Transcript
Adolescents in Low and Middle-Income Contexts
Julie Ruel-Bergeron Program in Human Nutrition
April 14, 2015
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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
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Adolescent Demographics in LMIC: Regional Trends
Source: UNICEF, 2012
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Nutrition: Determinants of Nutritional Status in Adolescence
Source: WHO, 2005.
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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
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Impact of Adolescent Pregnancy on Birth Outcomes: LBW and Preterm
Gibbs et al, Pediatr Perinatal Epi 2012
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Predictors of Stunting in Pregnant and Non-Pregnant Adolescent Girls (Bangladesh)
Source: Rah et al., 2009.
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Annual changes in anthropometric measurements by pregnancy status
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Mean annual changes in height by time since menarche and pregnancy status
Rah et al., 2008.
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Mean Annual Changes, by Time Since Menarche
Rah et al., 2008.
The Condition of the Adolescent in LMIC: Burkina Faso, Indonesia, Zambia
Risks and Challenges
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Population characteristics
Burkina Faso Indonesia Zambia
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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
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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
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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
Reaching Adolescents: Delivery Platforms
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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
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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
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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
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Technology-Based Platforms and Sensitization/Mobilization • Mhealth/nutrition • Mass media communication • Community-based sensitization
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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
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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
Questions?
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