Laura Roccograndi
Nutrition in Guatemala
From: Secretary of Health, Guatemala
To: Minister of Finance, Guatemala
Introduction
Undernutrition is a serious condition that imposes many health challenges for the vulnerable populations of Guatemala. Guatemala has the third highest rate of chronic malnutrition in the world with 54% of its population exhibiting signs of stunting1. The most prominent risk factors of undernutrition are micronutrient deficiencies of iron, and vitamin A2. The most highly affected populations are children under five, women who are pregnant or lactating, and those of indigenous descent3. Risk factors for this nutritional emergency can be attributed to poor infant feeding practices, high disease burden and limited education of the mother4. The effects of undernutrition expand into the education and productivity of children, which can impede future economic growth. Progress can be made in terms of prevention, promotion and treatment of the disease through fortification of food, education of mothers, and implementation of treatment initiatives such as prenatal treatment and fortification programs.
Nature and Magnitude of the Problem
Guatemala has the highest percentage of chronically malnourished children in Latin America, and the third largest in the world. One in eight infants is born with a low birth weight5. Nearly half of the country's children suffer from chronic malnutrition, and over one third of child deaths under five are related to malnutrition6. In Latin American countries, Guatemala remains the only country unable to significantly decrease its rate of malnutrition over the past decade. Even compared to poorer countries like Haiti, Guatemala has less success in addressing this problem. Stunting in some communities is so commonplace that inhabitants fail to comprehend the widespread effects of undernutrition7.
Although most of the population consumes enough calories, certain essential nutrients are deficient due to the normal Guatemalan diet of cereals and limited animal products8. Vitamin and mineral deficiencies due to iron, vitamin A and iodine deficiency are prevalent in Guatemala. A consequence of iron deficiency is anemia, which affects 38% of children under five and 22% of pregnant women9. This deficiency can lead to the impairment of cognitive development and to poor school performance10. Vitamin A also affects children, and about 16 % of preschool aged children are deficient in vitamin A11. An estimated 1,500 deaths in Guatemala can be attributed annually to vitamin A deficiency. Another main cause of vitamin and mineral deficiencies is iodine. Only half of all households in Guatemala use iodized salt. This iodine deficiency results in nearly 67,000 children per year being born with a mental impairment12.
Affected Populations
Poor, indigenous, and rural communities have higher rates of undernourishment compared to their counterparts13. In particular, 64% of the poorest populations suffer from chronic malnutrition which is nearly four times the rate compared to the richest populations. Children from birth to 24 months have the highest prevalence of stunting14. This time frame is the critical period in which irreversible developmental damage can occur due to malnutrition. The health of mothers and their children are interrelated and uneducated mothers tend to be more undernourished, more likely to experience complications due to undernutrition and more apt to engender these conditions to their children15. Other vulnerable populations are the communities which constitute most of the indigenous population. The indigenous population is twice as likely to be undernourished compared to ladino (non-indigenous) populations16. Nearly 8 out of 10 indigenous children are stunted compared to 4 out of 10 ladino children.
Risk Factors
The three main risk factors include poor infant feeding practices, high disease burden, and limited education of the mother. Poor infant feeding practices can lead to undernutrition and lower productivity later in life. Only 60% of all newborns receive breast milk within the first hour of birth16. Only half of infants less than six months are exclusively breast fed. During the important transition from breastfeeding to the introduction of complimentary foods, only one-third of infants between ages 6 to 9 months are fed with both breast milk and complimentary foods. Exclusively breastfeeding for the first six months provides the child with an adequate source of nutrients and antibodies that will greatly diminish illnesses since no infected utensils will be used to prepare formula17.
Undernutrition also results in a higher disease burden due to the relationship between undernutrition and infection. Higher rates of infection lead to higher rates of malnutrition and a continuance of this cycle. This high disease burden promotes malnutrition in children from common childhood ailments like diarrheal disease18. For those who survive these ailments, frequent illness depletes their nutritional status and continues the cycle of recurring sickness, diminishing growth, and decreasing learning ability. Another contributing factor is in households where the mother is uneducated. In these households children have a 57% chance of becoming stunted. While households where the mother has acquired more than a primary education, children only have a 23% chance of stunting19.
Economic and Social Consequences
If malnutrition is left unaddressed, Guatemala will continue to suffer social and economic consequences. The undernourished population in Guatemala, roughly 18 %, cost the country $3.1 billion, or 11.4 % of GDP, in lost productivity18. This figure represents over half of the combined total cost in terms of lost productivity for all of Central America. Additionally, children who are undernourished from conception to age two are more likely to have impaired cognitive development. This diminished intellectual growth can adversely affect productivity and growth. Childhood anemia alone is associated with a 2.5% drop in adult wages. In Guatemala, children receiving a fortified complementary food prior to age 3 grew up to have wages 46% higher than those who did not21. This implementation alone could increase GDP by at least 2 or 3%22.
Priority Action Steps
We need to target at risk populations by focusing on promotion, prevention and treatment of undernutrition. These programs must focus on nutritional training for the mother and child by beginning with prenatal nutrition and breastfeeding programs. We should target women and their families to encourage exclusive breastfeeding for up to six months, and to introduce adequate complementary foods when children are six months of age. We need to improve infant and child feeding through effective education and counseling services based on regular growth monitoring.
Additionally, we should implement programs that attempt to prevent and treat childhood infection and disease through hand-washing, de-worming, supplementation of zinc during diarrheal disease, with continued feeding during illness. We also need to reduce anemia among young children and pregnant women through supplementation and fortification of staple foods. Food fortification of sugar will maintain vitamin A levels, especially for high-risk groups and poor families. In households, we need to promote the usage of double fortified salt with iodine and iron through different community education campaigns. Furthermore, we must always be aware that the prevalence of undernutrition is substantially higher in rural settings and in indigenous communities, so our efforts must focus on increasing solidarity between these marginalized populations and their better off counterparts.
Undernutrition is one of the most urgent issues of public health in Guatemala. Delayed efforts in solving this health crisis will impede progress in economic and social development that Guatemala cannot afford or allow. Initiating and extending projects in marginalized communities will not only alleviate some of the strains on our economy, but also improve the quality of life for our citizens.
Bibliography
______
1”Nutrition at a Glance: Guatemala”. World Bank, 20 Apr. 2010. Web. 20 Oct. 2011. <http://siteresources.worldbank.org/INTLACREGTOPNUT/Resources/Guatemala4-20-10.pdf>.
2 “Nutrition at a Glance: Guatemala” World Bank.
3 Gragnolati, Michele, et al. “Malnutrition and Poverty in Guatemala.” Working paper. World Bank, 2003. Print.
4 Ibid.
5 Nybo, Thomas. "UNICEF - At a Glance: Guatemala - Fighting Chronic Malnutrition among Impoverished Children in Guatemala." UNICEF - UNICEF Home. Web. 20 Oct. 2011. <http://www.unicef.org/infobycountry/guatemala_48087.html>.
6 Nybo, Thomas. "UNICEF - At a Glance: Guatemala - Fighting Chronic Malnutrition among Impoverished Children in Guatemala." UNICEF - UNICEF Home. Web. 20 Oct. 2011. <http://www.unicef.org/infobycountry/guatemala_48087.html>.
7Loewenberg, Samuel. "Guatemala's Malnutrition Crisis." The Lancet 374.9685 (2009): 187-89. Print.
8 Gragnolati, Michele, et al. “Malnutrition and Poverty in Guatemala.” Working paper. World Bank, 2003. Print.
9“Nutrition at a Glance: Guatemala” World Bank.
10Ibid.
11 Ibid.
12 Ibid.
13Loewenberg, Samuel. "Guatemala's Malnutrition Crisis." The Lancet 374.9685 (2009): 187-89. Print.
14 Gragnolati, Michele, et al. «Malnutrition and Poverty in Guatemala.” Working paper. World Bank, 2003. Print.
15“Nutrition at a Glance: Guatemala” World Bank.
16 “Nutrition at a Glance: Guatemala” World Bank.
17 Gragnolati, Michele, et al. “Malnutrition and Poverty in Guatemala.” Working paper. World Bank, 2003. Print.
18Ibid.
19 Nybo, Thomas. "UNICEF - At a Glance: Guatemala - Fighting Chronic Malnutrition among Impoverished Children in Guatemala." UNICEF - UNICEF Home. Web. 20 Oct. 2011.
20 Nutrition at a Glance: Guatemala” World Bank.
21"Scaling up Nutrition: A Framework for Action." Food and Nutrition Bulletin 30.1 (2010): 178-86. Print.
22 Ibid.