Project GCP/BGD/037/MULNational Food Policy Capacity Strengthening Programme (NFPCSP)

  Training Workshop on

FOOD SECURITY CONCEPTS, BASIC FACTS & MEASUREMENT ISSUES25 June – 07 July, 2011

Topic: Analytical Approaches for Food security

Sub-topic 2c : Analytics 3: Food Utilization

Lecture : Food Utilization/Nutrition

By

Mohammad Abdul Mannan, PhD

Nutrition Advisor, NFPCSP-FAO

OUTLINE OF THE PRESENTATION

BackgroundConceptual frameworkNutrition and health statusFood consumption and nutrition situationSeasonality and disasterLinkage with different sectorsConcludingWay forward

Food security – An evolving concept

In the 50s and 60s: Food security = self sufficiency in major staples

After World Food Conference of 1974:Food Security = Access to sufficient food

World Food Summit of 1996:“Food security exists when all people, at all times, have physical and economic access tosufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life”.

Food Security is part of Nutrition Security The concept of Nutrition security — ensuring access to food that is

nutritious as well as sufficient — is increasingly being used to stress the importance of the quality of food for people of all ages

What is Nutrition?

Nutrition is the science and practice of consuming and utilizing foods. It is the study of nutrients in food, how the body uses nutrients, and the relationship between diet, health and disease.

Why nutrition is important?

Foundation to development contributing to MDG’s

Economic benefit

LBW perpetuates the intergenerational cycle of undernutrition and disease

Economic growth alone unlikely to yield Nutrition results

Underlying causes at

household / family level

Malnutrition, death & disability

Inadequate dietary intake Disease

Insufficient access to FOOD

Immediate causes

Basic causes at societal level

Conceptual framework for analyzing the causes of malnutrition

Outcomes

Quantity and quality of actual resources –human, economic & organisational - and the way they are controlled

Inadequate maternal & child CARE

practices

Poor water, sanitation &

inadequate HEALTH services

Potential resources: environment, technology, people

UNICEF

The food and agriculture sector and nutritionNarrowing the “nutrition gap”

the gap between what foods are available and what foods are needed for a healthy diet

Diets are often low in quantity, quality and variety (hunger and micro-nutrient deficiencies) Increased production of staple foods is not sufficient Need to ensure local availability and access of the right mix of

foods in all seasons Consumers must be informed Collaboration must be established with : (a) social protection

programmes to support the poorest and (b) with health & multi sectors/programmes

19

3753

239

578

Undernourishment in 2010, by Region (millions)

Developed Countries

Near East and North Africa

Latina America and the Caribbean

Sub-Saharan Africa

Asia and the Pacific

Total: 925 million

Source: FAO, 2010

Undernourishment: FAO estimates

Country Undernourished(millions)in 1991-93

Undernourished(millions)in 2005-07

Proportion (%) of population

undernourishedin 1991-93

Proportion (%) of population

undernourishedin 2005-07

Bangladesh 44.4 41.7 38 27

India 172.4 237.7 20 21

Nepal 4.2 4.5 21 16

Pakistan 29.6 43.4 25 26

Sri Lanka 4.8 3.8 28 19

Total South Asia 255.4 331.1 22 22

• Proportion of undernourished population remains the largest in South Asia • Between 1990-92 and 2005-07,prevalence of undernourished decreased in Bangladesh by 11%, the largest decline in South Asia

Source: SOFI ,2010

CONTEXT : Bangladesh continues to have the highest Cer DES - 80%

Undernutrition trends among <5 children in Bangladesh

47.8

1713

44.6

57.4

68.3

41

51

65.8

43

43.1

51.4

64.264.6

48.3

42.4

14.416.7 16.6

12 12.7

10

20

30

40

50

60

70

80

1989/90 1992 1995 2000 2005 2007 2009

Source: 1990-2005 CMNS; 2007 BDHS; 2009 HFSNA

Per

cen

t

Underweight <5 Stunting <5Wasting <5 MDG target for underweight

Undernourishment trends

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

RELATIONSHIPS WITHIN THE FS FRAMEWORK

Nutritional and health status

INADEQUATE DIETARY INTAKE

Weight loss, growth faltering and reduced immunity, which lower the body’s ability to resist infection.

leads to

this causes

Longer, more severe and more frequent disease episodes.

Loss of appetite, malabsorption of nutrients, altered metabolism and increased nutrient needs.

leads to

this results in

This ‘vicious cycle’ is known as the “malnutrition-infection cycle”:

Nutritional and health status

NUTRITIONAL STATUS

HEALTH STATUS

This can eventually lead to severe malnutrition and death.

Nutrition and health are closely linked:

disease contributes to malnutrition

while malnutrition makes an individual more susceptible to disease.

0

20

40

60

80

100

120

140

160

180

1991-92 1995-96 2000 2005

Consumption trend of non-rice foods in Bangladesh

Meat and Egg Milk Fish Potato Fruits Vegetables

Source: Adapted from BBS-HES/HIES, 1991-2005

FOOD CONSUMPTION SITUATION •Increase in consumption of vegetables by 20% (157g); potato by 50% (63g)

Decline in percent dietary energy intake (DEI) from cereals in Bangladesh (1991-2005)(BBS HIES) and

projection up to 2020

72.2 69

60

65

72.9

79.6

75.678.5

80.3

75.277.179.7

66.7

69.2 68.5

55

60

65

70

75

80

85

1991-92 1995-96 2000 2005 2010 2015 2020

DE

I cere

al (%

)

National Rural Urban

Source: Authors’ own calculations

FOOD CONSUMPTION SITUATION •DEI Cer % decreased from 80 % to 73 % in the last 10 years •FAO recommendation contribution of cereals to DEI optimally 60% •Prospects by 2020

Bangladesh Nepal Maldives India Sri Lanka Bhutan Thailand0

10

20

30

40

50

60

70

80

90

10097

7377

8582 84

92

59

39

81

52

8083

87

Population with access to improved water source and sanitation

water Sanitation

Selected Asian Countries

%

Source: WHO SEARO, 2007

Industrial emissionsand effluents

Landfills

Vehicleemission

Agriculturalpractices

Source of hazards in the food chain

Processing

Storage

CookingLivestock

Crops

Seafood

Distribution

Retail

Urban Rural Total0

10

20

30

40

50

60

70

80

90

10099.4

96.5 97.1

0.53.5 2.8

20.3

2.96.7

Household drinking water source and treatment prior to drinking

Improved sourceNon-improved source% of appropriate water treatment prior to drinking

Source: BDHS, 2007

% o

f hou

seho

lds

Population Pyramid - Bangladesh

Health services

Health services delivery includes-

Maternal, Neonatal and Child Health Communicable disease control TB and Leprosy control HIV/AIDS prevention and controlNon communicable disease control including Emergency preparedness programme and climate change, Hospital based emergency obstretic care,Health education and promotion, Hospital services at upazila, district, and tertiary level, andAlternative medical care.

NUTRITION SITUATION•% Decline in BMI (< 18.5) in women over the last decade 53 % to 26%•Emerging concern of double burden- prevalence of overweight (BMI > 23)

BDHS BDHS BDHS CMNS BDHS FSNSP1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

0%

10%

20%

30%

40%

50%

60%

52%

45%

38%

32% 33%

26%

6%9%

12%

17% 16%

25%

Maternal Nutrition Status

CED (BMI<18.5) Overweight (BMI>23.0)

Stunting and Underweight

NSP

NSP

NSP

NSP

NSP

NSP

CMN

S

NSP

*

BDH

S*

HFS

NA

*

HFS

NA

*

FSN

SP*

1-3, 8, 9

3-8 11-12 1 1-4

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

0%

10%

20%

30%

40%

50%

60%

70%

64%60%

58%55%

51% 50% 49% 48%45%

49% 49% 47%

54%50%

47% 45%43% 41% 41% 39%

42%37% 37%

32%

Trends in stunting and underweight (<-2 sd, children 6 to 59 months)

Stunting Underweight

Months of the survey

Slight increment in 2007 (underweight) and 2008 and 2009 (stunting).

Evidences of impact of the food crisis of 2007 and 2008 in reverting the posi-tive trend

• Indicators for under five children remain alarming despite improvements• Nutrition outcomes highly susceptible to variability of food prices

NUTRITION SITUATION• 3 fold increase in % of UW among 6-12 month infants

•Faulty weaning and feeding behaviour along with infectious disease are critical factors

0 3 6 9 12 15 18 21 24 27 30 33 36 39 42 45 48 51 54 570%

10%

20%

30%

40%

50%

60%

70%

Child Malnutrition by age in months - 5 month moving average

Stunting Wasting Underweight

Vitamin A supplementation

50

85 82

94 97

0102030405060708090

100

1995 2000 2005 2007 2008

Year

% c

hild

ren

6-59

mon

ths

rece

ivin

g tw

o do

ses

of v

itam

in A

dur

ing

cala

nder

yea

r

4.1

3.6

1.78

10.6

0.3 0.2 0.2

00.5

11.5

22.5

33.5

44.5

1962-64 1982 1989 1995 1997 1999 2002 2005

Pe

rce

nt

Decline in nightblindness among under-5 children in Bangladesh, 1962-2005

Source: HKI, 2006

NUTRITION SITUATION •Night blindness almost non existent, prevalence below 0.1% in 2006; •Attributed to blend of actions VAC distribution with EPI and food basedstrategies •VAD is still high, 30% among women and children

Change in goitre prevalence among women and children in Bangladesh, 1962-2005

6.2

26

49.9

17.2

32.7

55.6

24.2

11.7

0

1020

30

4050

60

1962-64 1993 1999 2004-5

To

tal g

oit

re r

ate

(%

)

Children Women

Source :Yusuf et al, 2008

NUTRITION SITUATION •Success due to USI initiated in 1994-95; marked annual decline of 3.48%; •Physiological iodine deficiency still exists around 36%

Food safety in horticulture : Bangladesh Results- Survey (fruit ripening)

JACKFRUIT RIPENING, BHALUKA, MYMENSINGH

Source: Hassan et al,2010, BAU

0

5

10

15

20

25

30

35

40

Up to 2% Up to 5% Up to 10% Up to 20% Up to 50%

2

12

34

15

0

6

26

37

6

0

% o

f co

nsu

me

rs

Dhaka (N=500)

Mymensingh (N=500)

Consumers’ willingness to pay more for purchasing safe fruits and vegetables

Consumers’ perception on quality and safety

Framework on access to education, credit, and health care

From farm to table, table to farm: a new agricultural paradigm (Rouse and Davis, 2004)

Source: DAE, MoA: GoB/FAO/UNDP Integrated Horticulture and Nutrition Development (BGD/97/041) 2000 -2006

AGRICULTURE-NUTRITION LINKAGES •Horticulture technology models from DAE show a wide range and quantity of fruits •Can be produced over a 10 year period at HH level•Fruits rich in vitamins and minerals; contribute to food security and dietary diversity

An example of a small mixed orchard intercropped with vegetables

Vitamin A supply /person/d (mcg)

02000400060008000

10000Mango

Papaya

Drumstick leaves

Source: Report on Food based Nutrition Strategies for Bangladesh, Integrated Horticulture and Nutrition Development Project, FAO/GoB/UNDP, 2000 -2006

AGRICULTURE-NUTRITION LINKAGES •Vitamin A supply from fruits/HH/d and per capita noted to be adequate•Provides substantial part of the RDA for micronutrients at HH and individual levels•Papaya and drumstick leaves : furnish 97% of the RDA for Vitamin A

Current intake of rice (g) and total energy kcal (HIES 2005) as against desired intake in

Bangladesh

469 448

930

2238

375 350

1050

2350

0

5001000

15002000

2500

Cereal, g Rice, g Total, g Kcal

Current intake Desired intake

Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

DESIRABLE DIETARY PATTERN•Current national average cereal intake 469 g/person/d (rice 449g) contributing to 70% DEI as against the optimal FAO/WHO norm of 55% -60%•Need to reduce cereal intake and increase non-cereal foods•Need to increase calorie intake

Desirable intake of non-rice foods vs current intake in Bangladesh

21 14

96

44

155

32 33

157

63

16 8 1825

60

180

5535

15

75

100

200

6040

18 20

0

50

100

150

200

250

g/c

ap

ita/d

ay

Current intake Desired intake

Source: FPMU, MoFDM, MoA, MoH&FW, NFPCSP Expert Consultation, August 2007

DESIRABLE DIETARY PATTERNDesirable food basket total energy intake set at 2350 kcal and % energy from cereals proposed at 55%; absolute terms 375 g(350 g rice + 25g wheat & other cereals) some 77 g less than present intake (rice low by 90g and wheat up by 13g)

Thresholds for assessing nutritional status in emergency situation

Severity of malnutrition

Prevalence of wasting

(% below median – 2SD)

Mean weight for height Z-score

Acceptable < 5% > -0.40

Poor 5–9% -0.40 to -0.69

Serious 10–14% -0.70 to -0.99

Critical > 15% < -1.00

• Starting point for interpretation, rather than the sole basis…

• Thresholds vary

Adaptation of Health sector: Community action for malnutrition amidst climate change

Climate change through nutrition intervention and mainstreaming nutrition consideration in food, agriculture and health sectors:

• Increase vector borne diseases like malaria and dengue fever due to global warming and climate change

• Increase depletion of nutrients, minerals and reserves due to diarrhoea – because of increased flooding and drainage congestion

• Increase heat strokes –further aggravated by shortages of drinking water

• Increase malnutrition, morbidity, mortality suffering and loss of productivity

• Reduce the capacity of individuals to adapt to climate change

Actions needed• Review evidence of relationship

among nutrition, health and climate change

• Establish community based nutrition program

• Deliver integrated package of health and nutrition

• Home gardening, poultry rearing, fisheries development

• Food storage and processing technologies

• Population planning at community level

Feeding programmes: decision making frameworks

Food availability at household level <2100 kcal/day

Unsatisfactory situation: improve general rations

Malnutrition rate 15% or more or 10-14% with aggravating factors

Serious situation:General rations, supplementary feeding for all members of vulnerable groups, therapeutic feeding

Malnutrition rate 10-14% or 5-9% with aggravating factors

Risky situation:No general rations, but supplementary feeding targeted to malnourished individuals, therapeutic feeding for severely malnourished

Malnutrition rate under 10% with no aggravating factors

Acceptable situation:No need for population interventionsAttention to malnourished individuals through regular community services

Malnutrition and Mortality – can we review rates in order to diagnose food crises, health crises and famines that kill?

0

0.2

0.4

0.6

0.8

1

1.2

1.4

1.6

1.8

0.00% 5.00% 10.00% 15.00% 20.00% 25.00% 30.00% 35.00%

Prevalence of Acute Malnutrition

Cru

de M

ort

ali

ty R

ate

Responding to L’Aquila Initiative and in line with the 5 Rome Principles, the CIP was Approved on 14 June 2010 following the Bangladesh Food Security Forum. Translates the policy frameworks in a comprehensive set of 12 priority investment programmes and aims at

• convergence and alignment of domestic and external funding

• mobilizing additional resources:Bangladesh qualified as first Asian country receiving a grant under the Global for US $ 52.5 million

The revised CIP, based on extensive consultation, incorporates over 400 projects of which 146 ongoing (for US$ 3.036 billion) and 262 in pipeline (for US$ 4.945 billion of which US$ 3.299 billion are priority).

The Country Investment Plan

Concluding Remarks Bangladesh is an exemplary case of a consistent long term effort to put in place

a comprehensive policy framework for food security and nutrition HPNSDP is ready for implementation This framework provides a platform for

Dialogue among government, civil society and development partners Alignment, coordination and harmonization of interventions

Within the FS framework, CIP is the tool for prioritizing, enhancing effectiveness and scaling up food security investments

Food security is critical to nutrition security – ensuring access to safe and nutritious food – emphasis on quality of food

A conducive institutional setting and continued commitment of all partners are needed to sustain the implementation and monitoring process in the medium/long term

Way Forward

Global/regional/national commitment to mobilize the necessary resources to address the problem decisively.

Improve capacity building and awareness raising on food and nutrition security at household level

Integrate /strengthen nutritional considerations into agriculture, food and health policies and interventions to improve food security and nutrition

Establishing information and surveillance systems that are critical for developing evidence-based food security and nutrition policies.

Sustain involvement of multiple actors – strengthen/establish community based and national mechanisms for nutrition

THANK YOU FOR YOUR KIND ATTENTION !