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Adolescent Nutrition_Ruel-Bergeron
1.
Adolescents in Low
and Middle-Income Contexts Julie Ruel-Bergeron Program in Human Nutrition April 14, 2015
2.
©2015, Johns Hopkins
University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Adolescent Demographics in LMIC: Global Trends 1.2 billion and growing 18% of the world’s population, 90% of which live in LMIC Source: UNICEF, 2012
3.
©2015, Johns Hopkins
University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Adolescent Demographics in LMIC: Regional Trends Source: UNICEF, 2012
4.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Nutrition: Determinants of Nutritional Status in Adolescence Source: WHO, 2005.
5.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Risks and Challenges in Adolescence: Nutrition, Early Marriage and Early Pregnancy • Adolescent girls often enter pregnancy with reduced nutritional stores – Competition for dietary energy and nutrients • Physical immaturity of the mother – More immature = ↑ obstetric risk – ↑ maternal mortality – ↑ prematurity, LBW • Higher incidence of poor child health care and child feeding behaviors – Varies by SES – Interference of pregnancy with schooling completion
6.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Impact of Adolescent Pregnancy on Birth Outcomes: LBW and Preterm Gibbs et al, Pediatr Perinatal Epi 2012
7.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Predictors of Stunting in Pregnant and Non- Pregnant Adolescent Girls (Bangladesh) Source: Rah et al., 2009.
8.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Annual changes in anthropometric measurements by pregnancy status
9.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Mean annual changes in height by time since menarche and pregnancy status Rah et al., 2008.
10.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Mean Annual Changes, by Time Since Menarche Rah et al., 2008.
11.
The Condition of
the Adolescent in LMIC: Burkina Faso, Indonesia, Zambia Risks and Challenges
12.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Population characteristics Burkina Faso Indonesia Zambia
13.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Risks and Challenges: Education, Reproductive Health, Sexual Practices and Marriage • Disparities by residence, wealth quintiles, and sex in young adolescents • In some instances, disparities become more pronounced in older adolescents (education gap) • Some unexpected trends: • Early marriage in Indonesia • Family planning in Indonesia and Zambia
14.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Risks and Challenges in Adolescence: Nutritional • Girls at greater risk of suffering nutritional difficulties than boys, with more severe consequences as it relates to childbearing and perpetuating the cycle of malnutrition – Underweight – Stunting – Micronutrient deficiencies (anemia especially) – Obesity Sources: UNICEF 2011, UNICEF 2012
15.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Risks and Challenges in Adolescence: Nutritional (cont) • Lifestyle and eating behaviors, and underlying psychosocial factors also threaten adequate nutrition • Adolescent pregnancy imposes additional physiological and nutritional stress, especially in stunted or underweight mothers
16.
Reaching Adolescents: Delivery Platforms
17.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. School and Education-Based Programming • School feeding • Anemia control • Nutrition-friendly school initiatives • Other school-based adolescent-focused programs – India’s Saloni Swasth Kishori Yojna, Uttar Pradesh – Zambia’s UN Girls Education Initiative
18.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Social Safety Net Programing • Cash Transfers: conditional and unconditional – Impact on HIV and education in Malawi – Unconditional • Varying impact based on recipient (mother/father) and conditionality – Conditionality matters more than recipient in terms of improved child health outcomes • Not a lot of evidence specific to adolescents, but a promising avenue for addressing factors proximally associated with adolescent nutrition and with broader social benefits – Education, early marriage, sexual behaviors, STIs, and early pregnancy • Microfinance interventions
19.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Youth Development and Community- Based Approaches • Peer education • Adolescent and youth centers • Faith-based community approaches • Other community-based approaches – Indonesia linking of marriage registries to target health messages and IFA supplementation – Promotion of gender equality at the community level to address violence and SRH
20.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Technology-Based Platforms and Sensitization/Mobilization • Mhealth/nutrition • Mass media communication • Community-based sensitization
21.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Other Interventions/Programming • Health Center-Based Programming – Youth-Friendly Health and Nutrition Services • Policy-level interventions – National-level • Incentives to delay early marriage (India and Bangladesh) • Scholarships for secondary education or life-skills training • HIV-specific legislation – Policies by large donor institutions • USAID’s Youth in Development Policy
22.
© 2014, Johns
Hopkins University. All rights reserved. © 2014, Johns Hopkins University. All rights reserved.© 2014, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved.©2015, Johns Hopkins University. All rights reserved. Summary and Key Points • Adolescents face many health and nutritional risks – Injuries are the leading cause of death – Other risks and challenges include mental health, substance abuse, sexual and reproductive health (HIV especially), education, violence and abuse – Girls are more vulnerable nutritionally, as a result of the link with early pregnancy and its impact on education, maternal obstetric outcomes, and child outcomes. • Various types of delivery platforms to reach populations with health and nutrition services in LMIC exist, but their potential for reaching adolescents (girls especially) has yet to be unleashed
23.
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