1. Stunting Reduction in Young Children
2nd National Conference on
Early Childhood Care and Education
‘Reconstructing Practices to Address Challenges and Trends in ECCE’
May 2-3, 2018

3. Regional Prevalence of Stunting

4. Child Stunting in Pakistan
Stunting improved from 1965 (48%) to 1994 (36.3%) but deteriorated from (41.6%) to 2011 (43.7%).
NNS: national Nutrition Survey

5. Provincial comparison of stunting, wasting and severe wasting
Newest MICS shows stunting rates above 41% in DI Khan and Bahawalpur
40% severe public
health concern

6. UNICEF

7. Consequences of malnutrition
Physical
Increased mortality at all ages
Increased morbidity at all ages due to infections
Stunted children have more diabetes, cardiac and hypertensive diseases as adults
Mental
Poor cognitive development
Trans generational transfer of poor intellect

8. Consequences of malnutrition

9. Consequences of malnutrition
Adults who were stunted as children:
Earn 20% less as adults
Are 30% more likely to live in poverty
Children who are stunted:
Have on average 13 Points less IQ
More likely to drop out of school
Poor nations loose 2-11 % of their annual GDP

10. By Focusing on 1000 Days We can Prevent Stunting
The period from pregnancy to 24 months is the crucial window of opportunity to reduce undernutrition - program efforts should focus here
UNICEF

11. Lancet Series 2013 Global and Regional Exposures and Health Consequences
Maternal and Child under nutrition is underlying cause of 35% of deaths and disease burden in young children
Deaths attributed to stunting, severe wasting and intrauterine growth restriction constitutes the largest risk to children U5
Suboptimal breastfeeding – especially in first 6 months results in 14% of deaths in children
Maternal short stature and iron deficiency anemia increases risk of death and accounts for 20% of maternal mortality
UNICEF

12. Thousand Days Approach- Key Nutrition Activities
Pregnancy
Birth
6 months
1 year
2 years
Iron and Folic Acid Supplements
Multi micronutrient Supplements
Iodized salt
Food Supplementation
Exclusive Breastfeeding for 6 months
Introduction Complementary Feeding
Continued Breast Feeding for 2 years
Multi micronutrient Supplementation (zinc)
Vitamin A ( and deworming)
Treatment of Malnutrition
Initiation of breastfeeding within one hour
UNICEF

13. Thousand Days Approach- Key Nutrition Sensitive Activities
Pregnancy
Birth
6 months
1 year
2 years
Improved availability, access use of local foods
Improved sanitation/hygiene practices
Antenatal care
Social protection/social safety nets
Promote increased marriage age
Workplace protection for new mothers
Hand washing with soap
Improved sanitation and water
Early Childhood Development
Immunization
Treatment of infectious diseases ( diarrhea and pneumonia)
Deworming
Improved food access/diversity
Kangaroo care
Birth registration
Baby Friendly Hospitals
UNICEF

14. Nutrition Theory of Change
UNICEF
Black et al, The Lancet  , DOI: ( /S (07)

15. Initiatives to address malnutrition
National multi-sectoral nutrition strategy in line with the already developed/endorsed provincial strategies
Ten point vision (2015) – RMNCAH and Nutrition strategy (focus on adolescent girls)
All PC 1s in provinces (Punjab, resource allocation in Sindh, KP & Balochistan)

16. Initiatives to address malnutrition (2)
Universal Salt iodization – legislation & implementation
CMAM and IYCF
National Fortification Alliance
Flour and vegetable oils fortification – partnership with the chambers of commerce in KPK, Sindh, Punjab, AJ&K
SUN (Scaling up Nutrition)
Breast feeding - legislation & implementation (Infant feeding boards)

17. Thank You