77171 Nutrition at a GLANCE Guinea-Bissau The Costs of Undernutrition • Over one-third of child deaths are due to under- Annually, Guinea-Bissau loses over US$6 million nutrition, mostly from increased severity of dis- in GDP to vitamin and mineral deficiencies.3,4 ease.2 Scaling up core micronutrient interventions • Children who are undernourished between con- would cost 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 direct costs such as the increased burden on the of Health and Agriculture. health care system, and indirect costs of lost pro- ductivity. Improve infant and young child feeding through • Childhood anemia alone is associated with a effective education and counseling services. 2.5% drop in adult wages.5 Increase coverage of vitamin A supplementation Country Context for young children and iron supplementation for pregnant women. HDI ranking: 173rd out of 182 Where Does Guinea-Bissau Stand? • 47% of children under the age of five are stunted, Achieve universal salt iodization. countries1 15% are underweight, and 8% are wasted.2 Improve dietary diversity through promoting home Life expectancy: 48 years2 • 24% of infants are born with a low birth weight.2 production of a diversity of foods and market and Lifetime risk of maternal death: • Guinea-Bissau is on track to meet MDG 1 (eradi- infrastructure development. 1 in 132 cate extreme poverty by 2015) but with nearly one in two children stunted, much work remains Under-five mortality rate: to be done.6 195 per 1,000 live births2 Global ranking of stunting Most of the irreversible damage due to FIgure 1  Guinea Bissau Has Higher Rates of Stunting prevalence: 14th highest out of malnutrition happens in gestation and than Many of its Income Peers 136 countries2 in the first 24 months of life.6 50 Prevalence of Stunting Among Guinea-Bissau As seen in Figure 1, Guinea-Bissau exhibits high- Children Under 5 (%) Democratic Republic 45 of the Congo Technical Notes er rates of child stunting relative to members of its Somalia Myanmar Eritrea region and income group. Countries with lower per 40 Stunting is low height for age (too short). capita incomes such as Liberia exhibit lower rates Liberia Underweight is low weight for age (too of child stunting, which shows that it is possible to 35 small). achieve better nutrition outcomes despite low in- Wasting is low weight for height (too thin). 30 come. 0 50 100 150 200 250 300 350 400 Current stunting, underweight, and wasting GNI per capita (US$2008) estimates are based on comparison of the most recent survey data with the WHO Vitamin and Mineral Deficiencies Cause Source: Stunting rates were obtained from the WHO Global Database on Child Growth and Malnutrition (figures based on WHO child growth refer- Child Growth Standards, released in 2006. Hidden Hunger ences). GNI data were obtained from the World Bank’s World Development Indicators. Low birth weight is a birth weight less Although they may not be visible to the naked eye, than 2500g. vitamin and mineral deficiencies impact well-being, and are pervasive in Guinea-Bissau, as indicated in The methodology for calculating nationwide costs of vitamin and mineral Figure 2. • Iron: Anemia is found in three-quarters of deficiencies, and interventions included in preschool aged children and 58% of pregnant the cost of scaling up, can be found at: • Vitamin A: Over one-half of preschool aged women, respectively.9 Approximately half of all www.worldbank.org/nutrition/profiles children and nearly one-fifth of pregnant women anemia is due to dietary iron deficiency. Iron- (55% and 18%, respectively) are deficient in vi- folic acid supplementation of pregnant women, tamin A.8 Supplementation of young children deworming, provision of multiple micronutrient and dietary diversification can eliminate this de- supplements to infants and young children, and ficiency. fortification of staple foods are effective strate- Solutions to Primary Causes of Undernutrition Guinea-Bissau Poor Infant Feeding Practices High Disease Burden Limited Access to Nutritious Food • Only 23% of all newborns receive breast milk • Undernutrition increases the likelihood of falling • 31% of households are food insecure, according to within one hour of birth.2 sick and the severity of disease. a measure of per capita access to calories.7 Many • 84% of infants under six months are not exclu- • Undernourished children who fall sick are much more households likely lack access to diverse diets sively breastfed.2 more likely to die from illness than well-nourished year round. • During the important transition period to a mix of children. • Achieving food security means ensuring quality and breast milk and solid foods between six and nine • Parasitic infestation diverts nutrients from the body continuity of food access, in addition to quantity, for months of age, about two-thirds of infants are and can cause blood loss and anemia. all household members. not fed appropriately with both breast milk and Solution: Prevent and treat childhood infection and • Dietary diversity is essential for food security. other foods.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, social protection, transport, gender, practice optimal breastfeeding and ensure timely feeding during illness are important. the food industry, health and other sectors, to ensure and adequate complementary feeding. Breast milk that diverse, nutritious diets are available and acces- fulfills all nutritional needs of infants up to six sible to all household members. months of age, boosts their immunity, and reduces exposure to infections. In high HIV settings, follow WHO 2009 HIV and infant feeding revised principles and recommendations.11 References Figure 2  High Rates of Vitamin A and Iron Deficiency World Bank Nutrition-Related Activities in Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. Guinea-Bissau 2. UNICEF. 2009. State of the World’s 80 The World Bank is supporting the second phase Children. 70 of the National Health Development Plan. The 3. UNICEF and the Micronutrient Initiative. 60 grant will support activities in four components: Prevalence (%) 2004. Vitamin and Mineral Deficiency: 50 A Global Progress Report. (1) improving service delivery in three pilot re- 40 4. World Bank. 2009. World Development gions through a better supervision system and 30 Indicators (Database). 20 greater accessibility of essential drugs at the pri- 5. Horton S, Ross J. 2003. The Economics of 10 mary care level; (2) improving the quality and Iron Deficiency. Food Policy 28: 51–75. management of human resources through sup- 0 6. UNICEF. 2009. Tracking Progress on Child Preschool Children Pregnant Women port to the National School of Public Health and and Maternal Nutrition. Vitamin A Deficiency Anemia to the Directorate of Human Resources of the 7. FAO. 2009. The State of Food Insecurity in the World: Economic Crises – Impacts Source: 1995–2005 data from the WHO Global Database on Child Growth and MoPH; (3) strengthening the health information and Lessons Learned. Malnutrition. system (HIS); and (4) improving the financial 8. WHO. 2009. Global Prevalence of Vitamin management of the sector. The Emergency Food A Deficiency in Populations at Risk Security Support Project (EFSSP) will help fi- 1995–2005. WHO Global Database on nance short- and medium-term activities to miti- Vitamin A Deficiency. gies to improve the iron status of these vulnerable gate the impact of rising food prices in Guinea- 9. WHO. 2008. Worldwide Prevalence subgroups. Bissau as a result of the global food price trends. of Anemia 1993–2005: WHO Global • Iodine: A mere 1% of households consume io- Database on Anemia. dized salt,6 leaving children in the vast majority of 10. Horton S. et al. 2009 Scaling Up Nutrition: households unprotected from iodine deficiency Addressing undernutrition is cost What will it Cost? disorders. effective: Costs of core micronutrient 11. World Health Organization (2009). HIV interventions are as low as • Adequate intake of micronutrients, particularly and infant feeding: Revised principles and recommendations – Rapid advice. iron, vitamin A, iodine and zinc, from concep- US$0.05–3.60 per person annually. tion to age 24 months is critical for child growth Returns on investment are as high as and mental development. 8–30 times the costs.10 THE WORLD BANK Produced with support from the Japan Trust Fund for Scaling Up Nutrition