77197 Nutrition at a GLANCE SUDAN The Costs of Undernutrition • Over one-third of child deaths are due to under- Scaling up core micronutrient interventions nutrition, mostly from increased severity of dis- would cost Sudan less than ease.2 US$21 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 government attention and resource allocation to • The economic costs of undernutrition include public health and nutrition. direct costs such as the increased burden on the Improve infant and young child feeding through effective health care system, and indirect costs of lost pro- education and counseling services. ductivity. • Childhood anemia alone is associated with a Increase coverage of vitamin A supplementation for young Photo: Arne Hoel. 2.5% drop in adult wages.3 children and iron supplementation for pregnant women. Country Context Where Does Sudan Stand? Achieve universal salt iodization. Improve dietary diversity through promoting home HDI ranking: 150th out of 182 • 40% of children under the age of five are stunted, production of a diversity of foods and market and countries1 27% are underweight, and 16% are wasted.2 infrastructure development. Life expectancy: 58 years2 • One-third of infants are born with a low birth weight.2 Lifetime risk of maternal death: 1 in 532 FIgure 2  Sudan has High Rates of Stunting Compared Most of the irreversible damage due to its Income Peers Under-five mortality rate: to malnutrition in Sudan happens 109 per 1,000 live births2 during gestation and in the first 60 Prevalence of Stunting Among Ethiopia Global ranking of stunting 24 months of life.4 50 Children Under 5 (%) Eritrea prevalence: 35th-highest out of 40 DR Congo Central African Sudan Uganda 136 countries2 As shown in Figure 1, malnutrition rates have 30 Mauritania Sao Tome Egypt not improved at all over the past two decades. Su- 20 and Principe dan will not meet MDG 1c (halving 1990 rates of 10 Technical Notes child underweight by 2015) with business as usual.4 0 0 200 400 600 800 1000 1200 1400 1600 1800 2000 Stunting is low height for age. FIgure 1  Sudan’s Progress Toward MGD 1 is Insufficient GNI per capita (US$2008) Underweight is low weight for age. 50 Source: Stunting rates were obtained from the WHO Global Database on Child Prevalence Among Children Wasting is low weight for height. 45 Growth and Malnutrition (figures based on WHO child growth standards). GNI 40 data were obtained from the World Bank’s World Development Indicators. Current stunting, underweight, and wasting 35 Under 5 (%) 30 estimates are based on comparison of the most recent survey data with the WHO 25 Undernutrition is not just a problem of poverty. 20 Child Growth Standards, released in 2006. 15 As Figure 3 shows, children are undernourished They are not directly comparable to the 10 in over one-quarter of even the richest households. trend data shown in Figure 1, which are 5 0 This is typically not an issue of food access, but of calculated according to the previously-used 1986 2006 1991 1992/93 2000 caring practices and disease. NCHS/WHO reference population. Stunting Underweight 2015 MDG Underweight Target Low birth weight is a birth weight less than 2500g. Source: WHO Global Database on Child Growth and Malnutrition (figures Vitamin and Mineral Deficiencies Cause based on the NCHS/WHO reference population). The methodology for calculating Hidden Hunger nationwide costs of vitamin and mineral As seen in Figure 2, while Sudan performs bet- Although they may not be visible to the naked deficiencies, and interventions included in ter than some of its poorer neighbors in the region, eye, vitamin and mineral deficiencies impact well- the cost of scaling up, can be found at: compared to its income peers in other regions, being and are pervasive in Sudan, as indicated in www.worldbank.org/nutrition/profiles stunting rates in Sudan are worse. Figure 4. Solutions to Primary Causes of Undernutrition SUDAN Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Just 1 in 3 infants under six months are exclusively • 28% of deaths of children under 5 are due to • 1 in 5 households is food insecure.5 breastfed.2 pneumonia or diarrhea.4 • Achieving food security means ensuring quality and • During the important transition period to a mix of • Undernutrition increases the likelihood of falling continuity of food access, in addition to quantity, for breast milk and solid foods between six and nine sick and severity of disease. all household members. months of age, about one-half of infants are not • Undernourished children who fall sick are much • Dietary diversity is essential for food security. fed appropriately with both breast milk and other more likely to die from illness than well-nourished Solution: Involve multiple sectors including agricul- foods.2 children. ture, education, transport, gender, the food industry, Solution: Support women and their families to prac- • Parasitic infestation diverts nutrients from the health and other sectors, to ensure that diverse, nutri- tice optimal breastfeeding and ensure timely and body and can cause blood loss and anemia. tious diets are available and accessible to all house- adequate complementary feeding. Breast milk fulfills Solution: Prevent and treat childhood infection and hold members. all nutritional needs of infants up to six months of other disease. Hand-washing, deworming, zinc sup- age, boosts their immunity, and reduces exposure to plements during and after diarrhea, and continued infections. In high HIV settings, follow WHO 2009 HIV feeding during illness are important. and infant feeding revised principles and recommen- dations.9 References Figure 3  Undernutrition Affects All Wealth Quintiles – Figure 4  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 Causes Report. 90 2. UNICEF. 2009. State of the World’s 80 Richest 28 70 Children. Prevalence (%) 60 3. Horton S and Ross J. 2003. The Fourth 39 50 Economics of Iron Deficiency. Food 40 Policy 28:517-5. Middle 44 30 4. UNICEF. 2009. Tracking Progress on 20 Second 45 Child and Maternal Nutrition. 10 5. FAO. 2009. The State of Food Insecurity 0 Poorest 39 Preschool Children Pregnant Women in the World: Economic Crises – Impacts Vitamin A Deficiency Anemia 0 10 20 30 40 50 and Lessons Learned. Prevalence of Stunting Among Children Under 5 (%) 6. WHO. 2008. Worldwide Prevalence Source: 1995–2005 data from the WHO Global Database on Child Growth and Malnutrition. of Anemia 1993–2005: WHO Global Source: Other Nutritional Survey (figures based on the WHO Child Growth Standards). Database on Anemia. 7. WHO. 2009. Global Prevalence of tion to age 24 months is critical for child growth Vitamin A Deficiency in Populations at • Iron: Current rates of anemia among preschool and mental development. Risk 1995-2005. WHO Global Database aged children and pregnant women are extraor- on Vitamin A Deficiency. dinarily high at 85% and 58%, respectively.6 Iron- 8. Horton S. et al. 2009. Scaling Up folic acid supplementation of pregnant women, World Bank Nutrition-Related Activities in Nutrition: What will it Cost? deworming, provision of multiple micronutrient Sudan 9. World Health Organization (2009). HIV supplements to infants and young children, and Projects: The World Bank is currently oversee- and infant feeding: Revised principles fortification of staple foods are effective strate- ing two health system development operations and recommendations — Rapid advice. gies to improve the iron status of these vulnerable —financed by the Multi-Donor Trust Fund for Geneva: WHO. subgroups. Sudan—with important interventions designed to • Vitamin A: 28% of preschool aged children improve child health and reduced mortality rates. and 16% of pregnant women are deficient in In the first phase, this project was supported with vitamin A.7 Supplementation of young children US$60 million; another US$63 million was recently and dietary diversification can eliminate this approved for phase two to focus on the provision deficiency. of a basic package of health service with emphasis • Iodine: Only 11% of households consume io- on maternal and child health. In addition, several dized salt, and over 1 million infants remain un- reports have been completed in past years including protected from iodine deficiency disorders.4 two health sector reviews and a how-to-guidance • Adequate intake of micronutrients, particularly on improving dialogue in areas including child and THE WORLD BANK iron, vitamin A, iodine and zinc, from concep- maternal health. Produced with support from the Japan Trust Fund for Scaling Up Nutrition