December 18, 2006— Malnutrition is not usually thought of as a Latin American problem. But in much of Central America - notably El Salvador, Guatemala, Honduras, and Nicaragua – chronic child malnutrition is as prevalent as it is in Africa or South Asia.
In Guatemala, half of all children under five years are chronically malnourished. In El Salvador, Honduras and Nicaragua, one out of every three children under five years is affected. And there has been no improvement in reducing malnutrition in these four countries for over a decade.
Monitoring children's growth regularly is essential to prevent malnutrition. (Credit: Lucy Bassett in Camalotales, Honduras)
“In Central America, malnutrition contributes directly to increased poverty and, in the long term, it can have a negative effect on a country’s economic growth of up to 3 percent of annual GDP,” says Evangeline Javier, Director for Human Development in the Latin America and the Caribbean Region of the World Bank.
Children in poor, indigenous, and rural communities suffer the worst rates of stunting (low height for age, an indicator of chronic malnutrition) in Central America. If malnutrition sets in before a child turns two years old, as is predominantly the case, the consequences are irreversible.
In order to raise the profile of malnutrition as a development issue in Central America, the Bank organized a workshop on Fighting Chronic Malnutrition in Central America in Tegucigalpa, Honduras on November 27-30, with support from the UK Department for International Development (DFID) and the Bank Netherlands Partnership Program (BNPP).
“In the past, there has not been enough exchange of knowledge between Central American countries, despite the fact that they share common challenges,” commented Laura Rawlings, Sector Leader for Human Development in the World Bank Country Management Unit for Central America.
“This workshop gave them an opportunity to learn from one another and to develop strategies for improving their own programs, particularly community-based programs focused on preventing malnutrition in children under two years old.”
The event brought together 150 participants, including practitioners from all six Central American countries and from several Andean countries, researchers, opinion-makers, government officials, and representatives of the World Bank, the World Food Program, the Pan American Health Organization, UNICEF, and USAID.
“Good nutrition is the cornerstone of the survival, health, and development of current and future generations,” said Xiomara Castro de Zelaya, First Lady of Honduras, at the opening of the event.
“Well-nourished women run fewer risks during pregnancy and childbirth. Well-nourished children perform better at school, become healthier adults, and can offer a better start in life to their own children,” she explained.
Wendy de Berger, First Lady of Guatemala, gave the other side of the coin. “Malnutrition is the lack of opportunities,” she said. The discussions in Tegucigalpa drew on the Bank’s research, including Repositioning Nutrition as Central for Development: A Strategy for Large-scale Action and a new regional study, Key Issues in Central America Health Reforms: Diagnosis and Strategic Implications, which identifies “the high and persistent prevalence of malnutrition” as one of the region’s top health challenges. This is especially true for four countries (El Salvador, Guatemala, Honduras and Nicaragua) which account for 96 percent of chronically malnourished children in Central America.
Community-based nutrition programs help mothers learn about hygiene, care, and feeding practices (Credit: Lucy Bassett in Camalotales, Honduras)
The research shows that the main cause of malnutrition in Central America is not lack of food, but a combination of factors such as poor maternal health, inappropriate infant care and feeding practices, and lack of access to safe water and sanitation.
Exclusive breastfeeding during an infant's first six months is a key factor in preventing chronic malnutrition. (Credit: photographer unknown. Nicaragua)
“Nutrition policies need to be national, multisectoral agendas,” said Christine Lao Peña, Senior Human Development Economist in the Bank’s Latin America and the Caribbean Region.
“They should combine short-term strategies such as nutrition advocacy with comprehensive, long-term strategies that include changing household and individual behavior and improving levels of female education and status in society.”
A central aim of the workshop was to review the performance of community-based child nutrition programs.
“These programs are being introduced or scaled up in many Central American countries and they have proven to be both affordable and effective,” said Rawlings.
The Bank is currently supporting community-based projects in El Salvador and Honduras, where the model has been adopted as the national nutrition strategy. The Bank has also approved a project that will expand community-based nutrition approaches in Guatemala, including intensive nutrition education counseling sessions for mothers, focusing on poor, indigenous areas.
Overall, the workshop helped to identify five priorities in the fight against malnutrition in Central America:
From left to right, Evangeline Javier, WB Director for Human Development, LAC Region; Wendy de Berger, First Lady of Guatemala; Xiomara Castro de Zelaya, First Lady of Honduras; Jenny Meza, Minister of Health, Honduras; and Adrian Fozzard, WB Country Manager for Honduras, at the workshop in Tegucigalpa. (Credit: María Amalia San Martin)
1. Prevention, especially through regular monitoring of children’s growth, coupled with early warning systems linking high-risk cases to trained health specialists;
2. Targeting efforts on pregnant women and children during the first two years of their life, and prioritizing the poor, rural and indigenous populations where malnutrition is concentrated;
3. Educating parents about hygiene, the importance of monitoring their children’s height and weight, and child care feeding practices, including exclusive breastfeeding in the first six months of life;
4. Action at the national, program and community levels, to ensure that combating malnutrition is a national priority, supported by an appropriate multisectoral agenda and effective nutrition programs in at-risk communities;
5. Monitoring and evaluation of nutrition programs.