77145 Nutrition at a GLANCE albania The Costs of Malnutrition Scaling up core micronutrient • Over one-third of child deaths are due to undernu- trition, mostly from increased severity of disease.2 nutrition interventions in Albania would • Children who are undernourished between con- cost US$1.2 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. Approximate • The Europe and Central Asia region is anticipat- Albania Return to ed to lose a cumulative US$7 billion to chronic disease by 2015.3 Must Act to: investment (%):14 • The economic costs of undernutrition and over- Achieve universal salt 3000 weight include direct costs such as the increased iodization burden on the health care system, and indirect Ensure an adequate up to 1000 costs of lost productivity. supply of zinc Country Context • Childhood anemia alone is associated with a supplements for the 2.5% drop in adult wages.4 treatment of diarrhea HDI ranking: 70th out of 182 countries1 Fortify staple foods 800 Where Does Albania Stand? with iron Life expectancy: 77 years2 • 19% of children under the age of five are stunted, Invest in Vitamin A 1700 Lifetime risk of maternal death: 5% are underweight, and 9% are wasted.5 Supplementation 1 in 4902 • 55% of those aged 15 and above are overweight or obese.6 Under-five mortality rate: • 7% of infants are born with a low birth weight.2 14 per 1,000 live births2 The Double Burden of Undernutrition and Global ranking of stunting As seen in Figure 1, stunting rates in Albania are the second highest in the region, and much higher Overweight prevalence: 70th highest out of Though Albania is currently on track to meet 136 countries2 than neighboring countries of similar income levels MDG 1c (halving 1990 rates of child underweight such as Bosnia-Herzegovenia. by 2015), it has seen a recent increase in adult obe- sity. Low-birth weight infants and stunted children may be at greater risk of chronic diseases such as Technical Notes FIgure 1  Albania has Higher Rates of Stunting than Most of its Neighbors diabetes and heart disease than children who start Stunting is low height for age (too short). out well-nourished.8 The prevalence of overweight 25 and obesity is particularly high among adults in the Prevalence of Stunting Among Underweight is low weight for age (too small). Ukraine 20 capital Tirana where type 2 diabetes has also been Children Under 5 (%) Wasting is low weight for height (too thin). Albania on the rise.9 15 This “double burden� is the result of various Current stunting, underweight, and wasting Romania 10 Bosnia-Herzegovenia factors. Progress in improving community infra- estimates are based on comparison of the Serbia Montenegro structure and development of sound public health most recent survey data with the WHO Child Growth Standards, released in 2006. 5 systems has been slow, thwarting efforts to reduce 0 undernutrition; while rapid urbanization and the Low birth weight is a birth weight less 2000 3000 4000 5000 6000 7000 8000 9000 adoption of diets high in refined carbohydrates, than 2500g. GNI per capita (US$2008) saturated fats and sugars, combined with a more Overweight is a body mass index (kg/m2) Source: Stunting rates for Albania were obtained from DHS 2010, and other sedentary lifestyle are commonly cited as the ma- of ≥ 25; obesity is a BMI of ≥ 30. countrie’s stunting rates were obtained from the WHO Global Database on Child Growth and Malnutrition (figures based on WHO child growth standards). jor contributors to the increase in overweight and The methodology for calculating nationwide GNI data were obtained from the World Bank’s World Development Indicators. chronic diseases.9, 10 costs of vitamin and mineral deficiencies, and interventions included in the cost of Most of the irreversible damage due to malnutrition happens scaling up, can be found at: during gestation and in the first 24 months of life.7 www.worldbank.org/nutrition/profiles Solutions to Primary Causes of Undernutrition albania Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 62% of all newborns do not receive breast milk • Undernourished children have an increased likeli- • Achieving food security means ensuring quality and within one hour of birth.2 hood of falling sick and severity of disease. continuity of food access, in addition to quantity, for • 60% of infants under six months are not exclu- • Undernourished children who fall sick are much all household members. sively breastfed.2 more likely to die from illness than well-nourished Solution: Involve multiple sectors including agricul- • During the important transition period to a mix of children. ture, education, transport, gender, the food industry, breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body health and other sectors, to ensure that diverse, nutri- months of age, 31% of infants are not fed ap- and can cause blood loss and anemia. tious diets are available and accessible to all house- propriately with both breast milk and other foods.2 Solution: Prevent and treat childhood infection and hold members. Solution: Support women and their families to other disease. Hand-washing, deworming, zinc sup- practice optimal breastfeeding and ensure timely plements during and after diarrhea, and continued and adequate complementary feeding. Breast milk feeding during illness are important. fulfills all nutritional needs of infants up to six months of age, boosts their immunity, and reduces exposure to infections. References Vitamin and Mineral Deficiencies Cause FIgure 2  High Rates of Vitamin A and Iron Deficiency Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. Hidden Hunger 2. UNICEF. 2009. State of the World’s Children. Although they may not be visible to the naked eye, 40 3. Abegunde D et al. 2007. The Burden and Costs of Chronic Diseases in Low-Income and Middle- vitamin and mineral deficiencies impact well-being 35 Income Countries. The Lancet 370: 1929–38. in Albania, as indicated in Figure 2. Prevalence (%) 30 25 4. Horton S, Ross J. 2003. The Economics of Iron 20 Deficiency. Food Policy 28:51–75. • Vitamin A: 19% of preschool aged children are 5. Institute of Statistics, Institute of Public 15 deficient in vitamin A.11 10 Health [Albania] and ICF Macro. 2010. Albania Demographic and Health Survey 2008-09. • Iron: Approximately one third of both preschool 5 Tirana, Albania: Institute of Statistics, Institute aged children and pregnant women are anemic 0 Preschool Children Pregnant Women of Public Health and ICF Macro. (31% and 34%, respectively).12 Iron-folic acid 6. WHO. 2009. WHO Global InfoBase (Database). supplementation of pregnant women, deworm- Vitamin A Deficiency Anemia 7. UNICEF. 2009. Tracking Progress on Child and ing, provision of multiple micronutrient supple- Source: 1995–2005 data from the WHO Global Database on Child Growth and Maternal Nutrition. 8. Victora CG et al. 2008. Maternal and Child ments to infants and young children, and forti- Malnutrition. Undernutrition: Consequences for Adult Health fication of staple foods are effective strategies to and Human Capital. The Lancet 371:340–57. improve the iron status of these vulnerable sub- 9. Shapo L el al. 2004. Type 2 Diabetes in Tirana groups. City, Albania: A Rapid Increase in a Country in • Iodine: 40% of households do not consume World Bank Nutrition-Related Activities in Transition. Diabetic Medicine 21;1:77–83.  10. Popkin BM et al. 1996. Stunting is Associated iodized salt,7 leaving children in two-fifths of Albania with Overweight in Children of Four Nations households in Albania unprotected from iodine The World Bank is not currently supporting any nutri- that are Undergoing the Nutrition Transition. J deficiency disorders. tion-related activities in Albania. Nutr 126:3009–16. • Adequate intake of micronutrients, particularly 11. WHO. 2009. Global Prevalence of Vitamin A iron, vitamin A, iodine and zinc, from concep- Deficiency in Populations at Risk 1995-2005. tion to age 24 months is critical for child growth Addressing undernutrition is WHO Global Database on Vitamin A Deficiency. 12. WHO. 2008. Worldwide Prevalence of Anemia and mineral development. cost effective: Costs of core 1993–2005: WHO Global Database on Anemia. micronutrient interventions are as 13. Horton S et al. 2009 Scaling Up Nutrition: What low as US$ 0.05–4.86 per person Will it Cost? 14. Micronutrient Initiative. 2009. Investing in the annually. Returns on investment are Future: A United Call to Action on Vitamin and as high as 8–30 times the costs.13 Mineral Deficiencies. THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition