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State of the World's Children 1998

Carol Bellamy, Executive Director, United Nations Children's Fund


CHAPTER II

Statistical tables

1  Basic indicators
2  Nutrition
3  Health
4  Education
5  Demographic indicators 
6  Economic indicators 
7  Women 
8  The rate of progress
   Measuring human development 
   Regional summaries country list

Statistics, vital indicators of the care, nurture and
resources that children receive in their communities and
countries, help chart progress towards the goals set at the
1990 World Summit for Children. The eight tables in this
report have been expanded to give the broadest possible
coverage of important basic indicators for nutrition, health,
education, demographics, economic indicators and the
situation of women, plus rates of progress and regional
summaries. They also include complete data, as available, on
less populous countries, covering 193 countries in all,
listed alphabetically. Countries are shown on page 93 in
descending order of their estimated 1996 under-five mortality
rates, which is also the first basic indicator in table 1.

Panels

1  Vitamin A supplements save pregnant women's lives
2  What is malnutrition?
3  Stunting linked to impaired intellectual development
4  Recognizing the right to nutrition
5  Growth and sanitation: What can we learn from chickens?
6  Breastmilk and transmission of HIV
7  High-energy biscuits for mothers boost infant survival by  
   50 per cent
8  UNICEF and the World Food Programme
9  Triple A takes hold in Oman
10 Celebrating gains in children's health in Brazil
11 Rewriting Elias's story in Mbeya
12 Women in Niger take the lead against malnutrition
13 BFHI: Breastfeeding breakthroughs
14 Tackling malnutrition in Bangladesh
15 Kiwanis mobilize to end iodine deficiency's deadly toll
16 Indonesia makes strides against vitamin A deficiency
17 Making food enrichment programmes sustainable
18 Zinc and vitamin A: Taking the sting out of malaria
19 Protecting nutrition in crises
20 Progress against worms for pennies
21 Child nutrition a priority for the new South Africa

Spotlights

World Food Summit
Ten steps to successful breastfeeding
Vitamin A
Zinc
Iron
Iodine
Folate

Text figures

Fig.1  Malnutrition and child mortality
Fig.2  Trends in child malnutrition, by region
Fig.3  From good nutrition to greater productivity and beyond
Fig.4  Poverty and malnutrition in Latin America and the      
       Caribbean
Fig.5  Causes of child malnutrition
Fig.6  Inadequate dietary intake/disease cycle
Fig.7  Intergenerational cycle of growth failure
Fig.8  Better nutrition through triple A
Fig.9  Iodine deficiency disorders and salt iodization
Fig.10 Progress in vitamin A supplementation programmes
Fig.11 Measles deaths and vitamin A supplementation
Fig.12 Zinc supplementation and child growth (Ecuador, 1986)
Fig.13 Maternal height and Caesarean delivery (Guatemala,     
       1984-1986)

References

Glossary

Press Kit
 Summary: Malnutrition: Causes, consequences and solutions
 Fact Sheet: Summing up malnutrition's shame
 Fact Sheet: Malnutrition: Causes
 Fact Sheet: Micronutrients
 Feature: Child malnutrition and women's rights
 Feature: In Burundi camps, the spetre of malnutrition looms
 Feature: Malnutrition in industrialized countries




The state of the world's children 1998 - Chapter II
******

Spotlight

Ten steps to successful breastfeeding

Every facility providing maternity  services and care for
newborn  infants should:

1.  Have a written breastfeeding  policy that is routinely
communicated to all health care staff.

2.  Train all health care staff in skills necessary to
implement this policy.

3.  Inform all pregnant women about the benefits and
management of breastfeeding.

4.  Help mothers initiate breastfeeding within a half-hour of
birth.

5.  Show mothers how to breastfeed and how to maintain
lactation even if they should be separated from their
infants.

6.  Give newborn infants no food or drink other than
breastmilk,  unless medically indicated.

7.  Practise rooming-in - allow mothers and infants to remain 
together - 24 hours a day.

8.  Encourage breastfeeding on  demand.

9.  Give no artificial teats or pacifiers (also called
dummies or soothers) to breastfeeding  infants.

10.  Foster the establishment of breastfeeding support groups
and refer mothers to them on discharge from the hospital or
clinic.

In addition, facilities should refuse to accept free and
low-cost supplies of breastmilk substitutes, feeding  bottles
and teats.

- From Protecting, Promoting and Supporting Breastfeeding:
The special role of maternity services; A Joint WHO/UNICEF
Statement (WHO, 1989) and 'The Global Criteria for the
WHO/UNICEF Baby-Friendly Hospital Initiative' (UNICEF, 1992)

                        * * * *

Spotlight on Vitamin A

Impact of deficiency

Vitamin A deficiency makes children especially vulnerable to
infection and worsens the course of many infections.
Supplementation with vitamin A is estimated to lower a
child's risk of dying by approximately 23 per cent. The
deficiency is also the single most important cause of
blindness among children in developing countries.

Who is affected

Over 100 million pre-school-age children suffer from vitamin
A deficiency. Vitamin A deficiency is also likely to be
widespread among women in their reproductive years in many
countries.

What vitamin A does

Vitamin A, stored normally in the liver, is crucial for
effective immune-system functioning, protecting the 
integrity of epithelial cells lining the skin, the surface of
the eyes, the inside of the mouth and the  alimentary and
respiratory tracts. When this  defence breaks down in a
vitamin A-deficient  child, the child is more likely to
develop infections, and the severity of an infection is
likely to be greater.

Depending on the degree of the deficiency, a range of
abnormalities also appears in the eyes of vitamin A-deficient
children. In the mildest form, night-blindness  occurs
because the rods in the eye no longer produce rhodopsin, a
pigment  essential for seeing in the dark. In more severe
forms, lesions occur on the conjunctiva and the cornea that
if left  untreated can cause irreversible damage, including
partial or total blindness.

Sources

Vitamin A is found as retinol in breast milk, liver, eggs,
butter and whole cow's milk. Carotene, a precursor of vitamin
A that is converted to retinol in the abdominal walls, is
found in green leafy vegetables, orange and yellow fruits,
and red palm oil.

                         * * * *

Spotlight: Zinc

Impact of deficiency

Zinc deficiency in malnourished  children contributes to
growth failure and susceptibility to infections. Zinc
deficiency is also thought to be  associated with 
complications of childbirth.

Who is affected

Data on the prevalence of zinc deficiency are unavailable, as
there is no reliable method of determining zinc status at the
population level. Zinc deficiency is likely to be a public
health problem, however, in areas where overall malnutrition
is prevalent; it is now recognized as such in many countries.

What zinc does

Zinc promotes normal growth and  development. It forms part
of the  molecular structure of 80 or more known enzymes that
work with red blood cells to move carbon dioxide from tissues
to lungs. Zinc also helps maintain an effective immune
system. Severe zinc deficiency causes growth retardation,
diarrhoea, skin lesions, loss of appetite, hair loss and, in
boys, slow sexual  development. Zinc has now been shown to
have a therapeutic effect on diarrhoea  cases.

Sources

Breastmilk has small amounts of zinc that are readily
absorbed. Other sources include whole-grain cereals, legumes,
meat, chicken and fish. Vegetables and fruits contain little
zinc but when eaten with cereals may increase the
bio-availability  of zinc in cereals.

                      * * * *

Spotlight: Iron

Impact of deficiency

Iron deficiency anaemia, the most  common nutritional
disorder in the world,  impairs immunity and reduces the
physical and mental capacities of populations. In infants 
and young children, even mild anaemia can  impair
intellectual development. Anaemia in pregnancy is an
important cause of maternal mortality,  increasing the risk
of haemorrhage and sepsis  during childbirth. Infants born to
anaemic mothers often suffer from low birthweight and anaemia
themselves. Causes include blood loss associated with
menstruation and parasitic infections such as hookworm, but
an inadequate intake of iron is the main cause.

Who is affected

Nearly 2 billion people are estimated to be anaemic and even
more are iron  deficient, the vast  majority of them women.
Between 40 and 50 per cent of children under five in
developing countries - and over 50 per cent of pregnant women
- are iron  deficient.

What iron does

The body needs iron to produce haemoglobin, the protein in
red blood cells responsible for carrying oxygen. Iron is also
a component of the many enzymes essential for the adequate
functioning of brain, muscle and the immune-system cells.

A certain amount of iron is stored in the liver, spleen and
bone marrow. Iron deficiency develops as these stores are 
depleted and there is insufficient iron  absorption. In
anaemia, the iron deficiency is so severe that the production
of haemoglobin is significantly reduced. The main symptoms
and signs are paleness of the tongue and inside the lips,
tiredness and breathlessness. Deficiencies of folic acid,
vitamin A, ascorbic acid,  riboflavin and various minerals
can also contribute to anaemia.

Sources

Iron is found in liver, lean meats, eggs, whole-grain breads
and molasses.

                       * * * *

Spotlight: Iodine

Impact of deficiency

Iodine deficiency is the single most  important cause of
preventable brain damage and mental retardation, most of the
damage occurring before birth. It also significantly raises
the risk of stillbirth and miscarriage for pregnant women.

Who is affected

The successful global campaign to iodize all edible salt is
reducing the risk associated with this deficiency, which
threatened 1.6 billion people as recently as 1992.
Nevertheless, it is estimated that 43 million people
worldwide are suffering from varying degrees of brain damage;
there are an estimated 11 million overt cretins. Some 760
million people have goitres.

What iodine does

Iodine is needed by the thyroid gland for normal mental and
physical development. Most commonly and visibly associated
with goitre (a swelling of the neck as the enlarged thyroid
works to collect iodine from the blood), iodine deficiency
takes a graver toll in impaired mental acuity. Persons
suffering from IDD face a range of serious impairments
including cretinism, spastic diplegia (a spastic paralysis of
the lower limbs) and dwarfism. Less severe deficiencies in
both adults and children can mean the loss of 10 to 15
intelligence quotient (IQ) points, as well as impaired
physical  coordination and lethargy.

Sources

Iodized salt is the best source of  iodine. Sea fish and some
seaweed also contain iodine, although sea salt does not.

                         * * * *

Spotlight: Folate

Impact of deficiency

Folate deficiency causes birth defects in the developing
foetus during the earliest weeks of pregnancy - before most
women are aware that they are pregnant. Folate deficiency has
been found to be associated with a high risk of pre-term
delivery and low birthweight, though it is not clear that
this would hold in all populations. Folate deficiency also
contributes to anaemia, especially in pregnant and lactating
women.

Who is affected

Although data are not abundant, in several developing
countries women in their  reproductive years have been found
to have very high rates of folate deficiency. Young children
are also likely to be at risk.

What folate does

This B vitamin helps in the formation of red blood cells.
Folate also regulates the nerve cells at the embryonic and
foetal stages of development, helping to prevent serious
neural tube defects (of the brain and/or spinal cord).

Sources

Folate is found in almost all foods, but the best sources are
liver, kidney, fish, green leafy vegetables, beans and
groundnuts.

                          * * * *

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