77155 NUTRITION at a GLANCE COMOROS The Costs of Undernutrition • Over one-third of child deaths are due to undernu- Scaling up core micronutrient nutrition trition, mostly from increased severity of disease.2 interventions in Comoros would cost less than • Children who are undernourished between con- US$ 400,000 per year. ception and age two are at high risk for impaired (See Technical Notes for more information) cognitive development, which adversely affects the country’s productivity and growth. Key Actions to Address Malnutrition: • The economic costs of undernutrition include Increase nutrition capacity within the Ministries of direct costs such as the increased burden on the Health and Agriculture. health care system, and indirect costs of lost pro- Improve infant and young child feeding through effective ductivity. education and counseling services. • Childhood anemia alone is associated with a 2.5% drop in adult wages.3 Implement multiple solutions to tackle anemia including multiple micronutrient sachets for young children and iron supplementation for pregnant women. Where Does Comoros Stand? Country Context • 44% of children under the age of five are stunted, Achieve universal salt iodization. HDI ranking: 139th out of 182 8% are wasted, and 25% are underweight.2 Improve dietary diversity through promoting home countries1 • 1 in 4 infants are born with a low birth weight.2 production of a diversity of foods and market and • Comoros is not on track to meet MDG 1c (halv- infrastructure development. Life expectancy at birth: 65 years2 ing 1990 rates of child underweight by 2015).4 Lifetime risk of maternal death: 1 in 522 As seen in Figure 1, Comoros has high rates of stunting relative to countries in the same region and Vitamin and Mineral Deficiencies Cause Under-five mortality rate: 105 per income group. Countries with lower per capita in- 1,000 live births2 comes, such as Haiti and Tajikistan, exhibit reduced Hidden Hunger Global ranking of stunting rates of child stunting, which demonstrates the abil- Although they may not be visible to the naked eye, ity to achieve better nutrition outcomes despite low vitamin and mineral deficiencies impact well-being prevalence: 19th highest out of 136 income. and are widespread in Comoros, as indicated in countries2 Figure 2. FIGURE 1  Comoros Has Higher Rates of Stunting than Technical Notes its Income Peers FIGURE 2  High Rates of Vitamin A and Iron Deficiency Contribute to Lost Lives and Diminished Productivity Stunting is low height for age (too short). 50 Prevalence of Stunting Among 45 Tajikistan Comoros 70 Underweight is low weight for age (too 40 Children Under 5 (%) Mali Cambodia Vietnam small). 60 35 Kenya 30 Haiti Mauritania 50 Prevalence (%) Wasting is low weight for height (too thin). 25 40 20 Current stunting and wasting estimates are 15 30 based on comparison of the most recent 10 20 survey data with the WHO Child Growth 5 0 10 Standards, released in 2006. Underweight 500 600 700 800 900 1000 0 prevalence is based on the previously-used GNI per capita (US$2008) Preschool Children Pregnant Women NCHS/WHO reference population. Vitamin A Deficiency Anemia Source: Stunting rates were obtained from WHO Global Database on Child Low birth weight is a birth weight less Growth and Malnutrition. GNI data were obtained from the World Bank’s Source: 1995–2005 data from the WHO Global Database on Child Growth and than 2500g. World Development Indicators. Malnutrition. The methodology for calculating nationwide costs of vitamin and mineral deficiencies, and interventions included in the cost of Most of the irreversible damage due to • Vitamin A: 22% of preschool aged children, scaling up, can be found at: malnutrition happens during gestation and 15% of pregnant women are deficient in www.worldbank.org/nutrition/profiles and in the first 24 months of life.4 vitamin A.6 Supplementation of young children Solutions to Primary Causes of Undernutrition COMOROS Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 3 out of 4 newborns do not receive breast milk • Undernutrition increases the likelihood of falling • More than half of households in Comoros are food within one hour of birth.2 sick and the severity of disease. insecure, according to a measure of per capita ac- • 4 out of 5 infants under six months are not exclu- • Undernourished children who fall sick are much cess to calories.5 Many more households likely lack sively breastfed.2 more likely to die from illness than well-nourished access to diverse diets year round. • During the important transition period to a mix of children. • Achieving food security means ensuring quality and breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body continuity of food access, in addition to quantity, for months of age, almost two-thirds of infants are and can cause blood loss and anemia. all household members. not fed appropriately with both breast milk and Solution: Prevent and treat childhood infection and • Dietary diversity is essential for food security. other foods.2 other disease. Hand-washing, deworming, zinc sup- Solution: Involve multiple sectors including agricul- Solution: Support women and their families to plements during and after diarrhea, and continued ture, education, social protection, transport, gender, practice optimal breastfeeding and ensure timely feeding during illness are important. the food industry, health and other sectors, to ensure and adequate complementary feeding. Breast milk that diverse, nutritious diets are available and acces- fulfills all nutritional needs of infants up to six sible to all household members. months of age, boosts their immunity, and reduces exposure to infections. References and dietary diversification can eliminate this de- World Bank Nutrition-Related Activities in 1. UNDP. 2009. Human Development Report. ficiency. 2. UNICEF. 2009. State of the World’s • Iron: Current rates of anemia among preschool Comoros The World Bank is not currently supporting any Children. aged children and pregnant women are 65% and 3. Horton S, Ross J. 2003. The Economics of nutrition-related activities in Comoros. 55%, respectively.7 Iron-folic acid supplementa- Iron Deficiency. Food Policy 28: 51–75. tion of pregnant women, deworming, and the 4. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. provision of multiple micronutrient supplements 5. FAO. 2009. The State of Food Insecurity to infants and young children are effective strate- in the World: Economic Crises — Impacts gies to improve the iron status of these vulnerable and Lessons Learned. subgroups. 6. WHO. 2009. Global Prevalence of Vitamin • Zinc: Nearly one-half of the population is at risk Addressing undernutrition is cost A Deficiency in Populations at Risk for insufficient zinc intake.8 Zinc supplementa- 1995–2005. WHO Global Database on effective: Costs of core micronutrient tion during diarrheal episodes can reduce mor- Vitamin A Deficiency. bidity from diarrhea by more than 40%.9 interventions are as low as 7. WHO. 2008. Worldwide Prevalence US $0.05–3.60 per person annually. of Anemia 1993–2005: WHO Global • Iodine: 82% of households consume iodized Database on Anemia. salt.2 Comoros should continue progress toward Returns on investment are as high as 8. Micronutrient Initiative. 2009. Investing universal salt iodization. 8–30 times the costs.10 in the Future: A United Call to Action on • Adequate intake of micronutrients, particularly Vitamin and Mineral Deficiencies. iron, vitamin A, iodine and zinc, from concep- 9. Bhandari N., et al. 2008. Effectiveness tion to age 24 months is critical for child growth of Zinc Supplementation Plus Oral and mental development. Rehydration Salts Compared With Oral Rehydration Salts Alone as a Treatment for Acute Diarrhea in a Primary Care Setting: A Cluster Randomized Trial. Pediatrics 121; e1279–e1285. 10. 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