77184 Nutrition at a GLANCE MONGOLIA The Costs of Malnutrition Annually, Mongolia loses nearly US$32 million in • The East Asia region is anticipated to lose at least a cumulative US$5 billion to chronic disease by GDP to vitamin and mineral deficiencies.3,4 Scaling 2015.5 up core micronutrient nutrition interventions • Over one-third of child deaths are due to undernu- would cost less than US$1 million per year. trition, mostly from increased severity of disease.2 (See Technical Notes for more information) • Children who are undernourished between con- ception and age two are at high risk for impaired Approximate cognitive development, which adversely affects Key Actions to Address Return on the country’s productivity and growth. Malnutrition: Investment(%)15: • The economic costs of undernutrition and over- Improve infant and young child 1400 weight include direct costs such as the increased feeding through effective education burden on the health care system, and indirect and counseling services. costs of lost productivity. Achieve universal salt iodization. 3000 Country Context • Childhood anemia alone is associated with a Ensure an adequate supply of zinc 1300 HDI ranking: 115th out of 182 2.5% drop in adult wages.6 supplements for the treatment of countries1 diarrhea. Where Does Mongolia Stand? Life expectancy: 67 years2 • 27% of children under the age of five are stunted, Invest in vitamin A Supplementation. 1700 Lifetime risk of maternal death: 5% are underweight, and 3% are wasted.2 1 in 412 • 70% of those aged 15 and above are overweight or obese.7 Figure 1  Mongolia has Higher Rates of Stunting than Under-five mortality rate: Some of its Income Peers • 5% of infants are born with a low birth weight.2 840 per 1,000 live births2 60 Global ranking of stunting Prevalence of Stunting Among Most of the irreversible damage due 50 Timor-Leste prevalence: 67th highest out of Children Under 5 (%) to malnutrition in Indonesia happens 40 Myanmar Cambodia 136 countries2 Indonesia during gestation and in the first 24 30 Vietnam Phillippines months of life.9 Bolivia Mongolia 20 Sri Lanka As seen in Figure 1, Mongolia performs better Technical Notes than many of its neighbors in the region. However, 10 0 0 1000 2000 3000 Stunting is low height for age. countries with similar per capita incomes, such as GNI per capita (US$2008) Sri Lanka and Bolivia exhibit reduced rates of child Underweight is low weight for age. stunting. Source: Stunting rates were obtained from WHO Global Database on Child Growth and Malnutrition. GNI data were obtained from the World Bank’s Wasting is low weight for height. World Development Indicators. Current stunting, underweight, and wasting The Double Burden of Undernutrition and undernutrition; while urbanization and the adop- estimates are based on comparison of the Overweight tion of diets high in refined carbohydrates, animal most recent survey data with the WHO Though Mongolia is currently on track to meet Child Growth Standards, released in 2006. protein and saturated fats and sugars, combined MDG 1c (halving 1990 rates of child underweight with a more sedentary lifestyle are commonly cited Low birth weight is a birth weight less by 2015) it has seen a recent increase in adult obe- than 2500g. as the major contributors to the increase in over- sity. Low-birthweight infants and stunted children weight and chronic diseases.11 Overweight is a body mass index (kg/m2) may be at greater risk of chronic diseases such as of ≥ 25; obesity is a BMI of ≥ 30. diabetes and heart disease than children who start out well-nourished.10 Vitamin and Mineral Deficiencies Cause The methodology for calculating nationwide costs of vitamin and mineral deficiencies, Hidden Hunger and interventions included in the cost of This “double burden� is the result of various Although they may not be visible to the naked scaling up, can be found at: factors. Progress in improving community infra- eye, vitamin and mineral deficiencies impact well- www.worldbank.org/nutrition/profiles structure and development of sound public health being, and are prevalent in Mongolia, as indicated systems has been slow, thwarting efforts to reduce in Figure 2. Solutions to Primary Causes of Undernutrition MONGOLIA Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Close to 1 in 4 of all newborns do not receive • Undernutrition increases the likelihood of falling • 29% of households are food insecure.8 breast milk within one hour of birth.2 sick and severity of disease. • Achieving food security means ensuring quality and • 43% of infants under six months are not exclu- • Undernourished children who fall sick are much continuity of food access, in addition to quantity, for sively breastfed.2 more likely to die from illness than well-nourished all household members. • During the important transition period to a mix children. • Dietary diversity is essential for food security. of breast milk and solid foods between six and • Parasitic infestation diverts nutrients from the body Solution: Involve multiple sectors including agricul- nine months of age, 43% of infants are not fed and can cause blood loss and anemia. ture, education, transport, gender, the food industry, appropriately with both breast milk and other Solution: Prevent and treat childhood infection and health and other sectors, to ensure that diverse, nutri- foods.2 other disease. Hand-washing, deworming, zinc sup- tious diets are available and accessible to all house- Solution: Support women and their families to plements during and after diarrhea, and continued hold members. practice optimal breastfeeding and ensure timely feeding during illness are important. and adequate complementary feeding. Breast milk fulfills all nutritional needs of infants up to six months of age, boosts their immunity, and reduces exposure to infections. References Figure 2  High Rates of Vitamin A and Iron Deficiency • Iodine: Two-thirds of households are not con- 1. UNDP. 2009. Human Development Report. Contribute to Lost Lives and Diminished Productivity suming iodized salt,9 leaving infants and children 2. UNICEF. 2009. State of the World’s Children. unprotected from iodine deficiency which can 40 3. UNICEF and the Micronutrient Initiative. 2004. 35 reduce IQ. Vitamin and Mineral Deficiency: a Global 30 • Adequate intake of micronutrients, particularly Progress Report. Prevalence (%) 25 iron, vitamin A, iodine and zinc, from concep- 4. World Bank. 2009. World Development Indicators (Database). 20 tion to age 24 months is critical for child growth 5. Abegunde D et al. 2007. The Burden and Costs 15 and mental development. of Chronic Diseases in Low-Income and Middle- 10 Income Countries. The Lancet 370: 1929–38. 6. Horton S and Ross J. 2003. The Economics of 5 0 World Bank Nutrition-Related Activities in Iron Deficiency. Food Policy 28:517-5. Preschool Children Pregnant Women Mongolia 7. WHO. 2009. WHO Global InfoBase (Database). Vitamin A Deficiency Anemia The World Bank is currently engaging with Mongo- 8. FAO. 2009. The State of Food Insecurity in the World: Economic Crises – Impacts and Lessons Source: 1995–2005 data from the WHO Global Database on Child Growth and lia through its analytic and advisory work. A knowl- Learned. Malnutrition. edge sharing forum on results based financing in 9. UNICEF. 2009. Tracking Progress on Child and health (with discussion of interventions related to Maternal Nutrition. • Vitamin A: Almost 1 in 5 preschool aged chil- nutrition) is scheduled for delivery next fiscal year. 10. Victora CG et al. 2008. Maternal and child dren and pregnant women are deficient in vita- undernutrition: consequences for adult health A health policy note and workshop in health-relat- and human capital. The Lancet 371: 340–57. min A.12 ed issues in Mongolia were also recently completed. 11. Popkin BM. et al. 1996. Stunting is Associated • Iron: Current rates of anemia among preschool with Overweight in Children of Four Nations aged children and pregnant women are 21% and Addressing undernutrition is that are Undergoing the Nutrition Transition. J 37%, respectively.13 Iron-folic acid supplementa- Nutr 126:3009–16. tion of pregnant women, deworming, provision cost effective: Costs of core 12. WHO. 2009. Global Prevalence of Vitamin A micronutrient interventions are Deficiency in Populations at Risk 1995-2005. of multiple micronutrient supplements to infants WHO Global Database on Vitamin A Deficiency. and young children, and fortification of staple as low as US$0.05-3.60 per person 13. WHO. 2008. Worldwide Prevalence of Anemia foods are effective strategies to improve the iron annually. Returns on investment are 1993-2005: WHO Global Database on Anemia. status of these vulnerable subgroups. 14. Horton S. et al. 2009. Scaling Up Nutrition: as high as 8–30 times the costs14. What will it Cost? 15. Micronutrient Initiative. 2009. Investing in the Future: A United Call to Action on Vitamin and Mineral Deficiencies. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition