Situational Analysis and Expert Evaluation of the 1000 Days: Nutritional and Health Status in 4 Countries in Latin America

Abstract

Background: The first 1000 days of life, including pregnancy and the first 2 years of age have been considered essential for an adequate development and growth. Several studies have stated that malnutrition during pregnancy and not having a normal birth weight have negative impact on childhood and adulthood, and contribute to burden of disease. Adequate information on this matter provides the possibility for making recommendations on health and nutrition policies. Objective: The aim is to describe the nutritional status during the first 1000 days in four countries of Latin America: Colombia, Argentina, Chile and Brazil. Methods: The analysis consists of two complementary approaches: 1) An extensive search on published and gray literature and a critical analysis of secondary data bases was conducted in Colombia, Argentina, Chile and Brazil following a standardized methodology in 2013. Maternal and child nutritional status, breast feeding, nutritional deficiencies, and dietary habits during the first 1000 days were the variables of interest; 2) Information gaps were identified, interviews to local experts from academia, government and hospitals were conducted to fill each of the countries information gap. Data was organized in an online data base called NutriPl@net. Results: Despite the inherent country differences, the nutritional challenges during the first 1000 days are similar. Obesity prevalence is increasing in pregnant women. Under weight remains a problem in all 4 countries, with the highest prevalence in Argentina. Over weight prevalence is highest in Chile and obesity prevalence in Brazil. Micronutrient deficiencies in pregnant women have been described, especially high for folic acid, iron, zinc, vitamins A, B6, B12, C, E and riboflavin. Moreover, in the region, anemia is the most common micronutrient deficiency during pregnancy. Gestational diabetes, hypertension, obesity and pre-eclampsia * Corresponding authors.A. Ramírez et al. 445are major causes of maternal, perinatal and infant morbidity and mortality. Conclusions: In order to understand regional and country-specific needs, it is fundamental to collect standardized information related to the nutrition status during the first 1000 days. The low prevalence of exclusive breastfeeding and micronutrient deficiencies such as iron, zinc and vitamin A as risk factors for morbidity and mortality in children 0 -2 years old is common and priority issues in the region. Persistence of anemia despite the use of fortified foods and supplementation remains a problem, and no complete data regarding sugar, sodium and fatty acids consumption and changes in the diet and habits before, during and after pregnancy are available. The gaps that are found to justify the need for further studies including population based surveys with standardized methodology that can warrant comparability.

Promoting healthy eating in primary health care from the perspective of health professionals: a qualitative comparative study in the context of South America

“…We performed a qualitative study, whose methodological procedure consisted of a comparison of two contexts, those of the cities of São Paulo and Bogotá, the respective economic centers of Brazil and Colombia. Both Brazil and Colombia have been experiencing similar and rapid demographic, epidemiological, and nutritional transitions, with a growing prevalence of overweight [28,29]. To contextualize the panorama of the countries for the decade 2000-2010, the malnutrition estimates of children aged 0-59 months correspond to: Wastingmoderate and severe: 1.6 and 0.9%; Stunting 7.1 and 12.7% and Overweight: 7.3 and 4.8% [5].…”