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NutritioN at a GLANCE MyanMar The Costs of Malnutrition Annually, Myanmar loses nearly US$400 million Public Disclosure Authorized • Over one-third of child deaths are due to under- in GDP to vitamin and mineral deficiencies.3,4 nutrition, mostly from increased severity of disease.2 Scaling up core micronutrient nutrition • Children who are undernourished between con- interventions would cost US$20 million per year. ception and age two are at high risk for impaired (See Technical Notes for more information) cognitive development, which adversely affects the country’s productivity and growth. Key Actions to Approximate • Myanmar is anticipated to lose a cumulative return to 14 US$430 million to chronic disease by 2015.5 Address Malnutrition: investment(%): • The economic costs of undernutrition and over- Improve infant and young weight include direct costs such as the increased child feeding through effective 1400 burden on the health care system, and indirect education and counseling Country Context costs of lost productivity. services. HDi ranking: 138th out of 182 • Childhood anemia alone is associated with a Invest in vitamin A Public Disclosure Authorized 6 1700 countries1 2.5% drop in adult wages. supplementation. Life expectancy: 62 years2 Achieve universal salt iodization. 3000 Where Does Myanmar Stand? Fortify commonly consumed Lifetime risk of maternal death: • 41% of children under the age of five are stunted, 800 2 foods with iron. 1 in 110 30% are underweight, and 11% are wasted.2 Ensure an adequate supply under-five mortality rate: • 40% of those aged 15 and above are overweight 1370 98 per 1,000 live births2 or obese.7 of zinc supplements for the • Close to 1 in 7 infants are born with a low birth treatment of diarrhea. Global ranking of stunting weight.2 Improve equitability of food access and quality to prevalence: 32nd highest out of address the dual burden of food insecurity and 2 136 countries As shown in Figure 1, although the overall prev- undernutrition for some, and obesity for others. alence of stunting and underweight has been de- Public Disclosure Authorized creasing over the past two decades, Myanmar will Technical Notes not meet MDG 1c (halving 1990 rates of child underweight by 2015) with business as usual.8 Figure 2 Myanmar has Higher rates of Stunting than Stunting is low height for age. its Neighbors and income Peers Figure 1 Myanmar’s Progress toward MDG 1 is underweight is low weight for age. 70 insufficient 60 Wasting is low weight for height. Timor-Leste 60 50 Myanmar Current stunting, underweight, and wasting Vietnam 50 40 Indonesia estimates are based on comparison of the Liberia Cambodia 30 Phillippines most recent survey data with the WHO 40 Mongolia 20 Child Growth Standards, released in 2006. 30 Children Under 5 (%) They are not directly comparable to the 10 Prevalence of Stunting Among Under 5 (%) 20 trend data shown in Figure 1, which are 0 calculated according to the previously-used 10 0 500 1000 1500 2000 2500 NCHS/WHO reference population. Prevalence Among Children GNI per capita (US$2008) 0 1991 1994 2000 2003 Source: Stunting rates were obtained from the WHO Global Database on Public Disclosure Authorized Low birth weight is a birth weight less Stunting Underweight 2015 MDG Underweight Target Child Growth and Malnutrition (figures based on WHO child growth stan- than 2500g. dards). GNI data were obtained from the World Bank’s World Development Indicators. overweight is a body mass index (kg/m2) Source: WHO Global Database on Child Growth and Malnutrition (figures based on the NCHS/WHO reference population) of ≥ 25; obesity is a BMI of ≥ 30. The methodology for calculating nationwide As seen in Figure 2, Myanmar performs worse Most of the irreversible damage costs of vitamin and mineral deficiencies, than most of its East Asian neighbors including due to malnutrition in Myanmar and interventions included in the cost of those with lower income. Myanmar also has higher happens during gestation and in scaling up, can be found at: stunting rates than other poorer nations. the first 24 months of life.8 www.worldbank.org/nutrition/profiles Solutions to Primary Causes of Undernutrition MyanMar Poor infant Feeding Practices High Disease Burden Access to Nutritious Food • Only 15% of infants under six months are exclu- • 1 in 5 child deaths are due to diarrhea.8 • 17% of households are food insecure.9 sively breastfed.2 • Undernourished children have an increased risk of • There are inequities in food access, with low avail- • During the important transition period to a mix of falling sick and greater severity of disease. ability of food in some parts of the delta (or for breast milk and solid foods between six and nine • Undernourished children who fall sick are much some groups), and in the dry zone (central Myan- months of age, one-third of infants are not fed ap- more likely to die from illness than well-nourished mar). propriately with both breast milk and other foods.2 children. • Achieving food security means ensuring quality and Solution: Support women and their families to • Parasitic infestation diverts nutrients from the body continuity of food access, in addition to quantity, for practice optimal breastfeeding and ensure timely and can cause blood loss and anemia all household members. and adequate complementary feeding. Breast milk Solution: Prevent and treat childhood infection and Solution: Involve multiple sectors including agricul- fulfills all nutritional needs of infants up to six other disease. Hand-washing, deworming, zinc sup- ture, education, transport, gender, the food industry, months of age, boosts their immunity, and reduces plements during and after diarrhea, and continued health and other sectors, to ensure that diverse, nutri- exposure to infections. feeding during illness are important. tious diets are available and accessible to all household members. references The Double Burden of Undernutrition and Figure 3 High rates of Vitamin A and iron Deficiency Contribute to Lost Lives and Diminished Productivity 1. UNDP. 2009. Human Development Report. Overweight 2. UNICEF. 2009. State of the World’s Children. Myanmar has also seen a recent increase in adult 70 3. UNICEF and the Micronutrient Initiative. 2004. obesity. Low-birth weight infants and stunted chil- 60 Vitamin and mineral deficiency: a global progress report. dren may be at greater risk of chronic diseases such 50 4. World Bank. 2009. World Development as diabetes and heart disease than children who 40 15 Indicators (Database). start out well-nourished. 30 5. The Lancet. 2007. The Burden and Costs of This “double burden” is the result of various Prevalence (%) 20 Chronic Diseases in Low-Income and Middle- factors. Progress in improving community infra- Income Countries. 10 structure and development of sound public health 0 6. Horton S. and Ross J. The Economics of Iron Preschool Children Pregnant Women Deficiency. Food Policy. 003;28:517–5. systems has been slow, thwarting efforts to reduce 7. WHO. 2009. WHO Global InfoBase (Database). undernutrition; while the adoption of Western di- Vitamin A Deficiency Anemia 8. UNICEF. 2009. Tracking Progress on Child and ets high in refined carbohydrates, saturated fats Source: 1995–2005 data from the WHO Global Database on Child Growth and Maternal Nutrition. and sugars, as well as a more sedentary lifestyle are Malnutrition 9. FAO. 2009. The State of Food Insecurity in commonly cited as the major contributors to the in- the World: Economic Crises – Impacts and 10 Lessons Learned. crease in overweight and chronic diseases. • Iodine: While it is estimated that 92% of house- 10. Popkin BM. et al. 1996. Stunting is Associated holds consume iodized salt, over 72,000 infants with Overweight in Children of Four Nations Vitamin and Mineral Deficiencies Cause remain unprotected from iodine deficiency dis- that are Undergoing the Nutrition Transition. 8 11. WHO. 2009. Global Prevalence of Vitamin A Hidden Hunger orders. Deficiency in Populations at Risk 1995–2005. Although they may not be visible to the naked WHO Global Database on Vitamin A eye, vitamin and mineral deficiencies impact well- World Bank Nutrition-Related Activities in Deficiency. being, and are pervasive in Myanmar, as indicated 12. WHO. 2008. Worldwide Prevalence of Anemia Myanmar 1993–2005: WHO Global Database on Anemia. in Figure 3. The World Bank is currently not involved in any 13. Horton S. et al. 2009 Scaling Up Nutrition: • Vitamin A: 37% of preschool aged children and nutrition-related program or activity in Myanmar. What will it Cost? 18% of pregnant women are deficient in vitamin A.11 14. Micronutrient Initiative. 2009. Investing in the • Iron: Current rates of anemia among preschool Future: A United Call to Action on Vitamin and aged children and pregnant women are 63% Mineral Deficiencies. 12 15. Victora, CG et al. Maternal and Child and 50%, respectively. Iron-folic acid supple- Addressing undernutrition is Undernutrition: Consequences for Adult Health mentation of pregnant women, deworming, cost effective: Costs of core and Human Capital. The Lancet 2008; 371: provision of multiple micronutrient supple- micronutrient interventions are as low 340–57. ments to infants and young children, and for- tification of staple foods are effective strategies as US$0.05–3.60 per person annually. to improve the iron status of these vulnerable Returns on investment are as high as subgroups. 8–30 times the costs.13 THE WORLD BANK Produced with support from the Japan trust Fund for Scaling up Nutrition.

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