77162 Nutrition at a GLANCE Eritrea The Costs of Undernutrition • Over one-third of child deaths are due to un- Annually, Eritrea loses over US$18 million in dernutrition, mostly from increased severity of GDP to vitamin and mineral deficiencies.3,4 disease.2 Scaling up core micronutrient interventions • Children who are undernourished between con- would cost just over US$1 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: • The economic costs of undernutrition include Increase nutrition capacity within the Ministries of direct costs such as the increased burden on Health and Agriculture. the health care system, and indirect costs of lost Improve infant and young child feeding through effective productivity. education and counseling services. • Childhood anemia alone is associated with a Increase coverage of vitamin A supplementation for young 2.5% drop in adult wages.5 Country Context children and iron supplementation for pregnant women. Achieve universal salt iodization. HDI ranking: 165th out of 182 Where Does Eritrea Stand? countries1 • 44% of children under the age of five are stunted, Improve dietary diversity through promoting home 35% are underweight, and 15% are wasted.2 production of a diversity of foods and market and Life expectancy: 60 years2 infrastructure development. • 14% of infants are born with a low birth weight.2 Lifetime risk of maternal death: • At its current rate of progress in tackling undernu- 1 in 442 trition indicators, Eritrea will not meet MDG 1c Under-five mortality rate: (halving 1990 rates of child underweight by 2015).6 58 per 1,000 live births2 Vitamin and Mineral Deficiencies Cause Global ranking of stunting As seen in Figure 1, Eritrea has high stunting rates Hidden Hunger relative to countries in the same region and income Although they may not be visible to the naked prevalence: 19th-highest out of group. Countries with similar per capita incomes eye, vitamin and mineral deficiencies impact well- 136 countries2 exhibit reduced rates of child stunting, which dem- being and are prevalent in Eritrea, as indicated in onstrate the ability to achieve better nutrition out- Figure 2. comes despite low income. Technical Notes FIgure 1  Eritrea has Higher Rates of Stunting than Figure 2  High Rates of Vitamin A and Iron Deficiency Contribute to Lost Lives and Diminished Productivity Stunting is low height for age. some of its Income Peers 80 Underweight is low weight for age. 50 70 Prevalence of Stunting Among 45 Eritrea Wasting is low weight for height. 40 Somalia 60 Children Under 5 (%) Myanmar Prevalence (%) 35 Liberia Mauritania 50 Current stunting, underweight, and wasting 30 Gambia Ghana 40 estimates are based on comparison of the 25 Togo 30 most recent survey data with the WHO 20 20 Child Growth Standards, released in 2006. 15 10 10 Low birth weight is a birth weight less 5 0 Preschool Children Pregnant Women than 2500g. 0 0 100 200 300 400 500 600 700 800 900 1000 Vitamin A Deficiency Anemia The methodology for calculating GNI per capita (US$2008) nationwide costs of vitamin and mineral Source: 1995–2005 data from the WHO Global Database on Child Growth and Source: Stunting rates were obtained from WHO Global Database on Child Malnutrition. deficiencies, and interventions included in Growth and Malnutrition. GNI data were obtained from the World Bank’s the cost of scaling up, can be found at: World Development Indicators. www.worldbank.org/nutrition/profiles • Iron: Anemia is found in about 70% of preschool Most of the irreversible damage due to aged children and 55% of pregnant women, re- malnutrition happens in gestation and spectively.9 Approximately half of all anemia is in the first 24 months of life.6 due to dietary iron deficiency. Iron-folic acid Solutions to Primary Causes of Undernutrition Eritrea Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 48% of infants under six months are not exclu- • Undernutrition increases the likelihood of falling • An alarming two-thirds (66%) of households are sively breastfed.2 sick and severity of disease. food insecure.7 • During the important transition period to a mix • Undernourished children who fall sick are much • Achieving food security means ensuring quality and of breast milk and solid foods between six and more likely to die from illness than well-nourished continuity of food access, in addition to quantity, for nine months of age, over half (57%) of infants children. all household members. are not fed appropriately with both breast milk • Parasitic infestation diverts nutrients from the body • Dietary diversity is essential for food security. and other foods.2 and can cause blood loss and anemia. • Lack of consistently-accessible diverse diets con- Solution: Support women and their families to Solution: Prevent and treat childhood infection and tributes to high levels of micronutrient deficiencies practice optimal breastfeeding and ensure timely other disease. Hand-washing, deworming, zinc sup- and lost human capital. and adequate complementary feeding. Breast milk plements during and after diarrhea, and continued Solution: Involve multiple sectors including agricul- fulfills all nutritional needs of infants up to six feeding during illness are important. ture, education, transport, gender, the food industry, months of age, boosts their immunity, and reduces health and other sectors, to ensure that diverse, nutri- exposure to infections. In high HIV settings, follow tious diets are available and accessible to all house- WHO 2009 HIV and infant feeding revised principles hold members. and recommendations.11 References supplementation of pregnant women, deworm- • Adequate intake of micronutrients, particularly 1. UNDP. 2009. Human Development ing, provision of multiple micronutrient supple- iron, vitamin A, iodine and zinc, from concep- Report. ments to infants and young children, and forti- tion to age 24 months is critical for child growth 2. UNICEF. 2009. State of the World’s fication of staple foods are effective strategies to and mental development. Children. improve the iron status of these vulnerable sub- 3. UNICEF and the Micronutrient Initiative. groups. 2004. Vitamin and Mineral Deficiency: A Addressing undernutrition is cost • Vitamin A: 21% of preschool aged children Global Progress Report. effective: Costs of core micronutrient 4. World Bank. 2009. World Development and 16% of pregnant women are deficient in vi- tamin A.8 Supplementation of young children interventions are as low as Indicators (Database). 5. Horton S and Ross J. 2003. The and dietary diversification can eliminate this de- US$0.05–3.60 per person annually. Economics of Iron Deficiency. Food ficiency. Returns on investment are as high as Policy 28:517-5. • Iodine: Nearly one-third of households do not 8–30 times the costs.10 6. UNICEF. 2009. Tracking Progress on consume iodized salt,6 leaving infants and chil- Child and Maternal Nutrition. dren in those households unprotected from io- World Bank nutrition activities in Africa can be 7. FAO. 2009. The State of Food Insecurity in the World: Economic Crises – Impacts dine deficiency disorders. found at: http://go.worldbank.org/R2KBERG1X0 and Lessons Learned. 8. WHO. 2009. Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995–2005. WHO Global Database on Vitamin A Deficiency. 9. WHO. 2008. Worldwide Prevalence of Anemia 1993-2005: WHO Global Database on Anemia. 10. Horton S. et al. 2009 Scaling Up Nutrition: What will it Cost? 11. World Health Organization (2009). HIV and infant feeding: Revised principles and recommendations — Rapid advice. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition