77206 Nutrition at a GLANCE ZAMBIA The Costs of Undernutrition • Over one-third of child deaths are due to undernu- Annually, Zambia loses US$186 million to vitamin trition, mostly from increased severity of disease.2 and mineral deficiencies.3,4 Scaling up core • Children who are undernourished between con- micronutrient interventions would cost less than ception and age two are at high risk for impaired US$7 million per year. cognitive development, which adversely affects the (See Technical Notes for more information) country’s productivity and growth. • The economic costs of undernutrition include di- Key Actions to Address Malnutrition: rect costs such as the increased burden on the health care system, and indirect costs of lost productivity. Increase nutrition capacity within the Ministries • Childhood anemia alone is associated with a 2.5% of Health and Agriculture, and increase coordination drop in adult wages.5 between sectors to reduce undernutrition. Continue and expand programs that increase Where Does Zambia Stand? breastfeeding and improve appropriate young child feeding, such as the Baby Friendly Hospital Initiative. Country Context • 45% of children under the age of five are stunted and 15% are underweight, and 5% are wasted.2 Prioritize stunting prevention through community- HDI ranking: 164th out of 182 • Malnutrition rates in Zambia have remained vir- based interventions targeted to pregnant women and countries1 tually unchanged since the early 1990s, and with children under age two before the problem worsens into business as usual, Zambia will not meet MDG 1c severe acute malnutrition. Life expectancy: 45 years2 (halving child underweight by 2015).6 Reduce iron deficiency through multiple interventions, Lifetime risk of maternal death: • 12% of infants are born with a low birth weight.2 including deworming of young children, iron-folic acid 1 in 272 • Zambia has achieved high rates of vitamin A sup- supplementation of pregnant women, and dietary plementation: 96% of children 6–59 months of age Under-five mortality rate: diversification. receive the recommended two doses of vitamin A 148 per 1,000 live births2 approximately six month apart.2 This intervention Improve dietary diversity through promoting home Global ranking of stunting helps to decrease vitamin A deficiency and child production of a diversity of foods, and market and prevalence: 17th-highest out of mortality. infrastructure development. 136 countries2 • The percentage of children with low urinary iodine levels has been on the decline, which may be at- tributed to a enforcement of universal salt iodiza- tion legislation passed in 1978 and reinforced since FIgure 1  Zambia Has Higher Rates of Stunting than its Technical Notes 1996.7 Income Peers Stunting is low height for age. 50 Prevalence of Stunting Among As seen in Figure 1, Zambia displays significantly 45 Zambia Nigeria Underweight is low weight for age. higher prevalence of child stunting than other Afri- 40 Côte d’Ivoire Lesotho Children Under 5 (%) 35 Kenya Cameroon Wasting is low weight for height. can nations with similar or lower per capita income, 30 Mauritania Sao Tome including Kenya and Mauritania. This shows that it is 25 and Principe Current stunting, underweight, and wasting possible to achieve better nutrition outcomes despite 20 estimates are based on comparison of 15 the most recent survey data with the low income. 10 WHO Child Growth Standards, released in Undernutrition is not just a problem of poverty. As 5 2006. They are not directly comparable Figure 2 shows, almost 30% of the children even in the 0 0 200 400 600 800 1000 1200 1400 1600 1800 2000 to the data shown in Figure 2, which are wealthiest quintile are stunted. This is not an issue of GNI per capita (US$2008) calculated according to the previously-used food access, but of caring practices and disease. NCHS/WHO reference population. Source: Stunting rates were obtained from the WHO Global Database on Child Growth and Malnutrition. GNI data were obtained from the World Low birth weight is a birth weight less Vitamin and Mineral Deficiencies Cause Bank’s World Development Indicators. than 2500g. Hidden Hunger The methodology for calculating nationwide Although they may not be visible to the naked eye, would have been without coverage of vitamin A sup- costs of vitamin and mineral deficiencies, micronutrient deficiencies impact well-being and are plementation campaigns, but dietary diversification and interventions included in the cost of widespread in Zambia, as shown in Figure 3. is needed to further reduce vitamin A deficiency. scaling up, can be found at: • Vitamin A: 54% of preschool aged children and • Iron: About half of preschool aged children and www.worldbank.org/nutrition/profiles pregnant women are anemic.10 Iron-folic acid 14% of pregnant women are deficient in vitamin A.9 The rate among preschool children is lower than it supplementation of pregnant women, deworm- Solutions to Primary Causes of Undernutrition ZAMBIA Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 43% of all newborns do not receive breast milk • Undernutrition increases the likelihood of falling • Nearly half (45%) of households are food insecure within one hour of birth.2 sick and severity of disease. as defined as per capita access to calories.8 Many • 39% of infants under six months are not exclu- • Undernourished children who fall sick are much more households likely lack access to diverse diets sively breastfed.2 more likely to die from illness than well-nourished year round. Solution: Support women and their families to children. • Achieving food security means ensuring quality and practice optimal breastfeeding and ensure timely • Parasitic infestation diverts nutrients from the body continuity of food access, in addition to quantity, for and adequate complementary feeding. Breast milk and can cause blood loss and anemia. all household members. fulfills all nutritional needs of infants up to six Solution: Prevent and treat childhood infection and • High rates of hidden hunger indicate that dietary months of age, boosts their immunity, and reduces other disease including worms. Hand-washing, de- diversity may be low. exposure to infections. In high HIV settings, follow worming, zinc supplements during and after diarrhea, Solution: Involve multiple sectors including agricul- WHO 2009 HIV and infant feeding revised principles and continued feeding during illness are important. ture, education, transport, gender, the food industry, and recommendations.12 health, environment, and other sectors, to ensure that diverse, nutritious diets are available and accessible to all household members. References Figure 2  Undernutrition Affects All Wealth Quintiles – Figure 3  High Rates of Vitamin A and Iron Deficiency Poor Infant Feeding Practices and Disease Are Major Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. Causes 2. UNICEF. 2009. State of the World’s 60 Children. 50 Richest 28.9 3. UNICEF and the Micronutrient Initiative. Prevalence (%) 40 2004. Vitamin and Mineral Deficiency: Fourth 34.6 A Global Progress Report. 30 4. World Bank. 2009. World Development Middle 41.7 20 Indicators (Database). Second 43.5 10 5. Horton S and Ross J. 2003. The Economics of Iron Deficiency. Food Policy 0 Poorest 41.9 Preschool Children Pregnant Women 28:517-5. 0 10 20 30 40 50 Vitamin A Deficiency Anemia 6. UNICEF. 2009. Tracking Progress on Child Prevalence of Stunting Among Children Under 5 (%) and Maternal Nutrition. Source: 1998–2003 data from the WHO Global Database on Child Growth and 7. Technical Note of a World Bank Mission Malnutrition. Source: DHS 2005/06 (figures based on NCHS/WHO reference population). on Nutrition. Nutrition Improvement in Zambia. February 9–12, 2010. 8. FAO. 2009. The State of Food Insecurity ing, provision of multiple micronutrient supple- Therapeutic Care for Severe Acute Malnutrition in the World: Economic Crises – Impacts ments to infants and young children, and forti- (SAM)� was implemented by Valid International be- and Lessons Learned. fication of staple foods are effective strategies to tween 2007–2009. The project established a system 9. WHO. 2009. Global Prevalence of Vitamin improve the iron status of these vulnerable sub- of treating severely malnourished children, and at- A Deficiency in Populations at Risk groups. tained a cure rate of more than 97% in SAM-affected 1995–2005. WHO Global Database on • Iodine: About one-quarter of the population does children. Vitamin A Deficiency. not consume iodized salt,2 leaving infants and chil- The Bank also supported the “Scale up Nutrition- 10. WHO. 2008. Worldwide Prevalence dren in those households unprotected from iodine al Activities in the Ministry of Health� project. The of Anemia 1993–2005: WHO Global deficiency disorders. project focused on nutritional screening for children Database on Anemia. aged 6 to 59 months and dissemination of infant and 11. Horton S. et al. 2009 Scaling Up young child feeding messages during 2009 Child Nutrition: What Will it Cost? World Bank Nutrition Related Activities in Health Week. It was successful and was scaled up to 12. WHO. 2009. HIV and infant feeding: Zambia other districts using Government resources and lo- Revised principles and recommendations The Scaling Up Nutrition initiative is supporting the cal support. Child Health Week is a biannual event — Rapid advice. reinvigorated National Food and Nutrition Council held every year in June and November. It presents an in providing leadership in nutrition policy develop- opportunity to reach children under 5, with critical ment and implementation. An initial activity is the child survival services which has recently been ex- design and implementation of a comprehensive situ- panded to include nutrition screening and referral. ation analysis. Building on lessons learned, these programs are go- The World Bank Development Market Place- ing to be scaled up through inclusion in the next Na- THE WORLD BANK funded project “Provision of Community based tional Strategic Plan 2011–2015. Produced with support from the Japan Trust Fund for Scaling Up Nutrition