Catalog

Small Investments Could Save Millions of Asia's Children
Early childhood development is critical to stopping micronutrient deficiencies

By Joseph M. Hunt (jhunt@adb.org)
Senior Health and Nutrition Economist

The world's underweight and stunted children and mothers are concentrated in Asia. The Asian Development Bank (ADB)'s Annual Report 2000 reveals in its theme chapter, Develop A Child, some stark and alarming facts about the crisis facing Asia's young.

• Six million children under five years of age—more than half of the world's total—die each year in developing Asia. Underweight children account for more than half of these deaths. Of the rest, most die from diseases that could be prevented by vaccination and simple medication.
• Three quarters of the world's underweight and stunted children are in Asia.
• Three quarters of those suffering from vitamin A, iodine, and iron deficiencies—mostly young children and their mothers—are in Asia.

The human body needs only tiny amounts of vitamins and minerals for normal development, yet micronutrient deficiency is a major cause of death and disability. Vitamin A deficiency is implicated in a substantial proportion of maternal and under-five deaths. Major supplement programs are in place to raise vitamin A status in the region. But in South Asia, only one child in four receives them.

Iodine deficiency disorders are the world's leading cause of mental disability. Iodized salt is the cost-effective solution. The Universal Salt Iodization initiative, led by the United Nations Children's Fund (UNICEF), increased the percentage of the world's households using iodized salt from one fourth to over two thirds in the late 1990s. But a billion Asians still lack sufficient iodine in their diets. In Bangladesh and Central Asia, palpable goiter is endemic.

Anemia, a form of iron deficiency, is the most prevalent nutritional problem. In Asia, more than a billion people lack iron. In South Asia, nine out of 10 pregnant women are anemic and at higher risk of dying during pregnancy. An ADB study showed that at least 65,000 anemic pregnant women die each year in low-income Asia. For half of Asia's infants and school-age children, anemia leads to poor motor skills and delayed speech and reading.

The consequences of malnutrition are staggering: unsafe fertility, premature death, disability, lifelong susceptibility to illness, poor cognitive and learning skills, low achievement in school, low wages, and weak capacity to invest in the quality of the next generation's children.

Economic and social costs are high. Low-cost investments could significantly and sustainably improve the health, nutrition, education, and environment of children. Yet within the region, the share of a national budget allocated to basic education and children's health and nutrition is often low.

Political will, and the willingness of public and private sectors to work together, can change this. For example, since the dissolution of the former Soviet Union, republics in Central Asia and the Caucasus have been unable to produce high-quality essen ial foods, and this has led to a sharp increase in micronutrient malnutrition and stunting of children. In a pilot project, ADB, regional governments, and food manufacturers are working together to fortify salt and flour.

Early childhood development (ECD) programs support the biological and mental development of children from birth through the early years of primary school. They provide integrated child health, nutrition, and early education programs for children up to six years of age, often followed by an enriched ECD-friendly curriculum and learning environment in the early primary grades.

At the World Summit for Children and Education for All (EFA), governments in Asia and the Pacific committed themselves to major improvements in child health, nutrition, and educational enrollment by 2000. But few of these goals were reached. The EFA global review in 2000 concluded that child readiness for learning had been underemphasized and that ECD programs are vital to reaching poor children and children in remote areas who might enroll late or never, and are more likely to drop out of primary school.

ECD programs combine nutrition, health, psychosocial care, and cognitive stimulation. These synergies optimize impact and lower unit costs. Children with a preschool background socialize more, are less likely to drop out, and adjust more quickly to formal learning.

Poverty reduction is best sustained when the lives of young children are transformed. An ECD Project (1998–2003) in the Philippines, cofinanced by ADB and the World Bank, is doing just that for five million children. This is another novel partnership between national and local governments, international agencies, and communities. In few other important fields can relatively small investments go a long way in saving millions of children.

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