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Poor maternal and child health and malnutrition as a cause for structural damage of the brain and

cognitive development

Prepared and delivered by Leena Rammah

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Evidence shows - good health, nutrition of pregnant women and young children, along with an appropriate stimulation during the early years have an important positive effect on cognitive development.

Deeper analysis shows maternal health and nutrition affects child’s health right from fetus brain development till later stages.

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A concept that includes:

Family planning Prenatal, and postnatal care Education provision Health promotion

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Let us look at Health, Nutrition and Cognitive Development during two major phases:

1. Prenatal phase

2. Postnatal phase

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Studies prove women with proper prenatal care have better health results than women who miss PNC during pregnancy.

The health and the well being of women and their children are inter-linked. This process requires a substantial strengthening of the health system (DFID)

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Early or late age pregnancies Premature delivery Contact with potentially toxic substances (e.g. alcohol tobacco, and drug abuse, etc. Existence of certain diseases (maternal measles,

toxoplasmosis,..)

Factors that affect mother’s and child’s health Factors that affect mother’s and child’s health and can damage brain development (prenatal)and can damage brain development (prenatal)

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Exposure to Radiation Maternal attitudes and behaviors Absence of skilled health personnel during delivery High blood pressure (pre-eclampsia) Intake of certain medication due to illness Poor education

Factors that affect mother’s and child’s health Factors that affect mother’s and child’s health and can damage brain development (prenatal)and can damage brain development (prenatal)

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Intrauterine position Obstructed labor and asphyxia Prolonged labor Obstetrical trauma Pelvic fetus incompatibility

Factors that affect mother’s and child’s health Factors that affect mother’s and child’s health and can damage brain development (perinatal)and can damage brain development (perinatal)

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The younger the age at pregnancy, the greater the health risks for mother and child and the higher risk of infant mortality (60%)

Children who survive are more likely to suffer from low birth weight, under nutrition and delayed cognitive development. (Lawn et al., 2006;UNICEF, 2008b; WHO, 2005).

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Postnatal care is likewise important and includes: Child birth Newborn’s care ECD’s education

Factors that affect child’s health and can damage Factors that affect child’s health and can damage brain development (postnatal)brain development (postnatal)

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Poor disease prevention and vaccination Exposure to accidents Lack of physical activity Improper stimulation

Factors that affect child’s health and can damage Factors that affect child’s health and can damage brain development (postnatal)brain development (postnatal)

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Lack of early education Lack of psychological and social care Lack of love and parents’ care, (bonding) Existence of Infectious diseases (Meningitis,..)

Factors that affect child’s health and can damage Factors that affect child’s health and can damage brain development (postnatal)brain development (postnatal)

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Folic Acid deficiency Iron deficiency anemia (IDA) Iodine deficiency Omega 3 deficiency

Maternal nutrition deficiency that affect brain and cognitive development (prenatal)

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Iron deficiency and its effect upon brain and cognitive development.

Iodine deficiency and its affects Vitamin A deficiency. Lack of exclusive breastfeeding till the age of six

months. Insufficient supplementary food and of micronutrients

introduced after the age of six with continuation of breast feeding well into the second year.

Child’s nutrition deficiency that affect brain and cognitive development (postnatal)

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Iron deficiency has been clearly linked to cognitive deficits in young children. Iron is critical for maintaining an

adequatenumber of oxygen-carrying red blood cells, which in turn arenecessary to fuel brain growth. (http://www.zerotothree.org/brainwonders).

How do poor maternal and child’s malnutrition affect cognitive development? (Postnatal)

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Children who are malnourished usually: are fussy eaters are deprived of adequate calories are deprived of protein in their diet experience insufficient growth in early years suffer from lasting behavioral and cognitive deficits,including slower language and fine motor development, lowerIQ, and poorer school performance. (www.zerotothree.org/brainwonders)

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How do poor maternal and child’s malnutrition affect cognitive development? (Postnatal)

Breast milk contains all the amino and fatty acids needed for brain development. Research has shown that babies who are breast-fed as compared to babies who are formula fed score higher on IQ tests.

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Child illness / malnutrition reduce cognitive development and intellectual performance, school enrolment and attendance.

Intrauterine growth retardation and malnutrition during early childhood have long term effects on body size and strength with implication on productivity in adulthood (WHO 2006)

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Micronutrient deficiencies can severely affect early cognitive

development, including a loss of up to fifteen points on IQ test

even in moderate forms. Children are also affected by Vitamin A deficiency which

causes blindness, poor health and concentration (Victoria et al., 2008).

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Baseline 6 mo 12 mo 18 mo 24 mo

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Baseline 6 mo 12 mo 18 mo 24 mo

IQIQ

non-stuntednon-stuntedBothBoth

controlcontrol

Grantham-McGregor et al, 1991Grantham-McGregor et al, 1991

supplemented

stimulated

Intervention with stunted children

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Average Brain Weights at Different Times of

Development: AGE BRAIN WEIGHT (grams) 20 weeks of gestation 100 Birth 400 18 months old 800 3 years old 1100 Adult 1300-1400

What is brain development in prenatal phase?

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Brain development in prenatal phase

The brain grows at an amazing rate during this period. From the 3rd week of Intrauterine life 250,000 neurons proliferate every minute.

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Neurons which are continuously firing or activated, through stimulation will consolidate and strengthen over time.

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The child has by birth 100 Billion Neurons. For the brain to function in proper way, these neurons have to be connected by synapses. These synapses can be developed by:1. Appropriate nutrition, especially breast feeding, that helps to form

myelin that cover the synapses and can allow the impulse to pass. 2. Early stimulation for the brain through interaction with the child.

Through ECD, a child may form and reinforce over 1 trillion connections.

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Severemalnutrtion

Moderatemalntrtion

Wellnourished

Adopted before theage of 2

Adopted after theage of 2

Study on level of intelligence among orphaned Vietnamese girls according to the level of nutrition.

American Journal of clinical nutrition 1977, 30

Combination between nutrition and stimulation that can affect cognitive development

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Poverty reduction

Lancet Paper 1, Lancet Paper 1, S Grantham-McGregor S Grantham-McGregor 20072007

preschool childlow IQ, behaviour problems

schoolpoor school achievementbehaviour problems

poor stimulation, nutrition & health

Intergenerational transmission of poverty

adultlow education

low skilled / no work high fertility

depressed/stressed

Nationaleconomy

Poor maternal health is associated with poverty

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1. The value of women and children’s health.2. Inexpensive ways to save lives of women and children3. The economic soundness.4. The political soundness, including social stability and

human security5. The improvement of the health system.

Why invest in maternal health, newborn and child health?

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A key to beat poverty

Integration of disease prevention and care for mothers

newborns and children makes economic sense as it

maximizes benefits and minimizes costs for mothers,

newborns and children. Indeed high under 5 mortality and

morbidity and high level of malnutrition have a serious

economic and development cost. (DFID)

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Short-term distress in the form of rising malnutrition will have negative long-term consequences for education.

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Countries with at least one formal program for children under 3 in 2005 (%)

Many countries lack programs addressing health, nutrition, care, and education of children under 3, a critical period in life.

0% 50% 100%

World

Arab States

Central/ East. Europe

Sub-Saharan Africa

East Asia/ Pacific

South/ West Asia

L. America/ Carib.

Central Asia

N. America/ W. Europe

Source: EFA Global Monitoring Report 2007.

Situation analysis of health, education

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10% of worldwide disease is caused by under nutrition (WHO 2005)

According to 2007 MDG report, 84% of women who have completed secondary or higher education are attended by skilled personnel during child birth, more than twice the rate of mothers with no formal education (UNICEF 2008)

Children of educated mothers are 50% more likely to survive until the age of 5 and beyond than those whose mothers who didn’t receive or complete schooling (UNICEF 2008)

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To advocate for services that should include: Education on safe motherhood. Promotion of maternal nutrition. Supplementation of micronutrient and tetanus toxoid,

where appropriate. Prenatal care and counseling. Delivery assistance in all cases by a skilled professional

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Care for obstetric emergencies, including referral for pregnancy, childbirth, and abortion complications.

Postnatal care. Promotion of longer intervals between births through

family counseling.

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Postnatal care, including exclusive breast-feeding.Early stimulation for the brain of the child through interaction.ECD as Holistic approach on policy level

Recommendations

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Mrs. Lara Hussain Dr. Mahendra Sheth Dr. Malak Zalouk Mr. Moncef Moalla

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Thank you