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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] or