HEYWARD RESERVE LIBRARY

atCentre for Social Policy Studies University of Ghana.Legon

NUTRITION IN GHANA: INVESTING NOW FOR THE YEAR 2020

Nutrition Profile

Introduction
Ghana has a vision of becoming a middle income country by the year 2020. This vision can only be realized if the children being conceived and born today are giving the opportunity to live to their full potential. Sadly, however, this opportunity is outside their reach because if malnutrition. Current estimate indicate that about 28% of children under 5 years of age are underweight, as compared to 20% in Senegal and 12% in Cote de Ivoire. The main nutrition problems include inadequate intakes of energy and protein, iodine deficiency disorders, iron deficiency anemia and vitamin A deficiency. Although these problems are enormous, their full magnitude is unappreciated because usually there are no obvious signs of the problems, and the victims themselves are not aware. As a result not enough attention is paid to malnutrition. Adequate nutrition requires three complementary inputs, ie caring practices, (such as exclusive breastfeeding and appropriate complementary feeding in infancy), the protection of child health and the provision of adequate household food security. All are necessary to ensure good nutrition.

ii. Goals

Ghana's commitment to ensuring the health and well-being of children is manifest in the fact that following the World Summit for Children in 1990, it was the first country in the world to ratify the Convention on the Right of the Child. As a follow-up to the international Conference on Nutrition in 1992, The Government developed a National Plan of Action on Food and Nutrition with eleven specific objectives, including ensuring household food security, and the reduction of malnutrition in the population. The Ministry of Health has recently established targets for the prevention and control of Vitamin A, iron and iodine deficiences

iii. Consequences of malnutrition and benefits of action

To estimate the consequences of malnutrition in Ghana, PROFILES computer software were used. This software consists of a set of spreadsheet models based on recently published scientific research relating malnutrition to functional consequences in terms of death, sickness, mental capacity and economic productivity.
These consequences are calculated over a five year period from 1997-2001, the period of the current Medium Term Development Plan of the Ministry of Health for the Vision 2020.Costs and benefits are quantified in US dollars due to the significant fluctuation of the Cedi in recent years. The demographic data are based on the United Nations medium population projection for Ghana and the nutrition data come from national surveys. The consequences of malnutrition, beginning with Health.

a. Nutrition and outcomes

The major health consequences of malnutrition are mortality and morbidity. And the groups most at risk are children and women. Recent scientific evidence shows the massive contribution that malnutrition makes to under-five mortality levels in developing countries. Malnourished children have impaired immune systems which increases their risk of sickness and death. Being underweight dramatically increases the risk of death. In Ghana 28% percent of under five children suffer from being underweight. The contribution of this to Ghana's under five mortality rate is staggering.
Looking at the effect of malnutrition on child mortality we have estimated that in Ghana about 45% of all child death beyond early infancy are due to protein-energy malnutrition, making this the single greatest cause of child mortality. Because only one in six nutrition related deaths is due to severe malnutrition, significant reductions in mortality can only be achieved by preventing mild and moderate malnutrition.
If no improvement are made, malnutrition will account for 214,000 child deaths between 1997-2001. Another important nutrition related determinant that contributes to young child mortality is sub-optimal breast feeding practices. International experts recommend that babies should be exclusively breastfed for the first ^ months of life with no additional water, liquid or foods given.
However, in Ghana only 6% of mothers exclusively breast-feed their babies for the first 6 months. The infant mortality rate in Ghana is 66 deaths per 1000 live births during the first year of life. We have that sub-optimal breast-feeding practices contribute to about 10% of these infant deaths. In human terms the cost to Ghana of the current practices of non-exclusive breastfeeding during the first 6 months of life totals over 5,000 infant deaths each year. Optimal breastfeeding would also contribute to increase birth intervals, which in turn would benefit the health and nutrition of mothers and infants. Micro nutrient deficiencies also have an immense impact on child mortality in Ghana.
A significant problem is Vitamin A deficiency, which affects 26% of the country's under five population. Our calculations show that vitamin A deficiency accounts for 1 out of 6 of all child deaths between the ages of 6 and 59 months. Between 1997 and 2001 the number of child deaths due to Vitamin A deficiency will totals 49,000. In addition, women who are malnourished are more likely to face serious reproduction health problems which can lead to maternal and infant death.
For example, anemia during pregnancy, estimated in Ghana to affect close to 70% of pregnant women, has implications for maternal mortality. Ghana has an unacceptably high maternal mortality rate of 214/100,000.about 20% of this is due to anemia.

b. Child Morbidity

The strong relationship between child malnutrition and mortality is mediated through morbidity. Optimal breastfeeding protects infants against infections. About 14% of all acute respiratory infections under one year are due to sub-optimal breastfeeding practices as are 23% of all diarrhoea cases.
Vitamin A deficiency in children also has immense impact on morbidity levels. For example, vitamin A deficiency accounts for close to 5% of clinic attendances and 18% of hospital admissions of pre-school children. Improving nutrition would lead to substantial savings for the country because of the positive impact it would have on morbidity reduction especially in under-five children. For example, significant financial savings could be made if vitamin A deficiency were be to be eliminated by the year 2001. The savings to Ghanaian families in terms of the care of sick children would be about 11 million US dollars and savings to Government about 58 million US dollars. Let's see now how malnutrition can affect the learning capacity of children.

a. Education

Good nutrition is a major determinant of educational performance in children. Iodine, for example, is essential for the development of the brain during fetal life. Pregnant women living in iodine-deficient areas are likely to give birth to mentally retarded children. Results from various studies shows that 3% of all babies born to iodine-deficient mothers will be cretins,10% will be severely mentally retarded, and 87% would present some degree of intellectual deficit.
In iodine deficient communities, there is an average loss of IQ by about 13.5 points. The mental impairment on children resulting from iodine deficiency is permanent, having considerable impact on children's educability and drop-out rates. This leads to under-utilization of school facilities
In Ghana, the total goiter rate is 9.5%. using the projected birth rates for the five years approximately 11,000 babies will be cretins, 36,000 babies will be severely mentally retarded and 320,000 will be mildly impaired. With the appropriate intervention,176,000 children could be saved from various forms of mental retardation over the next five years. Such an intervention would have an enormous impact on the FCUBE program. Iron deficiency anemia reduces the learning ability, cognitive development and educability of children
. Recent data from the Ministry of Health's nationwide anemia survey show that 81% of pre-school children are anemic. Surveys conducted in the Volta region also show that 56% of school age children anemic.
Now let's look at the effects of malnutrition on.

c. Education Development

• Mental impairment due to iodine deficiency.
• Stunting due to protein-energy malnutrition; and
• Iron deficiency anemia

These three problems have a profound impact on work productivity.

Iodine Deficiency

The mental impairment caused by iodine deficiency is permanent. The present value of lost future wages due to iodine deficiency over the next five years is a bout 207 million dollars.

Stunting Due to Protein-Energy Malnutrition.

Stunting occurs when children do not get enough food to eat during the first, two years of life. Currently about 39% of all Ghanaian 2 year olds are moderately or severely stunted. Stunted children grow up to become stunted adults. And one of the most significant consequences of adult stunting is reduced physically capacity and productivity.
Research conducted in the Philippines shows that the productivity of physical labor declines by 1.4% for every 1% reduction in adult height. If current levels of stunting remain unchanged over the next five years, Ghana will lost 297 million dollars in future economic production as the direct result of the poor.

Iron Deficiency Anemia

Iron deficiency is another nutritional problem that has far-reaching effects on productivity. In Ghana, iron deficiency, is most common in young children and in women childbearing age. Data from national surveys indicate at about 81% of children under 5 years, 17% of non-regnant women and 69% pregnant women are anemic
Scientific research shows that there is at least a 1% reduction in productivity for each 1% drop in iron status. We project that between 1997 and 2001, 90 million dollars will be lost in agricultural productivity as a consequence of iron deficiency anemia in the female labour force.

SUMMARY OF CONSEQUENCES

Thus the total cost of malnutrition to worker productivity in Ghana is
• 207 Million due to mental impairment
• 297 Million due to stunting and
• 90 Million due to Iron deficiency anemia

This is a total loss of 594 million dollars- just over the 5 years and just for the problems we have examined here

Benefit Productivity increase

Now let's look at the productivity gains that can be realized by reducing goiter, stunting and iron deficiency anemia, as proposed. In calculating these potentials benefits we assume that these proposal targets are achieved by the year 2001; the virtually elimination of iodine deficiency in pregnancy, a reduction of both severe and moderate stunting by 1 percentage point per year, and education of anemia in women by a third. Summing all the potential productivity gains over the five years. Ghana is expected to gain. 105 million dollars from education of Iodine deficiency, 32 million dollars from reduction of stunting, and 16 million dollars from reduction of iron deficiency. This is a total of 153 million dollars in present value gained over five years. However, these gains cannot be realized without commitment, resources and effort put into solutions.

V. Solutions

If Ghana is to become a middle-income country by the year 2020, conscious efforts must be made to reduce malnutrition, particularly in infants, children and women of reproductive age. Specifically, intervention programs should:

• Promote better infant growth through Optimal breastfeeding;
• and appropriate infant practices

Strengthen the ongoing iron-folate supplementation program for pregnant women, Address the deficient iron status of infants and school-age children, Strength the vitamin A supplementation program for lactating women and children; and Implement a national communication strategy to promote the consumption of iodated salt
These strategies will only be successful and sustainable if they are coordinated with other programs such as those design to improve:

Household food security through

• Income generating activities
• Increased household food production
• Appropriate food utilization practices
• Timely relief form drought and other emergencies

Programs designed to improve maternal health through Labor saving devices Prenatal care, and Nutritional support for girl children and adolescents
Program designed to improve child health through
• Immunization
• Safe water supply
• Safe sanitation
• Vector control, and
• Integrated case management

V. Costs compared to benefits

The costs of implementing these programs are considerable but we have seen that if we only count the economic productivity benefits, these programs will still pay for themselves many times over. The unit costs of the project components, estimated from the literature, are shown in this table. Targeting the more expensive and intensive components of the program will reduce over-all costs and will maximize benefits.
The 5-year cumulative benefits and costs of each intervention components with an impact on economic productivity are summarized in this table: Compared to the 153 million dollar estimated five -year cumulative benefits, the 16 million dollar cost is relatively small, making this an investment opportunity with a benefit cost ratio equal to 9.6 Every 100 dollars invested will generate over 960 dollars just in economic productivity gains.
Given the conservative nature of many of our assumptions and the omission of many benefits, this must be considered an underestimate of the true value of this investment.

VI. Summary

In summary, our presentation shows that an adequate investment in nutrition in Ghana would avoid massive numbers of child deaths, a tragic dulling of mental capacity and huge losses in economic productivity.
This situation will only change if there is a strong political commitment and bold new investment strategy in nutrition. This investment will reap benefits far outweighing the cost; benefits to education, agriculture, industry and to the economic future of the country. Attainment of these social and economic benefits is our only hope of making Ghana's economic vision for the year 2020 a reality.

TABLE 1

BENEFIT COST ANALYSIS

UNIT COST PROJECT COMPONENT $0.05 Per Capita/year Salt Fortification $2.50 Per Infant Breast Feeding Promotion $10.00 Per Infant Intensive Education $2.50 Per Pregnancy Iron Supplement TABLE 2 BENEFIT COST RATIOS DISORDER BENEFIT COST B:C IDD 105.3 6.6 16.0 PEM 32.3 5.2 6.2 ANAEMIA 15.5 5.4 2.2 TOTAL 153.2 16.O 9.6

Key Results of Ghana PROFILES Analysis

Mortality

Almost half (45%) of child deaths beyond early infancy are due to the effects of malnutrition as indicated by underweight. Severe malnutrition (60% weight-for -age) accounts for only 1 out of 6 ( 16.2%) of these nutrition-related deaths.
Marginal Vitamin A deficiency, estimated to effect 26.1% of Ghanaian children, kills over 9,000 each year. Poor breastfeeding practices account for the deaths of 5,600 infants each year. All of these conditions make infants more susceptible to infections. Because diarrhoea and respiratory infections are the direct causes of these deaths, the role of nutrition is grossly unappreciated.

Education

Goitre, caused by iodine deficiency, affects 9.5% of the population. About 9.5% of infants are born with some mental impairment, reducing their future ability in school. Growth faltering and iron deficiency, affecting over half of school children, also reduce the efficient use of educational resources.

Economic Productivity

Current Losses

The present value of lost future productivity of children due to stunting in 1997 alone in $64 million. Iodine deficiency results in additional losses of about $40 million per year. Iron deficiency anemia, affecting an estimated 17.4% of women, results in current productivity losses of about $17 million per year.

Potential Gains

Not all these losses can be recovered feasibly over the next five years. However, reductions in moderate and severe stunting by 1 percentage point per year, virtual elimination of iodine deficiency and reduction of anemia by a third would yield economic productivity benefits worth an estimated $594 million over five years.