THE first 1000 DAYS: CHANGE A LIFE, CHANGE THE FUTURE!

Provincial Planning Launches

Nutrition indicators for children under five

Commonly used anthropometric indicators

a.Stunting (Low height for age compared to the reference population)b.Underweight (Low weight for age compared to the reference population) c.Wasting (Low weight for height compared to the reference population) d.Low birth weight (below 2.5 kg)

Stunting: A silent emergency!

Implication for Zambia

• Zambia is at 45 % stunting in children under five (2007 ZDHS).

• According to WHO, the severity of the situation is very high when stunting is above 40%

• Zambia is classified as a country with high burden of stunting which requires immediate actions

Stunting in Zambia45% of children under five are stunted!

What is stunting?

• Stunting is being short for one’s age if compared to the reference population (healthy and well nourished children of the same age)

Normal height/age Low height/age

Chanda, 5 years old, stunted

Nawa, 5 years old

Consequences of Stunting (1) Stunting does not affect only the skeletal system, short stature is just one feature of a complex syndrome, “the stunting syndrome”, which includes:•Developmental delay (retarded milestones such as walking)•Impaired immune function (increased morbidity and mortality)•Reduced cognitive function (Decreased school performance and future earning)•Metabolic disturbance (Increased risk of chronic diseases in adulthood e.g. obesity and hypertension)

Consequences of Stunting (2)

A small adult has also some functional limitations compared to a taller one (referring to direct effects of small size)•Short stature in women results in intra-uterine growth retardation (inter-generational cycle of stunting)•Shorter adults have a reduced working capacity (perpetration of poverty in labor-intensive societies)

Is the stunting syndrome reversible?

• Growth catch-up is possible in later childhood with sustained improvement in living conditions.

• Children, who remain in poor living condition, in which they became stunted, experience little or no catch-up in growth later in life.

• Mental and cognitive impairment are often permanent and irreversible after the age of 24 months.

The concept of 1000 days• Stunting commonly occurs during fetal life,

and soon after birth up to until the second year of life.

• The development of stunting follows the same pattern in all the regions of the world

• This critical period is equivalent to first 1000 days of life = 270 days (9 months of pregnancy) + 365 days (1st year of life) + 365 days (2nd year of life).

Cont’d• The first 1000 critical days is a period of

critical nutritional needs and key days for physical growth, motor and intellectual development.

• Prevention should occur during this critical period using the life cycle approach which includes:• adequate maternal nutrition • appropriate age-specific IYCF practices• a healthier environment (sufficient care, good

hygiene etc.)

Tackling malnutrition requires a multi-sectoral approach!

Zambia National Food & Nutrition Strategic Plan (2011-2015)

8 priority areas for the country

1. Prevention of stunting in children under two years of age: 1st 1000 most critical days.

2. Increasing micronutrient and macronutrient availability, accessibility and utilization.

3. Early identification, treatment and follow-up of acute malnutrition.

4. Improving nutrition education and nutritious feeding through schools.

Zambia National Food & Nutrition Strategic Plan (2011-2015)

5. Increasing linkages among hygiene, sanitation, infection control and nutrition.

6. Food and Nutrition and Mitigation of HIV and AIDS.

7. Food and nutrition actions to prevent and control non-communicable diseases.

8. Improving preparedness and response to needs for food and nutrition during environment.

What is the 1000 days Programme?

1. Scaling up an integrated package of high-impact cost-effective interventions and proven nutrition actions focusing on the first 1,000 Most Critical days (window of opportunity from pregnancy to 24 months of age).

2. High-impact cost-effective interventions have been identified in the Lancet series on Maternal and Child Under-nutrition, 2008.

IRON & FOLIC ACIDIRON & FOLIC ACID

USE IODIZED SALTUSE IODIZED SALT

CORRECT FEEDING OF A SICK CORRECT FEEDING OF A SICK CHILDCHILD

SLEEP UNDER TREATED BED SLEEP UNDER TREATED BED NETSNETS

SAFE BIRTH & SAFE BIRTH & NORMAL BIRTH NORMAL BIRTH WEIGHT BABYWEIGHT BABY

DEWORMINGDEWORMINGVACCINATIOVACCINATIONSNS

EXTRA MEAL/ DIVERSE EXTRA MEAL/ DIVERSE DIETDIET

CORRECT COMPLEMENTARY FEEDING & FOODSCORRECT COMPLEMENTARY FEEDING & FOODS

VITAMIN VITAMIN A A

ANTENATAL ANTENATAL CARECARE

SAFE WATER & CAREFUL SAFE WATER & CAREFUL HYGIENE HYGIENE

GROWTH MONITORING & PROMOTIONGROWTH MONITORING & PROMOTION

EXCLUSIVE EXCLUSIVE BREASTFEEDINGBREASTFEEDING

CONTINUED CONTINUED BREASTFEEDINGBREASTFEEDING

FORTIFIED STAPLESFORTIFIED STAPLES

1,000 CRITICAL DAYS1,000 CRITICAL DAYS

PMTCT (NUTRITION AND BREASTFEEDING PMTCT (NUTRITION AND BREASTFEEDING OPTIONS)OPTIONS)

Examples of interventions to be focussed on

Examples of interventions to be focussed on

Direct Nutrition Interventions Promote Breastfeeding Promote Complementary

feeding Vitamin A

supplementation Deworming Home fortification

micronutrients powder Zinc supplementation

Nutrition sensitive Interventions Food security and

agriculture. Cash and food voucher

transfers Water, sanitation and

hygiene promotion Health

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Phase 1 districts

1. Mbala2. Kasama3. Kaputa4. Chinsali5. Chipata6. Lundazi7. Samfya

8. Mansa9. Mumbwa10. Chongwe11. Zambezi12. Mongu 13. Shangombo14. Kalabo

Note: Selected based on high levels of stunting and poverty in addition to donor presence

Launching of the1000 Days Programme

25/04/2013

Thank you

Other Direct intervention• Adolescent health and preconception nutrition• Maternal dietary supplementation.• Micronutrient supplementation and

fortification.• Breastfeeding & complementary feeding.• Dietary supplementation for children.• Feeding behaviour and stimulation.• Treatment of severe malnutrition, disease

prevention .