Malnutrition in Peru

Malnutrition is a condition that affects bodily capacities of an individual, including growth, pregnancy, lactation, resistance to illness, and cognitive and physical development.[1] Malnutrition is commonly used in reference to undernourishment, or a condition in which an individual's diet does not include sufficient calories and proteins to sustain physiological needs, but it also includes overnourishment, or the consumption of excess calories.[2]

Other terms exist to describe the specific effects of malnutrition on the body. Stunting refers to low height for age with reference to a population of healthy children. It is an indicator of chronic malnutrition, and high stunting levels are associated with poor socioeconomic conditions and a greater risk of exposure to adverse conditions such as illness.[3] Wasting refers to low weight for height with reference to a population of healthy children.[3] In most cases, it reflects a recent and acute weight loss associated with famine or disease.[3]

UNICEF statistics collected between 2008 and 2012 indicate that the level of stunting in Peru is 19.5%.[4] The percentage of the population that is underweight is 4.1%, and 9.8% of the population is overweight.[4] The physical effects of stunting are permanent, as children are unlikely to regain the loss in height and corresponding weight. Stunting can also have adverse effects on cognitive development, school performance, adult productivity and income, and maternal reproductive outcome.[3] The problem of stunting is most prevalent in the highland and jungle regions of Peru, disproportionately affecting rural areas within these regions.[5]

Causes

Major causes of malnutrition in Peru include food insecurity, diet, poverty, and agricultural productivity, with a combination of factors contributing to individual cases.[6]

Poverty plays a major factor in malnutrition because of the deprivations associated with it.[7] A study conducted by the Pan American Health Organization (PAHO) reported that children in the poorest 20% of Peruvian households had an eight-fold risk of dying from malnutrition than children from the richest 20%.[8] Families living under poverty have limited access to healthy, nutritious foods. Additionally, access to clean water and sanitation services may be restricted due to poor living conditions, which increases the risk of infection transmission.[7] Low school attendance rates means that children are excluded from school feeding programs.[7]

Rural-urban disparity

A study by Van de Poel et al. found that the proportion of under-5 stunting in urban Peru was 0.18 and 0.47 in rural Peru, with an absolute difference of 0.29.[9] Among the 47 developing countries surveyed for the study, Peru had the greatest rural- urban disparity in stunting rates.[9] One cause of the disparity could be the effectiveness of public expenditures in reaching target groups in rural and urban areas, as public spending only had a positive impact in children's nutrition outcomes in urban regions.[10] However, even in urban regions, there is a nutritional disparity among children of varying socioeconomic statuses due to barriers in place that limit indigenous and poorer children's access to public services.[10]

Effects

Malnutrition can cause physical, cognitive, and developmental problems, oftentimes irreversible and permanent. According to UNICEF, 30% of children below five years of age in Peru are stunted, and 18% are underweight.[11]

Health and productivity

One third of child deaths in Peru can be attributed to undernutrition, often because the existing state exacerbates disease.[11] In response to infectious diseases, the body's immune system activates, requiring increased energy consumption. Individuals who are undernourished fail to consume the minimum amount of calories necessary for baseline physiological needs, much less a full immunological response.[12] Thus, malnourished individuals are more susceptible to infection and are less able to fight diseases.[12] Additionally, low birth weight and stunted children are also at a greater risk of chronic diseases like heart disease and diabetes than healthy children.[13]

Micronutrient deficiencies are prevalent in Peru and impact human well-being. The World Health Organization (WHO) found that 15% of preschoolers in Peru were deficient in vitamin A.[14] They also found that the levels of anemia in preschoolers and pregnant women were respectively 50% and 43% in Peru.[15] Anemia is a condition linked with iron deficiency, which is linked to an increased risk of maternal mortality and impaired cognitive development in children.[15]

Management

Government intervention to improve nutritional health began in the seventies with the creation of the National Office for Food Support (ONAA) in 1972, an organization that primarily handled donations from overseas aid groups.[16] During the 1980s, the government expanded its role in food assistance with the creation of the Direct Assistance Program (PAD) for employment-based food aid for and the Vaso de Leche (VL) for young children under six years old.[17] By the 1990s, many food assistance initiatives and programs existed under different government agencies.[18] The ONAA and PAD offices merged to form the National Program for Food Assistance (PRONAA), controlled by the Office of the Presidency (Office of the Prime Minister).[18]

Despite the number of government aid groups targeting malnutrition and food accessibility, rates of chronic malnutrition did not significantly decrease during the 1900s.[16] The urban rate of child chronic malnutrition in 1996 was 25.8%, which dropped to 22.9% in 2005.[16] In rural populations, the child chronic malnutrition rate was 40.4% in 1996 and only dropped 0.3% by 2005.[16] A study conducted by Mendizabal and Vasquez examined the public budget on children from 1990 to 2000.[19] They found that much of the budgeted money failed to reach the extreme poor and the geographically isolated, such as individuals living in remote, rural villages.[20] There was high leakage in food and nutrition programs; more than US$1.2 billion was spent on this between 1996 and 2000 to yield a 1% decrease in the level chronic malnutrition in children under five.[20]

Vaso de Leche program

The Vaso de Leche (VL), or Glass of Milk, program is the largest social assistance program in Peru, with an annual budget of US$97 million in 2001, reaching over 3 million people, or 44% of households with young children.[21] In December 1984, around 25,000 women marched the streets of Lima to demand that children have the legal right to a glass of milk a day, because milk is often believed to be a commodity that meets the body's nutritional needs.[22] A month later, the government responded with Law 20459, laying the foundation for the Vaso de Leche program.[22]

Money is distributed to Peru's 1,608 local municipalities by the Ministry of Economy and Finance.[23] Each municipality is required to have an administrative committee of elected representatives.[24] In addition to milk and milk substitutes, the program also distributes cereals and other commodities.[24] The primary target group consists of households with children under the age of seven and pregnant or lactating mothers.[24] Secondary beneficiaries include families with children up to twelve years of age, the elderly, and individuals with tuberculosis.[22]

A study conducted in 2006 sought to evaluate the impact of the VL program on child nutritional outcomes.[24] The authors collected data from VL monthly program expenditures, VL Public Expenditure Tracking Survey, Demographic and Health Surveys from 1996 and 2000, and national household living standard surveys with information about participation in the VL program and child measurements. They examined the distribution of VL transfers at each quintile of income and calculated the intent-to-treat estimates of impact based on the value of the transfers. Calculations were controlled for household factors. They found that the VL transfers were targeted more toward lower quintile households, with the poorest 40% receiving three times as much aid as the richest 20%. From 1996 to 2000, the stunting rate among children decreased by 0.2%, from 26% to 25.8%, a statistically insignificant decrease. The study concluded that the VL program was effective at targeting households with low income or malnourished children, but it made no positive impact on reducing child stunting.[24]

JUNTOS conditional cash transfers

Peru's conditional cash transfer program commenced in 2005, aiming to reduce poverty and promote better education and health practices.[25] Eligible households must comply with conditions that include accessing basic public services for their children in order to receive a monthly cash transfer of US$30. The program targets impoverished households with children under the age of 14, and transfers are given to mothers. The agreement includes the completion of vaccination charts and pre and post-natal health check-ups, as well as using the National Nutritional Assistance Program package for children under three years old, which includes using chlorinated water and anti-parasite medicine. The program aims to focus more on addressing malnutrition in children, encouraging families to use the transfers to purchase more high protein foods. A study conducted by Perova and Vakis revealed that the program increased spending on food categories such as breads and cereals, vegetables, fruits, and tubers among participating households compared to a control group. The evidence suggests that more nutritious calories were consumed as a result of the cash transfers. Despite improving diets and increasing health service utilization, the JUNTOS program has not been able to affect final outcome indicators of nutrition.[25]

See also

References

  1. ↑ "Hunger Glossary". World Food Programme. Retrieved 12 October 2014.
  2. ↑ "Nutrition, Survival, and Development". UNICEF. Retrieved 12 October 2014.
  3. 1 2 3 4 "Global Database on Child Growth and Malnutrition". World Health Organization. Retrieved 12 October 2014.
  4. 1 2 "At a glance: Peru Statistics". UNICEF. Retrieved 3 October 2014.
  5. ↑ Rogers, Beatrice; Rajabiun, Serena; Levinson, James; Tucker, Katherine (February 2002). "Reducing Malnutrition in Peru: A Proposed Strategy".
  6. ↑ Aguiar, Christine; Rosenfeld, Josh; Stevens, Beth; Thanasombat, Sup; Masud, Harika (April 2007). "An Analysis of Malnutrition Programming and Policies in Peru".
  7. 1 2 3 Dewey, KG; Begum, K (2011). "Long-term consequences of stunting in early life". Matern Child Nutr. 7 (3): 5–18. doi:10.1111/j.1740-8709.2011.00349.x.
  8. ↑ Pan American Health Organization (2002). "Peru". Health in the Americas. 2: 454–470. Retrieved 17 October 2014.
  9. 1 2 Van de Poel, E; O'Donnell, O; van Doorslaer, E (2007). "Are Urban Children really healthier? Evidence from 47 developing countries". Tinbergen Institute Discussion Paper. TI 2007-035/3.
  10. 1 2 Gajate-Garrido, Gissele (2013). "Excluding the Rural Population: the Impact of Public Expenditure on Child Malnutrition in Peru". Policy Research working paper (6666).
  11. 1 2 UNICEF. "State of the World's Children. Estimates based on comparison of the most recent survey data with the WHO Child Growth Standards, 2006".
  12. 1 2 Schaible, UE; Kaufmann, SH (May 2007). "Malnutrition and infection: complex mechanisms and global impacts". PLoS Med. 5 (115): e115. doi:10.1371/journal.pmed.0040115. PMC 1858706Freely accessible. PMID 17472433.
  13. ↑ Cesar, VG; Adair, L; Fall, C; Hallal, P; Martorell, R; Richter, L; Harshpal, SS (Jan 26, 2008). "Maternal and child undernutrition: consequences for adult health and human capital". Lancet. 371 (9609): 340–357. doi:10.1016/S0140-6736(07)61692-4. PMC 2258311Freely accessible. PMID 18206223.
  14. ↑ WHO. "Global Prevalence of Vitamin A Deficiency in Populations at Risk 1995–2005". WHO Global Database on Vitamin A Deficiency.
  15. 1 2 WHO. "Worldwide Prevalence of Anemia 1993–2005" (PDF). WHO Global Database on Anemia.
  16. 1 2 3 4 Acosta, AM (2011). "Analyzing Success in the Fight against Malnutrition in Peru". IDS Working Paper (367).
  17. ↑ World Bank (2008). "Realizing Rights through Social Guarantees: An Analysis of New Approaches to Social Policy in Latin America and South Africa". Social Development Department (40047).
  18. 1 2 Acosta, AM; Haddad, L (2014). "The Politics of Success in the Fight against Malnutrition in Peru". Food Policy (44): 26–35.
  19. ↑ Minujin, A; Delamonica, E; Komarecki, M (2004). Human Rights and Social Policies for Children and Women: The Multiple Indicator Cluster Survey (MICS) in Practice. New York: New School University.
  20. 1 2 Vasquez, E; Mendizabal, E (2002). "Children First? Study of Focalized Social Expenditure in Children in Peru: 1990-2000". University del Pacifico/ Save the Children Sweden.
  21. ↑ Instituto Apoyo and the World Bank (2002). "Central Government Transfers to Municipalities in Peru: A Detailed Look at the Vaso de Leche Program".
  22. 1 2 3 Copestake, J (September 2006). "Multiple Dimensions of Social Assistance: The Case of Peru's Glass of Milk Program". WeD Working Paper 21.
  23. ↑ Bustamente, MAS (2003). "Caracterization del programa del Vaso de Leche". Ministry of Economy and Finance.
  24. 1 2 3 4 5 Stifel, D; Alderman, H (2006). "The 'Glass of Milk' Subsidy Program and Malnutrition in Peru". The World Bank Economic Review. 20 (3): 421–448. doi:10.1093/wber/lhl002.
  25. 1 2 Perova, Elizaveta; Vakis, Renos (March 2009). "Welfare impacts of the "Juntos" Program in Peru: Evidence from a non-experimental evaluation". The World Bank.
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