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Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
Tamer RabieSenior Health Specialist
The World Bank Europe & Central
Asia
Building Tomorrow Through Better Nutrition
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Irrefutable Evidence for Nutrition
47
THE RESULTSTop Ten
1 Micronutrient supplements (vitamin A & zinc) - Malnutrition2 The Doha development agenda - Trade3 Micronutrient fortification (iron and salt) - Malnutrition4 Expanded immunization coverage for children - Diseases5 Agricultural R&D - Malnutrition6 Deworming and nutrition programs at school - Malnutrition7 Lowering the price of schooling - Education8 Increase and improve girls’ schooling - Women9 Community-based nutrition promotion - Malnutrition10 Provide support for women’s reproductive role - Women
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Impact of Undernutrition Interventions on the MDGs
MDG Impact of Undernutrition Intervention
1. Eradicate poverty & hunger
Target is to reduce prevalence of underweight children < 5 years
2. Achieve universal primary education
Reducing undernutrition increases cognitive development, contributes to learning & school completion rates
3. Promote gender equality
Maternal education and empowerment lead to better nutrition and health practices. Reduces discrimination against girls in family feeding practices.
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Impact of Undernutrition Interventions on the MDGs cont’d
MDG Impact of Undernutrition Intervention
4. Reduce child mortality
Enormous impact of reducing undernutrition on decreasing child mortality.
5. Improve maternal health
Reduced maternal mortality by reducing anemia with IFA or multiple MN supplementation.
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Background for KG Nutrition Report•Joint World Bank/UNICEF report
•Objective to calculate the potential human & economic benefits from increasing nutrition investments
•Situational Analysis
Epidemiology of undernutrition
Physical & economic consequences
Systems for delivering nutrition interventions Coverage of nutrition interventions
Economic gains
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Three Domains for Nutrition Analysis
Domain Content
Epidemiological Nutrition burden, evidence for efficacy & effectiveness of interventions
OperationalCoverage, quality & utilization of nutrition -related programs, capacities, opportunities, & constraints to improving them
Economic and sociopolitical
Factors from community, national & international levels that may enhance or inhibit efforts and strengthen policies & programs
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
(A)Physical Burden of Undernutrition
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Deaths Resulting from Undernutrition
Prevalence Annual DeathsLow birth weight
1,500–1,999 g 0.6 1392,000–2,499 g 4.4 249
Vitamin A deficiency< 5 months 18.0 1466–59 months 32.0 105
Stunting<-3 SD 3.7 442<-2 SD 13.7 326
Wasting<-3 SD 0.4 140
Total 1,547
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
DALYs Caused by Undernutrition
Male Female Total
All causes DALYs 171,190 145,648 316,839
Growth deficiencies
Low birth weight 23,738 18,68842,426 (13.4%)
Stunting 3,109 3,0326,141 (1.9%)
Micronutrient deficienciesIron-deficiency anemia 1,027 963
1,990 (0.6%)
Iodine deficiency 978 1,0121,990
(0.6%)Vitamin A deficiency 12 12
24 (0.01%)
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
(B)Economic Burden of
Undernutrition
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Cost of Lost Workforce
Number of deaths
Value(US$ millions)
Low birth weight 388 1.28
Vitamin A deficiency 251 0.97
Stunting 768 1.86
Wasting 140 0.34
Total 1,547 4.45
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Cost of Future Productivity Losses
NPV at 3% discount rate
(US$ million/year)Iodine deficiency disorders
15.30
Stunting (< 5 years) 5.25
Low birth weight 1.30
Childhood anemia 6.09
Total 27.94
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Iodine Sufficient Brain
Iodine Deficient Brain
Source: From Legrand, 1967
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Total Economic Losses Attributable to Undernutrition
US$ 32 millionAnnually
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
(C)Benefits from Scaling Up Nutrition Interventions
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Future Gain in Productivity, Million US$/Year
Intervention LBW Stunting IDDChildhood Anemia
Maternal MMN or IFA supplements 0.18 Maternal/energy protein supplements 0.42
Use of IPT/ITN during pregnancy 0.47 Complementary feeding promotion (food-secure pop.) 1.35
Complementary feeding promotion (food-insecure pop.) 1.59
Zinc for diarrhea treatment 1.71 Iodized salt 0.52 Micronutrient supplements (Sprinkles) 1.21
Deworming of child 0.45Package 0.78 1.93 0.52 1.58
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Future Gain in Workforce, Million US$/Year
InterventionLow Birth
WeightStuntin
gMaternal MMN or IFA supplements 0.17
Maternal energy/protein supplements 0.39
Use of IPT/ITN in pregnancy 0.44 Complementary feeding promotion (food-secure pop.) 0.45
Complementary feeding promotion (food-insecure pop.) 0.53
Zinc for diarrhea treatment 0.57Package 0.75 0.64
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
(D)Choosing Priorities
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Prioritization Method
Three criteria used to rank interventions1. Deaths averted 2. Economic return on investments3. Feasibility of implementation at scale
Two ranking systems developeda. Operational priority -- weight to feasibility
of implementation at scaleb. Evidence for interventions – weight to the
“evidence base” set out in The Lancet series
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Highest Priority Interventions
• Early initiation of breastfeeding, exclusive breastfeeding until six months of age, and timely and appropriate complementary feeding
• Supplementing pregnant women with iron folic acid or multiple micronutrients
• Expand salt iodization and flour fortification programs
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Second Priority Interventions
•Maintain twice-annually vitamin A supplementation
•Expand deworming program•Zinc for the management of diarrhea•Severe acute malnutrition treatment•Address underlying and basic causes of
undernutrition through other sectors•Promoting handwashing and hygiene
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Conclusions• Undernutrition costs the Kyrgyz Republic more
than US$ 32 million annually• Scaling up proven interventions could save over
US$ 6 million annually• SUN Framework brings global consensus on
implementing two complementary approaches addressing:▫Immediate causes: a set of direct public health
interventions focusing on the minus 9 to 24-month window of opportunity
▫Underlying causes: a broader set of longer-route interventions in agriculture & social protection
Human Development Europe & Central Asia
The World Bank Europe & Central
Asia
The World Bank Europe & Central
Asia
Building
Tomorrow
Through
Better
Nutrition