77172 Nutrition at a GLANCE Honduras The Costs of Malnutrition • Over one-third of child deaths are due to un- Scaling up core micronutrient nutrition dernutrition, mostly from increased severity of interventions would cost only disease.2 US$6 million per year. • Children who are undernourished between con- (See Technical Notes for more information) ception and age two are at high risk for impaired cognitive development, which adversely affects Key Actions to Address Malnutrition: the country’s productivity and growth. Reduce stunting through effective education and • The Latin America and Caribbean region is an- counseling regarding optimal infant and young child ticipated to lose a cumulative US$8 billion to feeding, and regular growth monitoring and promotion chronic disease by 2015.5 of children. • The economic costs of undernutrition and over- Reduce micronutrient deficiencies through access weight include direct costs such as the increased to high quality fortified complementary food after six burden on the health care system, and indirect months of age, supplementation, staple food fortification, costs of lost productivity. and dietary diversification. Country Context • Childhood anemia alone is associated with a Reduce disparities in the nutritional status 2.5% drop in adult wages.6 HDI ranking: 112th out of 182 between the poor and the rich through the adoption countries1 of policy and programs focusing on improving nutrition, Where Does Honduras Stand? education and income of low income families. Life expectancy: 72 years2 • 10% of infants are born with a low birth weight2. Address the growing burden of overweight and Lifetime risk of maternal death: • More than 50% of children 6–24 months are obesity through policies that promote the adoption of a 1 in 932 anemic.7 healthy lifestyle including healthy eating and increased • 29% of children under the age of five are stunted, Under-five mortality rate: physical activity. and 8% of children under the age of five are un- 31 per 1,000 live births2 derweight.2 Global ranking of stunting • There are regional disparities in child nutritional prevalence: 56th highest out of status: in 1/3 of the regions in Honduras, 50% of Figure 1  Honduras has Higher Rates of Stunting than 136 countries2 children are stunted, and children in rural areas its Neighbors and Income Peers are 2.5 times more at risk of growth faltering than 35 those living in urban areas.7 Prevalence of Stunting Among 30 • There are large disparities in nutrition based Haiti Honduras Technical Notes Children Under 5 (%) 25 Mongolia Iraq on socioeconomic status: Children living in the Bolivia Ecuador Stunting is low height for age. poorest households are 8 times more likely to be 20 Sri Lanka stunted than children in the richest households7. 15 Underweight is low weight for age. Among mothers with no education, more than 10 Wasting is low weight for height. half of children are stunted, and among mothers 5 with only primary education, one-third of chil- 0 Current stunting, underweight, and wasting 0 1000 2000 3000 4000 dren are stunted.8 GNI per capita (US$2008) estimates are based on comparison of the most recent survey data with the WHO • 46% of those aged 15 and above are overweight Child Growth Standards, released in 2006. or obese.9 Source: Stunting rates were obtained from WHO Global Database on Child Growth and Malnutrition. GNI data were obtained from the World Bank’s • Rates of childhood overweight have doubled in World Development Indicators. Low birth weight is a birth weight less five years.7 than 2500g. Overweight is a body mass index (kg/m2) As seen in Figure 1, Honduras has higher malnu- The Double Burden of Undernutrition and of ≥ 25; obesity is a BMI of ≥ 30. trition rates than countries in the same region and Overweight The methodology for calculating income group. Countries with similar per capita in- Though Honduras is currently on track to meet nationwide costs of vitamin and mineral comes exhibit lower rates of child stunting, which MDG 1c (halving 1990 rates of child underweight deficiencies, and interventions included in demonstrate the ability to achieve better nutrition by 2015) it has seen a recent increase in obesity.11 the cost of scaling up, can be found at: outcomes despite low income. This “double burden� is the result of various factors. www.worldbank.org/nutrition/profiles Solutions to Primary Causes of Undernutrition Honduras Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • 1 in 5 newborns do not receive breast milk within • Undernourished children have a higher risk of falling • 12% of households are food insecure.10 one hour of birth.2 sick and greater severity of disease. • Achieving food security means ensuring quality and • 70% of infants under six months are not exclu- • Undernourished children who fall sick are much continuity of food access, in addition to quantity, for sively breastfed.2 more likely to die from illness than well-nourished all household members. • 53% of children 4–5 months are bottle fed.16 children. • High rates of micronutrient deficiencies, particularly • Almost 1/3 of infants are not fed appropriately • Parasitic infestation diverts nutrients from the body anemia, concurrent with obesity in the population, with both breast milk and other foods during the and can cause blood loss and anemia. indicate that dietary quality is not optimal. important transition period to a mix of breast milk Solution: Prevent and treat childhood infection and • Dietary diversity is essential for food security. and solid foods between 6 and 9 months of age.2 other disease. Hand-washing, deworming, zinc sup- Solution: Involve multiple sectors including agricul- Solution: Support women and their families to plements during and after diarrhea, and continued ture, education, transport, gender, the food industry, practice exclusive breastfeeding up to 6 months feeding during illness are important. Also promote health and other sectors, to ensure that diverse, nutri- of age. Breast milk fulfills all nutritional needs of adoption of healthy lifestyles including sound eating tious diets are available and accessible to all house- infants up to six months of age, boosts their im- habits that allow maintenance of a healthy weight hold members, and households of all income levels. munity, and reduces exposure to infections. After 6 from birth to adulthood. months, support mothers to feed infants frequently with a diversified diet rich in nutrient dense comple- mentary foods plus continued breastfeeding. References Progress in improving community infrastructure staple foods are effective strategies to improve the 1. UNDP. 2009. Human Development Report. and development of sound public health systems iron status of these vulnerable subgroups. 2. UNICEF. 2009. State of the World’s Children. has been slow, thwarting efforts to reduce undernu- • Vitamin A: 14% of preschool aged children are 3. UNICEF and the Micronutrient Initiative. 2004. Vitamin and Mineral Deficiency: a Global Progress trition; while rapid urbanization and the adoption deficient in vitamin A.14 Report. of diets high in refined carbohydrates, saturated 4. World Bank. 2009. World Development Indicators (Database). fats and sugars, combined with a more sedentary World Bank Nutrition-Related Activities in 5. Abegunde D et al. 2007. The Burden and Costs lifestyle are commonly cited as the major contribu- of Chronic Diseases in Low-Income and Middle- tors to the increase in overweight and chronic dis- Honduras Income Countries. The Lancet 370: 1929–38. The World Bank is currently supporting the US$20 6. Horton S and Ross J. 2003. The Economics of eases.12 Iron Deficiency. Food Policy 28:517–5. million Nutrition and Social Protection Project with The combination of undernutrition and obesity 7. Encuesta Nacional de Demografia y Salud more than half of financing supporting the Com- (ENDESA) 2005–2006. does not bode well for health. Low-birthweight in- munity Based Nutrition Program. It aims to prevent 8. Lutter CK, Chaparro CM. 2008. Malnutrition in fants and stunted children may be at greater risk infants and young children in Latin America chronic early childhood malnutrition by expanding and the Caribbean: Achieving the Millennium of chronic diseases such as diabetes and heart dis- coverage of a community-based program of growth Development Goals. PAHO. ease than children who start out well-nourished.17 9. WHO. 2009. WHO Global InfoBase (Database). promotion and basic health activities. 10. FAO. 2009. The State of Food Insecurity in the Chronic diseases are especially common in under- In 2010 the new government announced the World: Economic Crises – Impacts and Lessons nourished children who experience rapid weight Learned. implementation of a large-scale conditional cash 11. PAHO, 2008, Malnutrition in Infants and Young gain after infancy.7 For women, obesity during preg- transfer program that will give cash to families that Children in Latin America and the Caribbean: nancy is associated with greater use of health care Achieving the Millennium Development Goals. make efforts to improve children’s school attendance 12. Popkin BM. et al. 1996. Stunting is Associated services and longer hospital stay,7 as well as reduced and their use of the nutrition and preventive health with Overweight in Children of Four Nations that rates of breastfeeding. are Undergoing the Nutrition Transition. J Nutr care services. The program will cover about 600,000 126:3009–16. families or 30% of the population, the equivalent of 13. WHO. 2008. Worldwide Prevalence of Anemia 1993–2005: WHO Global Database on Anemia. Vitamin and Mineral Deficiencies Cause the extreme poverty rate. Similar programs in the 14. WHO. 2009. Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995–2005. Hidden Hunger region proved effective in improving the nutrition WHO Global Database on Vitamin A Deficiency. Although they may not be visible to the naked eye, status of young children. 15. Horton S. et al. 2009 Scaling Up Nutrition: What vitamin and mineral deficiencies impact well-being will it Cost? 16. Addendum to the 2006 Honduras DHS, Infant and and are critical for child growth and mental devel- Addressing undernutrition is cost Young Child Feeding (IYCF) Practices. opment. 17. Victora CG et al. 2008. Maternal and child • Iron: Nearly one third of preschool aged children effective: Costs of core micronutrient undernutrition: consequences for adult health and human capital. The Lancet 371: 340–57. and pregnant women are anemic.13 Iron-folic acid interventions are as low as supplementation of pregnant women, deworming, US$0.05–8.46 per person annually. provision of multiple micronutrient supplements Returns on investment are as to infants and young children, and fortification of high as 6–30 times the costs.15 THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition