77160 Nutrition at a GLANCE Equatorial Guinea The Costs of Malnutrition • Over one-third of child deaths are due to under- Scaling up core micronutrient nutrition nutrition, mostly from increased severity of dis- interventions in Equatorial Guinea would cost ease.2. roughly US$0.5 million per year. • Children who are undernourished between con- (See Technical Notes for more information.) ception and age two are at high risk for impaired cognitive development, which adversely affects Key Actions to Address Malnutrition: the country’s productivity and growth. Increase nutrition capacity within the Ministries • The Africa region is anticipated to lose at least a of Health and Agriculture. cumulative US$4.0 billion to chronic disease by Improve infant and young child feeding through 2015.3. effective education and counseling services. • The economic costs of undernutrition and over- weight include direct costs such as the increased Implement multiple solutions to tackle anemia Country Context burden on the health care system, and indirect including multiple micronutrient sachets for young costs of lost productivity. children and iron supplementation for pregnant women. HDI ranking: 118th out of 182 countries1 • Childhood anemia alone is associated with a Achieve universal salt iodization. 2.5% drop in adult wages.4. Improve dietary diversity through promoting home Life expectancy: 50 years2 production of a diversity of foods and market and Lifetime risk of maternal death: Where Does Equatorial Guinea Stand? infrastructure development. 1 in 282 • 43% of children under the age of five are stunted, Under-five mortality rate: 16% are underweight, and 9% are wasted.2. • 47% of those aged 15 and above are overweight 148 per 1,000 live births2 or obese.5 in Figure 1, Equatorial Guinea has higher rates of Global ranking of stunting • 13% of infants are born with a low birth weight.2. stunting than many countries in the same region prevalence: 23rd highest out of with much lower per capita income. That countries 136 countries2 with lower per capita incomes exhibit reduced rates Most of the irreversible damage due to of child stunting shows that malnutrition is not a malnutrition happens during gestation function of income alone. and in the first 24 months of life.6 Equatorial Guinea is a far wealthier country The Double Burden of Undernutrition and Overweight Technical Notes than most in Sub-Saharan Africa, yet it still has extremely high rates of child malnutrition. As seen While high rates of child undernutrition persist, Stunting is low height for age (too short). Equatorial Guinea has seen a recent increase in Underweight is low weight for age (too adult obesity. The coexistence of undernutrition small). FIgure 1  Equatorial Guinea Has Higher Rates of and overnutrition may lead to particular risks: low- Wasting is low weight for height (too thin). Stunting than its Lower Income Peers birth weight infants and stunted children may be at greater risk of chronic diseases such as diabetes Current stunting, underweight, and wasting 50 and heart disease than children who start out well- Prevalence of Stunting Among estimates are based on comparison of the 45 Equatorial Guinea most recent survey data with the WHO 40 Cameroon nourished.7 Children Under 5 (%) Child Growth Standards, released in 2006. 35 Congo This “double burden� is the result of various 30 25 Togo Sao Tome Botswana factors. Progress in improving community infra- Low birth weight is a birth weight less and Principe than 2500g. 20 structure and development of sound public health 15 systems has been slow, thwarting efforts to reduce Overweight is a body mass index (kg/m2) 10 Turkey 5 undernutrition; while rapid urbanization and the of ≥ 25; obesity is a BMI of ≥ 30. 0 adoption of diets high in refined carbohydrates, The methodology for calculating 0 3000 6000 9000 12000 15000 18000 GNI per capita (US$2008) saturated fats and sugars, combined with a more nationwide costs of vitamin and mineral deficiencies, and interventions included in sedentary lifestyle are commonly cited as the major the cost of scaling up, can be found at: Source: Stunting rates were obtained from WHO Global Database on Child Growth and Malnutrition. GNI data were obtained from the World Bank’s contributors to the increase in overweight and www.worldbank.org/nutrition/profiles World Development Indicators. chronic diseases.8 Solutions to Primary Causes of Malnutrition Equatorial Guinea Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Three out of four infants under six months are not • Undernourished children have an increased likeli- • Achieving food security means ensuring quality and exclusively breastfed.2 hood of falling sick and severity of disease. continuity of food access, in addition to quantity, for • During the important transition period to a mix • Undernourished children who fall sick are much all household members. of breast milk and solid foods between six and more likely to die from illness than well-nourished • Dietary diversity is essential for food security. nine months of age, it is critical that all infants children. • High levels of micronutrient deficiencies coexisting are fed appropriately with both breast milk and • Parasitic infestation diverts nutrients from the body with obesity indicate that diet quality is not optimal. other foods.2 and can cause blood loss and anemia Solution: Involve multiple sectors including agricul- Solution: Support women and their families to Solution: Prevent and treat childhood infection and ture, education, social protection, transport, gender, practice optimal breastfeeding and ensure timely other disease. Hand-washing, deworming, zinc supple- the food industry, health and other sectors, to ensure and adequate complementary feeding. Breast milk ments during and after diarrhea, and continued feed- that diverse, nutritious diets are available and acces- fulfills all nutritional needs of infants up to six ing during illness are important. sible to all household members. months of age, boosts their immunity, and reduces exposure to infections. References Vitamin and Mineral Deficiencies Cause Figure 2  High Rates of Vitamin A and Iron Deficiency Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. Hidden Hunger 2. UNICEF. 2009. State of the World’s Although they may not be visible to the naked eye, 45 Children. vitamin and mineral deficiencies impact well-being, 40 3. Abegunde D et al. 2007. The Burden and 35 and are prevalent in Equatorial Guinea, as indicated Prevalence (%) Costs of Chronic Diseases in Low-Income 30 and Middle-Income Countries. Lancet 370: in Figure 2. 25 1929–38. 20 4. Horton S, Ross J. 2003. The Economics of • Vitamin A: 14% of preschool aged children and 15 10 Iron Deficiency. Food Policy 28: 51–75. 17% of pregnant women are deficient in vitamin 5 5. WHO. 2009. WHO Global InfoBase A.9 Supplementation of young children and di- 0 (Database). etary diversification can eliminate this deficiency. Preschool Children Pregnant Women 6. UNICEF. 2009. Tracking Progress on Child • Iron: Current rates of anemia among preschool Vitamin A Deficiency Anemia and Maternal Nutrition. 7. Victora CG et al. Maternal and Child aged children and pregnant women are 41% and Source: 1995-2005 data from the WHO Global Database on Child Growth and Undernutrition: Consequences for Adult 42%, respectively.10 Iron-folic acid supplementa- Malnutrition. Health and Human Capital. Lancet 2008: tion of pregnant women, deworming, provision 371:340–57. of multiple micronutrient supplements to infants Addressing undernutrition is cost 8. Popkin BM et al. 1996. Stunting is and young children, and fortification of staple effective: Costs of core micronutrient Associated with Overweight in Children foods are effective strategies to improve the iron of Four Nations that are Undergoing interventions are as low as status of these vulnerable subgroups. the Nutrition Transition. J Nutr 126: • Iodine: Two thirds of households do not con- US$0.05–3.60 per person annually. 3009–3016. Returns on investment are as high as 9. WHO. 2009. Global Prevalence of Vitamin sume iodized salt,6 leaving children in those A Deficiency in Populations at Risk households unprotected from iodine deficiency 8–30 times the costs.11 1995–2005. WHO Global Database on disorders. Vitamin A Deficiency. • Adequate intake of micronutrients, particularly World Bank Nutrition-Related Activities in 10. WHO. 2008. Worldwide Prevalence iron, vitamin A, iodine and zinc, from concep- Equatorial Guinea of Anemia 1993–2005: WHO Global tion to age 24 months is critical for child growth The World Bank is not currently supporting any Database on Anemia. and mental development. nutrition-related activities in Equatorial Guinea. 11. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition