Recently, I was once again confronted with a puzzling situation I have seen too often during the course of my career: flat growth curves for children. This especially worried me in light of the current context of rising food prices and global economic instability, and the impact that previous crises have had on the nutritional status of mothers and children.
I was on a supervision mission for a Bank-supported nutrition program, in the remote mountain community of Chinacla in Honduras. Little 20-month old Ana (in the picture) had not gained weight for 8 months in a row, and her growth curve consistently demonstrates that she is malnourished. She is pale, weary, and cannot perform the simple task of scribbling with a pen on a piece of paper. Ana’s mother, who is no more than 5 feet tall, listens with teary eyes to the volunteer and swears she is following her advice of regularly giving food to her daughter. The volunteer reports that the little girl has been referred several times to the nearest health center, but the doctor always says that she is fine. Ana’s mother has been devotedly taking her to monthly health education sessions, where she is weighed and dedicated community volunteers assess her motor and cognitive development. So, why is she not gaining weight?
Somehow, Ana is not receiving the care she needs. Whether it is more food, more vitamins and minerals, treating an underlying infection or illness, or just better care at home, somehow the health system has not been able to adequately respond to the problem of her stagnant weight.
Unfortunately, Ana’s case of is not an exception. Honduras is facing high level of chronic malnutrition. In some of the poorest Honduran communities, almost 1 out of 2 children are too short for their age. On the other hand, overweight rates in children in the country have greatly increased in the last few years. Thus, as in many Latin American countries, more and more children in Honduras are “short and chubby”.
Sadly, chronic malnutrition in Honduras is even higher than in Haiti, the poorest country in the Western Hemisphere. This situation has disastrous impact on human and economic growth and contributes to keeping the country into poverty. Losses to GDP in the country due to under nutrition are estimated to be as high as US$400 million (roughly 2 to 3 percent of the country’s GDP, according to World Bank data).
In the context of high food prices and global economic instability, it is imperative to protect the poorest and most vulnerable, notably women and children. During hard times, poor families switch away from nutritious foods to cheaper sources of calories such as fat and simple sugars. The effects are particularly severe for young children: when mothers are exposed to high food prices, their infants are progressively stunted, as several studies have shown. This leads to losses in human capital development (including cognitive abilities) that are impossible to recuperate later on.
Yet, actual investments to improve nutrition are far from sufficient. As in many developing countries, Honduran doctors are trained to treat severe cases of malnutrition, not to detect and prevent the irreversible effects of hidden hunger. The current nutrition interventions in the country can become much more effective if they were aligned with the most recent international recommendations, such as regularly monitoring the height of children and using the latest World Health Organization (WHO) growth curves.
This situation is exactly what prompts the Government and the World Bank to action. In Honduras, the World Bank is supporting the Atención Integral a la Niñez en la Comunidad (AIN-C) program as part of a US$20 million commitment made in 2005. AIN-C empowers families, communities and municipal authorities to recognize growth and development of children as an indicator of health, welfare and development. Currently, this strategy is implemented in over a thousand communities and benefits nearly 16,000 children. Designed in the 1990’s, the AIN-C Program in Honduras is seen as a successful and low-cost model to prevent malnutrition in the region.
This initiative has a strong educational component that aims to create awareness about the perils of malnutrition and ensure the sustainability of investments in the Bank’s Nutrition and Social Protection Projects. To this effect the Bank recently launched the video: “My future in my first centimeters” in collaboration with Honduras’ Secretariat of Health.
Among other things, the video underscores the fact that all children – everywhere in the world -- have the same growth potential if given the appropriate nutrition critical to development in the first two years of life.
The video has had a significant impact on key audiences, including Honduran policy makers. "The video profoundly touched my heart," said Minister of Health Arthur Benda. “I am now convinced more than ever that all children have the same growth potential no matter their ethnic or cultural background. The difference depends on the quality of the nutrition services they receive and the involvement and commitment of parents in caring for their children.”