Nutrition Program Secondary 2014 DHS Analysis Reference: National - PowerPoint PPT Presentation

Nutrition Program “Secondary 2014 DHS Analysis” Reference: National Nutrition Program, Nutrition secondary analysis 2014 CDHS, UNICEF/IRD/MOH, Phnom Penh, Cambodia, January 2016

Team For the secondary analysis: IRD MOH Dr Frank Wieringa Dr Prak Sophonneary Dr Valerie Grefeuille ICF Dr Jacques Berger Mr Ludovic Gauthier Mr Rathavuth Hong FiA UNICEF Dr Chhoun Chamnan Dr Etienne Poirot Mr Khov Kuong Dr Rathmony Hong Mr Samoeurn Un Dr Arnaud Laillou Special thanks to 1. WFP, ILSI, World Vision for their financial support to the micronutrient survey 2. FiA for the data collection 2

Economic Burden of malnutrition (I) The impact of the indicators of malnutrition analyzed in the report represent a burden to the national economy of Cambodia estimated at more than 260 million USD annually -1.7% of GDP . Figure. Impact on the total economic burden of malnutrition from each indicators

Economic Burden of malnutrition (II) Depending on the discount rate, 0.9-1.7% of the GDP (145-266 million USD) are lost annually

Quantitative Practices during the 1,000 Days window We analyzed the inequities between different groups

How to read the graphs? If * than the 2 prevalence are sig. different Shows the difference in 2010 between rural and urban If letter different than the differences are significantly different otherwise no sig. diff. If * on the line than the prevalence data in 2010 and 2014 for the different clusters (here urban and rural) are sig. different otherwise no difference If letter different than the national prevalence in 2010 and 2014 are significantly different otherwise no sig. diff.

Health behavior and Impact indicators practices

Health behaviors and Practices Urban vs Rural Prevalence of mother seeking treatment Prevalence of Diarrhea 25.0 70.0 Diff: -0.9 a Diff: -9.9* a 60.0 20.0 a Diff: -5.3* a 50.0 Diff: 11.5* b a * Diff: -0.4 a 40.0 a 15.0 * a 30.0 10.0 20.0 10.0 5.0 0.0 2000 2005 2010 2014 0.0 2000 2005 2010 2014 seeking treatment/advice Total Urban Rural Total Urban Rural In 2014, Richest women are 1.5 significantly more likely to In 2014, no difference odds between rural and urban seek treatment than poorest women Prevalence of mother receiving ORT Diff: -6.0 a 40.0 Diff: -1.0 a 35.0 Diff: 7.9* b a But zinc supplements 30.0 a 25.0 given to only 5.4% in 20.0 2014 vs 2.4% in 2010: 15.0 • Urb: 1.4% to 3.3% 10.0 • Rur.: 2.5% to 5.8% 5.0 0.0 2000 2005 2010 2014 Total Urban Rural

Health behaviors and Practices Poorest vs Richest Prevalence of mother seeking treatment Prevalence of Diarrhea 70.0 Diff:-16.8* a Diff: 3.7 a 25.0 60.0 * Diff: -7.8* a a 20.0 a Diff: 13.5* b 50.0 Diff:-4.0* a * 40.0 a 15.0 30.0 a 10.0 20.0 10.0 5.0 0.0 2000 2005 2010 2014 0.0 seeking treatment/advice 2000 2005 2010 2014 Total poorest richest Total poorest richest In 2014, Richest women are 2 significantly more likely to seek In 2014, Poorest women are 1.4 significantly more likely to treatment than poorest women have diarrhea than richest women Prevalence of mother receiving ORT Diff:-15.4* a 45.0 Diff:28.7* b 40.0 Diff: -0.3 a a 35.0 But zinc supplements a 30.0 given to only 5.4% in 25.0 2014 vs 2.4% in 2010: 20.0 • 15.0 pooresr: 1.7% to 6.3% • 10.0 richest: 1.3% to 5.3% In 2014, Richest women are 2 5.0 significantly less likely to 0.0 2000 2005 2010 2014 receive ORT than poorest women Total poorest richest

Health behaviors and Practices Urban vs Rural Prevalence of mother seeking treatment Prevalence of ARI 10.0 80.0 Diff: 3.9 a Diff: 1.0 a 9.0 70.0 Diff: -3.8* a a 8.0 60.0 a * 7.0 Diff: -0.1 b 50.0 a 6.0 * a * 40.0 5.0 4.0 30.0 * 3.0 20.0 2.0 10.0 1.0 0.0 0.0 2005 2010 2014 2005 2010 2014 seeking treatment/advice ARI Total Urban Rural Total Urban Rural In 2014, no difference odds between rural and urban In 2014, no difference odds between rural and urban Prevalence of mother receiving Antibiotic Diff: -8.0* b 90.0 * 80.0 b * 70.0 Diff: 10.6* a 60.0 50.0 * 40.0 * a 30.0 20.0 10.0 0.0 2005 2010 2014 Total Urban Rural

Health behaviors and Practices Poorest vs Richest Prevalence of mother seeking treatment Prevalence of ARI 14.0 80.0 Diff: 8.2 a Diff: -1.9 a 70.0 12.0 a a 60.0 10.0 Diff: -4.6* a 50.0 Diff: -2.1 a 8.0 40.0 a 6.0 a 30.0 4.0 20.0 2.0 10.0 0.0 0.0 2005 2010 2014 2005 2010 2014 ARI seeking treatment/advice Total poorest richest Total poorest richest In 2014, Poorest women are 1.5 significantly more likely to In 2014, no difference odds between poorest and richest have ARI than richest women Prevalence of mother receiving Antibiotic 100.0 Diff: -13.2* b * 90.0 80.0 b 70.0 Diff: 21.3* a 60.0 50.0 a 40.0 * 30.0 20.0 In 2014, Richest women are 2.5 10.0 0.0 significantly less likely to 2005 2010 2014 receive antibiotic than poorest Total poorest richest women

Health behavior and practices Other inequities Key Variables Gender (Boys vs Girls) in 2014 Trends among gender categories between 2010 and 2014 Diarrhoea No significant difference was The prevalence decreased observed significantly among boys (B: 15.9-13.4%) while no change among girls Seeking treatment for No significant difference was No significant difference was diarrhoea observed observed ARI No significant difference was No significant difference was observed observed Seeking treatment Significant difference was No significant difference was for ARI observed (B: 62.2% vs G: 75.9%) observed 2014 analysis shows that mothers are 2 times more likely to get advice or treatment for a girl than a boy during a ARI episode

Breastfeeding and Complementary feeding Impact indicators practices

Feeding practices Exclusive Breastfeeding (0-5.9 months) 24mo Partial breast and complementary feeding Diff:-30.9* b Diff:-11.2* a Diff:-11.9* a 80.0 80.0 Diff:-30.9* b 70.0 70.0 a * b 60.0 60.0 * 50.0 50.0 40.0 40.0 * * % % 30.0 30.0 20.0 20.0 10.0 10.0 12mo 0.0 0.0 2000 2005 2010 2014 2000 2005 2010 2014 Total Urban Rural Total poorest richest In 2014, Rural children are 3.5 significantly In 2014, Poorest children are 5 significantly more likely to be EBF than urban children more likely to be EBF than richest children 6mo Exclusive breastfeeding I. Median duration of exclusive breastfeeding decreased from 4.9mo to 4.5mo II. Median duration of predominant breastfeeding decreased from 5.6mo to 5.4mo Birth

Feeding practices Continuing Breastfeeding (6-23.9 months) 24mo Partial breast and complementary feeding 100.0 90.0 Diff:-21.9* a Diff:-28.7* a Diff:-27.9* b 90.0 80.0 * Diff:-22.5* a * * 80.0 a 70.0 a * b 70.0 b 60.0 * 60.0 50.0 50.0 * 40.0 40.0 30.0 30.0 20.0 20.0 12mo 10.0 10.0 0.0 0.0 2000 2005 2010 2014 2000 2005 2010 2014 Total Urban Rural Total poorest richest In 2014, Rural children are 3.3 significantly In 2014, Poorest children are 2.6 significantly more likely to be PBF than urban children more likely to be PBF than richest children 6mo Exclusive breastfeeding Birth

Feeding practices Minimum Acceptable Diet (6-23.9 months) 24mo Partial breast and complementary feeding Diff:19.4* b 50.0 60.0 * 45.0 Diff: 30.1* b 50.0 40.0 * 35.0 40.0 a 30.0 b Diff:0 Diff: 8.1* a 25.0 b * 30.0 * % a % 20.0 a 20.0 15.0 12mo 10.0 10.0 5.0 0.0 0.0 2010 2014 2010 2014 2000 2005 2000 2005 Total Urban Rural Total poorest richest In 2014, Richest children are 4.2 significantly In 2014, Urban children are 2.3 significantly 6mo Exclusive breastfeeding more likely to receive the minimum more likely to receive the minimum acceptable diet than poorest children acceptable diet than rural children Birth

Feeding practices Minimum Acceptable Diet (6-23.9 months) 24mo Partial breast and complementary feeding 45.0 * 40.0 35.0 Diff: 12.4* a * * 30.0 25.0 * 20.0 12mo Diff:9.3* a 15.0 10.0 5.0 6mo Exclusive breastfeeding 0.0 2010 2014 MAD Total 6-8 9-11 12-17 18-23 In 2014, Children 18-23mo are 1.9 significantly more likely to receive the minimum acceptable diet than younger Birth children 6-8mo

Feeding practices Other inequities Key Variables Gender (Boys vs Girls) in 2014 Trends among gender categories between 2010 and 2014 Exclusive Significant difference was observed The prevalence decreased breastfeeding (B: 60.1% vs G: 68.7%) significantly among boys (B: 74.7- 60.1%) while no change among girls Partial breastfeeding No significant difference was The prevalence decreased observed significantly among boys (B: 78.3- 69.6%) while no change among girls Minimum acceptable No significant difference was The prevalence increased diet observed significantly in both groups (B: 23.8-30.0%; G: 23.9-30.5%) 2014 analysis shows that a girl is 1.5 times more likely to be exclusively breastfed

Impact indicators Nutritional status

Impact Indicators : Nutritional status Women Child overweight/obese: rural < urban population High disparity and inequities (17.3% vs 22.9%, p<0.05) Double burden of malnutrition in Under-nutrition still population dominant