77167 Nutrition at a GLANCE Guatemala The Costs of Malnutrition Annually, Guatemala loses over US$300 million • Underweight in Guatemala (at 18%) cost the country $3.1 million, or 11.4% of GDP, in lost in GDP to vitamin and mineral deficiencies.9,10 productivity in 2004. This is over half the com- Scaling up core micronutrient nutrition interventions bined cost of undernutrition for all of Central would cost less than US$16 million per year. America.3 (See Technical Notes for more information) • Over one-third of child deaths are due to undernu- trition, mostly from increased severity of disease.2 Key Actions to Address Malnutrition: • Children who are undernourished between con- ception and age two are at high risk for impaired Improve infant and young child feeding through cognitive development, which adversely affects the effective education and counseling services based on country’s productivity and growth. regular growth monitoring of children. • Childhood anemia alone is associated with a 2.5% Reduce anemia among young children and drop in adult wages.4 pregnant women through supplementation and • The Latin America and Caribbean region is antici- fortification of staple foods. pated to lose a cumulative US$8 billion to chronic Country Context disease by 2015.5 Address the growing burden of overweight and obesity through policies that promote diverse diets HDI ranking: 122nd out of 182 and physical activity. countries1 Where Does Guatemala Stand? Life expectancy: 70 years 2 • Guatemala has the third highest rate of chronic malnutrition (stunting) in the world (54.5%).2 Ethnicity and nutrition Lifetime risk of maternal death: • Indigenous children suffer disproportionately, Indigenous groups have disproportionately high rates 1 in 712 with rates of stunting and underweight almost of malnutrition. Nearly 8 out of 10 indigenous chil- twice that of non-indigenous children.11 dren are stunted compared to 4 of 10 non-indigenous Under-five mortality rate: • 67% of Guatemalans aged 15 and above are over- children. Large differentials in chronic malnutrition 35 per 1,000 live births2 by ethnicity may reflect social exclusion or other weight, of which 29% are obese.6 Global ranking of stunting • 1 in 8 infants are born with a low birth weight.2 forms of differential access to services.7 Indeed, sup- prevalence: 3rd highest out of ply side barriers have been shown to be particularly 136 countries2 As seen in Figure 1, Guatemala has higher rates important for the indigenous population.8 of stunting than other countries in its region and in- As seen in Figure 2, indigenous groups within the come group, and has the third highest rate of stunt- country have disproportionately high rates of stunt- ing in the world. Countries with similar per capita ing compared to other ethnic groups. Technical Notes incomes in other regions, such as Iraq and Swaziland, Stunting is low height for age. also exhibit lower rates of child stunting. The Double Burden of Undernutrition and Underweight is low weight for age. Overweight Figure 1  Guatemala has Higher Rates of Stunting than Not only does Guatemala show one of the worst Wasting is low weight for height. its Neighbors and Income Peers chronic malnutrition rates in the world, it has also Current stunting, underweight, and wasting 70 experienced a recent and rapid increase in adult obe- Prevalence of Stunting Among estimates are based on comparison of the sity, particularly among those living in urban areas.7 60 Low-birth weight infants and stunted children may Children Under 5 (%) most recent survey data with the WHO 50 Guatemala Child Growth Standards, released in 2006. be at greater risk of obesity and chronic diseases such 40 Honduras Peru as diabetes and heart disease than children who start Low birth weight is a birth weight less 30 than 2500g. Haiti Swaziland Iraq out well-nourished.12 20 Nicaragua Bolivia Ecuador This “double burden� is the result of various fac- Argentina Overweight is a body mass index (kg/m2) 10 Costa Rica Chile tors. Progress in improving community infrastruc- Brazil of ≥ 25; obesity is a BMI of ≥ 30. 0 ture and development of sound public health systems 0 1000 2000 3000 4000 5000 6000 7000 8000 9000 10000 The methodology for calculating nationwide GNI per capita (US$2008) has been slow, thwarting efforts to reduce undernu- costs of vitamin and mineral deficiencies, trition; while the adoption of diets high in refined and interventions included in the cost of Source: Stunting rates were obtained from the WHO Global Database on carbohydrates, saturated fats and sugars, as well as a Child Growth and Malnutrition. GNI data were obtained from the World scaling up, can be found at: Bank’s World Development Indicators. more sedentary lifestyle are commonly cited as the www.worldbank.org/nutrition/profiles Solutions to Primary Causes of Undernutrition guatemala Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Just over one-half (60%) of all newborns receive • Malnutrition increases the likelihood of falling sick • For most households in Guatemala, access to calo- breast milk within one hour of birth.2 and the severity of disease. ries is not a problem. • One-half (51%) of infants under six months are • Undernourished children who fall sick are much • Dietary diversity is essential for food security. exclusively breastfed.2 more likely to die from illness than well-nourished • Achieving a diverse and nutritious diet seems to be • During the important transition from breastfeed- children. a problem reflected in high rates of anemia, over- ing to a mix of breast milk and solid foods be- • Parasitic infestation diverts nutrients from the body weight and obesity. tween 6 and 9 months of age, one-third of infants and can cause blood loss and anemia. Solution: Involve multiple sectors including educa- are not fed appropriately with both breast milk Solution: Prevent and treat childhood infection and tion, health, agriculture, gender, the food industry, and and other foods.2 disease through hand-washing, deworming, zinc other sectors, to ensure that diverse, nutritious diets Solution: Support women and their families to ex- supplements during and after diarrhea, and continued are available and accessible to all household mem- clusively breastfeed up to six months, and to intro- feeding during illness. bers. Examine food policies and the country regula- duce adequate complementary foods when children tory system as they relate to overweight and obesity. are six months of age, while still breastfeeding. References Figure 2  Indigenous Groups in Guatemala Suffer from 1. UNDP. 2009. Human Development Report. High Rates of Stunting World Bank Nutrition-Related Activities in 2. UNICEF. 2009. State of the World’s Children. 3. Martinez, R. and A. Fernandez. 2008. The Cost 100 Guatemala Projects: The World Bank is currently supporting a Prevalence Among Children of Hunger: Social and Economic Impact of 80 Child Undernutrition in Central America and the US$49 million Maternal-Infant Health and Nutrition Dominican Republic. ECLAC and WFP. project which includes components geared towards Under 5 (%) 4. Horton S, Ross J. 2003. The Economics of Iron 60 Deficiency. Food Policy 28: 517–5. reducing child malnutrition, and will be supporting 40 5. Abegunde D et al. 2007. The Burden and Costs a US$120 million Expanding Opportunities for Vul- of Chronic Diseases in Low-Income and Middle- Income Countries. The Lancet 370: 1929–38. 20 nerable Groups project which aims to increase access 6. WHO. 2009. WHO Global InfoBase (Database). to essential health and nutrition services, especially 0 7. Marini A, Gragnolati M. 2003. Malnutrition and Underweight Stunting Overweight in poor and indigenous areas. This project is pending Poverty in Guatemala. World Bank Policy Research Paper. Indigenous Ladino government approval. 8. Gragnolati M, Marini A. Health and Poverty in Guatemala. World Bank Policy Research Working Paper 2966. Source: 2003 data cited in WHO/PAHO 200811 (figures based on WHO child Analytic Work: A new protocol for local evaluation growth standards). 9. UNICEF and the Micronutrient Initiative. 2004. of the child growth monitoring program is being pi- Vitamin and Mineral Deficiency: a Global Progress major contributors to the increase in overweight and loted and will be evaluated soon. This will be financed Report. 10. World Bank. 2009. World Development Indicators chronic diseases.13 by the Japan Trust Fund for Scaling-Up Nutrition. (Database). The World Bank, in collaboration with the Minis- 11. WHO/PAHO 2008. Malnutrition in Infants and Vitamin and Mineral Deficiencies Cause try of Health, has also produced and disseminated Young Children in Latin America and the Caribbean: a video to make chronic malnutrition more visible Achieving the Millennium Development Goals. 12. Victora CG et al. Maternal and Child Hidden Hunger and promoted the use of basic health and nutrition Undernutrition: Consequences for Adult Health and Although they may not be visible to the naked eye, services. Finally, the World Bank recently published Human Capital. The Lancet 2008; 371: 340–57. vitamin and mineral deficiencies impact well-being 13. Popkin BM et al. 1996. Stunting is Associated a review of all the community based growth pro- with Overweight in Children of Four Nations that and are prevalent in Guatemala. motion programs in Central America, highlighting are Undergoing the Nutrition Transition. J Nutr 126:3009–16 promises and challenges in their attempt to extend 14. WHO. 2008. Worldwide Prevalence of Anemia • Iron: 38% of children under-five and 22% of preg- coverage of preventive nutrition services to the most 1993–2005: WHO Global Database on Anemia. nant women suffer from anemia.14 Iron deficiency vulnerable populations18. 15. WHO. 2009. Global Prevalence of Vitamin A increases the risk of maternal mortality and in Deficiency in Populations at Risk 1995–2005. WHO Global Database on Vitamin A Deficiency. children leads to impaired cognitive development, World Bank nutrition activities in Latin America: 16. UNICEF. 2009. Tracking Progress on Child and poor school performance, and reduced work pro- www.worldbank.org/lacnutrition Maternal Nutrition. ductivity. 17. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? • Vitamin A: 16% of preschool aged children are 18. Marini A et al. 2009. Promoción del Crecimiento deficient in vitamin A.15 An estimated 1,500 deaths Addressing undernutrition is cost para Prevenir la Desnutrición Crónica: Lecciones in Guatemala are precipitated by vitamin A defi- de Programas con Base Comunitaria en Centro effective: Costs of core micronutrient America. World Bank. ciency annually.9 • Iodine: Just under half of all households use io- interventions are as low as dized salt in Guatemala, and an estimated 67,000 US$0.05–8.46 per person annually. children annually are born mentally impaired due Returns on investment are as high as THE WORLD BANK to iodine deficiency.16 6–30 times the costs.17 Produced with support from the Japan Trust Fund for Scaling Up Nutrition