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Economics of Malnutrition Symposium on Nutrition for DDOs, ICDS Prog Officers & CDHOs Gandhinagar 13.5.06 Is there need to invest in reduction of malnutrition ? • • • • • • • Single biggest contributor (60%) to child mortality Anaemia causes 60,000 deaths yearly in women It’s a silent emergency Low weight infants have 2 to 10 times risk of death Leads to growth faltering & stunting Reduced physical work capacity & productivity Poor resistance & predisposition to infections Is there need to invest (Contd) ? • • • • • • • • Impaired drug response (anti-retrovirals) Defective vision & low immunity Folate def causes severe birth defects in 250,000 Iodine def causes mental impairment in 18m yearly The damage is irreversible and life long It passes from generation to generation Poverty reduction strategies can be de-railed MDG on nutrition would not be achieved by 2015 When does the damage take place ? • Major damage caused by malnutrition takes place in – the womb – first two years of life Window of opportunity How are poverty & malnutrition interrelated Income Poverty Low Food Intake Frequent Infections Hard Physical Labour Frequent Pregnancies Large Families Malnutrition Direct losses In productivity from poor Physical status Indirect losses in productivity from poor cognitive development & schooling Loss in resources from increased health care costs of ill health What is the economic fall out ? • • • • Productivity losses to individuals are estimated at more than 10% lifetime earnings, and gross domestic product (GDP) lost to malnutrition runs as high as 2 to 3% Median total losses (physical and cognitive) due to iron def are $16.8 per capita,4.05% of GDP Improving nutrition is therefore as much–or moreof an issue of economics as one of welfare, social protection and human rights Improving nutrition is a pro poor strategy, disproportionately increasing the income-earning potential of the poor Does malnutrition also occurs in families that are not poor ? Yes But Why? – – – – – – – Preg & nursing mothers eat less than body needs Exclusive breastfeeding is not universal People do not always know what food and feeding practices are best for their small children Food intake is restricted during illness in children People can not easily tell when their child is becoming malnourished Growth faltering is not visible in the early stages Micronutrient deficiencies are not visible to untrained eyes How much can economic growth achieve ? • • • • With substantial increase in income, malnutrition in developing countries has not declined correspondingly When GNP doubles, malnutrition improves by 32 to 23% Its estimated that sustained per capita economic growth of 2.5% between 1990s and 2015 would reduce malnutrition by 27% This is just half of the MDG goal of 50% reduction What investments give best returns ? Health & nutrition related Non Health • • • • • • • • • Controlling HIV/AIDS Providing micronutrients Controlling malaria Improving infant/child nutrition • Scaling up basic health services • Reducing prevalence of LBW Liberalizing trade Lowering barriers to migration New agricultural technology Small scale water technology Community managed water systems • Research on water in agricult • Lowering cost of business Copenhagen Consensus May 2004 What are the quick routes to improving nutrition status ? • • • • • • • Micronutrient supplementation – Vitamin A, Iodine and Iron-Folate Exclusive breastfeeding for first 6 months Periodic growth monitoring Timely & adequate complementary feeding Complete immunization cover Prompt treatment of childhood diseases Birth spacing (> 2 years) What are the long term measures to sustain gains of improving nutrition • • • • • • • Economic growth Macroeconomic policies Female education and enhanced women’s status Women’s workload Food production Water supply & sanitation Family planning – birth timing & limiting What are the ongoing interventions ? • • • • • • • • Growth monitoring Supplementary feeding & counseling Supplementation of Vitamin A, IFA & Iodine Immunization Breastfeeding, NBC, Disease control, IMNCI and child care at home Maternal care TSC & Swajaldhara PDS, SHG, Food for Work, etc. What is missing ? • • • • • • Community level awareness Early & exclusive breastfeeding Quantity & frequency of feeding Prompt treatment of illnesses Sanitation & hand washing with soap Action following growth monitoring What can the District Managers do? • Ensure 300 days of feeding by ICDS for <3s • Monthly growth monitoring & counseling of mothers • Visits homes of children of Grade III/IV, with growth faltering and absentees for any risks • AWW to visit homes of pregnant and nursing for counseling on feeding/care practices • Medical check-up of Gr III/IV children • Hand washing with soap, safe drinking water, toilet use & sanitation at AW In the village ………. ? • • • • • • • • Iodized salt and food grains at the PDS shop Iron-Folate tabs for adolescent girls Any marriage < 18 yrs All births registered in Ist wk & certificates issued Any infant, child or maternal death Immunization sessions held in last three months Any child 6-14 out of school Availability of ORS, Condoms, drinking water, home toilets • Visit home where birth taken place recently • Link couples, VEC, Women SHG, Volunteers, etc Can the children be well-nourished and contribute to the economic growth of the State? Yes!!! Because- Science is known Systems are in place With little systemic and effective support by all, children in Gujarat could be well nourished. Thank You!!!