Why nutrition

matters?
Kedir Teji ( PhD, Food and Nutrition)
Haramaya University, College of Health & Medical
sciences

2020
 Brain storming
• Why nutrition matters?

• Why invest in nutrition?

• What is the cost of malnutrition?

• What is double burden of malnutrition?

• What is the economic impacts of malnutrition? In
Ethiopia?
Why nutrition
matters?
 Declaration of the
1974 World Food Summit

‘… all governments & the international community

as a whole …. eliminate within a decade hunger
& malnutrition’

(Resolution V)
Malnutrition today – what progress
have we achieved today,
after 4 decades?

Some global trends

in malnutrition…
Focus on levels of stunting (low ht/age)

 Child stunting level good indicator of socio-economic

conditions
 malnutrition can ‘cost’ a young child up to 11 cm of height by the age of
two years

 Much better reflection of human development than

economic indicators
State of malnutrition
in sub-Sahara
Africa…

…the problem is
getting worse
 WHY…..

• Rates of stunting in children < 5 years

remained high in Africa

• The number of stunted children is rising

dramatically in Africa
• Question how was in Ethiopia from 2000 to
2016?
Trend of malnutrition in percentage

Ht/Age

Wt/Age

Wt/Height
Why invest in nutrition?
 Why investing…..
Human & Economic Costs
Nutrition is a human right…
Not able to be
Ethical Imperative taken away; or
given away

“every man, woman & child has the

inalienable right to be free from
hunger & malnutrition in order to
develop their physical & mental
faculties”
WFS 1974
 Malnutrition: Hidden Problem

• No obvious signs

UNICEF/94-1173 Pirozzi
• Victims not aware
 Four Functional Consequences

 Mortality

 Illness

 Intelligence loss

 Reduced productivity
 Malnutrition & Child Survival

• Child malnutrition is viewed as one important

manifestation of a larger development problem that
reaches across multiple sectors:
Social,
Political,
Economic, and
Cultural institution
Malnutrition & Infection

 Increased risk of:

 Illness
 Death
 How much cost on Health?
Country
Egypt Ethiopia Swaziland Uganda Burkina Faso Ghana Malawi

Total (millions of USD) 213 154 7 259 63 199 46

% of costs covered by the

families
73% 89% 88% 87% 58% 70% 49%

Public costs as % of health

public expenditure
1.60% 2.30% 0.60% 11.00% 4.5% 4.1% 19.5%

Total health costs as % of GDP 0.10% 0.50% 0.20% 1.60% 0.60% 0.5% 0.8%

The economic cost of undernutrition ranged from values equivalent to 0.6% to 20% of
government budget allocated to Health and from 0.1% to 1.6% of GDP
Causes of Child (0-5yrs) Mortality in Ethiopia

Malnutrition
53%
Other
47%

• Greatest single cause of child

mortality
Child Mortality (2006-2015)

UNICEF/C-56-19/Murray-Lee
1.3 million child deaths
 Underweight & Mortality

… the majority of these deaths, as

much as 80%, are associated with
mild & moderate malnutrition

… invisible to ‘see’ as nearly all

Ethiopian children are
malnourished
 Causes of Child Mortality in Ethiopia

Mild &
moderate

severe

• Only 1 in 5 malnutrition-related deaths

is due to severe malnutrition
Infant Deaths due to Poor Breastfeeding
Practices

18%

50,000 infant deaths every year

 Vitamin A Deficiency

 Night blindness

 Ulceration of the cornea

 Permanent blindness

 Increased mortality

 Improving vit A status can reduce child mortality up to 25%

Children with Vitamin A Deficiency
(VAD)

Permanent blindness

Xerophthalmia

Night blindness

Sub-clinical
Vitamin A deficiency
VAD: Prevalence

61%

UNICEF/ Pirozzi
VAD: Associated Mortality

32%

UNICEF/ Pirozzi
800,000 child lives lost
 Low Birth Weight

13.5%

UNICEF/C-56-19/Murray-Lee
• 2006-2015: 0ver 600,000 infant deaths
 Child Mortality (2006-2015)
1.3 million child deaths

UNICEF/C-56-19/Murray-Lee
1 million died between 2000-2005
Malnutrition

&
•
Education
1/10/2020 32
 How much on Education?
% Repetitions associated Economic Cost Proportion covered by the
Country with Stunting Families
Local Currency USD (in millions)

Egypt 10% EGP 271 49 39%

Ethiopia 16% ETB 93 million 8 64%

Swaziland 12% SZL 6 million 1 70%

Uganda 7% UGX 16.5 billion 8 45%

Burkina Faso 5,8% 853 millions FCFA 1.7 75%

Ghana 10,5% 14,9 millions GHC 8.3 66%

Malawi 18% 3,4 billions MWK 13.9 35%

Rwanda 13,5% 2,4 billion RWF 3.9 67%

Total 93.8 46%

Malnutrition & Intellectual Development

Reduced:

 Learning ability

UNICEF/C-56-19/Murray-Lee
 School performance

 Retention rates
 Intellectual Consequences
• Iron deficiency anemia lowers IQ by about 9 points

• Mild iodine deficiencies lowers IQ by about 10 points

• Severe stunting associated with IQ loss of 5-10 points

• Low birth weight babies have IQs 5 points lower

Nutritional Problems Associated with Brain
Development

%
Iodine Deficiency during Pregnancy

 severe mental & physical damage

 moderate mental retardation

 mild intellectual disability

UNICEF/HQ93-2200/Pirozzi
 Iodine Deficiency in Ethiopia
Total Goiter Rate = 38%

Of babies born from IDD mothers:

Cretinism; congenital Iodine
deficiency Syndrome xtized by
impaired physical and mental
development due to hypothyrodism

• 3% cretins
sec. to low I- intake during pregnancy

• 10% moderate mental retardation

• 87% mild intellectual deficit

Iodine Deficiency & Intellectual Development

87
Intelligence Quotient

UNICEF/C-56-19/Murray-Lee
 Total Goiter Rate = 38%

2006-2015:
15 million babies born
intellectually impaired

2000-2005:

UNICEF/Ethiopia
4.5 million babies already born
intellectually impaired
 Malnutrition

&
•
Economic Development
 Malnutrition in Ethiopia
Quantifying the human & economic losses

Current scientific data

Profiles
Computer model

Functional Consequences
Economic Consequences of Malnutrition

Malnutrition results in:

 Mental Impairment

 Physical Stunting
 Iodine Deficiency & Productivity

 Mental retardation(Cretinism) in fetuses & children

 Physical shortness (Iodine dewarfism) in children

 Weakness, poor reproduction & morbidity in adults

 Mortality

 Unemployement & discounting future earnings

 Productivity Losses
due to Iodine Deficiency (2006-2015)

• Present Value = 64 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
• Past value = 11.3 billion Birr (2000-2005)
 How much on Productivity?
Population of Working Age Lost Productivity in Lost Productivity in

Country (15-64) Non-Manual Activities Manual Activities

Estimated stunting
Number of People National Currency USD % of GDP National Currency USD % GDP
Prevalence

Egypt 20 Million 40% 2.7 billion EGP 483 million 0.30% 10.7 billion EGP 2 billion 1.00%

Ethiopia 26 Million 67% 616 million ETB 52 Million 0.20% 12.9 billion ETB 1.1 billion 3.80%

Swaziland 270 Thousand 40% 251 million SZL 30 million 1.00% 126 million SZL 15 million 0.50%

Uganda 8 Million 54% 218 billion UGX 108 million 0.70% 366 billion UGX 180 million 1.10%

Burkina Faso 4,7 million 52% 20,8 billion CFA 40,8 million 0.39% 37,2 billion CFA 73 million 0.70%

Ghana 5,5 million 37% 628 million GHC 350 million 0.86% 319 million GHC 178 million 0.44%

Malawi 4,5 million 60% 25 billion MWK 102 million 1.76% 16,5 billion MWK 67 million 1.15%

Rwanda 3,0 million 49% 40,4 billion RWF 66 million 0.98% 86,5 billion RWF 141 million 1.98%
 Anemia & Productivity
100

Anemia Prevalence

75

%
50
57

25
24

0 (EDHS - 2016)
Children <5yrs Women
 Anemia

• Iron deficiency anaemia leads to:

 Decreased physical growth in children & results in short

stature

 Impaired learning (Decreased attention span) in children

 Poor metabolic efficiency & physical productivity

 Productivity Losses
due to Anemia (2006-2015)

• Present Value = 36 billion Birr

UNICEF/93-COU-0931/Ethiopia/Thomas
 Stunting at Age 2:
Inadequate nutrition in early childhood
(EDHS - 2000) EDHS 2011( 44%)

• Height deficit as much as

11cm by 24 months of
age

• …stunted children become

stunted adults
 Consequence of Stunting

• Reduced productivity

1.4% decrease in productivity

for every
1% decrease in height
(Haddad & Bouis, 1990)
Total Economic Losses with & without Nutrition
Improvement (2005-2015)

144 billion
150

44
Birr (billions)

100 Stunting
36 Anemia
Iodine Deficiency
50
64

0
No Change Improved
Total Economic Losses with & without Nutrition
Improvement (2005-2015)

144 billion
150

44 Gain = 46 billion
98 billion
Birr (billions)

100 Stunting
36 37 Anemia
Iodine Deficiency
50 30
64
31
0
No Change Improved
 Total cost of child stunting to Ethiopia, 2014

.
Losses in Local Annual Losses
Country
Currency in USD
BURKINA FASO
Egypt EGP 20.3 billion $3.7 billion 7.6% of GDP
$ 802 million
Ethiopia ETB 55.5 billion $4.5 billion
Rwanda
Swaziland SZL 783 million $76 million 11.5_% of GDP
$ 820 million
Uganda UGX 1.8 trillion $899 million

Burkina Faso FCFA 409 billion $ 802 million

MALAWI
10.3% GDP
Ghana GHC 4.6 trillion $2.6 billion $ 597
million
Rwanda RWF 503 billion $ 820 million
MWK 147
Malawi $597 million
billion

The aggregate cost estimation for Health, Education and Productivity are
equivalent to between 1.9% to 16.5% of GDP

1/10/2020 54
 Summary of Savings Scenarios, 2014
Average Annual Savings
Country Scenario #1: Halving the Scenario #2: The ‘Goal’ Scenario:
Prevalence of Child Under-nutrition “10% Stunting and 5% Underweight
by 2025 (in million USD) by 2025” (in million USD)

Egypt 133 165

Ethiopia 376 784

Swaziland 3 4

Uganda 88 131

Burkina Faso 851 1,453

Ghana 2,285 2,954

Malawi 814 1,137

Rwanda 149 184

Total 4,700 6,811

1/10/2020 55
 Discussion

Comparison
This Year National Budget
Vs.
Economic Loss due to Malnutrition
(Stunting, Anemia & Iodine Deficiency)
 In summary, the functional consequences of
malnutrition are immense:

Deficiency Reduces

Vitamin A survival
PEM productivity
Iron
Iodine
intelligence
Impact is significant

Human costs

Economic costs
 The Intergenerational
Cycle of Malnutrition

Child growth failure

Low birth Early Low weight &

weight babies pregnancy height in teens

Small adult women

ACC/SCN,
“In developing countries, effective nutrition interventions are
likely to have MORE of an effect on human health than
comparable investments in medical care”

National Research Council, 1977

 In Ethiopia

What is the way forward?

Improved nutrition is an essential input
into human & national development

Key word is

“input”

Can’t afford to wait for improved nutrition to be an

output of overall ‘trickle-down’ development
Planners from each sector
need to address:

 impact of nutrition on their

sector

 impact of their sector on

nutrition
 The MDGs & Relevance of
Nutrition…
Sustainable développent
goals
…nutrition is central to MDGs/SDG
Thank You