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International Nutrition International Nutrition When was the problem of undernutrition first recognized as a global concern? Which 3 UN bodies deal with nutrition issues? How does the focus of each differ? UNICEF United Nations Children’s Emergency Fund Infant Health & Survival Program GOBI - Growth/development, Oral rehydration, Breastfeeding promotion, Immunization Which deficiency problem has UNICEF addressed? FAO Food and Agriculture Organization Collaboration of agriculture & health sectors World leader in fight against food insecurity Strong advocate for nutrition policy development FAO World Food Program (WFP) Largest humanitarian agency Strives to eradicate hunger Distributed 4.2 million tons of food to 96.7 million people in 82 countries Funded by world governments, corporations, private donations WHO World Health Organization 1948 Emphasizes prevention of nutrition problems What nutrition issues has WHO programs addressed? UN Agencies Which other UN agencies have become involved in international nutrition issues? How has The World Bank assisted with nutrition issues of countries? United Nations University? SCN? International Nutrition Programs Strengthen institutions Supplementary foods to vulnerable groups Targeted financial assistance Health & nutrition services Nutrition education Treatment of anemia Small scale food production Food technology Water supply & sanitation control Food commercialization Is International Work for you? Entrepreneurial spirit needed “We can create the jobs” (Stacia Nordin in Aase, p. 1509) “requires some thinking out of the box about your career” (Camella Rising in Aase, p. 1509) “Adapting to a new culture demands flexibility, resilience, patience, openness, confidence, and the willingness to learn (Aase, p. 1510) Careers in International Nutrition Undergraduate degree in Nutrition or Agriculture International internship Graduate degree e.g., Coady, CIDA, Healthbridge An advantage Development Second language helpful To Breastfeed or Not The Dilemma of HIV Positive Women HIV and Breastfeeding Child mortality rates are increasing 5 million children have died from AIDS 2.7 million children are living with AIDS 800,000 children where infected in 2001 90+% of HIV infected children live in subSaharan Africa HIV and Breastfeeding Mother-to-child transmission of HIV Pregnancy Childbirth Breastfeeding Breast Milk Without HIV Best food for infants Prevents ~ 6 million infant deaths Provides optimum nutrition Protection against common childhood diseases (diarrhea and respiratory infections) Promotes child spacing Transmission of HIV during Breastfeeding Stats 1985 first case Results in ~ 200,000 – 300,000 infant HIV infections MechanismsComposition of breast milk Undergoes several changes Increased leukocyte numbers and immunoglobulin concentrations found in colostrum Therefore it is suggested that colostrum has a greater concentration of cell-associated HIV Timing of Breast Milk Transmission Depends on when the mother acquired the infection Infected just before delivery or during breastfeeding = Rate of transmission Summary of Transmission Rates Type of HIV Transmission Estimate Overall risk of breastfeeding Risk of transmission by a mother who acquired transmission just before or during breastfeeding period Risk of transmission by a mother with a preexisting HIV infection Estimated Risk 12-14% 29% (range 1553%) 7-10% The Decision The risk of HIV transmission through breastfeeding is substantial The risks of morbidity and mortality from diarrhea & respiratory disease in non breastfed infants is also substantial Possible Alternatives Oral antiretroviral (ARV) therapy Banked donor human milk Mothers own modified milk (heat treatment inactivates virus) Commercial infant formula Current Recommendations “When children born to women living with HIV can be ensured uninterrupted access to nutritionally adequate substitutes that are safely prepared and fed to them, they are at less risk of illness and death if they are not breastfed. However, when these conditions are not fulfilled, in particular in an environment where infectious diseases and malnutrition are the primary causes of death during infancy, artificial feeding substantially increases children’s risk of illness and death.” WHO HIV and Breast Feeding Ethical concerns arising from recommendation to not breastfeed if HIV-positive? Increased diarrheal disease ID mother as HIV positive (Stigma) Factors policy makers must take into account when setting guidelines? Transmission rates Finances Clean water supply Social stigma / norms Required Readings Maillet, 2008. Ethical and legal issues in nutrition, hydration and feeding. Knowles, & Gilmore, 1994. Discontinuation of Total Parenteral Nutrition. Duester, 1997. Building your business – Setting your fees: A cost-based approach. Gross, & Ostrowski, 2008. Getting started in private practice.