77193 Nutrition at a GLANCE Sao Tome and Principe The Costs of Undernutrition • Over one-third of child deaths are due to undernu- Scaling up core micronutrient interventions trition, mostly from increased severity of disease.2 in Sao Tome and Principe would cost • Children who are undernourished between con- approximately US$112,000 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: • Childhood anemia alone is associated with a Increase coverage of vitamin A supplementation 2.5% drop in adult wages.3 for young children. Increase nutrition capacity within the Ministries Country Context Where Does Sao Tome and Principe Stand? of Health and Agriculture. • 29% of children under the age of five are stunted, HDI ranking: 131st out of 182 Improve infant and young child feeding through 7% are underweight, and 9% are wasted.2 countries1 effective education and counseling services. • 8% of infants are born with a low birth weight.2 Life expectancy: 66 years2 • Sao Tome and Principe is currently on track to Achieve universal salt iodization. meet MDG 1c (halving 1990 rates of child under- Improve dietary diversity through promoting home Under-five mortality rate: weight by 2015).4 production of a diversity of foods and market and 98 per 1,000 live births2 infrastructure development. Global ranking of stunting Most of the irreversible damage due to prevalence: 56th highest out of malnutrition happens during gestation FIgure 1  Sao Tome and Principe Has Higher Rates of 136 countries2 and in the first 24 months of life.4 Stunting than Lower-Income Peers As seen in Figure 1, compared to Sao Tome and 29.5 Prevalence of Stunting Among Principe, countries with lower per capita incomes 29.0 Haiti Sao Tome and Principe Children Under 5 (%) such as Togo and The Gambia exhibit reduced rates of 28.5 child stunting. This shows that it is possible to achieve 28.0 Ghana better nutrition outcomes despite low income. Gambia 27.5 Vitamin and Mineral Deficiencies Cause 27.0 Togo Technical Notes Hidden Hunger 26.5 0 500 1000 1500 2000 Stunting is low height for age (too short). Although they may not be visible to the naked eye, GNI per capita (US$2008) Underweight is low weight for age (too micronutrient deficiencies are widespread in Sao Source: Stunting rates were obtained from WHO Global Database on Child small). Tome and Principe, as shown in Figure 2. Growth and Malnutrition. GNI data were obtained from the World Bank’s World Development Indicators. Wasting is low weight for height (too thin). • Vitamin A: Available data suggest that nearly all Current stunting, underweight, and wasting preschool aged children (96%) and 18% of preg- Figure 2  High Rates of Vitamin A and Iron Deficiency estimates are based on comparison of the nant women are deficient in vitamin A.6 Supple- Contribute to Lost Lives and Diminished Productivity most recent survey data with the WHO mentation of young children and dietary diversi- 100 Child Growth Standards, released in 2006. fication can eliminate this deficiency. 80 Low birth weight is a birth weight less • Iron: Current rates of anemia among preschool Prevalence (%) than 2500g. aged children and pregnant women are 37% and 60 The methodology for calculating 40% respectively.7 Iron-folic acid supplementa- 40 nationwide costs of vitamin and mineral tion of pregnant women, deworming, provision deficiencies, and interventions included in of multiple micronutrient supplements to infants 20 the cost of scaling up, can be found at: and young children, and fortification of staple 0 www.worldbank.org/nutrition/profiles foods are effective strategies to improve the iron Preschool Children Pregnant Women status of these vulnerable subgroups. Vitamin A Deficiency Anemia • Iodine: Close to two-thirds of households do not Source: 1995–2005 data from the WHO Global Database on Child Growth and consume iodized salt,4 leaving children in those Malnutrition. Solutions to Primary Causes of Undernutrition Sao Tome and Principe Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 65% of all newborns do not receive breast milk • Undernutrition increases the likelihood of falling • Access to adequate calories is not generally a prob- within one hour of birth.2 sick and severity of disease. lem in Sao Tome and Principe.5 However, achieving • 40% of infants under six months are not exclu- • Undernourished children who fall sick are much food security is defined as ensuring not only quan- sively breastfed.2. more likely to die from illness than well-nourished tity, but quality and continuity of food access for all • During the important transition period to a mix of children. household members. breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body • Dietary diversity is essential for food security. High months of age, 40% of infants are not fed ap- and can cause blood loss and anemia. rates of micronutrient deficiencies indicate that di- propriately with both breast milk and other foods.2 Solution: Prevent and treat childhood infection and etary diversity may be inadequate. Solution: Support women and their families to other disease. Hand-washing, deworming, zinc sup- Solution: Involve multiple sectors including agricul- practice optimal breastfeeding and ensure timely plements during and after diarrhea, and continued ture, education, social protection, transport, gender, and adequate complementary feeding. Breast milk feeding during illness are important. the food industry, health and other sectors, to ensure fulfills all nutritional needs of infants up to six that diverse, nutritious diets are available and acces- months of age, boosts their immunity, and reduces sible to all household members. exposure to infections. References households unprotected from iodine deficiency • Adequate intake of micronutrients, particularly disorders. iron, vitamin A, iodine and zinc, from concep- 1. UNDP. 2009. Human Development Report. 2. UNICEF. 2009. State of the World’s • Zinc: 37% of the population is at risk for insuf- tion to age 24 months is critical for child growth Children. ficient zinc intake.8 Zinc supplementation during and mineral development. 3. Horton S, Ross J. 2003. The Economics of diarrheal episodes can reduce diarrhea morbidity Iron Deficiency. Food Policy 28: 51–75. by more than 40%.9 World Bank Nutrition-Related Activities in 4. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. Sao Tome and Principe 5. FAO. 2009. The State of Food Insecurity Addressing undernutrition is cost The World Bank is not currently supporting in the World: Economic Crises – Impacts any nutrition-related activities in Sao Tome and and Lessons Learned. effective: Costs of core micronutrient Principe. 6. WHO. 2009. Global Prevalence of Vitamin interventions are as low as A Deficiency in Populations at Risk US$0.05–3.60 per person annually. 1995–2005. WHO Global Database on Vitamin A Deficiency. Returns on investment are as high as 7. WHO. 2008. Worldwide Prevalence 8–30 times the costs.10 of Anemia 1993–2005: WHO Global Database on Anemia. 8. Micronutrient Initiative. 2009. Investing in the Future: A United Call to Action on Vitamin and Mineral Deficiencies. 9. Bhandari N., et al. 2008. Effectiveness of Zinc Supplementation Plus Oral 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