Nutrition

at a
GLANCE
SUDAN
The Costs of Undernutrition
Over one-third of child deaths are due to under-
Scaling up core micronutrient interventions
nutrition, mostly from increased severity of dis- would cost Sudan less than
ease.2 US$21 million per year.
Children who are undernourished between con- (See Technical Notes for more information)
ception and age two are at high risk for impaired
cognitive development, which adversely affects Key Actions to Address Malnutrition:
the countrys productivity and growth. Increase government attention and resource allocation to
The economic costs of undernutrition include public health and nutrition.
direct costs such as the increased burden on the
Improve infant and young child feeding through effective
health care system, and indirect costs of lost pro-
education and counseling services.
ductivity.
Childhood anemia alone is associated with a Increase coverage of vitamin A supplementation for young
Photo: Arne Hoel. 2.5% drop in adult wages.3 children and iron supplementation for pregnant women.

Country Context Where Does Sudan Stand?

Achieve universal salt iodization.
Improve dietary diversity through promoting home
HDI ranking: 150th out of 182 40% of children under the age of five are stunted, production of a diversity of foods and market and
countries1 27% are underweight, and 16% are wasted.2 infrastructure development.
Life expectancy: 58 years2 One-third of infants are born with a low birth
weight.2
Lifetime risk of maternal death:
1 in 532 FIgure 2 Sudan has High Rates of Stunting Compared
Most of the irreversible damage due to its Income Peers
Under-five mortality rate: to malnutrition in Sudan happens
109 per 1,000 live births2 during gestation and in the first 60
Prevalence of Stunting Among

Ethiopia
Global ranking of stunting 24 months of life.4 50
Children Under 5 (%)

Eritrea
prevalence: 35th-highest out of 40 DR Congo Central African Sudan
Uganda
136 countries2 As shown in Figure 1, malnutrition rates have 30 Mauritania Sao Tome Egypt
not improved at all over the past two decades. Su- 20
and Principe

dan will not meet MDG 1c (halving 1990 rates of

10
Technical Notes child underweight by 2015) with business as usual.4
0
0 200 400 600 800 1000 1200 1400 1600 1800 2000
Stunting is low height for age. FIgure 1 Sudans Progress Toward MGD 1 is Insufficient GNI per capita (US$2008)
Underweight is low weight for age. 50 Source: Stunting rates were obtained from the WHO Global Database on Child
Prevalence Among Children

Wasting is low weight for height. 45 Growth and Malnutrition (figures based on WHO child growth standards). GNI
40 data were obtained from the World Banks World Development Indicators.
Current stunting, underweight, and wasting 35
Under 5 (%)

30
estimates are based on comparison of the
most recent survey data with the WHO
25 Undernutrition is not just a problem of poverty.
20
Child Growth Standards, released in 2006. 15 As Figure 3 shows, children are undernourished
They are not directly comparable to the 10 in over one-quarter of even the richest households.
trend data shown in Figure 1, which are 5
0
This is typically not an issue of food access, but of
calculated according to the previously-used 1986 2006
1991 1992/93 2000 caring practices and disease.
NCHS/WHO reference population.
Stunting Underweight 2015 MDG Underweight Target
Low birth weight is a birth weight less
than 2500g. Source: WHO Global Database on Child Growth and Malnutrition (figures Vitamin and Mineral Deficiencies Cause
based on the NCHS/WHO reference population).
The methodology for calculating
Hidden Hunger
nationwide costs of vitamin and mineral As seen in Figure 2, while Sudan performs bet- Although they may not be visible to the naked
deficiencies, and interventions included in ter than some of its poorer neighbors in the region, eye, vitamin and mineral deficiencies impact well-
the cost of scaling up, can be found at: compared to its income peers in other regions, being and are pervasive in Sudan, as indicated in
www.worldbank.org/nutrition/profiles stunting rates in Sudan are worse. Figure 4.
 Solutions to Primary Causes of Undernutrition SUDAN

Poor Infant Feeding Practices
Just 1 in 3 infants under six months are exclusively
breastfed.2
During the important transition period to a mix of
breast milk and solid foods between six and nine
months of age, about one-half of infants are not
fed appropriately with both breast milk and other
foods.2
Solution: Support women and their families to prac-
tice optimal breastfeeding and ensure timely and
adequate complementary feeding. Breast milk fulfills
all nutritional needs of infants up to six months of
age, boosts their immunity, and reduces exposure to
infections. In high HIV settings, follow WHO 2009 HIV
and infant feeding revised principles and recommen-
dations.9
High Disease Burden
28% of deaths of children under 5 are due to
pneumonia or diarrhea.4
Undernutrition increases the likelihood of falling
sick and severity of disease.
Undernourished children who fall sick are much
more likely to die from illness than well-nourished
children.
Parasitic infestation diverts nutrients from the
body and can cause blood loss and anemia.
Solution: Prevent and treat childhood infection and
other disease. Hand-washing, deworming, zinc sup-
plements during and after diarrhea, and continued
feeding during illness are important.
Limited Access to Nutritious Food
1 in 5 households is food insecure.5
Achieving food security means ensuring quality and
continuity of food access, in addition to quantity, for
all household members.
Dietary diversity is essential for food security.
Solution: Involve multiple sectors including agricul-
ture, education, transport, gender, the food industry,
health and other sectors, to ensure that diverse, nutri-
tious diets are available and accessible to all house-
hold members.

References
1. UNDP. 2009. Human Development
Report.
2. UNICEF. 2009. State of the Worlds
Children.
3. Horton S and Ross J. 2003. The
Economics of Iron Deficiency. Food
Policy 28:517-5.
4. UNICEF. 2009. Tracking Progress on
Child and Maternal Nutrition.
5. FAO. 2009. The State of Food Insecurity
in the World: Economic Crises Impacts
and Lessons Learned.
6. WHO. 2008. Worldwide Prevalence
of Anemia 19932005: WHO Global
Database on Anemia.
7. WHO. 2009. Global Prevalence of
Vitamin A Deficiency in Populations at
Risk 1995-2005. WHO Global Database
on Vitamin A Deficiency.
8. Horton S. et al. 2009. Scaling Up
Nutrition: What will it Cost?
9. World Health Organization (2009). HIV
and infant feeding: Revised principles
and recommendations Rapid advice.
Geneva: WHO.
THE WORLD BANK
Produced with support from the Japan Trust Fund
for Scaling Up Nutrition
Figure 3 Undernutrition Affects All Wealth Quintiles Figure 4 High Rates of Vitamin A and Iron Deficiency
Poor Infant Feeding Practices and Disease are Major Contribute to Lost Lives and Diminished Productivity
Causes
90
80
Richest 28 70
Prevalence (%)
60
Fourth 39
50
40
Middle 44
30
20
Second 45
10
0
Poorest 39 Preschool Children Pregnant Women
Vitamin A Deficiency Anemia
0 10 20 30 40 50
Prevalence of Stunting Among Children Under 5 (%)
Source: 19952005 data from the WHO Global Database on Child Growth and
Malnutrition.
Source: Other Nutritional Survey (figures based on the WHO Child Growth
Standards).
tion to age 24 months is critical for child growth
Iron: Current rates of anemia among preschool
and mental development.
aged children and pregnant women are extraor-
dinarily high at 85% and 58%, respectively.6 Iron-
folic acid supplementation of pregnant women, World Bank Nutrition-Related Activities in
deworming, provision of multiple micronutrient Sudan
supplements to infants and young children, and Projects: The World Bank is currently oversee-
fortification of staple foods are effective strate- ing two health system development operations
gies to improve the iron status of these vulnerable financed by the Multi-Donor Trust Fund for
subgroups. Sudanwith important interventions designed to
Vitamin A: 28% of preschool aged children improve child health and reduced mortality rates.
and 16% of pregnant women are deficient in In the first phase, this project was supported with
vitamin A.7 Supplementation of young children US$60 million; another US$63 million was recently
and dietary diversification can eliminate this approved for phase two to focus on the provision
deficiency. of a basic package of health service with emphasis
Iodine: Only 11% of households consume io- on maternal and child health. In addition, several
dized salt, and over 1 million infants remain un- reports have been completed in past years including
protected from iodine deficiency disorders.4 two health sector reviews and a how-to-guidance
Adequate intake of micronutrients, particularly on improving dialogue in areas including child and
iron, vitamin A, iodine and zinc, from concep- maternal health.