77207 Nutrition at a GLANCE ZIMBABWE The Costs of Undernutrition • Over one-third of child deaths are due to undernu- Annually, Zimbabwe loses nearly US$24 million trition, mostly from increased severity of disease.1 in GDP to vitamin and mineral deficiencies.2,3 • Children who are undernourished between con- Scaling up core micronutrient interventions ception and age two are at high risk for impaired would cost less than US$8 million per year. cognitive development, which adversely affects (See Technical Notes for more information) the country’s productivity and growth. • The economic costs of undernutrition include Key Actions to Address Malnutrition: direct costs such as the increased burden on the Increase nutrition capacity within the Ministries of health care system, and indirect costs of lost pro- Health and Agriculture. ductivity. • Childhood anemia alone is associated with a Improve infant and young child feeding through effective 2.5% drop in adult wages.4 education and counseling services. Increase coverage of vitamin A supplementation for Where Does Zimbabwe Stand? young children. Country Context • 33% of children under the age of five are stunted, Achieve universal salt iodization. Life expectancy: 44 years1 12% are underweight, and 7% are wasted.1 Improve dietary diversity through promoting home Lifetime risk of maternal death: • 11% of infants are born with a low birth weight.1 production of a diversity of foods, and market and 1 in 431 • Zimbabwe is currently not on track to meet MDG infrastructure development. 1c (halving 1990 rates of child underweight by Under-five mortality rate: 2015) with business as usual.5 96 per 1,000 live births1 As seen in Figure 1, when overall rates of child Global ranking of stunting stunting are examined,  Zimbabwe performs better Vitamin and Mineral Deficiencies Cause prevalence: 28th highest out of Hidden Hunger 136 countries1 than countries in its region and income group. How- ever, within the country, there is likely to be variation Although they may not be visible to the naked eye, across geographies and socio-demographic groups. micronutrient deficiencies impact well-being, and are widespread in Zimbabwe as shown in Figure 2. FIgure 1  Zimbabwe Has Relatively Lower Overall Figure 2  High Rates of Vitamin A and Iron Deficiency Technical Notes Stunting Rates than its Neighbors and Income Peers, but Large Inequities Exist Contribute to Lost Lives and Diminished Productivity Stunting is low height for age. 40 50 Prevalence of Stunting Among 35 Underweight is low weight for age. 45 Zambia Children Under 5 (%) 30 Prevalence (%) Wasting is low weight for height. Mozambique 25 40 20 Current stunting, underweight, and wasting 35 15 estimates are based on comparison of the Zimbabwe 10 most recent survey data with the WHO 30 Namibia Botswana 5 Child Growth Standards, released in 2006. South Africa 0 25 Preschool Children Pregnant Women Low birth weight is a birth weight less 0 1000 2000 3000 4000 5000 6000 7000 Vitamin A Deficiency Anemia than 2500g. GNI per capita (US$2008) Source: WHO Global Prevalence of Vitamin A Deficiency in Populations at The methodology for calculating Source: Stunting rates were obtained from WHO Global Database on Child Risk 1995–2005; WHO Worldwide Prevalence of Anemia 1993–2005. Growth and Malnutrition (figures based on WHO child growth standards). GNI nationwide costs of vitamin and mineral data were obtained from the World Bank’s World Development Indicators. deficiencies, and interventions included in the cost of scaling up, can be found at: • Adequate intake of micronutrients, particularly www.worldbank.org/nutrition/profiles Most of the irreversible damage due to iron, vitamin A, iodine and zinc, from concep- malnutrition happens during gestation tion to age 24 months is critical for child growth and in the first 24 months of life.5 and mental development. Solutions to Primary Causes of Undernutrition ZIMBABWE Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Close to one-third (31%) of all newborns receive • Undernutrition increases the likelihood of falling • 39% of households are food insecure as defined as breast milk within one hour of birth.1 sick and severity of disease. per capita access to calories.6 Many more house- • More than three-quarters of all infants under six • Undernourished children who fall sick are much holds likely lack access to diverse diets year round. months are exclusively breastfed.1 more likely to die from illness than well-nourished • Achieving food security means ensuring quality and • During the important transition period to a mix of children. continuity of food access, in addition to quantity, for breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body all household members. months of age, 1 out 5 infants are not fed ap- and can cause blood loss and anemia. • Dietary diversity is essential for food security. propriately with both breast milk and other foods.1 Solution: Prevent and treat childhood infection and Solution: Involve multiple sectors including agricul- Solution: Support women and their families to other disease. Hand-washing, deworming, zinc sup- ture, education, transport, gender, the food industry, practice optimal breastfeeding and ensure timely plements during and after diarrhea, and continued health and other sectors, to ensure that diverse, nutri- and adequate complementary feeding. Breast milk feeding during illness are important. tious diets are available and accessible to all house- fulfills all nutritional needs of infants up to six hold members. months of age, boosts their immunity, and reduces exposure to infections. In high HIV settings, follow WHO 2009 HIV and infant feeding revised principles and recommendations.10 References • Vitamin A: Over one-third of preschool aged World Bank Nutrition-Related Activities in children, and 1 in 5 pregnant women are defi- 1. UNICEF. 2009. State of the World’s cient in vitamin A.7 Supplementation of young Zimbabwe Children. The World Bank is engaging with Zimbabwe children and dietary diversification can eliminate 2. UNICEF and the Micronutrient through its analytic and advisory work. An institu- Initiative. 2004. Vitamin and Mineral this deficiency. tional development plan on Zimbabwe’s Food Secu- Deficiency: A Global Progress Report. • Iron: Current rates of anemia among preschool rity Crisis was recently produced. A more in depth 3. World Bank. 2009. World Development aged children and pregnant women are 19% for assessment on nutrition has been scheduled to take Indicators (Database). both groups.8 Iron-folic acid supplementation of place in April 2010. 4. Horton S and Ross J. 2003. The pregnant women, deworming, provision of mul- Economics of Iron Deficiency. Food tiple micronutrient supplements to infants and Policy 28:517-5. young children, and fortification of staple foods 5. UNICEF. 2009. Tracking Progress on are effective strategies to improve the iron status Child and Maternal Nutrition. of these vulnerable subgroups. Addressing undernutrition is cost 6. FAO. 2009. The State of Food Insecurity • Iodine: An estimated 91% of households con- effective: Costs of core micronutrient in the World: Economic Crises – sume iodized salt.1 Consumption of iodized salt Impacts and Lessons Learned. is a major factor in controlling iodine deficiency, interventions are as low as 7. WHO. 2009. Global Prevalence of which can cause IQ loss in infants and young US$0.05–3.60 per person annually. Vitamin A Deficiency in Populations at children. Progress toward universal salt iodiza- Returns on investment are as high as Risk 1995–2005. WHO Global Database tion should be continued. 8–30 times the costs.9 on Vitamin A Deficiency. 8. WHO. 2008. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. 9. Horton S. et al. 2009. Scaling Up Nutrition: What will it Cost? 10. WHO. 2009. HIV and infant feeding: Revised principles and recommendations — Rapid advice. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition