

% HH with integrated home gardens + + +

Selected core indicators: harmonization with PoA, CIP, FSNSP (outcome and output)

Indicators NFP PoA CIP FSNSP

# compulsory food items standardized by BSTI + + ----

BCC operational + + +

DDP established + + -----

FCT updated + + -----

Existing FS/N surveillance systems/databases -- + ----

Dietary energy supplies (DES) from cereals % + + ------

Food groups as % share of DES + + ------

Dietary Energy consumption /intake (DEI) from cereals % + + ------

Food groups as % share of DEI + + -------

Selected core indicators: harmonization with PoA, CIP, FSNSP (output)

Nutrition sensitive indicators –OUTCOME

• % share of dietary energy supply (DES) from food groups• % share of dietary energy intake (DEI) from food groups

(≤ 60% from cereals) and rest from non –cereals• % households with dietary diversity score (HDDS)

minimum 6 out of 12 food groups (FANTA/FAO, 2011)• % women/maternal dietary diversity score :minimum 5

out of 9 food groups (FANTA/FAO, 2011)• Proportion of children (6 -23 mo) receiving minimum

acceptable diet (+ 4 out of 7 food groups)• Dietary energy and nutrient/micronutrient

intake/adequacy

Nutrition sensitive indicators –OUTPUT

• % of poor households raising home gardening and backyard poultry –BASELINE 41%

• Diversity of food production # of vegetables and fruits grown (minimum of 8 vegetable and fruit varieties per homestead garden) ( < 0.50 acres landless; 0.50 – 0.99 acres marginal; 1.0 – 2.49 acres small)

• % children with improved hygiene practices including hand washing

NATIONAL NUTRITION SERVICES

Intervening at different stages of the life cycle through NNS, MoHFW with a focus on the 1st 1000 days

Coordinating and ensuring active engagement with other key Government agencies (Agriculture, Food, Industries, Local Government, Women and Children’s Affairs)

Specific Objectives Reduce the prevalence of low birth weight Reduce the prevalence of underweight in children

<5 years Reduce the prevalence of stunting in children <5

years Reduce wasting in <5 years Reduce night blindness among pregnant women,

lactating women and children aged 12-59 months Reduce the prevalence of anaemia in < 5 years

children, adolescents and in pregnant women

Specific Objectives (Cont.)

Reduce the prevalence of iodine deficiency (UIE <100 g/L) of all school aged (6-12 years) children

Increase knowledge among general population Increase exclusive breast feeding up to 6 months and

complementary feeding rate Expand health and nutrition education at school level Decrease micronutrient deficiency diseases (zinc,

calcium, vitamin-D) Decrease nutrition related NCDs

Priority indicators and targets (NNS/HPNSDP)