IDB considering US$5M malnutrition reduction programme for Guyana By Gitanjali Singh
Stabroek News
June 16, 2002

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The Inter-American Development Bank (IDB) is considering a stand-alone US$5 million programme to reduce malnutrition using a more focused approach, which would emphasize integrated management of the mother and child nutrition while promoting behavioural changes.

The government had embarked on a national plan of action on nutrition in 1998 to improve the nutritional status of the population which included supplements, fortification, complementary feeding, education and management of sick children but the results of implementation have been mixed.

SIMAP 1 and SIMAP II had financed the distribution of milk and rice to beneficiary communities, but an evaluation of this strategy found that while the transfers increased the use of health clinics, there was no beneficial impact on child and maternal nutritional status due to the type of foods distributed.

SIMAP III does not cater for this transfer programme.

Reports of acute malnutrition (weight for height) in children under five in Guyana are extremely high and are similar to those reported in countries suffering from famine and food shortages, the IDB sector facility profile on the project said.

Overall malnutrition (weight for age) and chronic malnutrition (height for age) were found to be moderate when compared with countries at similar levels of economic growth.

The report said overall malnutrition declined between 1993 and 2000 but there had been no discernable improvement in the nutritional status of children in the last two nutrition surveys.

In 1993, overall malnutrition in children under five was 18.3%, while chronic malnutrition was 12.4% and acute malnutrition 7.7%. Overall malnutrition declined to 11.8% in 1997 but increased to 13.6% in 2000. Chronic malnutrition declined to 10.1% in 1997 and increased marginally to 10.8% in 2000. However, acute malnutrition increased to 11.5% in 1997 and dropped to 10.6% in 2000.

The IDB profile said ethnicity appeared to be a decisive factor in malnutrition with overall malnutrition greatest among Indo-Guyanese and least among the Amerindian populations. This, it said, was attributable to the duration of exclusive breastfeeding and infant feeding practices. Age was also found to be related to overall malnutrition with children from six to 23 months suffering the highest levels. The report said this may be because of the early cessation of exclusive breastfeeding and inadequate complementary feeding and infectious diseases. Being a member of a large family or living in a female headed household are also risk factors.

Chronic malnutrition is predominant in the interior where the Amerindian communities are concentrated, the report said, while acute malnutrition is concentrated in the rural coast and is attributed to poverty rather than inadequate food availability.

The US$5 million nutrition project would seek to reduce the level of malnutrition in Guyana by focusing on child-feeding practices, anaemia reduction, training, institutional strengthening and impact evaluation.

In the case of child feeding, the project will promote exclusive breastfeeding during the first six months of life and the introduction of appropriate complementary feeding from six to 24 months of age.

The activities to be financed by the project, which is to go before the bank’s board in October will include education and communication, clinical supervision and outreach, community-based counselling and other interventions based on best practices to improve household nutrition behaviours, community support for breastfeeding and facility based nutrition services.

For complementary feeding after six months of age in babies, the project will see the purchase and distribution of an appropriate fortified weaning food through health-care clinics in targeted communities and financed on a declining basis by the bank. This distribution would be focused on the rural coastal region where acute malnutrition is highest.

The profile noted the importance of appropriate infant feeding practices for survival, growth, development, health and nutrition of infants and children. It noted that the World Health Organisation recommends exclusive breastfeeding for six months to be followed by complementary feeding through the introduction of nutritionally adequate, safe and appropriate foods in conjunction with continued breastfeeding until age two.

It noted that in Guyana, breastfeeding predominates until the second year of life but is only exclusive in a small proportion of children in the first six months which is when it yields the greatest benefits. It said nearly 40% of breastfed children began to receive other foods before they are four months old and only 15% of children under three months were exclusively breastfed.

The report said that the higher incidence of malnutrition seen at six to 24 months is therefore likely because of a poor choice of non-breast foods. It noted that 60% of the infants in a Ministry of Health clinic survey of feeding practices received plain or sweetened water and infant formula from as early as the first month of life. It said that while the majority of women who participated in the survey are aware of the health and economic benefits of exclusive breastfeeding in theory, misconceptions and negative attitudes regarding the adequacy of breast milk saw nutrient poor foods such as water, fresh juice, unfortified cornmeal, and barley or plantain porridges being used.

The anaemia component of the project will focus on pregnant women and children under five years with heavy focus on pre and post natal micronutrient supplementation regimes and the modification of the diet to assure iron absorption. The activities to be financed are similar as in the previous component and may include the purchase and distribution of iron and folate supplement tablets on a declining basis.

In both pregnant women and children under five in Guyana, iron deficiency stands at 50%, a moderate to severe population level deficiency by international standards. This has been the case since 1971 with minimal changes. The profile said that half of the anaemia cases are categorized as severe and anaemia is one of the primary causes of maternal death and is a major cause of childhood mortality.

The report noted that other consequences of iron deficiency are impaired physical growth; potentially permanent effects on neurological functions involving cognition, emotional behaviour, reaction to and reception of stimuli, attention span, learning capacity and neuro-motor development and function; decreased capacity for physical work; lowered immunity resulting in increased susceptibility to infections and alterations in the reproductive process.

Low birth weight and obesity are also other factors at work in the health of mothers and children. The report said 11 per cent of newborns weigh under 2,500 grammes (5.5 pounds), a relatively high figure suggesting the possibility of high rates of maternal malnutrition or low weight gain during pregnancy.

The report said that the 1997 study showed that 20% of women between 20 and 30 years had a body mass index below 18.5 and were three to four times at risk of bearing a child weighing less that five and a half pound or underweight.

Additionally, the report noted that 12% of the births in Guyana are among women younger than 20 years and the birth spacing is short, both factors highly related to low birth weight.

Obesity was seen as a growing malnutrition problem in Guyana. Nearly 40% of adults are overweight with the prevalence of obesity increasing with age. Women were found to be significantly more obese than men. Obesity is associated with an increased risk of premature death and is a major risk factor for chronic diseases that impact on the quality of life in adulthood.

The IDB has to date financed several nutrition interventions in Guyana including food distribution as part of a broader poverty alleviation operation. This new programme will be its first stand-alone programme, the third component of which will support the development and implementation of continuous training course for all primary health care providers in nutrition education and counseling services.

The Ministry of Health policy and programme managers are also to receive specialized training in nutrition policy and programme management.

Another subcomponent of this third area will be support for the government in developing, testing and implementing nutrition and maternal and child health information system modules as well as providing training in the use of the information system technology at the regional level. In the area of surveillance, support will be provided for the household income and expenditure survey for next year for the addition of a nutrition module to collect data to allow for detailed analysis.

A third subcomponent will allow for a rigorous evaluation of the proposed interventions.

A small project execution unit in the Ministry of Health will be responsible for the project. The principal analysis mission from the bank for the project is due in August.