77158 Nutrition at a GLANCE Ecuador The Costs of Malnutrition Scaling up core micronutrient nutrition interventions • The Latin America and Caribbean region is an- ticipated to lose a cumulative US$8 billion to would cost less than US$7 million per year. chronic disease by 2015.3 (See Technical Notes for more information) • Over one-third of child deaths are due to under- nutrition, mostly from increased severity of dis- Key Actions to Address Malnutrition: ease.2 Improve infant and young child feeding through • Children who are undernourished between con- effective education and counseling services based on ception and age two are at high risk for impaired regular growth monitoring of children. cognitive development, which adversely affects Fortify staple foods with high quality iron. the country’s productivity and growth. • The economic costs of undernutrition and over- Achieve effective iron and vitamin A weight include direct costs such as the increased supplementation to the poorest and most vulnerable populations (pregnant women and young children). burden on the health care system, and indirect costs of lost productivity. Country Context • Childhood anemia alone is associated with a Most of the irreversible damage 2.5% drop in adult wages.4 HDI ranking: 80th out of 182 due to malnutrition in Ecuador countries1 happens from 6 to 18 months of life.6 Where Does Ecuador Stand? Life expectancy: 75 years2 • 23% of children under the age of five are stunted Lifetime risk of maternal death: and 6% are underweight.2 The Double Burden of Undernutrition and 1 in 1702 • There are roughly equivalent numbers of over- Overweight weight and underweight children in Ecuador, Though Ecuador is currently on track to meet Under-five mortality rate: and overweight is increasing.5 MDG 1c (halving 1990 rates of child underweight 25 per 1,000 live births2 • 50% of those aged 15 and above are overweight, by 2015) it has seen a recent increase in child obe- Global ranking of stunting of which 14% are obese.6 sity.5 Low-birth weight infants and stunted children prevalence: 76th highest out of • 10% of infants are born with a low birth weight.2 may be at greater risk of chronic diseases such as 136 countries2 diabetes and heart disease than children who start Ecuador has comparable rates of stunting to out well-nourished.7 many countries in its region, despite having a high- This “double burden� is the result of various er per capita income than many (Figure 1). Technical Notes factors. Progress in improving community infra- structure and development of sound public health Stunting is low height for age. systems has been slow, thwarting efforts to reduce Figure 1  Ecuador has Similar Rates of Stunting Underweight is low weight for age. undernutrition; while rapid urbanization and the Compared to its Neighbors, Despite its Higher Income adoption of Western diets high in refined carbohy- Wasting is low weight for height. 60 drates, saturated fats and sugars, combined with a Prevalence of Stunting Among Current stunting, underweight, and wasting 50 Guatemala more sedentary lifestyle are commonly cited as the Children Under 5 (%) estimates are based on comparison of the major contributors to the increase in overweight 40 most recent survey data with the WHO and chronic diseases.8 Cultural factors, perceptions 30 Child Growth Standards, released in 2006. Haiti Honduras Peru and beliefs about different food types may also play Bolivia Ecuador Low birth weight is a birth weight less 20 Nicaragua a significant role.9 Colombia than 2500g. 10 Costa Rica Overweight is a body mass index (kg/m2) 0 Vitamin and Mineral Deficiencies Cause 0 1000 2000 3000 4000 5000 6000 7000 of ≥ 25; obesity is a BMI of ≥ 30. GNI per capita (US$2008) Hidden Hunger The methodology for calculating nationwide Although they may not be visible to the naked eye, Source: Stunting rates were obtained from WHO Global Database on Child costs of vitamin and mineral deficiencies, Growth and Malnutrition. GNI data were obtained from the World Bank’s vitamin and mineral deficiencies impact well-being and interventions included in the cost of World Development Indicators. in Ecuador, as indicated in Figure 2. scaling up, can be found at: www.worldbank.org/nutrition/profiles Solutions to Primary Causes of Undernutrition Ecuador Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Over half (60%) of infants under six months are • Undernourished children have an increased risk of • For most households in Ecuador, access to calories not exclusively breastfed.2 falling sick and greater severity of disease. is not a problem. • During the important transition period to a mix of • Undernourished children who fall sick are much • Dietary diversity is essential for food security. breast milk and solid foods between six and nine more likely to die from illness than well-nourished • Achieving a diverse and nutritious diet seems to be months of age, 23% of infants are not fed ap- children. a problem reflected in high rates of anemia, over- propriately with both breast milk and other foods.2 • Parasitic infestation diverts nutrients from the body weight and obesity. Solution: Support women and their families to ex- and can cause blood loss and anemia. Solution: Involve multiple sectors including educa- clusively breastfeed newborns for six months, and Solution: Prevent and treat childhood infection and dis- tion, health, agriculture, gender, the food industry, and to introduce adequate complementary foods when ease through hand-washing, deworming, zinc supple- other sectors, to ensure that diverse, nutritious diets infants are six months of age, while still breast- ments during and after diarrhea, and continued feeding. are available and accessible to all household mem- feeding. Promote adequate coverage of basic health and nutri- bers. Examine food policies and the country regula- tion services, and improve community outreach. tory system as they relate to overweight and obesity. References Figure 2  High Rates of Vitamin A and Iron Deficiency World Bank Nutrition-Related Activities in Contribute to Lost Lives and Diminshed Productivity 1. UNDP. 2009. Human Development Report. Ecuador 2. UNICEF. 2009. State of the World’s 40 The World Bank is supporting the Government of Children. 3. Abegunde D et al. 2007. The Burden and 35 Ecuador in its efforts to reduce malnutrition largely Costs of Chronic Diseases in Low-Income 30 through its analytical and advisory work. A nutri- Prevalence (%) 25 and Middle-Income Countries. The Lancet tion review was completed in 20069 and high- 370: 1929–38. 20 lighted key recommendations for improving the 4. Horton S, Ross J. 2003. The Economics of 15 Iron Deficiency. Food Policy 28:517–5. 10 nutrition situation. The Bank is now working with 5. PAHO. Malnutrition in Infants and Young 5 the government through a Non Lending Technical Children in Latin America and the 0 assistance program (NLTA) to implement some of Preschool Children Pregnant Women Caribbean: Achieving the Millennium the recommendations of the study, and strengthen- Development Goals. Vitamin A Deficiency Anemia ing the nutrition monitoring system, SIVAN. The 6. WHO. 2009. WHO Global InfoBase (Database). Source: 1995–2005 data from the WHO Global Database on Child Growth and Bank, in collaboration with the Ministry of Social 7. Victora CG et al. Maternal and Child Malnutrition Development, has also recently produced and dis- Undernutrition: Consequences for Adult seminated a video to make chronic malnutrition Health and Human Capital. The Lancet • Vitamin A: 15% of preschool aged children are more visible and promote the use of basic health 2008; 371: 340–57. deficient in vitamin A.10 and nutrition services. 8. Popkin BM. et al. 1996. Stunting is • Iron: Current rates of anemia among preschool Associated with Overweight in Children aged children and pregnant women are 38%.11 of Four Nations that are Undergoing the World Bank nutrition activities in Latin America: Nutrition Transition. J Nutr 126:3009–16. Iron-folic acid supplementation of pregnant www.worldbank.org/lacnutrition 9. World Bank. 2007. Nutritional failure in women, deworming, provision of multiple mi- Ecuador: Causes, Consequences, and cronutrient supplements to infants and young Solutions children, and fortification of staple foods are ef- 10. WHO. 2009. Global Prevalence of Vitamin Addressing undernutrition is cost fective strategies to improve the iron status of A Deficiency in Populations at Risk 1995– these vulnerable subgroups. effective: Costs of core micronutrient 2005. WHO Global Database on Vitamin A Deficiency. • Adequate intake of micronutrients, particularly interventions are as low as 11. WHO. 2008. Worldwide Prevalence of iron, vitamin A, iodine and zinc, from concep- US$0.05–8.46 per person annually. Anemia 1993–2005: WHO Global Database tion to age 24 months is critical for child growth Returns on investment are as high as on Anemia. 12. Horton S. et al. 2009 Scaling Up Nutrition: and mental development. 6–30 times the costs.12 What will it Cost? THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition