(January 2003) According to the World Bank, over half of child mortality in developing countries can be linked to malnutrition.1 From the earliest stages of fetal development into adolescence, proper food and good nutrition are essential to survival, physical growth, mental development, productivity, health, and well-being. Good nutrition increases children's resistance to disease and allows them to take full advantage of educational and social opportunities, laying the groundwork for a healthy and productive adult life.

According to the 2000 Cambodia Demographic and Health Survey (CDHS), almost half of all children in Cambodia (45 percent) under age 5 are malnourished.2 Lack of food is not the only cause of malnutrition. Poor feeding practices including inadequate breastfeeding, inappropriate foods, and insufficient quantities are all contributing factors. Infection — frequent or persistent diarrhea, pneumonia, and malaria — also undermines children's nutritional health. Interventions in Cambodia to improve child nutrition must focus on appropriate feeding practices for infants and young children and on the prevention and management of malnutrition and micronutrient deficiencies.

Early Breastfeeding an Important First Step

Proper nutrition begins from the first moment of life. Initial breastfeeding is one of the most effective interventions for child health: It provides nutrients, warmth, and immunological protection for the baby; promotes bonding between mother and child; and reduces postpartum hemorrhaging for the mother. The World Health Organization (WHO) recommends that newborns should be put to the breast within one hour of birth and should not go without breastfeeding for longer than three hours.3

In Cambodia, only 11 percent of newborns are breastfed in the first hour of life, and about 1 in 4 during their first day of life. Thus, the majority of newborns in Cambodia miss out on the disease-protective benefits of colostrum. Mothers who deliver at a health facility are slightly more likely to start breastfeeding within one hour of birth. Yet breastfeeding is initiated within 24 hours for only about 1 in 3 babies born in a health facility (see Figure 1).4


Figure 1
Initial Breastfeeding by Place of Delivery, Cambodia

 

Source: Cambodia Demographic and Health Survey 2000.


Exclusive Breastfeeding for the First 6 Months

Breastfeeding is the best way to meet the nutritional needs of infants. WHO recommends exclusive breastfeeding — receiving only breast milk without additional food or drink (including water) — during the first six months of a child's life. Exclusive breastfeeding limits exposure to pathogens and reduces infants' risk of infection (particularly diarrheal diseases) and provides all the nutrients that a baby requires. The Joint United Nations Programme on HIV/AIDS (UNAIDS) also recommends exclusive breastfeeding for the prevention of mother-to-child HIV transmission in developing countries where infant mortality is high. While HIV can be transmitted through breast milk, the risk is reduced with exclusive breastfeeding and the benefits against other infections outweigh the risks of nonexclusive breastfeeding.5

Only 11 percent of children in Cambodia are exclusively breastfed (see Figure 2). The introduction of other liquids such as water, juice, and formula takes place earlier than the recommended age of 6 months. Even among breastfed children under 2 months old, 82 percent consume other liquids: The majority (70 percent) drink plain water in addition to breast milk.6


Figure 2
Breastfeeding Status of Infants Ages 0 to 5 Months in Cambodia

Source: Cambodia Demographic and Health Survey 2000.


Complementary Feeding After 6 Months

WHO recommends the introduction of solid food to infants around the age of 6 months because by that age breast milk is no longer sufficient to maintain a child's optimal growth. Rapid weaning from exclusive breastfeeding has also been shown to reduce the risk of HIV transmission from an infected mother to her child.7 The transition from exclusive breastfeeding to receiving complementary foods such as cereals, grains, and solid or semi-solid food is a vulnerable period. It is the time when malnutrition starts for many infants and contributes significantly to the 40 percent prevalence in children under age 5 worldwide. In Cambodia, almost one-third of breastfed infants under 6 months old consume cereals, grains, and some type of solid and semi-solid food. Weaning takes place more rapidly by ages 6 months to 7 months — more than two-thirds of children receive complementary food by this age.8

Nutritional Status of Young Children

Meeting the body's needs for calories and nutrients is essential for good health. Prolonged reduction in calories or nutrients below children's needs can impede their physical growth and mental development.

Malnutrition

Nearly half of children (45 percent) under age 5 are short for their age as a result of prolonged poor diet and disease. Fifteen percent of children are thin for their height, which reflects recent and severe weight loss, often as a consequence of acute shortage of food or severe disease (see Figure 3).9 Malnourished children have lower resistance to infection and are more likely to get sick and die from common childhood ailments like diarrheal diseases and respiratory infections. For those who survive, frequent illness can weaken their nutritional status, locking them into a cycle of recurring sickness, faltering growth, and diminished learning ability.


Figure 3
Percent of Malnourished Children Under Age 5 in Cambodia

 

Source: Cambodia Demographic and Health Survey 2000.


Micronutrient Deficiencies

Anemia Iron deficiency anemia (IDA) is another indicator of overall nutrition deficiency. IDA can be the result of lack of iron in the diet, poor absorption of dietary iron, malaria, or parasitic infection. In children, IDA can impair mental performance, coordination, language skills, and scholastic achievement. Anemic children are also more susceptible to disease due to impaired functioning of the immune system and lower levels of energy and productivity. Figure 4 shows the prevalence of anemia among children under 5 in Cambodia.


Figure 4
Anemia in Children Ages 6 Months to 59 Months, Cambodia

 

Source: Cambodia Demographic and Health Survey 2000.


Vitamin A Vitamin A is an essential micronutrient for normal eye function, growth and development, the ability to fight disease, and reproduction. Affecting about 100 million young children worldwide, vitamin A deficiency (VAD) is the leading cause of blindness in children in developing countries. Even mild deficiencies can compromise a young child's immune system, reducing resistance to diseases such as malaria and diarrhea. Children with VAD face a 25 percent greater risk of dying from childhood illnesses than those with an adequate intake of this micronutrient.

While the CDHS did not directly assess the extent of VAD, it did assess the percentage of children under age 5 who consumed vitamin A-rich foods in the seven days preceding the survey. More than three-fourths (76 percent) of children under age 5 consumed vitamin A-rich foods (e.g., pumpkin, red or yellow yams, or squash; green leafy vegetables; fruits such as mango, papaya, and jackfruit; and protein sources such as poultry, fish, shellfish, or eggs).11 Further assessment of VAD prevalence across Cambodia is urgently needed, and current efforts to combat VAD through the distribution of high-dose vitamin A capsules need to be improved.12

Policy Implications

Breastfeeding and complementary feeding behaviors are important predictors of infant and child nutrition, health, and survival. Survey data indicate that breastfeeding practices in Cambodia fall far short of international recommendations. Education on breastfeeding and feeding practices should be included as part of maternal care and in the prevention of mother-to-child HIV transmission, emphasized in community-based behavioral change interventions, and supported by advocacy at the national level.

Investing in childhood nutrition has both short- and long-term benefits of economic and social significance, including reduced health care costs throughout the life cycle, increased educational attainment, greater intellectual capacity, and increased adult productivity. The consequences of undernourishment extend into adulthood. Meeting the dietary needs of Cambodia's young and growing population is key to sustaining its well-being and its mental, physical, and social development.


References

  1. World Bank International Development Association (IDA), IDA: Providing for a Healthier Population, accessed online at www.worldbank.org/ida/idahnp.htm, on Aug. 1, 2002.
  2. National Institute of Statistics (NIS), Directorate General for Health [Cambodia] and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000 (Phnom Penh, Cambodia, and Calverton, Maryland: NIS Directorate General for Health and ORC Macro, 2001): 174.
  3. World Health Organization (WHO), Nutrition and Infant Feeding, accessed online at www.who.int/child-adolescent-health/NUTRITION/infant_exclusive.htm, on Aug. 3, 2002.
  4. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 164.
  5. Joint United Nations Programme on HIV/AIDS (UNAIDS), Report on the Global AIDS Epidemic (Geneva: UNAIDS, 2002).
  6. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 166.
  7. UNAIDS, Report on the Global AIDS Epidemic.
  8. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 166.
  9. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 174.
  10. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 179.
  11. NIS Directorate General for Health and ORC Macro, Cambodia Demographic and Health Survey (CDHS) 2000: 185.
  12. Helen Keller International (HKI), "Vitamin A Capsule Distribution After the NID — Lessons Learned," Cambodia Helen Keller International Nutrition Bulletin 1, no. 2 (Jan. 2000).