77192 Nutrition at a GLANCE RWANDA The Costs of Undernutrition • Globally, over one-third of child deaths are due to Annually, Rwanda loses nearly US$50 million undernutrition, mostly from increased severity of in GDP to vitamin and mineral deficiencies.3,4 disease.2 Scaling up core micronutrient interventions • Children who are undernourished between con- would cost US$6 million per year. 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: Increase nutrition capacity within the Ministries of Where Does Rwanda Stand? Health and Agriculture. • 52% of children under the age of five are stunted, Improve infant and young child feeding through effective 16% are underweight, and 5% are wasted.12 education and counseling services. • 6% of infants are born with a low birth weight.2 Photo: Arne Hoel. • Rwanda’s progress over the past two decades has Improve dietary diversity through promoting home not improved to meet MDG 1c (halving 1990 production of a diversity of foods and market and Country Context rates of child underweight by 2015) with business infrastructure development. HDI ranking: 167th out of 182 as usual.6 Continue high coverage of vitamin A supplementation for young children, and progress toward universal salt countries1 As seen in Figure 1, Rwanda performs worse than iodization. Life expectancy: 50 years2 countries in its region and income group. Countries Ensure deworming of preschool children to help control Lifetime risk of maternal death: with lower per capita incomes, such as Togo and anemia. 1 in 162 DRC exhibit reduced rates of child stunting. Under-five mortality rate: 112 per 1,000 live births2 FIgure 1  Rwanda has Higher Rates of Stunting than Figure 2  Undernutrition Affects all Wealth Quintiles – Lower-Income Peers Poor Infant Feeding Practices and Disease are Major Global ranking of stunting Causes prevalence: 8th highest out of 60 Prevalence of Stunting Among 136 countries2 Children Under 5 (%) 55 Richest 30 Rwanda Fourth 45 50 Guinea Bissau Technical Notes 45 Democratic Republic of Congo Niger Middle 46 Mozambique Stunting is low height for age. Eritrea Second 48 Myanmar Underweight is low weight for age. 40 0 100 200 300 400 500 Poorest 54 Wasting is low weight for height. GNI per capita (US$2008) 0 10 20 30 40 50 60 Current stunting, underweight, and wasting Source: Stunting rates were obtained from WHO Global Database on Child Prevalence of Stunting Among Children Under 5 (%) estimates2 are based on comparison of the Growth and Malnutrition (figures based on WHO child growth standards). GNI data were obtained from the World Bank’s World Development Indicators. Source: DHS 2005 (figures based on NCHS/WHO reference population). most recent survey data with the WHO Child Growth Standards, released in 2006. They are not directly comparable to the wealth Undernutrition is not just a problem of poverty. Vitamin and Mineral Deficiencies Cause quintile data shown in Figure 2, which are calculated according to the previously-used As Figure 2 shows, children are undernourished in Hidden Hunger NCHS/WHO reference population. close to one-third of even the richest households. Although they may not be visible to the naked eye, This is not typically an issue of food access, but of micronutrient deficiencies are widespread in Rwan- Low birth weight is a birth weight less than 2500g. caring practices and disease. da, as shown in Figure 3. The methodology for calculating nationwide costs of vitamin and mineral • Iron: Current rates of anemia among preschool deficiencies, and interventions included in Most of the irreversible damage due to aged children and pregnant women are 42% and the cost of scaling up, can be found at: malnutrition happens during gestation 11% respectively.9 Provision of multiple micronu- 6 www.worldbank.org/nutrition/profiles and in the first 24 months of life. trient supplements to infants and young children, Solutions to Primary Causes of Undernutrition RWANDA Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 59% of all newborns do not receive breast milk • Undernutrition increases the likelihood of falling • 40% of households are food insecure as defined as within one hour of birth.2 sick and severity of disease. per capita access to calories.7 Many more house- • 1 out of 8 infants under six months are not exclu- • Undernourished children who fall sick are much holds likely lack access to diverse diets year round. sively breastfed.2 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 all household members. months of age, almost 1 in 3 infants are not fed body and can cause blood loss and anemia. • Adequate calories and micronutrients are essential appropriately with both breast milk and other foods.2 Solution: Prevent and treat childhood infection and for child growth and development. These can be Solution: Support women and their families to prac- other disease. Hand-washing, deworming, zinc sup- provided by diverse diets. tice optimal breastfeeding and ensure timely and plements during and after diarrhea, and continued Solution: Involve multiple sectors including agricul- adequate complementary feeding. Breast milk fulfills feeding during illness are important. ture, education, transport, gender, the food industry, all nutritional needs of infants up to six months of health and other sectors, to ensure that diverse, nutri- age, boosts their immunity, and reduces exposure to tious diets are available and accessible to all house- infections. In high HIV settings, follow WHO 2009 HIV hold members. and infant feeding revised principles and recommen- dations.11 References Figure 3  High Rates of Vitamin A and Iron Deficiency • Iodine: In Rwanda, 88% of households consume Contribute to Lost Lives and Diminished Productivity iodized salt.2 Consumption of iodized salt is a ma- 1. UNDP. 2009. Human Development Report. 2. UNICEF. 2009. State of the World’s jor factor in controlling iodine deficiency, which 45 Children. 40 can cause IQ loss in infants and young children. 3. UNICEF and the Micronutrient Initiative. 35 Progress toward universal salt iodization should Prevalence (%) 2004. Vitamin and Mineral Deficiency: 30 be continued. A Global Progress Report. 25 • Adequate intake of micronutrients, particularly 4. World Bank. 2009. World Development 20 15 iron, vitamin A, iodine and zinc, from concep- Indicators (Database). 10 tion to age 24 months is critical for child growth 5. Horton S and Ross J. 2003. The Economics of Iron Deficiency. Food Policy 28:517-5. 5 and mental development. 0 6. UNICEF. 2009. Tracking Progress on Child Preschool Children Pregnant Women and Maternal Nutrition. Vitamin A Deficiency Anemia Addressing undernutrition is cost 7. FAO. 2009. The State of Food Insecurity in the World: Economic Crises – Impacts Source: WHO Global Prevalence of Vitamin A Deficiency in Populations at effective: Costs of core micronutrient Risk 1995–2005; WHO Worldwide Prevalence of Anemia 1993–2005. and Lessons Learned. interventions are as low as 8. WHO. 2009. Global Prevalence of Vitamin deworming, iron-folic acid supplementation of US$0.05–3.60 per person annually. A Deficiency in Populations at Risk 1995–2005. WHO Global Database on pregnant women, and fortification of staple foods Returns on investment are as high as Vitamin A Deficiency. are effective strategies to improve the iron status 8–30 times the costs.10 9. WHO. 2008. Worldwide Prevalence of these vulnerable subgroups. of Anemia 1993–2005: WHO Global • Vitamin A: Coverage of vitamin A supplemen- Database on Anemia. 10. Horton S. et al. 2009 Scaling Up tation is high in Rwanda, with 91% of children World Bank Nutrition-Related Activities in receiving a twice-yearly vitamin A supplement.12 Rwanda: Nutrition: What will it Cost? 11. World Health Organization (2009). HIV High coverage should be continued, and is a posi- http://go.worldbank.org/R2KBERG1X0 and infant feeding: Revised principles tive factor in relatively low prevalence of vitamin and recommendations — Rapid advice. A deficiency: 6% of preschool aged children and Geneva: WHO. pregnant women are deficient in vitamin A.8 12. Rwanda Comprehensive Food Security and Vulnerability Analysis and Nutrition Survey. World Food Programme, VAM Food Security Analysis, July 2009. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition