77204 Nutrition at a GLANCE Uganda The Costs of Undernutrition Annually, Uganda loses $145 million to vitamin 3,4 • Over one-third of child deaths are due to under- and mineral deficiencies. Scaling up core nutrition, mostly from increased severity of dis- micronutrient interventions would cost less than ease.2 US$19 million per year. • Children who are undernourished between con- 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 Photo: Arne Hoel. Increase coverage of vitamin A supplementation for young 2.5% drop in adult wages.5 children and iron supplementation for pregnant women. Country Context Where Does Uganda Stand? Achieve universal salt iodization. HDI ranking: 157th out of 182 Improve dietary diversity through promoting home • 38% of children under the age of five are stunted, 16% production of a diversity of foods, and market and countries1 are underweight, and 6% are wasted.2 infrastructure development. Life expectancy at birth: • 14% of infants are born with a low birth weight.2 53 years2 As shown in Figure 1, although the prevalence of Lifetime risk of maternal death: stunting and underweight have been decreasing over FIgure 2  Uganda has Higher Rates of Stunting than 1 in 25 the past two decades, the rate of progress is insufficient Countries with Lower Per Capita Income Under-five mortality rate: to meet MDG 1c (halving 1990 rates of child under- 40 135 per 1,000 live births2 weight by 2015) with business as usual.6 Prevalence of Stunting Among 38 Uganda Burkina 36 Sierra Leone Faso Children Under 5 (%) Global ranking of stunting FIgure 1  Uganda’s Progress Toward MDG1 is 34 Zimbabwe prevalence: 40th highest out of Insufficient 32 30 136 countries2 28 Gambia 50 Togo 26 Prevalence Among Children 45 24 Technical Notes 40 22 35 20 Under 5 (%) 30 200 300 400 500 Stunting is low height for age. 25 GNI per capita (US$2008) 20 Underweight is low weight for age. 15 Source: Stunting rates were obtained from the WHO Global Database on Wasting is low weight for height. 10 Child Growth and Malnutrition (figures based on WHO child growth stan- 5 dards). GNI data were obtained from the World Bank’s World Development Current stunting, underweight, and wasting 0 1998/89 1995 2000/01 2006 Indicators. estimates are based on comparison of the most recent survey data with the WHO Child Stunting Underweight 2015 MDG Underweight Target Growth Standards, released in 2006. They the wealthiest quintile are stunted3. Western and south- are not directly comparable to the trend Source: WHO Global Database on Child Growth and Malnutrition (figures data shown in Figure 1, which are calculated based on NCHS Standards). western regions, arguably regions that are wealthier, are according to the previously-used NCHS/WHO noted for high malnutrition because of poor child feed- reference population. ing practices.11 As seen in Figure 2, Uganda displays higher preva- Low birth weight is a birth weight less lence of child stunting than several African nations with than 2500g. lower per capita incomes including Togo, Gambia, and The methodology for calculating nationwide Zimbabwe. This underscores that nutritional gains can Most of the irreversible damage due costs of vitamin and mineral deficiencies, be made despite low income. to malnutrition in Uganda happens and interventions included in the cost of scaling up, can be found at: www.worldbank. Undernutrition is not just a problem of poverty. during gestation and in the first 24 6 org/nutrition/profiles As Figure 3 shows, one-fourth of the children in even months of life. Solutions to Primary Causes of Undernutrition UGANDA Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Only 42% of all newborns receive breast milk • 15% of deaths among children under five are • 15% of households are food insecure, as defined as within one hour of birth.2 caused by diarrhea.6 per capita access to calories.7 • 40% of infants under six months are not exclu- • Undernutrition increases the likelihood of falling • Many more households likely lack access to diverse sively breastfed.2 sick and severity of disease. diets year round. • During the important transition period to a mix of • Undernourished children who fall sick are much • Achieving food security means ensuring quality and breast milk and solid foods between six and nine more likely to die from illness than well-nourished continuity of food access, in addition to quantity, for months of age, one-fifth of infants are not fed ap- children. all household members. propriately with both breast milk and other foods2. • Parasitic infestation diverts nutrients from the body • Dietary diversity is essential for food security. Solution: Support women and their families to and can cause blood loss and anemia. Solution: Involve multiple sectors including agricul- practice optimal breastfeeding and ensure timely Solution: Prevent and treat childhood infection and ture, education, transport, gender, the food industry, and adequate complementary feeding. Breast milk other disease. Hand-washing, deworming, zinc sup- health and other sectors, to ensure that diverse, nutri- fulfills all nutritional needs of infants up to six plements during and after diarrhea, and continued tious diets are available and accessible to all house- months of age, boosts their immunity, and reduces feeding during illness are important. hold members. exposure to infections. In high HIV settings, follow WHO 2009 HIV and infant feeding revised principles and recommendations12. 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 Causes Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. 70 Richest 24 2. UNICEF. 2009. State of the World’s 60 Children. Fourth 38 50 Prevalence (%) 3. UNICEF and the Micronutrient 40 Initiative. 2004. Vitamin and Mineral Middle 44 Deficiency: A Global Progress Report. 30 4. World Bank. 2009. World Development Second 38 20 Indicators (Database). 10 Poorest 43 5. Horton S and Ross J. 2003. The 0 Preschool Children Pregnant Women Economics of Iron Deficiency. Food 0 10 20 30 40 50 Policy 28:517-5. Prevalence of Stunting Among Children Under 5 (%) Vitamin A Deficiency Anemia 6. UNICEF. 2009. Tracking Progress on Source: DHS 2006 (figures based on the WHO Child Growth Standards). Source: 2000–2001 data from the WHO Global Database on Child Growth Child and Maternal Nutrition. and Malnutrition. 7. FAO. 2009. The State of Food Insecurity in the World: Economic Vitamin and Mineral Deficiencies Cause Crises – Impacts and Lessons Learned. 8. WHO. 2009. Global Prevalence of Hidden Hunger tected from iodine deficiency disorders due to Vitamin A Deficiency in Populations at Although they may not be visible to the naked eye, poor iodized salt coverage.6 Risk 1995-2005. WHO Global Database micronutrient deficiencies impact well-being, and • Adequate intake of micronutrients, particularly on Vitamin A Deficiency. are widespread in Uganda, as shown in Figure 4. iron, vitamin A, iodine and zinc, from concep- 9. WHO. 2008. Worldwide Prevalence tion to age 24 months is critical for child growth of Anemia 1993–2005: WHO Global • Vitamin A: 28% of preschool aged children and mental development. Database on Anemia. and 23% of pregnant women are deficient in 10. Horton S. et al. 2009 Scaling Up vitamin A.8 World Bank Nutrition Related Activities in Nutrition: What will it Cost? • Iron: 64% of preschool aged children are anemic, 11. Uganda DHS 2006. as are 41% of pregnant women.9 Iron-folic acid Uganda 12. WHO. 2009. HIV and infant supplementation of pregnant women, deworming, The World Bank currently is not directly support- feeding: Revised principles and provision of multiple micronutrient supplements ing nutrition activities. A US$130 million Uganda recommendations — Rapid advice. to infants and young children, and fortification of Health Systems Strengthening Project is under staple foods are effective strategies to improve the preparation and is scheduled for board submission iron status of these vulnerable subgroups. in May 2010. It is aimed at delivering the Uganda • Iodine: While 96% of households consume io- Minimum Health Care Package with a focus on ma- dized salt, 62,000 million infants remain unpro- ternal health, neonatal care, and family planning. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition