Adolescent Nutrition_Ruel-Bergeron

Adolescents in Low and Middle-Income Contexts

Julie Ruel-Bergeron Program in Human Nutrition

April 14, 2015

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Adolescent Demographics in LMIC: Global Trends

1.2 billion and growing 18% of the world’s population, 90% of which live in LMIC

Source: UNICEF, 2012

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Adolescent Demographics in LMIC: Regional Trends

Source: UNICEF, 2012

© 2014, Johns Hopkins University. All rights reserved.

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Nutrition: Determinants of Nutritional Status in Adolescence

Source: WHO, 2005.



Risks and Challenges in Adolescence: Nutrition, Early Marriage and Early Pregnancy • Adolescent girls often enter pregnancy with reduced

nutritional stores – Competition for dietary energy and nutrients

• Physical immaturity of the mother – More immature = ↑ obstetric risk – ↑ maternal mortality – ↑ prematurity, LBW

• Higher incidence of poor child health care and child feeding behaviors – Varies by SES – Interference of pregnancy with schooling completion



Impact of Adolescent Pregnancy on Birth Outcomes: LBW and Preterm

Gibbs et al, Pediatr Perinatal Epi 2012



Predictors of Stunting in Pregnant and Non-Pregnant Adolescent Girls (Bangladesh)

Source: Rah et al., 2009.



Annual changes in anthropometric measurements by pregnancy status



Mean annual changes in height by time since menarche and pregnancy status

Rah et al., 2008.



Mean Annual Changes, by Time Since Menarche

Rah et al., 2008.

The Condition of the Adolescent in LMIC: Burkina Faso, Indonesia, Zambia

Risks and Challenges



Population characteristics

Burkina Faso Indonesia Zambia



Risks and Challenges: Education, Reproductive Health, Sexual Practices and Marriage • Disparities by residence, wealth quintiles, and sex in

young adolescents • In some instances, disparities become more

pronounced in older adolescents (education gap) • Some unexpected trends:

• Early marriage in Indonesia • Family planning in Indonesia and Zambia



Risks and Challenges in Adolescence: Nutritional • Girls at greater risk of suffering nutritional difficulties than boys,

with more severe consequences as it relates to childbearing and perpetuating the cycle of malnutrition – Underweight – Stunting – Micronutrient deficiencies (anemia especially) – Obesity

Sources: UNICEF 2011, UNICEF 2012



Risks and Challenges in Adolescence: Nutritional (cont) • Lifestyle and eating behaviors, and underlying psychosocial factors also

threaten adequate nutrition • Adolescent pregnancy imposes additional physiological and

nutritional stress, especially in stunted or underweight mothers

Reaching Adolescents: Delivery Platforms



School and Education-Based Programming

• School feeding • Anemia control • Nutrition-friendly school initiatives • Other school-based adolescent-focused

programs – India’s Saloni Swasth Kishori Yojna, Uttar Pradesh – Zambia’s UN Girls Education Initiative



Social Safety Net Programing • Cash Transfers: conditional and unconditional

– Impact on HIV and education in Malawi – Unconditional

• Varying impact based on recipient (mother/father) and conditionality – Conditionality matters more than recipient in terms of

improved child health outcomes • Not a lot of evidence specific to adolescents, but a

promising avenue for addressing factors proximally associated with adolescent nutrition and with broader social benefits – Education, early marriage, sexual behaviors, STIs, and early

pregnancy • Microfinance interventions



Youth Development and Community-Based Approaches • Peer education • Adolescent and youth centers • Faith-based community approaches • Other community-based approaches

– Indonesia linking of marriage registries to target health messages and IFA supplementation

– Promotion of gender equality at the community level to address violence and SRH



Technology-Based Platforms and Sensitization/Mobilization • Mhealth/nutrition • Mass media communication • Community-based sensitization



Other Interventions/Programming

• Health Center-Based Programming – Youth-Friendly Health and Nutrition Services

• Policy-level interventions – National-level

• Incentives to delay early marriage (India and Bangladesh)

• Scholarships for secondary education or life-skills training

• HIV-specific legislation

– Policies by large donor institutions • USAID’s Youth in Development Policy



Summary and Key Points

• Adolescents face many health and nutritional risks – Injuries are the leading cause of death – Other risks and challenges include mental health, substance

abuse, sexual and reproductive health (HIV especially), education, violence and abuse

– Girls are more vulnerable nutritionally, as a result of the link with early pregnancy and its impact on education, maternal obstetric outcomes, and child outcomes.

• Various types of delivery platforms to reach

populations with health and nutrition services in LMIC exist, but their potential for reaching adolescents (girls especially) has yet to be unleashed

Questions?

Government & Nonprofit

Adolescent Nutrition_Ruel-Bergeron