77185 Nutrition at a GLANCE mozambique The Costs of Undernutrition • Over one-third of child deaths are due to undernu- Annually, Mozambique loses US$116 million to trition, mostly from increased severity of disease.2 vitamin and mineral deficiencies.4,5 Scaling up • Children who are undernourished between con- core micronutrient interventions would cost less ception and age two are at high risk for impaired than US$13 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.6 education and counseling services. Increase coverage of vitamin A supplementation for young Country Context Where Does Mozambique Stand? children and iron supplementation for pregnant women. HDI ranking: 172nd out of 182 • 44% of children under the age of five are stunted, Achieve universal salt iodization. 4% are wasted, and 18% are underweight.2 countries1 Improve dietary diversity through promoting home • 15% of infants are born with a low birth weight.2 production of a diversity of foods and market and Life expectancy: 48 years 2 infrastructure development. Lifetime risk of maternal death: Most of the irreversible damage due to 1 in 452 malnutrition happens during gestation FIgure 2  Mozambique has Higher Rates of Stunting Under-five mortality rate: and in the first 24 months of life.7 than Many of its Income Peers 138 per 1,000 live births2 Global ranking of stunting As shown in Figure 1, the prevalence of under- 55 Prevalence of Stunting Among Rwanda prevalence: 19th-highest out of weight has decreased enough to stay on track with 50 Children Under 5 (%) 136 countries2 meeting MDG 1c (halving 1990 rates of child un- 45 Mozambique Central African derweight by 2015).7 The prevalence of stunting is 40 Guinea Uganda stagnating, however, and progress to reduce malnu- 35 Zimbabwe trition must continue. 30 Technical Notes 25 Gambia Togo Stunting is low height for age. FIgure 1  Mozambique is on Track to Meet MDG 1 20 250 300 350 400 450 500 Underweight is low weight for age. 60 GNI per capita (US$2008) Prevalence Among Children Wasting is low weight for height. 50 Source: Stunting rates were obtained from the WHO Global Database on Child Growth and Malnutrition (figures based on WHO child growth standards). GNI 40 data were obtained from the World Bank’s World Development Indicators. Current stunting and wasting estimates are Under 5 (%) based on comparison of the most recent 30 survey data with the WHO Child Growth Standards, released in 2006. They are 20 Undernutrition is not just a problem of poverty. not directly comparable to the trend data 10 As Figure 3 shows, although the poorest suffer from shown in Figure 1, which are calculated the highest stunting levels, about one-fourth of the 0 according to the previously-used NCHS/ 1995 2000 2003 2008 children in the wealthiest quintile are stunted. This WHO reference population. Stunting Underweight 2015 MDG Underweight Target is typically not an issue of food access, but of caring Low birth weight is a birth weight less practices and disease. Source: WHO Global Database on Child Growth and Malnutrition (figures than 2500g. based on the NCHS/WHO reference population). The methodology for calculating Vitamin and Mineral Deficiencies Cause nationwide costs of vitamin and mineral As seen in Figure 2, Mozambique displays higher Hidden Hunger deficiencies, and interventions included in prevalence of child stunting than many other African Although they may not be visible to the naked eye, the cost of scaling up, can be found at: nations with similar or lower per capita incomes, in- micronutrient deficiencies are widespread in Mo- www.worldbank.org/nutrition/profiles cluding Zimbabwe, Gambia, Guinea, and Togo. zambique, as shown in Figure 4. Solutions to Primary Causes of Undernutrition MOZAMBIQUE Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • One-third of all newborns do not receive breast milk • 13% of deaths among children under five are • Over one-third of households are food insecure.8 within one hour of birth.2 caused by diarrhea.7 • Achieving food security means ensuring quality and • Only 37% of infants under six months are exclu- • Undernutrition increases the likelihood of falling continuity of food access, in addition to quantity, for sively breastfed.2 sick and severity of disease. all household members. • During the important transition period to a mix of • Undernourished children who fall sick are much • Dietary diversity is essential for food security. breast milk and solid foods between six and nine more likely to die from illness than well-nourished • Lack of consistently-accessible diverse diets con- months of age, 16% of infants are not fed appropri- children. tributes to high levels of micronutrient deficiencies ately with both breast milk and other foods.2 • Parasitic infestation diverts nutrients from the and lost human capital. Solution: Support women and their families to prac- body and can cause blood loss and anemia. Solution: Involve multiple sectors including agricul- tice optimal breastfeeding and ensure timely and Solution: Prevent and treat childhood infection and ture, education, transport, gender, the food industry, adequate complementary feeding. Breast milk fulfills other disease. Hand-washing, deworming, zinc sup- health and other sectors, to ensure that diverse, nutri- all nutritional needs of infants up to six months of plements during and after diarrhea, and continued tious diets are available and accessible to all house- age, boosts their immunity, and reduces exposure to feeding during illness are important. hold members. infections. In high HIV settings, follow WHO 2009 HIV and infant feeding revised principles and recommen- dations.12 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 Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Causes Report. 90 2. UNICEF. 2009. State of the World’s 80 Richest 20 Children. Prevalence (%) 70 3. Mozambique Multi Indicator Cluster 60 Fourth 35 Survey (MICS). 2008. 50 40 4. UNICEF and the Micronutrient Initiative. Middle 46 30 2004. Vitamin and Mineral Deficiency: A 20 Global Progress Report. Second 47 10 5. World Bank. 2009. World Development 0 Poorest 49 Preschool Children Pregnant Women Indicators (Database). 6. Horton S. and Ross J. The Economics 0 10 20 30 40 50 60 Vitamin A Deficiency Anemia of Iron Deficiency. Food Policy. 2003; Prevalence of Stunting Among Children Under 5 (%) Source: 1995–2005 data from the WHO Global Database on Child Growth and 28:517-5. Malnutrition Source: DHS 2003 (figures based on the WHO Child Growth Standards). 7. UNICEF. 2009. Tracking Progress on Child and Maternal Nutrition. 8. FAO. 2009. The State of Food Insecurity • Vitamin A: More than 2/3 of preschool aged chil- • Adequate intake of micronutrients, particularly in the World: Economic Crises – Impacts iron, vitamin A, iodine and zinc, from concep- and Lessons Learned. dren (69%) and 14% of pregnant women are de- ficient in vitamin A.9 Supplementation of young tion to age 24 months is critical for child growth 9. WHO. 2009. Global Prevalence of Vitamin children and dietary diversification can eliminate and mental development. A Deficiency in Populations at Risk 1995–2005. WHO Global Database on this deficiency. Vitamin A Deficiency. • Iron: Three-quarters of preschool aged children World Bank Nutrition Related Activities in 10. WHO. 2008. Worldwide Prevalence of Anemia 1993–2005: WHO Global are anemic, as are 52% of pregnant women.10 Mozambique Iron-folic acid supplementation of pregnant Projects: The World Bank is currently support- Database on Anemia. women, deworming, provision of multiple mi- ing the Health Service Delivery project, a US$72.4 11. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? cronutrient supplements to infants and young million project (co-financed with multiple donors) 12. World Health Organization (2009). HIV children, and fortification of staple foods are ef- which includes initiatives to reduce child and ma- and infant feeding: Revised principles fective strategies to improve the iron status of ternal mortality. and recommendations — Rapid advice. these vulnerable subgroups. Geneva: WHO. • Iodine: Only one-quarter of households consume Analytic Work: The World Bank intends to con- iodized salt, and 656,000 million infants remain duct a scoping mission in April 2010 to see how it unprotected from iodine deficiency disorders.7 can best engage in the nutrition sector. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition