84104 NUTRITION at a GLANCE LAO PDR The Costs of Undernutrition Annually, Lao PDR loses over US$102 million in • Nearly half (45%) of all deaths in children un- der five are due to undernutrition.3 GDP to vitamin and mineral deficiencies.7,8 • Children who are undernourished between (See Technical Notes for more information) conception and age two are at high risk for im- paired cognitive development, which adversely Approximate Key Actions to Return on affects the country’s productivity and growth. • The economic costs of undernutrition include Address Malnutrition: Investment (%):11 direct costs such as the increased burden on Improve infant and young 1400 the health care system, and indirect costs of child feeding through effective lost productivity. education and counseling services. • Childhood anemia alone is associated with a Invest in Vitamin A Supplementation. 1700 2.5% drop in adult wages.4 Achieve universal salt iodization. 3000 Country Context Where Does Lao PDR Stand? Fortify commonly consumed foods 800 with iron. HDI ranking: 138th out of 186 • 44% of children under the age of five are stunt- countries1 ed, 27% are underweight, and 6% are wasted. 5 Ensure an adequate supply of zinc 1370 • 15% of infants are born with a low birth weight.5 supplements for the treatment of Life expectancy: 67 years2 • 59% of children 6–59 months of age received a diarrhea. Lifetime risk of maternal death: vitamin A dose within the previous six months.5 1 in 835 As shown in Figure 1, Lao PDR performs level are more than 3 times as likely to be stunted Under-five mortality rate: worse than other countries in the same region as those in the richest income level. However, 42 per 1,000 live births2 undernutrition is not just a problem of poverty. and income group. Compared to African coun- Global ranking of stunting tries with less income, such as Uganda and Togo, As Figure 2 shows, children are undernourished prevalence: 7th highest out of 118 stunting rates in Lao PDR are more severe. in one-fifth of even the richest households. This countries2 Nutritional status also varies across income is not an issue of food access, but of caring prac- level. Children under five in the poorest income tices and high disease burden. Most of the irreversible damage due to Technical Notes malnutrition in Lao PDR happens during FIGURE 2   Undernutrition Affects All Wealth Quintiles Stunting is low height for age. gestation and in the first 24 months of life.6 Richest 20 Underweight is low weight for age. Fourth 32 Wasting is low weight for height. FIGURE 1   Lao PDR has Higher Rates of Stunting than its Neighbors and Income Peers Middle 42 Current stunting, underweight, and wasting estimates are based on the most recent Second 50 survey data from the Lao PDR Lao Social 60 Prevalence of Stunting Among Indicator Survey (LSIS) 2011–2012. Poorest 61 50 Ethiopia Lao PDR Children Under 5 (%) Nepal 0 10 20 30 40 50 60 70 Low birth weight is a birth weight less 40 Cambodia Indonesia Prevalence of Stunting Among Children Under 5 (%) than 2500g. Uganda Philippines 30 Togo Ghana Source: Lao Social Indicator Survey (LSIS) 2011–2012. The methodology for calculating nationwide 20 Vietnam Sri Lanka costs of vitamin and mineral deficiencies, Mongolia Thailand and interventions included in the cost 10 China of scaling up, can be found at: 0 Vitamin and Mineral Deficiencies Cause 0 1000 2000 3000 4000 5000 6000 www.worldbank.org/nutrition/profiles GNI per capita (US$2011) Hidden Hunger Although they may not be visible to the naked Source: Stunting rates were obtained from UNICEF 2013 State of the World’s eye, vitamin and mineral deficiencies impact Children. GNI data were obtained from the World Bank’s World Development THE WORLD BANK Indicators. well-being in Lao PDR, as indicated in Figure 3. Produced with support from the Japan Trust Fund for Scaling Up Nutrition Lao PDR Nutrition-at-a-Glance 12-2-13.indd 1 1/13/14 4:22 PM Solutions to Primary Causes of Undernutrition LAO PDR Poor Infant Feeding Practices • 39% of all newborns receive breast milk within one High Disease Burden Limited Access to Nutritious Food hour of birth.5 • In Lao PDR, 11% of deaths of children under 5 are • 27% of households were food insecure in 2013.14 • Less than half (40%) of infants under six months due to diarrhea.13 • Achieving food security means ensuring quality and are exclusively breastfed.5 • Undernourished children have an increased risk of continuity of food access, in addition to quantity, for • During the important transition period to a mix of falling sick and greater severity of disease. all household members. mix of breast milk and solid food between six and • Undernourished children who fall sick are much • Dietary diversity is essential for food security. nine months of age, nearly half (48%) of infants more likely to die from illness than well-nourished Solution: Involve multiple sectors including agri- are not fed appropriately with both breast milk and children. culture, education, transport, gender, food industry, other foods.5 • Parasitic infestation diverts nutrients from the body health and other sectors, to ensure that diverse, nutri- Solution: Support women and their families to practice and can cause blood loss and anemia. tious diets are available and accessible to all house- optimal breastfeeding and ensure timely and adequate Solution: Prevent and treat childhood infection and hold members. complementary feeding. Breast milk fulfills all nutrition- other disease. Hand-washing, deworming, zinc sup- al needs of infants up to six months of age, boosts their plements during and after diarrhea, and continued immunity, and reduces exposures to infections. feeding during illness are important. References FIGURE 3   High Rates of Vitamin A and Iron Deficiency World Bank Nutrition-related Engagements in 1. UNDP. 2013. Human Development Report. Contribute to Lost Lives and Diminished Productivity 2. UNICEF. 2013. State of the World’s Children. Lao PDR 3. Black R et al. 2013. Maternal and Child 60 55 The World Bank is supporting both nutrition- Undernutrition and Overweight in Low- 50 sensitive and nutrition-specific interventions Prevalence (%) income and Middle-income Countries. 45 40 involving multiple sectors. For example, in the Lancet.382: 427–451. 35 health sector, the Community Nutrition Project 4. Horton S. and Ross J. 2003. The Economics 30 25 includes sharing of key messages on infant and of Iron Deficiency. Food Policy. 28:517-5. 20 5. Lao PDR Lao Social Indicator Survey (LSIS) 15 young child feeding practices at the community- 2011–2012. 10 5 level, distribution of micronutrients, and encour- 6. UNICEF. 2009. Tracking Progress on Child 0 aging the use of preventative maternal and child Preschool Children Pregnant Women and Maternal Nutrition. health services at health facilities. The Health Ser- Vitamin A Deficiency Anemia 7. Micronutrient Initiative and UNICEF. 2004. vices Improvement Project is similarly focused on Vitamin and Mineral Deficiency: A Global Source: Data from the WHO Global Database on Child Growth and reducing the burden of disease among children Progress Report. Malnutrition and improving the health of pregnant women. In 8. World Bank. 2013. World Development Indicators. the water and sanitation sector, Community-led • Vitamin A: About 45% of preschool aged Total Sanitation is being piloted to create demand 9. WHO. 2009. Global Prevalence of Vitamin A children and 12% of pregnant women are de- for sanitation facilities and reduce environmen- Deficiency in Populations at Risk 1995– 2005: WHO Global Database on Vitamin A ficient in vitamin A.9 tal enteropathy and diarrheal diseases. In the ag- Deficiency. • Iron: About half of preschool aged children riculture sector, various projects are involved in 10. WHO. 2008. Worldwide Prevalence of Anemia (48%) and pregnant women (56%) have ane- interventions to improve rice productivity and to 1993–2005: WHO Global Database on Anemia. mia.10 Iron-folic acid supplementation of improve food security in the upland areas. 11. Micronutrient Initiative. 2009. Investing pregnant women, deworming, provision of in the Future: A united call to action on multiple micronutrient supplements to in- vitamin and mineral deficiencies. At the policy-level, the World Bank recently fants and young children, and fortification of collaborated with FAO on the Rice Policy Study 12. Bhandari N., et al. 2008. Effectiveness of Zinc Supplementation Plus Oral Rehydration staple foods are effective strategies to improve (2012) and is financing a knowledge exchange Salts Compared With Oral Rehydration Salts the iron status of these vulnerable subgroups. activity between Lao PDR and Indonesia to Alone as a Treatment for Acute Diarrhea • Iodine: 80% of households consume iodized facilitate high-level interactions among policy- in a Primary Care Setting: A Cluster salt.5 makers to improve the effectiveness of and to Randomized Trial. Pediatrics. Vol. 121 No. 5. • Zinc: Nearly 36% of the population is at risk scale-up nutrition interventions. 13. Institute for Health Metrics and Evaluation of insufficient zinc intake.11 Zinc supplemen- (IHME). 2013. Global Burden of Disease Data. tation during diarrheal episodes can reduce 14. FAO. 2013. The State of Food Insecurity in morbidity by more than 40%.12 Addressing undernutrition is cost effective: the World: The multiple dimensions of food Costs of core micronutrient interventions security. 15. Horton S. et al. 2009. Scaling Up Nutrition: are as low as US$0.05–3.60 per person What will it cost? annually. Returns on investment are as high as 8–30 times the costs.15 Lao PDR Nutrition-at-a-Glance 12-2-13.indd 2 1/13/14 4:22 PM