Food and Nutrition Situation

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The effects of household food security issues are most clearly reflected in the nation's food and nutrition status. As with any quantitative assessment for the Lao PDR, however, the food and nutrition situation presented here must be considered very carefully, since information systems are only rudimentarily developed and there are no institutionalized nutrition surveys. Even where nutrition status data are available, explicit statements of definitions, criteria, cut-off points, and the like are frequently varied and sometimes even missing. Nonetheless, data from a few prior nutrition surveys. current hospital records, site visits, and interviews highlight the Lao PDR's present nutrition problems and their extent.

Low birth weight

The prevalence of low birth weight (LBW) reflects infant and maternal nutrition status. In urban areas LBW appears to be under 10% and not a major problem. In 1984 Kripps collected data on 598 urban newborns and reported a mean birth weight of 3.07 + 0.42 kg 19]. A recalculation from these data, assuming a normal distribution. would give an incidence of urban LBW of approximately 8.8% at that time. Perez reported that LBW accounted for 9%-15% of newborns in some urban areas [10]. UNICEF noted an LBW of 8.38% among 4,510 deliveries at Mahosot Hospital between January 1989 and June 1990.

The data for rural estimates are cloudier but still below 10%. Data at the Lao PDR Maternal and Child Health Institute reveal wide discrepancies in LBW rates, with 6.78% (222 per 3,274 births) at Mahosot Hospital, compared to 4.73% (63 per 1,333) at the provincial hospital in Khammouane and 0.39% (10 per 2,534) in Champasak.

Protein-energy malnutrition in preschoolers

Three major nutrition-status surveys have been conducted among Lao preschool children (0-60 months of age). The 1984 Kripps study [9], conducted in day care centres in Vientiane and in Vientiane and Luang Prabang provinces and three provinces in the south (N = 6,612), is considered the first phase of the Lao PDR national nutrition survey; the Vijayaraghavan study in 1986 (unpublished WHO report) constituted a second phase covering selected areas of the other 11 provinces (N=6,967) [11]; and the unpublished Lao PDR Ministry of Health survey in 1988-1989 covered nine provinces, six in the north and three in the south (N= 6,378).

Assessments of nutrition status depend of course on the indicator and cut-off point used. Taking 60% of the US National Center for Health Statistics (NCHS) median weight for age (W/A) as the cut-off, severe malnutrition occurred in 2% of children in the 1984 study [9] and 2.8% in the 1986 study [11]. Bokeo, Luangnamtha, and Kammouane provinces were the poorest areas (more than 4%), and northern provinces were generally the worst off. With an 80% NCHS median cut-off point, malnutrition or undernutrition was 42% in 1984 and 55% in 1986 (average 48.5%). Northern provinces were worse off again by this criterion, and 60% of children were malnourished in Bokeo, Oudamsay, Luangnamtha, and Attapeu.

Using -2 standard deviations of the NCHS values for height for age (H/A) as the cut-off, stunting (which reflects chronic nutritional deprivation) was also widespread (40% in 1984 and 54.4% in 1986), especially in the north.

Recent small-scale surveys in three provinces by the Save the Children Fund (UK) have shown limited improvement in this situation. These surveys used -2 standard deviations as the cut-off point for both W/A (7%-14%) and H/A (20%-24%).

Children more than one year old who were being weaned constituted the most vulnerable group. In the 1986 survey, for each one-year stratum above one year of age, undernutrition (W/A) ranged from 61.9% to 62.8% [11]. Only 7% of infants under six months old and 36% of those 6-12 months old were considered malnourished. Regarding wasting (W/H), which reflects underfeeding, the problem is worst during the second half of the first year (15.9%) and then gradually improves thereafter (down from 11.3% in the third year to 2.5% in the fifth year). However, although the older children were better fed (W/H), stunting (H/A) persisted. Kripps [9] reports that severe wasting (W/H under 60%) occurred especially among children 12-24 months old (3%), with girls tending to be marginally better off than boys.

Micronutrient deficiencies

Micronutrient deficiencies are also an important nutritional problem in Lao PDR. Although up to the present there have been no detail precided data but most of those deficiencies are: Iodine, Vitamin and so on.

Bladder stones

Bladder stones are a major problem in Thailand and other countries of the region. They are caused by several nutrition factors, including (1) the early introduction of weaning foods, especially premasticated glutinous rice, which leads to less breast milk intake or water content; (2) inadequate phosphate intake, usually accompanied by high protein sources; and (3) high oxalate content from vegetables in the diet.

In the Lao PDR, Kripps noted that 40% of bladder-stone cases involved the introduction of rice within the first four weeks of life, while Vijayaraghavan reported rates of 22.1%-31.9%. Since people in north-east Thailand and the Lao PDR (especially Lao Loum) share a common culture and food habits, it is not surprising that bladder-stone disease is found among young boys in both populations. This was confirmed by team discussions with Lao PDR physicians. Experience in Thailand indicates that if supplementation is postponed until the child reaches the optimal age of 4-6 months and protein energy malnutrition has improved, a marked decrease in bladder-stone cases occurs.