77144 Nutrition at a GLANCE Haiti The Costs of Undernutrition Annually, Haiti loses over US$56 million in GDP • Over one-third of child deaths are due to undernu- trition, mostly from increased severity of disease.2 to vitamin and mineral deficiencies.3,4 Scaling up • The economic costs of undernutrition include di- core micronutrient interventions would cost less rect costs such as the increased burden on the health than US$12 million per year. care system, and indirect costs of lost productivity. (See Technical Notes for more information) • Childhood anemia alone is associated with a 2.5% drop in adult wages.5 Key Actions to Address Malnutrition: Reduce early stunting through improved exclusive Where Does Haiti Stand? breastfeeding and adequate complementary feeding • Over half of all households in Haiti (58%) are practices. food insecure.7 Reduce anemia among pregnant and lactating • 73% of children 6–24 months are anemic.8 women as well as children through giving Photo: Arne Hoel. • 30% of children under the age of five are stunted, supplements containing iron and deworming. Country Context 19% are underweight, and 10% are wasted.2 • 25% infants are born with a low birth weight.2 Address iodine deficiency through supplementation as HDI ranking: 149th out of 182 well as salt iodization. • Only 41% of infants under six months are exclu- countries1 sively breastfed.2 Take actions to reduce chronic food insecurity • 68% of children aged 6–24 months are not fed through investment in agriculture, increased attention Life expectancy: 61 years2 according to the three recommended infant and to sustainable food production, and multisectoral Lifetime risk of maternal death: young child feeding practices based on diet di- collaboration. 1 in 442 versity, adequate feeding frequency and receiving Under-five mortality rate: breastfeeding or milk products.9 Figure 2  Haiti has Higher Rates of Stunting than Some 72 per 1,000 live births2 Regional and Income Peers As shown in Figure 1, the overall prevalence of Global ranking of stunting stunting and underweight has only fallen slightly 60 Prevalence of Stunting Among Guatemala prevalence: 56th highest out of over the past two decades, though Haiti is not on 50 Children Under 5 (%) 136 countries2 track to meet MDG 1c (halving 1990 rates of child 40 underweight by 2015).6 30 Gambia Haiti Peru Ghana Togo Ecuador Technical Notes Bolivia 20 Nicaragua El Salvador Figure 1  Haiti is Not On Track To Meet MDG 1 Guyana 10 Stunting is low height for age. 30 Jamaica 0 Prevalence Among Children 25 0 1000 2000 3000 4000 5000 Underweight is low weight for age. GNI per capita (US$2008) 20 Under 5 (%) Wasting is low weight for height. Source: Stunting rates were obtained from WHO Global Database on Child 15 Growth and Malnutrition. GNI data were obtained from the World Bank’s Current stunting, underweight, and wasting World Development Indicators. 10 estimates are based on comparison of the most recent survey data with the WHO 5 stunted as the richest households. This is due to insuf- Child Growth Standards, released in 2006. 0 ficient food access, poor caring practices and disease. They are not directly comparable to the 1990 1995 2000 2006 data shown in Figures 1 or 3, which are calculated according to the previously-used Underweight 2015 MDG Underweight Target Vitamin and Mineral Deficiencies Cause NCHS/WHO reference population. Source: WHO Global Database on Child Growth and Malnutrition (figures based on the NCHS/WHO reference population) Hidden Hunger Low birth weight is a birth weight less Although they may not be visible to the naked eye, than 2500g. As seen in Figure 2, Haiti performs worse than its vitamin and mineral deficiencies are pervasive in income peers in Latin America, and has comparable Haiti and cause serious damage to well-being and The methodology for calculating stunting rates to African countries with similar in- productivity. nationwide costs of vitamin and mineral deficiencies, and interventions included in come. the cost of scaling up, can be found at: Wealth inequalities are stark in Haiti. As Figure 3 • Vitamin A: One-third of preschool aged children www.worldbank.org/nutrition/profiles shows, the poorest children are 8 times as likely to be are deficient in vitamin A.10 An estimated 3,200 Solutions to Primary Causes of Undernutrition haiti Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Less than one-half (44%) of all newborns receive • Malnutrition increases the likelihood of falling sick • Over half of all households (58%) are food insecure.7 breast milk within one hour of birth.2 and the severity of disease. • Achieving food security means ensuring quantity, • Less than half (41%) of infants under six months • Undernourished children who fall sick are much nutritional quality and continuity of food access for are exclusively breastfed.2 more likely to die from illness than well-nourished all household members. • 68% of children aged 6–24 months are not fed children. • The main strategies households adopt in response according to the three recommended infant and • Parasitic infestation diverts nutrients from the body to lack of food or money to obtain food are reducing young child feeding practices including (i) dietary and can cause blood loss and anemia. food quantity or number of meals per day, reducing diversity, (ii) adequate feeding frequency and • 40% of the population has no access to an improved dietary diversity, and adults reducing consumption (iii) receiving breastfeeding or milk products.9 water source and 80% has no access to sanitation for the benefit of children. Moreover the complementary food is usually of facilities.14 • Food price declines at the international level after the poor nutritional value. Solution: Prevent and treat childhood infection and food crisis were not fully reflected in local markets. Solution: Support women and their families to disease through hand-washing counseling, deworm- Solution: Involve multiple sectors including agricul- practice optimal breastfeeding and ensure timely ing, zinc supplements during and after diarrhea, and ture, trade, transport, gender, environment, the food and adequate complementary feeding. Breast milk continued feeding during diarrhea. industry, health and other sectors, to ensure that di- fulfills all nutritional needs of infants up to six verse, nutritious diets are available and accessible to months of age, boosts their immunity, and reduces all household members. exposure to infections. In high HIV settings, follow WHO 2009 HIV and infant feeding revised principles and recommendations.15 References Figure 3  Undernutrition Affects All Wealth Quintiles – • Iodine: Only 3% of households consume iodized 1. UNDP. 2009. Human Development Report. Poor Infant Feeding Practices and Disease are Major Causes salt.6 59% of children 6–12 are considered iodine 2. UNICEF. 2009. State of the World’s Children. deficient and an estimated 29,000 children an- 3. UNICEF and the Micronutrient Initiative. 2004. Richest 4.7 nually are born mentally impaired due to iodine Vitamin and Mineral Deficiency: A Global deficiency.12 Progress Report. Fourth 15.4 4. World Bank. 2009. World Development Indicators (Database). 5. Horton S, Ross J. 2003. The Economics of Middle 25.8 World Bank Nutrition Related Activities in Haiti Iron Deficiency. Food Policy 28:517–5. Second 31 The World Bank is providing technical assistance 6. UNICEF. 2009. Tracking Progress on Child and to support the nutrition security of children 0–2 Maternal Nutrition. Poorest 32.9 years and pregnant and lactating women. The pri- 7. FAO. 2009. The state of food insecurity in mary focus is on preventing and addressing chronic 0 5 10 15 20 25 30 35 the world: Economic crises – impacts and lessons learned. Prevalence of Stunting Among Children Under 5 (%) malnutrition and anemia. Activities, supported by 8. Haiti DHS 2005. the Japan Nutrition Trust Fund, include analysis Source: DHS 2005/2006 (figures based on NCHS/WHO reference population) 9. Addendum to the 2005 Haiti DHS, Infant and (e.g. assessment of nutrition programs and policies Young Child Feeding (IYCF) Practices. 10. WHO. 2009. Global Prevalence of Vitamin A child deaths are precipitated by vitamin A defi- and a costing exercise), support for the revision of Deficiency in Populations at Risk 1995–2005. ciency annually.3 the national nutrition policy and the development 11. WHO. 2008. Worldwide Prevalence of Anemia • Iron: Two-thirds of children under-five, three- of a national nutrition strategy, and the design of a 1993–2005: WHO Global Database on Anemia. community-based nutrition package for a pilot pro- fourths of children under-two and 60% of preg- 12. Ministere de la Sante Publique et de la Population (MSPP) and UNICEF, prepare par nant women suffer from anemia.11 Iron deficien- gram that aims to increase vulnerable families’ ac- l’Institut Haitien de l’Enfance. 2005. Enquete cy increases the risk of maternal mortality and cess to services and improve their nutritional status. sur la prevalence de la carence en vitamine in children leads to impaired cognitive develop- Immediately following the earthquake, the World A et de la déficience en iode en Haïti. ment, poor school performance, and reduced Bank also contributed US$3 million for blanket 13. Horton S et al. 2009 Scaling Up Nutrition: What will it cost? work productivity. supplementary feeding for children 6–23 months 14. World Bank. 2009. Development Economics, through WFP’s Emergency Operation (EMOP) Development Data Group (DECDG). Addressing undernutrition is cost and US$1 million to support PAHO’s health sector 15. WHO. 2009. HIV and infant feeding: Revised principles and recommendations – Rapid effective: Costs of core micronutrient response, including basic health and nutrition ser- advice. interventions are as low as vices for pregnant women and young children. US$0.05–8.46 per person annually. Returns on investment are as high World Bank nutrition activities in Latin America: www.worldbank.org/lacnutrition THE WORLD BANK as 6–30 times the costs.13 Produced with support from the Japan Trust Fund for Scaling Up Nutrition Note: The data in this brief have not been updated to reflect the impact of the Jan 12, 2010 earthquake.