the emerging double burden of malnutrition in timor leste: a … · 2015. 6. 15. · timor leste...
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The emerging double burden of malnutrition in Timor‐Leste: a time
to act?
Heather GrieveSenior Nutrition Specialist,
Australian Embassy Timor‐Leste and the Office of his Excellency the President of the Republic of Timor‐Leste
Presentation outline
1. A bit about Timor‐Leste2.The nutrition situation: Timor‐Leste3.The nutrition transition and the double burden of malnutrition (DBM): an example from Indonesia
4.The nutrition transition and the emerging DBM in Timor‐Leste
5. A time to act?6. Current activities
A bit about Timor‐LestePopulation:1.178 million(42% less than 15 years of age)
Independence: Portuguese colony from 1642, became independent 1975 (9 days). 1999 Referendum supporting independence; regained independence in 2002 following Indonesian occupation and unrest. Official Languages: Portuguese, Tetum
Religion: Catholic (97%)
Currency: US Dollar
Life expectancy: 68 years
Main labour force: agriculture (81%)
‘Least developed country ‘(UNCTAD)
A bit about Timor‐Leste
A bit about Timor‐Leste
A bit about Timor‐Leste
Changes in infant mortality rate (IMR), under 5 mortality rate (U5MR) and maternal mortality ratio (MMR)
Source: WHO (2014), UNICEF (2012) DHS 2003 /2009/10
A bit about Timor‐Leste
171
106
83
6457
129
60
45 4847
21 22 24
0
20
40
60
80
100
120
140
160
180
1990 2000 2003 2009 2012
U5MR
IMR
NMR
Deaths /1
000 live births
1200
1000
680
500570 *
0
200
400
600
800
1000
1200
1400
1990 1995 2000 2005 2013
MMR(Deaths/100,000 live births)
Deaths/100
,000
live births
A bit about Timor‐Leste
22
32
55
30
2225
93
62
39
0
10
20
30
40
50
60
70
80
90
100
Contraceptiveprevalence
rate
Iron folic acid90 days
ANC 4+ Skilledattendant at
birth
Delivery athealth facility
PNC within 2days
Early initiationof
breastfeeding
Exclusivebreastfeeding
Continuedbreastfeeding
to 20‐23months
Coverage of key interventions during the first 1000 days
%
Nutrition situation: Timor‐Leste
Nutrition situation: Timor‐Leste
Nutrition situation: Timor‐Leste
The global evidence base
• The Lancet Series on Maternal and Child Undernutrition (2008)
• The Lancet Maternal and Child Nutrition Series , 2013
• MIYCN Global Nutrition Targets (2025)
• Global NCD risk factor reduction targets (including reduction of salt intake by 30% and halting further increases in adult obesity)
• 2014 “Rome Declaration on Nutrition” & Framework for Action
Interface between under and overnutrition in early years
Source;WHO (2002), Black etal (2013)‐Menzies School of Health Research
The traditional diet in LMICs was mostly plant based foods which were low in fat and sugar. A “nutrition transition” is occurring, in which diets are becoming higher in processed foods which are high in fats and sugars
The nutrition transition
‘Receding famine’
‘Nutrition related non‐
communicable disease’
‘Policy and behaviour change’
Many LMICs are in the ‘receding famine/’nutrition‐related non‐communicable disease (NCDs) phase. The change in diet and lifestyles is associated with an increase in the prevalence of overweight, obesity and NCDs and in many countries the ‘double burden of malnutrition’
Many high income countries are in the policy/behaviour change phase and are promoting healthy food and physical activity environments
Source; Popkin et al (2001)
0
500
1000
1500
2000
2500
3000
3500
4000
2300
2350
2400
2450
2500
2550
2600
2650
2700
2750
2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
GDP pe
r cap
ita
KCalpe
r person pe
r day
Kcal GDP/ capita
Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( 2002‐2011)
Source: World Bank and FAOSTAT 92014)
The nutrition transition: Indonesia
0
500
1000
1500
2000
2500
3000
1991 2001 2011
Kcal per day per person
Alcoholic beverages and stimulants Fruits, vegetables, pulses and treenutsAnimal products Sugar crops, sugar and sweetenersStarchy Roots Oil crops and vegetable oilsCereals ‐ Excluding Beer
Changes in energy supply (Kcal per day per person)
Source :FAOSTAT (2014)
The nutrition transition: Indonesia
Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;
Changes in the prevalence of malnutrition in children (< 5 years)
The double burden of malnutrition: Indonesia
Source: 1995: MICS;1997 CDC; 2000: NHSS; 2004: SKRT; 2007: Riskesdas; 2010: Riskesdas;
Changes in the prevalence of malnutrition in women of reproductive age (aged 15‐49 years)
The double burden of malnutrition: Indonesia
Source :WHO (2011)
Estimated NCD risk factors (2008)
The nutrition transition: Indonesia
050100150200250300350400450
Men WomenCardiovascular diseases and diabetes CancersChronic respiratory disease Other
Source: WHO (2011), Shrimpton, and Rokx (2013)
Estimated age standardised NCD deaths per 100,000 people, Indonesia (2008)
In 2008 an estimated 582,000 men and 481,700 women died from NCD related deaths. NCDs are now the main cause of disability and death
The nutrition transition: Indonesia
Changes in Gross Domestic Product (GDP) per capita and energy (Kcal) supply per person per day ( 2002‐2011)
Source: World Bank and FAOSTAT (2015)
The nutrition transition: Timor‐Leste
1888
1934
2037
2083
463
876
1002
1105
0
200
400
600
800
1000
1200
1750
1800
1850
1900
1950
2000
2050
2100
1996 2001 2006 2010 2011 2012
Kcal/capita/day(food supply)
GDP/capita
Kcal/capita
/day
The nutrition transition: Timor‐Leste
Source; Tiimor‐Leste DHS 2003 and 2009/10Timor ‐Leste FNS, 2013
Changes in the prevalence of malnutrition in children (0‐59 months)
The emerging double burden of malnutrition: Timor‐LestePrevalen
ce of u
nder and
overw
eight
(%)
49
58.1
50.2
5
1.50
10
20
30
40
50
60
70
2003 2009/10 2013
Stunting (HAZ<‐2)TimorLesteOverweight (WHZ>+2)Timor Leste
Source; Timor Leste DHS 2003 and 2009/10Timor Leste FNS, 2013
Changes in the prevalence of malnutrition in women of reproductive age
The emerging double burden of malnutrition: Timor‐LestePrevalen
ce of u
nder and
overw
eight
(%)
37.7
27.2
24.8
3.15.1
10.2
0
5
10
15
20
25
30
35
40
2003 2009/10 2013
Underweight(BMI<18.5)TimorLesteOverweight (BMI≥25) Timor Leste
Source :WHO (2011)
Estimated NCD risk factors (2008)
The nutrition transition: Timor‐Leste
0
100
200
300
400
500
600
700
Men Women
All NCDsCardiovascular diseases and diabetesCancersChronic respiratory disease
Source: WHO (2011
Estimated age standardised NCD deaths per 100,000 people, Timor‐Leste (2008)
In 2008 an estimated 1400 men and 1000 women died from NCD related deaths. NCDs are now a significant cause of disability and death in Timor‐Leste
The nutrition transition: Timor‐Leste
Source: WHO (2011),
Proportional mortality (% of total deaths, all ages)
Whilst deaths from communicable, maternal, perinatal and nutrition related conditions make up the bulk of deaths, NCDs are now estimated to account for 34% of all deaths.
The nutrition transition: Timor‐Leste
A time to act ?
1. The Strategic Development Plan (2011‐2030 )
2. National Health Sector Strategic Plan (2011‐2030)
3. Action Plan for a Hunger and Malnutrition Free Timor ‐Leste (2015‐2025)
4. Draft National Nutrition Strategy (2015‐2019)
5. RMNCH Strategy (2015‐2019)
6. Draft National Nutrition and Food Security Policy
A time to act?
A time to act ?
A time to act ?
A time to act ?
Cigarettes sold inpackets and as singles
Lollies‘Pop mee or Super mee” 2 minute noodles
• High level advocacy through the Presidents Office and the cross ministerial nutrition and food security council
• Promoting improved complementary feeding and dietary diversity
• Integrated nutrition programming
• Promoting and rewarding success at the community level
What are we doing?
Obrigada wain