The views expressed in this paper are the views of the authors and do not necessarily reflect the

views or policies of the Asian Development Bank (ADB), or its Board of Governors, or the governments they represent. ADB does not guarantee the accuracy of the data included in this paper and accepts no responsibility for any consequence of their use. The countries listed in this paper do not imply any view on ADB's part as to sovereignty or independent status or necessarily conform to ADB's terminology.

Sharing experiences on gender, food security y and nutrition in the region/sub-region in intervention

Prof. Kraisid Tontisirin, M.D., PhD

Senior Advisor, Institute of Nutrition, Mahidol University, Thailand Former Director, Nutrition and Consumer Protection, FAO, Rome, Italy

ADB/FAOAsiaandPacificRegionalConsultation onGenderFoodSecurityandNutritionBangkok 24July2013

 Agriculture Food supply Food service

Food

Nutrition

Health

P ti Promotion Prevention Treatment

Nutrition is a link between food and health, regarding the fulfillment of energy, protein and micronutrient requirements from food throughout human life cycle

Ultimate Goals:

Food and nutrition security and wellwell being for all

Kraisid Tontisirin, Mahidol University

Food and nutrition security*

Food and nutrition security exists when all people at all times have physical, physical social and economics access to food, which is safe and consumed d in i sufficient ffi i t quantity tit and d quality lit tto meet their dietary needs and food preferences, and is supported by an environment of adequate sanitation, health services and cares, allowing for a healthy and active life.
*From FAO CFS 2012
Kraisid Tontisirin, Mahidol University

Food and nutrition challenges g

Continuingandpersistentundernutrition
Undernourished(proteinandenergydeficiency) inmothers,childrenandadults:foodinsecurity Micronutrientdeficiencies:ofiron,iodine,vit.A andothers:poordietsandfrequentinfection

Overnutritionanddietrelateddiseases
Overweight&obesity Diabetesmellitus, mellitus highbloodlipids, lipids highbloodpressure,cardiovasculardiseases Cancers

Foodsafetyandquality
Kraisid Tontisirin, Mahidol University

Undernourishment in 2010, by region (millions)

% prevalence of anemia in women In Asia Pacific Countries

Australia Japan New Zealand Nauru Thailand Republic p of Korea Timor Leste Singapore Seychelles Cook Islands Palau China Sri Lanka Niue Vietnam American Samoa Tuvalu Samoa Tonga DPR Korea Mongolia Micronesia Marshall Islands Malaysia Kiribati

Non-pregnant women Pregnant women

Brunei Darussalam Pakistan Philippines Indonesia Bangladesh Myanmar Bhutan India Solomon Islands Papua New Guinea Maldives Fiji Lao PDR Vanuatu French Polynesia Cambodia Nepal

(From WHO: SEARO & WPRO, 2007)

10

20

30

40

50

60

70

80

India (1999)

% prevalence of f low l bi birth th weight (2.5 Kg) in Asia Pacific countries

Bangladesh (1998) Cambodia (2000) Sri Lanka (2000) Maldives (2001) Nepal p (2001) ( ) N.Mariana Islands (2000) Micronesia (2000) Lao PDR (1998) Philippines (2000) Myanmar (2000) Bhutan (1999) Marshall Islands (1999) Timor-Leste (2002) Papua New Guinea (2002) Malaysia (2004) Fiji (1996) Thailand (2001) Singapore (2004) Palau (1998) Japan (2004) Indonesia (2002) Kiribati (2002) Guam (2004) New Zealand (2003) N New C Caledonia l d i (2002) French Polynesia (2001) DPR Korea (2002)

Brunei Darussalam (2003) Viet Nam (2004) Australia (2003) Tuvalu (2000) Mongolia (2004) Korean Republic (2004) Vanuatu (2003) Tonga (2002) American Samoa (2004)

(From WHO: SEARO & WPRO, 2007)

Samoa (2004) Cook Islands (2003) China (2002) Tokelau (2003) Niue (2005) 0 5 10 15 Prevalence (%) 20 25 30

Indonesia

% prevalence of stunting(<2SD) among Under five children in Asia Pacific countries

Cambodia Bangladesh Nepal Timor Leste Lao PDR Marshall Islands Bhutan India DPR Korea Philippines Vietnam Myanmar Maldives Vanuatu China Thailand Malaysia Sri Lanka

Brunei Darussalam Solomon Islands Samoa

(From WHO: SEARO & WPRO, 2007)

Fiji Singapore Tonga 0 5 10 15 20 25 30 35 40 45 50

Bangladesh

%Prevalence of underweight (<2SD ) among Under five children c d e in Asia sa Pacific countries

India Cambodia Nepal Timor Leste Papua New Guinea Lao PDR Marshall Islands Philippines Myanmar Vietnam Sri Lanka Indonesia Maldives DPR Korea Bhutan Brunei Darussalam Vanuatu Malaysia China Thailand Fiji Singapore New Caledonia Republic of Korea Samoa Solomon Islands Palau

(From WHO: SEARO & WPRO, 2007)

10

20

30

40

50

60

The Millennium Development Goals

MDGs
will not be achieved without nutrition improvement

Kraisid Tontisirin, Mahidol University

Trends in Preschool Child Malnutrition (weight for age) in Thailand

Kraisid Tontisirin, Mahidol University

Elimination of undernutrition: a global deficit and priorities*

*ACC/SCN 1999

Kraisid Tontisirin, Mahidol University

THAILANDS DEVELOPMENT PLANS

1961 1st NEDP 1966 2nd NEDP 1971 3rd NEDP 1976 4th NESDP 1981 5th NESDP 1986 6th NESDP 1991 7th NESDP 1996
Kraisid Tontisirin, Mahidol University

: Economic Infrastructure Sectoral Plans

: + Social S i l Pl Plan + Food and Nut. Plan, PHC : + Poverty Alleviation Plan (PAP) PHC BMN / QL indicators i di t

Poverty Alleviation Plan (PAP)

from 1982 on ward malnutrition was considered as symptom of poverty with organization g changes g for management g of rural development with h (new) ( ) 5 basic b principles l PAP

Fd/Nut.Prog.

PHC

BMN indicators
Kraisid Tontisirin, Mahidol University

Forging the Link Between Government and Community

Kraisid Tontisirin, Mahidol University

Community-Based Approaches
Isanintegrated g program p g implemented p atlocallevel(districtlevelandbelow) National commitment withsoundnutrition improvement p strategies g andg goals Community actions : basicservices,mass mobilization,mutualefforts/actionstoreach allpeopleandtopreventmalnutrition
Kraisid Tontisirin, Mahidol University

ComponentsofaSuccessfulCommunityBasedProgram MinimumBasicServices
(Health, Education, Agr. Extension)
Supportive pp System y
Training Funding Problem Solving Supervision

Menus (Activities)
ANCs for mothers GMP: BF, CF & cares Food production Nutrition education Food sanitation & safety School lunch (SLP) and school milk (SMP) programmes Other activities

Facilitators

Interface
(Service providers and community leaders) Plan/goals Implementation Monitoring/evaluation

Community Leaders Family Individual

Volunteers (1:10 households)

BasicMinimumNeedsGoals/Indicators
Kraisid Tontisirin, Mahidol University

MainCausesofChildMalnutrition
PoormaternalnutritionandhealthleadingtoLBWof newborn,lowmilkqualityandquantity Decliningofbreastfeedingpractices Inadequateandinappropriatecompl.feeding PoorsanitationinIYCfeedingandcares Recurrentillnessi i.e. e diarrheaandrespiratorytract infection Undesirable d bl eatinghabits h b
Kraisid Tontisirin, Mahidol University

MenuActivityonANCs
(t tmaternal t lmorbidity bidit and dmortality, t lit and dLBW) (toprevent

4ANCs visitsforallpregnantmothers Highriskcheckupandtreatment M it i wt. Monitoring t gain i Nutritionandhealtheducation Foodsupplementation MTV,ironandfolate supplementation Twotetanustoxoids Referrals system stemandsafedelivery deli er service ser ice
Kraisid Tontisirin, Mahidol University

 Gra ya sart
(Thai sweet rice with peanut and sesame)

Kanom Toob tub

Ingredients
Pop-rice Pop rice Peanuts Sesame Sugar

Ingredients
Flour Fl Peanuts Sugar
Kraisid Tontisirin, Mahidol University

Ingredients
Rice flake Dried shrimp Dried peanut Dried bean curd

Shredded Rice Grain ()

Kraisid Tontisirin, Mahidol University

MenuonGrowthMonitoringand Promotion(GMP)
Monthlyorquarterlymonitoringwt.&ht.andtakeremedyactions Childgrowtheducationandcares BreastfeedingandComplementaryfeeding Immunization Villagebasedfoodproduction(+CFforIYCandsupplementaryfood f mothers) for th ) Healthandnutritioneducation Cookingandfeedingdemonstration Treatmentofmalnourishedchild Referralofsevereillnessandmalnutrition
Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University

Kraisid Tontisirin, Mahidol University

CommunityFoodProduction
g Homeandschoolg gardens g growing vegetables,fruits,fishesandchickenfor learning, andincome g consumption p Supplementaryfoodforpregnantmothers ComplementaryfoodforIYC foodpreservation andsimplefoodprocessing techniques Cooperativeandmicrocredit
Kraisid Tontisirin, Mahidol University

Table 1 Suggested complementary feeding guidelines (adapted from Thailand complementary feeding guide-lines)

From Tontisirin, Ped Nutr in Practice, 2008

Kraisid Tontisirin, Mahidol University

Maternalandchildhealthandnutrition Th il d 1980 2006 Thailand,

1980 ANC coverage % Anemia in preg. % LBW % PEM (Wt/Age of U 5)% 35 50-75 16 51 1990 75 18.8 10 20 2006 95 10 <10 <10

Kraisid Tontisirin, Mahidol University

Prevalencesofstunting,wasting,overweight, andobesityinchildrenaged15years
%

Stunting

Wasting

Overweight

Obesity

Aekplakorn W, et al. NHES4, 2008-2009.

Trendofnutritionalstatusofchildren aged15years
%

Stunting

Underweight

Overweight& Obesity

NHES2;HolisticDevelopmentofThaiChildren;NFNS5;NHES4

Ensuringgenderequality
Femaleequalityisafundamentalandessentialforfood andnutritionsecurity. Femaleplaysakeyrolesinallphrasesofcontinuum fromagriculture,food,nutritionandhealthat householdandcommunitylevel Femaleneedsequalopportunityinnutrition,education, developmentandjobopportunity Female,asawellequippedmotherwithknowledgeand skillswillleadtonutritionwellbeingtoallfamily members
Kraisid Tontisirin, Mahidol University

Conclusion1
Interfaceofbasicsocialserviceswithstrong peopleparticipationatcommunitylevelis g coverage g andeffectiveactions crucialforhigh Nutritionindicatorsaremostuseful goalsetting gandfollowup pactions forg i.e.birthweight,underweightof under5, ,stunting, g,weight g forheight g andBody y MassIndex(BMI)

Kraisid Tontisirin, Mahidol University

Conclusion 2
Rolesoffemaleinachievingfoodandnutrition securityhavebeenrecognizedasover5060% ofserviceprovidersaswellasvillage volunteersarefemaleworkingwithcommunity leaderstoreachtheunreached. Thailandasacountrywithsuccessstoryis proudtosharelessonslearnttoother countrieshowtoalleviatemalnutritionand promotegenderequality.
Kraisid Tontisirin, Mahidol University

Thank You

For Your Attention