Global 4-1 undernutrition

undernutrition is a _______ factor?

"contributing" -underlying causes

number 1 "Cause" of under 5 death

"neonatal" causes -Neonatal>PNA>diarrhea

Of the 3 types of PEM= ______affects child more

"stunting" -India, SSA, SE Asian more than 40 stunted -Puts them more at a risk to chronic dzs

Primary reason children are dying- "fundamental cause"

"water"/sanitation

map- vitamin a

-central America and south America, -ssa, -asia

Underlying causes-

-intake, -access

UNICEF- PNA can be prevented....

-nutrition, exclusive breastfeeding for first 6mos, access to Hib and PNA vaccines, maintain clean physical environment

Insufficient nutrition

-quantity= how much -quality= how good- rice in Asia -poor nutrient uptake b/c of illness

Under 5-

0-5th birthday

Unprotected children - Major problem in 10 countries

= Ethiopia, Congo, India, Indonesia, Pakistan, Philippines, Uganda, south Africa, Iraq, and Nigeria

used to be the biggest killer, but now better at tx

Diarrheal dz-

diarrheal dz spread via?

Fecal-oral transmission - Water and sanitation

Solutions that are simple since building water infrastructure is hard

Oral rehydration salts =ORS/ORT

This is reason the death of children dropped from number 1 to 2

Oral rehydration salts =ORS/ORT -Zinc matters a lot - this means they are worse off if insufficient

S pneumoniae vaccine

PC: -covers multiple strains -S pneumoniae can have multiple strains

Nutrition role

PE and micronutrient - Breastfeeding- way for protection Environmental role - Housing, health facilities, ..

____ kills more children WW than any other single cause under 5

PNA

leading "single" cause of child death in L/MI countries

PNA/ALRI

type of oral rehydration salts (ORT) in the US?

Pedialyte-

who is at high risk of xeropthalmia from vitamin a deficiency?

Pregnant women

interventions When you have an acute situation - PEM

RUTF - Ready to use therapeutic foods - High density, high fat to save people from dying

Estimated deaths in under 5, most in?

SSA>south Asia

UNICEF- Guatemala - video

The United Nations Children's Emergency Fund is a United Nations program headquartered in New York City that provides long-term humanitarian and developmental assistance to children and mothers in developing countries.

Diarrheal dz is caused by?

a variety of pathogens (group of bugs) -Rotavirus(number 1), -ETEC (ecoli), -vibrio, -shigella, -salmonella, -campylobacter, -giardia, -clostridium = all bacteria

People in the US don't vaccinate their children for measles b/c of the fear of

autism

undernutrition is considered a ______ factor to child mortality

contributing

Perinatal-

first "week" of life

Infant-

first year of life

Iodine is key for?

mental health -Most common form of preventable mental health illness

iodine deficient= causes?

mental problems

necessary, but hard for people to get = most insufficient globally?

micronutrient deficiencies

number 1 cause of diarrheal dz

rotavirus

sign for "acute " undernutrition

wasting

stunting

you are too short for your age = height for age

GAVI-Public-private partnership

- Involves WHO, world bank and NGOs like Gates and people that make the vaccines and countries that cant afford them

Micronutrient deficiencies

- Vitamin A - Iron - Zinc - Iodine

Nutrition nerd- micronutrient video

- Vitamins and mineral that are needed for basic health - Hidden hunger- cant always see the effects it does to your body

Iodine causes?

-Goiter- in women -Impaired intellectual

Oral rehydration salts =ORS/ORT

-Sugar or salt with water - Children are really dying from dehydration- losing fluids -The gut cells need salt and sugar to maximize absorption (both)

tx for vitamin A deficiency

-Supplementation 2x/year because it stays in "liver" - Improvements in diet

PATH- agency in Seattle

-Work with vaccines and children = rotavirus vaccine drops - Rotavirus is leading cause of diarrheal dzs - Breastfeeding can reduce death by 50% - Water chemical tx, hygiene, sanitation - ORS and zinc

Vitamin a- causes?

-Xeropthalmia (night blindness) and blindness -Growth and immune system function

Globally ___ of child deaths are attributable to undernutrtion

1/3

Graph - Decrease in child deaths since?

1980 (recent) - Since we developed key interventions - Dip at the end- if we would have met the MDG we would have been lower

___ SD from median = undernourished

2

Protein energy malnutrition -

not enough energy, calories, etc -stunting, wasting, and underweight

GAVI alliance -Global alliance for vaccination and immunization: Mission?

provide vaccines to children in poor countries -"Closing three critical gaps in the provision of vaccines:

PNA- Sxs

- Rapid labored breathing, wheezing, cracking in lungs - Cough, fever, chills, loss of appetite

Main funder of GAVI alliance (vaccines)

Gates Foundation

Hib: vaccine

can be combined with DPT, polio, Hep. B

wasting

when a child is too skinny for their height =weight for height

ALRI (PNA)- Dx?

- X-ray or lab tests - Resource-poor settings: clinical sxs

ALRI- Transmission via

- air - Respiratory droplets, aerosol, normal flora into lungs(bugs live in you=carrier)

Neonatal

- first "month" of life

Vaccines for HIB and Pneumococcus

-"Conjugate" vaccines- simple vaccines with proteins - Very effective

Child survival

-70% decline in last 50 years -7% million under 5 die each year -Closely linked with poverty -99% deaths in L/MI countries

under 5 death Focus:

-ARI, -diarrheal dz -vaccine preventable, -neonatal mortality

diarrheal dz prevention

-Access to water supply and water sanitation -Rotavirus immunization -Exclusive breastfeeding the first 6 mos = Passive antibodies from the mother

Additional important vaccine-preventable diseases

-Diphtheria -Mumps -Rubella -Hepatitis B -Polio -Yellow Fever

access to water supply and sanitation against diarrheal dz=

-Disinfection and storage -Piped water

undernutrition= Deficiencies in ?

-Energy -Protein -Micronutrients

Cost effective short term interventions for micronutrient deficiency?

-Exclusive breastfeeding- for 6 mos of life in poor settings -Vitamin supplementation - take a capsule -Iodization salt -Fortification - food product spiked with nutrients they need to get- ex ^ salt - GMOs foods = fortification - golden rice

challenges for Hib and PC vaccines

-Expense - Because they are relatively new -Delivery - Remote areas -Targeting vaccine to areas with most dz

Key period to avoid nutrition gaps which can cause irreversible problems (mental, physical, etc.)

-First 1000 days of child's life -conception to 2nd birthday

3 goals for GAVI alliance

-Gap between children for whom immunization is given and those with "no access" to basic vaccine -Between the "time" intro of a new vaccine in rich countries and for the same vaccine to reach L/M -Gap between need for "new vaccines" in developing countries and the "lack of research and funds" (better vaccines)

Zinc deficiency causes?

-Growth retardation, -impaired immune function, -skin disorders, -hypothyroidism

Greater severity and mortality in L/MI countries due to?

-Malnutrition -Housing quality -Indoor smoke -HIV -less access to vaccines

problem with child deaths?

-Many of these deaths are preventable -Simple, low-cost interventions

diarrheal dz facts

-Mild to life threatening -Multiple episodes per year in children -Main thing is fecal-oral transmission and the relationship with water sources

diarrheal dz- tx?

-ORT-Oral rehydration therapy -Zinc supplementation -Axs (rarely)

ARI- acute respiratory infections

-PNA/ALRI (acute "lower" resp.= in lungs and bronchi) - 3-6 cases ARI/year per child

#1 Vaccine preventable dzs graph

-PNA= 32% - Rotavirus-vaccine prevents 30%

Long term solutions- micronutrient deficiencies

-Policies- agricultural and trade -Improvements in women's status and access to education -Access and consumption of affordable food that meets nutrition needs

Consequences of undernutrition

-Poor health -Low energy levels -Mental/cognitive impairment -Poverty - Vicious cycles

3 steps to deal with child who has PNA

-Recognize child is sick -Seek appropriate care -Treat appropriately with axs

diarrheal dz mortality graph

-Rota>shigella>typhoid - Cholera not as big- in terms of child death

Hunger map- world food program

-SSA, -S Asia, -S America

Half of all child deaths are in just __ countries

5 -India -China -Nigeria -DRC -Pakistan

who is more at risk of anemia from iron deficiency?

50%- pregnant women 40%- preschool children

all cause mortality from vitamin A deficiency?

6.5 of all deaths of children "under 5" in low and middle are due to vit. A deficiency

Measuring malnutrition -

Assessed as standardized deviation from a reference population in z-scores

Map and vaccine coverage

Blue area- all kids have access- Australia, US, Europe -SSA, and Asia - don't get it

immune system dysfunction from vitamin a= increase

Chances of fighting infections

"major" cause ALRI

H influenza (HIB)

diarrhea, PNA- causes?

Immune system problems-

HANS- movie and child deaths

Linked to family planning- the more we can provide access to planning= less child deaths

"leading" cause of ALRI

Streptococcal(S) Pneumoniae (pneumococcus)

Country where people don't get measles vaccines=

US - We are on the list b/c anti-vaccination movement- link between development of "autism"

how long has DPT3 been in play?

Using since the 80s - Trends in DPT coverage has increased for all countries (20-30 years)

DPT3

Vaccine that protects from diphtheria, pertussis, and tetanus

500 million have _______- from iron deficiency = less productivity

anemia

Iron deficiency causes?

anemic -30% of worlds population is anemic

PEM= indicators of protein undernutrition

anthropometric indicators

Underweight

child weighs too little for their age

Child mortality -Number 2 cause ?

diarrheal dz

1/3 vitamin a def- causes problems with?

immune system

Child mortality- highest percent of?

neonatal causes

Zinc-deficiency affects

organ systems - skin, neuro, reproductive, etc

when you have "chronic" undernutrition - long period of undernutrition, leads to?

stunting

1/2 of under 5 deaths from ________ as an underlying cause

undernutrition