Sharing Experiences on Gender, Food Security and Nutrition KTontisirin | Malnutrition | Nutrition

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views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. The countries listed in this paper do not imply any view on ADB's part as to sovereignty or independent status or necessarily conform to ADB's terminology.

Sharing experiences on gender, food security y and nutrition in the region/sub-region in intervention

Prof. Kraisid Tontisirin, M.D., PhD
Senior Advisor, Institute of Nutrition, Mahidol University, Thailand Former Director, Nutrition and Consumer Protection, FAO, Rome, Italy

ADB/FAO Asia and Pacific Regional Consultation  on Gender Food Security and Nutrition Bangkok  24 July 2013

• Agriculture • Food supply • Food service

Food

Nutrition

Health

P ti • Promotion • Prevention • Treatment

Nutrition is a link between food and health, regarding the fulfillment of energy, protein and micronutrient requirements from food throughout human life cycle

Ultimate Goals:

Food and nutrition security and wellwell being for all
Kraisid Tontisirin, Mahidol University

Food and nutrition security*
“Food and nutrition security exists when all people at all times have physical, physical social and economics access to food, which is safe and consumed d in i sufficient ffi i t quantity tit and d quality lit tto meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and cares, allowing for a healthy and active life.”
*From FAO CFS 2012
Kraisid Tontisirin, Mahidol University

Food and nutrition challenges g
Continuing and persistent undernutrition
Undernourished (protein and energy deficiency)  in mothers, children and adults: food insecurity  Micronutrient deficiencies: of iron, iodine, vit. A  and others: poor diets and frequent infection

Overnutrition and diet related diseases
Overweight & obesity Diabetes mellitus, mellitus  high blood lipids, lipids   high blood pressure, cardio‐vascular diseases Cancers

Food safety and quality
Kraisid Tontisirin, Mahidol University

Undernourishment in 2010, by region (millions)

% prevalence of anemia in women In Asia Pacific Countries

Australia Japan New Zealand Nauru Thailand Republic p of Korea Timor Leste Singapore Seychelles Cook Islands Palau China Sri Lanka Niue Vietnam American Samoa Tuvalu Samoa Tonga DPR Korea Mongolia Micronesia Marshall Islands Malaysia Kiribati

Non-pregnant women Pregnant women

Brunei Darussalam Pakistan Philippines Indonesia Bangladesh Myanmar Bhutan India Solomon Islands Papua New Guinea Maldives Fiji Lao PDR Vanuatu French Polynesia Cambodia Nepal

(From WHO: SEARO & WPRO, 2007)

0

10

20

30

40

50

60

70

80

India (1999)

% prevalence of f low l bi birth th weight (2.5 Kg) in Asia Pacific countries

Bangladesh (1998) Cambodia (2000) Sri Lanka (2000) Maldives (2001) Nepal p (2001) ( ) N.Mariana Islands (2000) Micronesia (2000) Lao PDR (1998) Philippines (2000) Myanmar (2000) Bhutan (1999) Marshall Islands (1999) Timor-Leste (2002) Papua New Guinea (2002) Malaysia (2004) Fiji (1996) Thailand (2001) Singapore (2004) Palau (1998) Japan (2004) Indonesia (2002) Kiribati (2002) Guam (2004) New Zealand (2003) N New C Caledonia l d i (2002) French Polynesia (2001) DPR Korea (2002)

Brunei Darussalam (2003) Viet Nam (2004) Australia (2003) Tuvalu (2000) Mongolia (2004) Korean Republic (2004) Vanuatu (2003) Tonga (2002) American Samoa (2004)

(From WHO: SEARO & WPRO, 2007)

Samoa (2004) Cook Islands (2003) China (2002) Tokelau (2003) Niue (2005) 0 5 10 15 Prevalence (%) 20 25 30

Indonesia

% prevalence of stunting(<2SD) among Under five children in Asia Pacific countries

Cambodia Bangladesh Nepal Timor Leste Lao PDR Marshall Islands Bhutan India DPR Korea Philippines Vietnam Myanmar Maldives Vanuatu China Thailand Malaysia Sri Lanka

Brunei Darussalam Solomon Islands Samoa

(From WHO: SEARO & WPRO, 2007)

Fiji Singapore Tonga 0 5 10 15 20 25 30 35 40 45 50

Bangladesh

%Prevalence of underweight (<2SD ) among Under five children c d e in Asia sa Pacific countries

India Cambodia Nepal Timor Leste Papua New Guinea Lao PDR Marshall Islands Philippines Myanmar Vietnam Sri Lanka Indonesia Maldives DPR Korea Bhutan Brunei Darussalam Vanuatu Malaysia China Thailand Fiji Singapore New Caledonia Republic of Korea Samoa Solomon Islands Palau

(From WHO: SEARO & WPRO, 2007)

0

10

20

30

40

50

60

The Millennium Development Goals

MDGs
will not be achieved without nutrition improvement

Kraisid Tontisirin, Mahidol University

Trends in Preschool Child Malnutrition (weight for age) in Thailand

Kraisid Tontisirin, Mahidol University

Elimination of undernutrition: a global deficit and priorities*

*ACC/SCN 1999

Kraisid Tontisirin, Mahidol University

THAILAND’S DEVELOPMENT PLANS
1961 1st NEDP 1966 2nd NEDP 1971 3rd NEDP 1976 4th NESDP 1981 5th NESDP 1986 6th NESDP 1991 7th NESDP 1996
Kraisid Tontisirin, Mahidol University

: Economic Infrastructure Sectoral Plans

: + Social S i l Pl Plan + Food and Nut. Plan, PHC : + Poverty Alleviation Plan (PAP) PHC BMN / QL indicators i di t

Poverty Alleviation Plan (PAP)
• from 1982 on ward • malnutrition was considered as symptom of poverty • with organization g changes g for management g of rural development • with h (new) ( ) 5 basic b principles l PAP

Fd/Nut.Prog.

PHC

BMN indicators
Kraisid Tontisirin, Mahidol University

Forging the Link Between Government and Community

Kraisid Tontisirin, Mahidol University

Community-Based Approaches
• Is an integrated g program p g implemented p   at local level (district level and below) • National commitment with sound nutrition improvement p  strategies g  and g goals • Community actions : basic services, mass  mobilization, mutual efforts/actions to reach  all people and to prevent malnutrition 
Kraisid Tontisirin, Mahidol University

Components of a Successful Community Based Program  Minimum Basic Services
(Health, Education, Agr. Extension)
Supportive pp System y
• Training • Funding • Problem Solving • Supervision

Menus (Activities)
• ANCs for mothers • GMP: BF, CF & cares • Food production • Nutrition education • Food sanitation & safety • School lunch (SLP) and school milk (SMP) programmes •Other activities

Facilitators

Interface
(Service providers and community leaders) • Plan/goals • Implementation • Monitoring/evaluation

Community Leaders Family Individual

Volunteers (1:10 households)

Basic Minimum Needs Goals/Indicators
Kraisid Tontisirin, Mahidol University

Main Causes of Child Malnutrition
• Poor maternal nutrition and health leading to LBW of  newborn, low milk quality and quantity • Declining of breast feeding practices • In adequate and in appropriate compl.feeding • Poor sanitation in IYC feeding and cares • Recurrent illness i i.e. e  diarrhea and respiratory tract  infection • Undesirable d bl  eating habits h b
Kraisid Tontisirin, Mahidol University

Menu Activity on ANCs
(t t maternal t l morbidity bidit  and d mortality, t lit  and d LBW) (to prevent

• • • • • • • •

4 ANCs visits for all pregnant mothers High risk check up and treatment M it i  wt. Monitoring t  gain i Nutrition and health education Food supplementation MTV, iron and folate supplementation Two tetanus toxoids Referral s system stem and safe delivery deli er  service ser ice
Kraisid Tontisirin, Mahidol University

กระยาสารท Gra ya sart
(Thai sweet rice with peanut and sesame)

ขนมตุ๊บตับ Kanom Toob tub

Ingredients
• Pop-rice Pop rice • Peanuts • Sesame • Sugar

Ingredients
• Flour Fl • Peanuts • Sugar
Kraisid Tontisirin, Mahidol University

Ingredients
• Rice flake • Dried shrimp • Dried peanut • Dried bean curd

Shredded Rice Grain (ข้าวเม่าหมี)
Kraisid Tontisirin, Mahidol University

Menu on Growth Monitoring and Promotion (GMP)
• • • • • • • • • Monthly or quarterly monitoring wt.& ht. and take remedy actions Child growth education and cares Breastfeeding and Complementary feeding Immunization Village based food production (+CF for IYC and supplementary food  f  mothers) for th ) Health and nutrition education Cooking and feeding demonstration Treatment of malnourished child Referral of severe illness and malnutrition
Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University

Community Food Production
g  • Home and school g gardens g growing vegetables, fruits, fishes and chicken for  learning,  and income g  consumption p • Supplementary food for pregnant mothers • Complementary food for IYC • food preservation and simple food processing  techniques  • Cooperative and micro credit
Kraisid Tontisirin, Mahidol University

Table 1 Suggested complementary feeding guidelines (adapted from Thailand complementary feeding guide-lines)

From Tontisirin, Ped Nutr in Practice, 2008
Kraisid Tontisirin, Mahidol University

Maternal and child health and nutrition Th il d  1980‐ 2006 Thailand,
1980 ANC coverage % Anemia in preg. % LBW % PEM (Wt/Age of U 5)% 35 50-75 16 51 1990 75 18.8 10 20 2006 95 10 <10 <10

Kraisid Tontisirin, Mahidol University

Prevalences of stunting, wasting, overweight,  and obesity in children aged 1‐5 years 
%

Stunting

Wasting

Overweight

Obesity

Aekplakorn W, et al. NHES4, 2008-2009.

Trend of nutritional status of children  aged 1‐5 years 
%

Stunting

Underweight

Overweight& Obesity

NHES 2; Holistic Development of Thai Children; NFNS 5; NHES 4

Ensuring gender equality 
• Female equality is a fundamental and essential for  food  and nutrition security. • Female plays a key roles in all phrases of continuum  from agriculture, food, nutrition and health at  household and community level  • Female needs equal opportunity in nutrition, education,  development and job opportunity • Female, as a well‐equipped mother with knowledge and  skills will lead to nutrition wellbeing to all family  members
Kraisid Tontisirin, Mahidol University

Conclusion 1
• Interface of basic social services with strong  people participation at community level is  g  coverage g  and effective actions crucial for high • Nutrition indicators are most useful  goal setting g and follow up p actions  for g i.e. birth weight, under weight of  under 5, , stunting, g, weight g  for height g  and Body y Mass Index (BMI)

Kraisid Tontisirin, Mahidol University

Conclusion 2
• Roles of female in achieving food and nutrition  security have been recognized as over 50‐60 %  of service providers as well as village  volunteers are female working with community  leaders to reach the unreached.  • Thailand as a country with success story is  proud to share lessons learnt to other  countries how to alleviate malnutrition and  promote gender equality.
Kraisid Tontisirin, Mahidol University

Thank You

For Your Attention

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