Comprehensive Africa Agriculture Development Programme (CAADP) West Africa Regional CAADP Nutrition Program Development Workshop Nutrition Country Paper – Liberia English Version DRAFT November 9-12, 2011 Dakar, Senegal This synthesis has been elaborated for a CAADP workshop on the integration of nutrition in National Agricultural and Food Security Investment Plan, held in Dakar, Senegal, from the 9th to the 12th November 2011. The purpose of this Nutrition Country Paper is to present key data and information required to improve nutrition in participating countries and scale up nutrition in agricultural strategies and programs. This work document has been initiated and updated by the workshop work team of the country, composed of focal points from different sectors; with the assistance of the technical piloting committee. It will be regularly updated and completed. Key policy documents to be consulted Other key documents: Please refer to the workshop material -Lift Liberia Poverty Reduction Strategy (PRS) 2008-2011 -Food and Agriculture Policy and Strategy (FAPS) 2008-2013 -Liberia Agriculture Sector Investment Program (LASIP) 2001-2015 General sources used to produce this document Sources Information Internet link when available Nutrition Country Profiles http://www.fao.org/ag/agn/nutrition/profiles_by_country_en.stm FAO FAO Country profiles http://www.fao.org/countries/ FAO STAT country profiles http://faostat.fao.org/site/666/default.aspx Nutrition Country Profiles http://www.childinfo.org/profiles_974.htm UNICEF MICS: Multiple Indicators Cluster Surveys http://www.childinfo.org/mics_available.html Food Security Country Profiles for 9 http://www.oecd.org/document/6/0,3746,en_38233741_38246823_41638790_1_1_1_1,00.html African Countries : Burkina Faso, Cape OCDE / CILLS Verde, Chad, Gambia, Guinea-Bissau, Mali, Mauritania, Niger, Senegal DHS DHS Indicators http://www.measuredhs.com/Where-We-Work/Country-List.cfm OMS Nutrition Landscape information system http://apps.who.int/nutrition/landscape/report.aspx Signed Compact / Investment plans / http://www.nepad-caadp.net/library-country-status-updates.php CAADP Stocktaking documents / Technical Review reports if available REACH multi-sectoral review of existing When available (Mauritania, Sierra Leone) REACH data on the nutrition situation, programmes and policies Progress Report from countries and their http://www.scalingupnutrition.org/wp-content/uploads/2011/09/compendiurm-of-country-fiches-ROME- SUN partners in the VERSION.pdf Movement to Scale Up Nutrition (SUN) http://www.scalingupnutrition.org/events/a-year-of-progress/ WFP Food security reports http://www.wfp.org/food-security/reports/search 2 I. Context- food and nutrition situation General Indicators Source include cocoa, rice, cassava (tapioca), palm oil, sugarcane, bananas, sheep, and Population below poverty line of US$1.25 per day 87% UNICEF 2011 goats. Agricultural production accounts for 70% of the labor force, with 22% and 8% Under-five mortality rate (per 1,000 live births) 112 UNICEF 2011 working in the service and industry sectors, respectively. Although nearly $5 Billion of international debt was permanently eliminated in 2010 and a low single-digit rate Infant mortality rate (per 1,000 live births) 80 UNICEF 2011 of inflation since 2009 (due to stable community prices), rebuilding infrastructure Primary cause of under-five deaths and raising incomes continue to be on-going challenges. Neonatal death 22% WHO 2011 Primary school net enrolment or attendance ratio 40% UNESCO 2007 Food security (food availability, access, utilization, and coping mechanisms) Primary school net enrolment -ratio of females/males 39% f /41% m NS 2007 In Liberia only 9% of the rural population is food secure and food diversity is Agro-nutrition indicators Source extremely low, consisting mainly of rice, roots and tubers (WFP 2010). The Cultivable land area 23.3% FAO 2007 production of rice – the most important staple – fell by 76 percent between 1987 Access to improved drinking water in rural areas 56% UNICEF 2008 and 2005, years characterized by war, mismanagement, and neglect of the agriculture sector. In 2007, Liberia produced only about 40% of its staple food Food Availability requirement, rice prices increased 60%, and real incomes have declined, further 2190 Average dietary energy requirement (ADER) FAO 2005- 2007 kcal/person/day stressing household coping mechanisms. Although agricultural production has 2160 increased in recent years as the sector slowly recovers, many challenges remain. Dietary energy supply (DES) FAO 2005-2007 kcal/person/day Liberia is not only food insecure but also exceedingly vulnerable to high food prices Total protein share in DES / (Animal protein) 6.6% / 1.1% FAO 2005-2007 and fluctuations in the global market. Fat share in DES 23.6% FAO 2005-2007 Geography, population, and human development Focus : Malnutrition and Food insecurity in Liberia The West African country of Liberia has six major rivers, and many short coastal Poor Infant Feeding Practices watercourses. The terrain is mostly flat to rolling coastal plains, rising to low - One-third of all newborns do not receive breast milk within one hour of birth. mountains, plateaus, and mountains (600 m) parallel to the coast. Children < 14 - 71% of infants under six months are not exclusively breastfed. years comprise 39% of the population (UIS, 2009), 52% of the population is rural and - During the important transition period to a mix of breast milk and solid (6-9 months), mean years of schooling is 3.9 years. Liberia ranks 162 out of 169 in the human over one-third are not feed appropriately with both breast milk and other foods. development index (UNDP, 2010). Although an average rate of 68% of the population High Disease Burden using improved drinking water is considered to be relatively high, in rural - Undernutrition increases the likelihood of falling sick, the severity of disease, and they are more likely to die from illness than well-nourished children. populations this figure drops to 56%. With 87% of the population living in below the Limited Access to Nutritious Food poverty line, persistent challenges to improving the nutritional status of the - 39% of households are food insecure, i.e. lacking access to calories, and many more lack population remain. Liberia has experienced modest recovery from a destructive access to diverse diets year round.. period of conflict; the country dropped from having nearly middle-income status and Source : http://siteresources.worldbank.org/NUTRITION/Resources/281846-1271963823772/Liberia.pdf self-sufficiency in food in the late 1970s to its present situation of being one of the poorest in the world. Economic development Liberia is a low-income country heavily reliant on foreign assistance for revenue. Many businesses fled the country, taking capital and expertise with them but with the conclusion of fighting, several have returned. Liberia is reviving its production and export sectors, primarily iron ore, raw timber and rubber. Other products 3 Agro-Nutrition Indicators (continued) Source STUNTING TRENDS UNDER-WEIGHT TRENDS % children <5 years of age stunted % children <5 years old underweight Nutritional Anthropometry (WHO Child Growth Standards) NCHS Reference Population NCHS reference population Prevalence of stunting in children < 5 years of age 39 % UNICEF 2011 100 Prevalence of wasting in children < 5 years of age 8 % UNICEF 2011 80 100 80 Prevalence of underweight children < 5 years of age 19 % UNICEF 2011 60 60 % Women (15-49 years) with a BMI < 18.5 kg/m² 10% DHS 2007 40 39 40 37 35 20 20 i 26 20 24 Nutritional anthropometry 0 0 Stunting levels are above WHO standards for extremely high rates (40%) among Liberian Other NS Other NS DHS Other NS Other NS DHS children under age five, with a prevalence rate of 41.8% (CFSNS, 2010). This rate is even 1976 1999 2007 1976 1999 2007 higher than reported by DHS in 2007. However, the 14.9% prevalence rate for underweight children <5 years reported by CFSNS in 2010, are lower than those shown Gender Residence Wealth Quintile in 2007 by the DHS. The highest levels of severe and moderate stunting are found in Indicator Male Female Ratio Urban Rural Ratio 1 2 3 4 5 Ratio (source DHS 2007) m / f u / r (poorest) (richest) richest to children between 18 and 29 months while younger children (6-17months) are less poorest stunted. In the latter age group, the rate of Global Acute Malnutrition is much higher Stunting prevalence < 5 y (7.1%) than in any other age group. The proportion of overweight or obese women (WHO Child Growth Standards) 42 37 1,1 31 43 0,7 45 45 40 35 26 0,6 stands at 21 percent, with 6 percent of women considered to be obese (BMI > 30.0), and Under weight prevalence < 5 y it is positively correlated with age; women between the ages of 40-49 years have the (WHO Child Growth Standards) 21 18 1,2 17 20 0,9 21 21 22 16 13 0,6 highest proportion (30%) of overweight or obesity, and the age group 15-19 has the lowest proportion at 8% (DHS, 2007). Women with a BMI<18.5 tend to be in the Source: UNICEF Nutrition Profile v2, October 2011 younger age categories. Infant feeding Early initiation of breastfeeding within one hour of birth occurs with a 67% prevalence rate. Although the median for exclusive breastfeeding is extremely short (less than one Agro-nutrition indicators (continued) Source month), the mean duration of any breastfeeding is long (20 months). For almost two- Infant feeding by age thirds of the children, complementary foods are introduced well before the Children <6 months who are exclusively breastfed 29% UNICEF 2011 recommended 6 months of age and a significant number of children do not receive Children (6-9 months) who are fed complementary food timely 62% UNICEF 2011 appropriate complementary food up to 10-11 months of age. Overall some progress in mean exclusive breastfeeding and the mean duration of breastfeeding rates can be Children (20-23 months) who are still breastfeeding 47 % UNICEF 2011 seen in the CFSNS of Liberia 2010 compared to 2006.