PHN

Malnutrition has an effect on the intellectual development not only because it get enough calories, but also because there is less movement so less motor skills trained and less exploring; aswell less schooling (teacher don't expect much of a "small" child): stunting between 12 and 36 months of age predicted poorer cognitive performance and/or lower school grades attained in middle childhood

Circle: if the mother is malnutritioned => the child is born underweight and starts already with deficiency => not good brain developement as an adult => poor => and it starts again from the beginning "hunger carusel". Problem: stunting is mostly not detected (when a lot of children are suffering of stunting, then you can't see, that your child is smaller than it should be => and if it is not detected, it can't be treated)!

The main actors are Vitamin A, zinc, iron and iodine => severe deficiencies cause typical clinical symptom, but they are often unnoticed but have serious consequences. Almost 1/3 of people are deficient

• Not always given for free
• Project food aid (for a specific project, sometimes it is bought in the country itself or it is brought from abroad)
• Relief food aid (i.e. during wars, food can be bought from local farmers and sold less expensive)
• 50% of the food aid is provided by the World Food Programme
• Depends on world markt prices and stocks. I.e. if there are too much food on the market, they provide it to poor country. If there is not enough, there is less food aid
• For emergency it is okay, but in gerneral, it is a difficult topic because it can damage local production! (decline in food prices and so local producers are hurted)

• May be effective, when well designed (school meals and snacks)
• In low- and middle-income countries designed to address malnutrition and hunger
• Improve schoolchildren's food consumption and dietary diversity
• Might help physical growth in terms of height and weight, but only limited effects (animal-products are lacking)
• Inflluence learning and educational performance and classroom attendance
• Ensure that girls are well prepared to become mothers
• May support rural livelihoods when produced locally
• Are more effective when integrated with school-based health and nutrition education

• Specific supplement
• The deficiency should be detected and the target group defined.
• Specifically for vitamin A, zinc and iron => should be longterm
• Malnourished children receiving supplementation of protein and micronutrients imrpove their physical and mental developent and their productivity
• May lead to reduction of child mortality (20-40% in children < 4)
• Relative low cost (vitamin A)
• Most widely practiced
• Home fortification with multiple micronutrient powders tackles widespread micronutrient deficiencies

=> not longterm, there should be more than one micronutrient supplemented

• Energydense, micronutrient enhanced pastes (with peanuts, oil, sugar, milk powder and vitamin and mineral supplements
• Targeted at children suffering from uncomplicated severe acute malnutrition and who retain an appetite (not treated in hospital)
• Good shelf life, does not spoil easily even after opening
• Not water based, risk of bacterial growth is very limited
• Safe and easy to use without close medical supervision
• May be used in combination with breastfeeding and other best practices for infant and young child feeding (not inhibit it)

• Mostly basic foods are being fortified with micronutrients
• Should be eaten at a daily basis by the targeted population
• Taste and appearance should not change and the price should not change
• Most common case: fortification of salt with iodine
• Industrilized countries: dairy products with vitamin D, flour with folic acid
• Developing countries: vitamin A

• Goal: enhance micronutrient denssity through breeding in agricultural products
• E.g. rice varieties with a high iron or zinc content and high biovailability
• Target population: poor rural population
• Crops must be adopted by farmers (their productionsystem should be taken in account) and consumed by the target population
• Narrow genetic variation, a long-development time, and the dependence on the phytoavailability of the mineral nutrients in the soil are limitations

• Rice variety which  accumulated carotenoids, source of vitamin A
• Beta-carotene derived from golden rice is effectively vitamin A in humans
• Contains actually two genes from maize - GMO-crop (genetically modified organism)
• No charge for the nutritional trait within the seed to smallholder farmers who sell locally
• No individual or organization involved with the development of golden rice will benefit financially from ist adoption

• Changes in food production (farmers) and food selection patterns
• Goal: enhance availability of and access to foods with high content and bioavailability of micronutrients throughout the year. But do they really eat it?
• Higher dietary diversity enhances food intake and micronutrient intake
• Mostly focus on fruit and vegetables, some additionally on grains and legumes
• Some improvement in absorption from zinc is likely with the reduction of phytate (soaking, wild-type maize)
• Increasing intake of absorption enhancers (flesh foods enhance the absorption of non-heam iron from plant-based foods), ascorbis acid enhances non-heam iron from single meals

• Rural population is more suffering under undernutrition and poverty
• More calories available in urban than rural (big difference between the riches and the poorest)
• Coverage of the basic need by the different farmes: only medium and big size farmes earn enough money to cover their basic needs. Landless and small one can cover only 1/4 or 1/2 of it. As bigger they are, as more possibilities for diversity they have => Access to land has a direct link to diversity; same accounts for animals
• Assets (land, animals, tools) allow for: crop diversification, access to credits and loans and resilience after shocks (disasters, severe illnesses, price shocks)

• Direct cash to poor and vulnerable households
• To imrpove food security, health and nutritional and educational status
• Studies show that such programs may work
• If you give people cash, there should be more money available and they should be more food secure
• More resources for improvements to sanitation dacilities
• More money for emergency if there is an illness
• Care practices and behaviour (e.g. breastfeeding)
• Resource control for main caregiver (usually mother) => may better advocate for her preferences
• Study shows: always good for child nutritonal status, food security, health care and caregiver empowerment

• Target group should be included in developing a program
• The food should be aavailable and affordable for them
• Not enough, together with other meassures (i.e. it needs changes of the law)
• How do you reach the most vulnerable groups?
• Focus on longterm interventions

The vitamin content of human milk correlates with the nutrition status of the mother. The effect of maternal suppl. In malnouriseh is effective, in well-nourished it is only limited effective.

=> Nourished mothers is the most effective way for public health for babies. You need to supplement the mother, so the baby will be well nourished. The macronutrient quantity is not influenced by the mother. But the quantity of the milk is, it will be less.=> nourished the mother and she will produce more milk.