Child Malnutrition

Five takeaways for better nutrition in South Asia—and beyond

In many developing countries, governments and health authorities face the dilemma of how to feed their growing population while ensuring their food is nutritious. Credit: World Bank

Together with more than 1,500 academics, scientists, and policymakers, we participated last week in the Rice Olympics.

The event—formally known as the International Rice Congress (IRC)—provides a unique window on the latest innovations and policies about the globe’s most important staple crop.

For many, rice may not seem worth the cost of a conference trip. Yet, half of the world’s population depend on it as their main supply of nutrients and energy.

“Rice isn’t just a crop,” said Rajan Garjaria, Executive Vice President for Business Platforms at Corteva Agriscience. “It’s a way of life. A place can be made or broken, based on their rice crop.”

The Congress discussed a breadth of topics, but what stood out the most is that rice can be instrumental in making people healthier and in sustaining the planet.

The South Asia Food and Nutrition Security Initiative (SAFANSI), a World Bank partnership that aims to improve food and nutrition security across the region, participated in the Symposium on Sustainable Food Systems and Diets and presented its latest research on linkages among food prices, diet quality, and nutrition security.

Overall, the event underscored how governments and health authorities in many developing countries face the dilemma of how to feed their growing population while ensuring their food is nutritious and discussed relevant strategies to transform nutrition security challenges into opportunities.

Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices. — Chronic malnutrition remains prevalent across South Asia as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.

In Sri Lanka, as in the rest of South Asia, improving agricultural production has long been a priority to achieve food security.

But growing more crops has hardly lessened the plight of malnutrition.

Chronic malnutrition remains prevalent across the region as many poor South Asians cannot afford nutritious foods or don’t have the relevant information or education to make smart dietary choices.
And children and the poorest are particularly at risk.

South Asia is home to about 62 million of the world’s 155 million children considered as stunted-- or too short for their age.

And more than half of the world’s 52 million children identified as wasted—or too thin for their height—live in South Asia.

Moderate-to-severe stunting rates ranged from 17 percent in Sri Lanka in 2016 to a high 45 percent in Pakistan in 2012–13, with rates above 30 percent for most countries in the region.

Moderate-to-severe wasting rates ranged from 2 percent in Bhutan in 2015 to 21 percent in India in 2015–16, with rates above 10 percent for most countries in the region.

The social and economic cost of malnutrition is substantial, linked to impaired cognitive development, chronic disease, and lower future earnings.

And sadly, much remains to be done to ensure children across South Asia can access the nutritious foods they need to live healthy lives.

Silvi and her mother arrive with Silvi’s birth certificate to enroll into Jawtno. a cash transfer program aimed to help 600,000 poor families in Bangladesh access prenatal and child care. — Silvi and her mother arrive with Silvi’s birth certificate to enroll into Jawtno. a cash transfer program that aims to help 600,000 poor families in Bangladesh access prenatal and child care. Credit: World Bank

Silvi is eight months old. She lives in a remote village in one of the poorest regions of Bangladesh.

Her mother Maya often reflects on her pregnancy and worries about her daughter’s wellbeing as she recalls her morning sickness, the uncertain and painful birth, and the long nights at Silvi’s side as the baby lay wide awake wailing, fighting one illness after the other.

She remembers, too, the thrills of hearing Silvi giggle at the sound of her rattle, and when she began to crawl.

Despite the little joys that her baby brings to Maya, Silvi’s early childhood was marked with apprehension: Shouldn’t she be a little heavier? When will she learn to walk? Will she be healthy and intelligent enough to earn a decent living when she grows up? Or would she be handed down her parents’ poverty and get married like Maya had to, at only sixteen?

But with the right kind of support, Silvi can have a chance at a better life and bring her family out of poverty.

Growing evidence has shown that adequate nutrition before birth and the two years after – or in the first 1,000-days – has lasting effects on a child’s intelligence and brain development.

When they’re properly fed and exposed to learning, children can reach their full potential and break the poverty trap.

Thus, investing in early childhood nutrition and cognitive development (CNCD) is critical to curbing poverty in a country like Bangladesh, where 36 percent of children below the age of 5 are stunted —or too short for their age--, low birth weight is prevalent, and maternal nutrition remains poor.

Sadly, poor families like Maya’s are not utilizing services available to them.

Holidays for me have always been about family and food. A time to relax, catch-up with loved ones and eat good food. When it’s our turn to cook, my husband and I take time to plan the menu. A central part of our meals are vegetables and fresh fruits but we have also learnt over the years that a good meal needs fresh ingredients, all procured as close to the preparation of the meal as possible.

Sri Lanka has not disappointed in its array of fruits and vegetables. I am still discovering the names of many; some of which I will never be able to pronounce for sure. Despite that, I love eating them!

Amongst my favourites are papaya, mangoes and kankun, the last for which I share a passion with my two pet turtles. But getting these vegetables and fruits from the same supplier on a constant basis is a challenge. Even common produce like onions, tomatoes, and cucumbers can be discoloured or squishy – not at all appetizing or conducive for a salad or other such type of fresh dish.

The price, of course, is the same whatever the quality. Fresh produce can be expensive, and regularly buying a variety of fruits and vegetables does strain the budgets of many families in Sri Lanka. Needless to say, this shouldn’t be the case in a country with such rich soils and plentiful sunshine.

The question of access to fresh and healthy food goes beyond our holiday tables. According to the World Health Organisation, 1 in 5 premature deaths in Sri Lanka are due to a non-communicable disease (NCD) such as diabetes, cardiovascular disease or cancer.[1] Tobacco use, unhealthy diets, harmful use of alcohol and physical inactivity have all been identified as risk factors.

Local communities in the Chittagong Hill Tracts have created awareness videos to encourage the consumption of nutritious foods, including indigenous foods, threatened by packaged food products with low nutritional value — Local communities in the Chittagong Hill Tracts of Bangladesh have created awareness videos to encourage the consumption of nutritious foods, including indigenous foods, threatened by packaged food products with low nutritional value.

In Bangladesh, chronic and acute malnutrition are higher than the World Health Organization’s (WHO) thresholds for public health emergencies—it is one of 14 countries where eighty percent of the world’s stunted children live.
Food insecurity remains a critical concern, especially in the Chittagong Hill Tracts (CHT).

Located in the southeastern part of Bangladesh, CHT is home to 1.7 million people, of whom, about a third are indigenous communities living in the hills. The economy is heavily dependent on agriculture, but farming is difficult because of the steep and rugged terrain.

With support from the South Asia Food and Nutrition Security Initiative (SAFANSI), the Manusher Jonno Foundation (MJF) conducted a food and nutrition analysis which finds that more than 60% of the population in CHT migrates during April – July when food becomes harder to procure.

Based on these findings, MJF helped raise awareness through nutrition educational materials and training. The foundation staff also formed courtyard theatres with local youth to deliver nutrition messages, expanded food banks with nutritious and dry food items, and popularized the concept of a “one dish nutritious meal” through focal persons or “nutrition agents” among these communities.

With India’s rapidly growing dairy industry, large-scale milk fortification of Vitamins A and D is a robust vehicle for increasing micronutrients intake across the population. Credit: India’s National Dairy Development Board (NDDB)

Micronutrient deficiencies, especially Vitamin A and D, are prevalent in India.

Yet, these deficiencies -- often referred to as ‘hidden hunger’ -- go largely unnoticed and affect large populations.

Night blindness, a condition afflicting millions of pregnant women and children, stems from low intake of foods rich in essential nutrients like Vitamin A.

Budget constraints limit access to nutrient-rich foods for many families, who are unaware or unable to afford a nutritious diet.

National programs help supplement diets with Iron and Vitamin, but their scope is too narrow to adequately address these deficiencies.

Fortified Milk Helps Increase Vitamins Intake

When fortified with vitamin A and D, milk, which remains a staple for many Indians, can help alleviate dietary deficiencies when supplementation is not available.

Food fortification is a relatively simple, powerful and cost-effective approach to curb micronutrient deficiencies. It is in general socially accepted and requires minimal change in existing food habits.

The process is inexpensive and costs about 2 paisa per liter or about one-tenth of a cent. And because it only adds a fraction of daily recommended nutrients, the process is considered safe.

For these reasons, food fortification has been successfully scaled up in some emerging economies.

However, except for salt fortification with iodine, India has not yet achieved large-scale food fortification.

With India’s rapidly growing dairy industry, large-scale milk fortification of Vitamins A and D is a robust vehicle for increasing micronutrients intake across the population.

A group of women in a Sri Lanka Estate. Credit: Joe Qian / World Bank

Happy New Year to all our Sri Lankan friends and colleagues celebrating the Sinhala and Tamil New Year this month; and Happy Easter to those celebrating it.

This is my first opportunity to celebrate these various holidays in my adopted country. I love the energy, the buzz of excitement everywhere and the decorations coming up in many of the commercial districts. I have been asking so many questions about the importance of the New Year holiday; and at the same time enjoying the preparations for the festivities, the anticipation of the big day as well as the serious messages.

I have learnt that the Sinhala and Tamil New Year, also known as 'Aluth Avurudda' (in Sinhala) and 'Puthandu' (in Tamil) is very important to all Sri Lankans and it celebrates the traditional Lunar New Year. It is celebrated by most Sri Lankans – a point of Unity and a Joyful occasion.

Even more importantly the holiday coincides with the New Year celebrations of many traditional calendars of South and South East Asia – a regional point of unity! Above all, this is also known as the month of prosperity.

So what does the holiday mean to you as a Sri Lankan, or maybe you are someone like me who may not be Sri Lankan but loves the country and its people?

At the World Bank Group, promoting shared prosperity and increasing the incomes of the poorest 40 percent of people in every country we work in is part of our mission. The first goal is to end extreme poverty or reduce the share of the global population that lives in extreme poverty to 3 percent by 2030.

Child Malnutrition

Five takeaways for better nutrition in South Asia—and beyond

It’s time to end malnutrition in South Asia

Can cash transfers solve Bangladesh’s malnutrition?

The quest for a well-resourced holiday meal

Rural Bangladeshis filming their way to better nutrition

Tackling India’s hidden hunger

Happy New Year! In Sri Lanka, a time to celebrate many things – and to think

Child Malnutrition

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