Laos - Food and Nutrition Security Profiles

Key Indicators Laos - Food and Nutrition Security Profiles In Lao PDR, GDP per capita has increased consistently during recent years, as has Dietary Energy Supply (DES) per person. Nevertheless, undernutrition indicators have not been ameliorated. Lao PDR thus still faces high levels of stunting, underweight, Vitamin A deficiency and anaemia. Although the country has experienced a significant improvement in access to improved water sources and improved sanitation, these continue to be a key development challenge. Large disparities exist between urban and rural settings. Lao PDR has joined the global Scaling Up Nutrition (SUN) movement since 211, and has adopted also a series of national food and nutrition security policies to address food and nutrition security. Figure 1.1 Food Availability From 199 to 211: DES increased 15% Animal-origin supply increased 87% Vegetal-origin products increased 11% and remain the major DES source 25 2 15 1 5 244 18 1936 2356 22 2154 199 211 Vegetal Origin Kcal per person per day Figure 1.2 Undernourishment and Economic Growth From 199 to 212: GDP increased 17% Undernourishment declined 4%, but remains at 27% overall GDP per person, PPP (constant 211 dollars) Undernourished in total population International $ 5 45 4 35 3 25 2 15 1 5 54 53 44.7 1622 5 4388 199 1992 1996 1998 2 22 24 26 28 21 212 Source: GDP: WDI 214 / Undernourished: FAO FSI_213 Figure 1.3 Child Malnutrition From 1993 to 211: Stunting declined 18%, but is still very high at 44% Underweight declined 33%, but is still high at 27% Wasting was 6 % in 211. Overweight stood at 2% Low Birth Weight is 15%, a public health concern Overweight Underweight 45 4 35 3 26.7 25 48 48 44 4 36 36 32 Stunting Wasting 27 Figure 1.4 Child Mortality From 199 to 212: Under-5 mortality reduced 56%, but is unlikely to meet the Millennium Development Goal (MDG) target without further acceleration of progress Infant mortality reduced 52% Neonatal mortality reduced 38 % 162.9 MDG Target 12 54 111.5 43.9 199 1995 Figure 1.5 Anaemia Anaemia is a severe public health issue, high among pregnant women (56%), non-pregnant women (46%) and under-2 children alike (48%) Deworming and iron supplementation can be effective for reducing anaemia in pregnant women as well as children. Total <2 yr Children <5 years Non - pregnant women of reproductive age Pregnant women 2 4 6 8 1 Prevalence of Anaemia (%) Source: WHO Worldwide prevalence of Anaemia (1993-25) Anthropometry (Table 1.1) Underweight women (BMI < 18.5 kg/m2) Overweight adults (BMI >= 25 kg/m2) 78.4 71.8 84.7 58.2 54 37.2 28.8 27.2 2 25 48 46 56 21 14.5 % 8.5 % 212 Infant Neonatal Under fives Source: Inter-agency Group for CME (213) 26 2 215 Animal Origin Total Dietary Energy Supply (DES) Source : FAOSTAT FBS: 214 update 1993 Source: 3 2 26 LAO_LSIS 211-212/WHO Global Database on Child Growth and Malnutrition 213 1 6 2 211-212 * BMI values calculated using adult cut off points, population < 2 should be analyzed using WHO growth reference for school aged children and adolescents Proportion of infants with low birth weight 15 % Source: Lao LSIS 211-212 /National Nutrition Survey, 26 211

Food Availability / Food Access Access to food Figure 2.2 Economic access to food General and food inflation 2 General inflation Food inflation 18 16 14 Food Availability Figure 2.1 Food supply by food group (kcal/person/year) Total dietary energy supply= 2,356 (211) 12 1 8 6 4 6 Cereals 211 199 158 1565 2 2 21 22 23 24 25 26 27 28 29 21 211 212 Rice 1436 1434 Source: ILOSTAT Database Consumer Price Indices 214 Wheat Meat & Milk & Eggs Sugars and syrups Fruits & vegetables 15 4 152 82 58 21 167 41 General inflation is correlated with food inflation (Fig. 2.2) Families spent 41% of their income on food. While cereals contributed with 81% of daily energy consumption; they only affected 16% of food expenditures at household level. In contrast, 5% of income was spent on fish, which represents 1% of food intake. Vegetable oils 15 29 Fish & Fish products 32 13 Animal fats Pulses Starchy roots 18 13 28 28 18 155 Figure 2.3 Share of food expenditure 1 Non food items (28) 4 8 1,2 1,6 2, Source: UN_FAO Food Balance Sheets_214 Update 8 Cereals Cereals remain as the most important source of food energy (67%), with rice comprising more than 9% of that Fruits and vegetables (75%), fish and fish products (59%), sugars and syrups (64%), and meat, milk and eggs (46%) all have increased significantly, though overall contributions are still minimal 6 59 Fruits and vegetables Fish Sugars 81 4 16 Veg oils 2 5 Meat, milk and 5 eggs 2 1 9 Other 5 5 6 % Total expenditure per person per day 1 % Dietry energy Consumption Sources: UN_FAO RAP based on national HIES, ECS, SES, HLSS_213 Update, Laos

Food Utilization Laos - Food and Nutrition Security Profiles Food utilization refers to household preparation practices of foods, which influence nutrient content of consumed foods, and to the absorption of nutrients by the human body after consumption. Nutrient absorption in the gut is strongly influenced by health status, particularly the presence of diarrhoea. Hygienic environmental conditions related to improved water and sanitation are important determinants of health and infection incidence and prevalence. Water and Sanitation Figure 3.1 Access to Improved Sanitation From to 212: Access to improved sanitation increased 221% in 18 years, but 35% of people still do not have such access Disparities between rural and urban areas persist, although areas have increased their access to improved sanitation % Population 1 8 6 4 2 62 2 9 65 51 % Population Figure 3.2 Open Defecation From to 212: In 211 29% of households continued this unhygienic practice, mostly in rural areas (42%) 1 8 6 4 2 78 7 26 42 29 % Population Figure 3.3 Access to Improved Water Sources From to 212: Access to improved water sources increased 8% during 18 years Disparities in access between urban and rural reduced considerably, mostly by improving the situation in rural areas, where access increased 88% 1 8 6 4 2 7 4 34 84 72 65 12 4 1997 2 23 26 29 212 1996 1998 2 22 24 26 28 21 212 1996 1998 2 22 24 26 28 21 212 Total Rural Urban Total Rural Urban Total Rural Urban Source: WHO-UNICEF Joint Monitoring Programme, 214 Source: WHO-UNICEF Joint Monitoring Programme, 214 Source: WHO-UNICEF Joint Monitoring Programme, 214 Food Safety Figure 3.4 Diarrhoea Diarrhoea is three rimes more frequent among the poorest wealth quintiles as among the wealthiest, reflecting disparities in improved sanitation as well as in general hygiene and food safety Management of Diarrhoea (Table 3.1) 25 2 15 15 11.6 1 8.4 5.7 4.7 5 Lowest Second Middle Fourth Highest Wealth quintile Source: LAO_Lao Social Indicator Survey 211-212 Zinc Share of children under age 5 with diarrhoea receiving zinc treatment Existing policy framework Zinc Supplementation and Reformulated Oral Rehydration Salt in the Management of Diarrhea Source: LAO_Lao Social Indicator Survey 211-212 1 %

Food Utilization Nutrition and Health Figure 3.5 Exclusive Breastfeeding Early initiation of breastfeeding increased from (32% to 39%) from 2 to 211 Exclusive breastfeeding have increased significantly, but still more than half of children don't exclusively breast fed from -5 months. Figure 3.6 Complementary Feeding Introduction of complementary feeding is timely for 5% of children Only 43% of children aged 6-23 months meet the minimum meal frequency 1 Introduction of solid, semi-solid or soft 5 food 8 Early initiation of breastfeeding Exclusive breast feeding rate (-5 months) Minimum dietary diversity 6 4 32 4 3 Minimum meal frequency 43 39 2 26 Minimum acceptable diet 2 26 211-2 4 6 212 Source: LAO_Lao Social Indicator Survey 211-212 Source: LAO_Lao Social Indicator Survey 211-212 Figure 3.7 Duration of Breastfeeding More than 5% of children continued to breastfed after age 2 years Complementary feeding begins prior to age 6 months for a significant proportion of breastfed children 1% 8% 6% Breast milk and complementary foods Not breastfeeding 4% 2% Exclusively breastfed % -1 2-3 4-5 6-7 mo 8-9 mo 1-11 12-13 14-15 16-17 18-19 2-21 22-23 mo mo mo mo mo mo mo mo mo mo Breast milk and other milk Breast milk and plain water only Breast milk and non-milk liquids Source: LAO_Lao Social Indicator Survey 211-212 Figure 3.8 Child Malnutrition and Poverty Children in the poorest quintile have 3 times higher stunting and weight deficits than children in the waelthier quintile Overweight is not a public health issue 7 6 5 4 3 2 Overweight Stunting Underweight Wasting 6.6 36.5 5.2 29.6 41.9 25.2 31.7 19.4 19.7 Micronutrient Status 1 Vitamin A Supplementation 75 Coverage - full children 6-59 months /a 5 59.1 44.7 Vitamin A Deficiency 25 (Pre-School Aged Children) <.7umoL /b * VAD is a severe public health problem if >2% of preschool children (6-71 months) have low serum retinol (<.7µmol/L) Source: a/ LAO_Lao Social Indicator Survey 211-212 b/ WHO Global prevalence of vitamin A deficiency in population at risk 1995-25 report. Figure 3.9 Vitamin A Vitamin A supplementation of 59% is not satisfactory and may be related to high vitamin A deficiency levels. Vitamin A deficiencies still represent a severe public health concern at 45%, indicating that Vitamin A remains lacking in the daily diet, and that food-based interventions, including food fortification, deserve ongoing attention. 1 12.1 6.4 6.4 5.8 5.2 5.1 2 2.5 1.7 2 2.1 Lowest Second Middle Fourth Highest Source: LAO_Lao Social Indicator Survey 211-212 Iodine (Table 3.2) Households consuming iodized salt /a Iodine deficiency (Urinary Iodine Concentration <1ug/L) among school-age children (23) /b 79.5 % 26.9 % *Optimal UIE 1-199ug/L Source: a/ LAO_Lao Social Indicator Survey 211-212 b/who Global database on idodine deficiency

Enabling environment for Nutrition and Food security - Policy documents addressing nutrition issues 1. National Food Security Strategy 2-21 Policy Table - 1 2. National Nutrition Policy 28 3. National Nutrition Strategy and Plan of Action 21-215 4. Decree on (mandatory) Universal Salt Iodization Nutrition related issues covered in these policies Covered Comments Maternal and Child Undernutrition Child undernutrition Low Birth Weight Policy covers stunting, wasting and underweight Community-Based Management of Acute Malnutrition (CMAM) piloted in vulnerable areas; requires capacity strengthening Maternal undernutrition Obesity and diet related NCDs Child obesity Adult obesity Diet related NCDs Infant and Young Child Nutrition Breastfeeding National Guidelines on Infant and Young Child Feeding 213 Complementary feeding Provisions of the Int l Code on BMS partially adopted (1995); revised in 27and undergoing another revision to be strengthened further; monitoring and enforcement weak. Int l Code of Marketing of BMS Vitamins and Minerals Supplementation: Vitamin A children/women Iron Folate children/women Zinc children Other vitamins & min child/women Vitamin A Supplementation guidelines for children 6-59 mo. Deworming guidelines for children 12-59 mo. Policy to use zinc with Oral Rehydration Salts in management of diarrhoea adopted but not implemented Ministry of Health is developing delivery modalities for home fortification with multiple microntrient powder for young childre through public and private sectors Food fortification Mandatory: Salt Food Safety Underlying and contextual factors Food security Food Aid Nutrition and Infection Gender Maternal leave 13 weeks Social Protection policies or legislation including food or nutrition component No institutionalized cash transfer schemes in Lao PDR, although a few donor-supported pilots are currently in operation The World Food Programme (WFP) provides unconditional food transfers, in the form of either on-site feeding or take-home rations, and under the WFP school feeding programme Food safety policies or legislation 1. Food law (213) This Law defines principles, regulations and measures on the management, monitoring and inspection of food and food business to ensure quality, effectiveness, and safety aiming at protection consumers' health. 2. Law on Hygiene, Disease Prevention and Health Promotion (212) 3. National Food Safety Policy, Ministry Health No 2/MoH, adopted by PM degree No: 28/PM 3/2/29 http://www.foodsecuritylink.net/laopdr/index.php?option=com_remository&itemid=13&func=fileinfo&id=44 Other policies addressing food security The National Nutrition Policy promotes a multisectoral approach, although multi sectorial coordination mechanisms need further strengthening. Maternity leave for 15 days at full pay; provisions for nursing breaks after return to work This Law defines principles, regulations and measures on the management, monitoring and inspection of food and food business to ensure quality, effectiveness, and safety aiming at protection consumers' health.

Policy Table - 2 Demographic Indicators (Table - 5.1) Year Economic Indicators (Table - 5.3) Year Population size (thousands) /a 6,646 212 GDP annual growth rate /c 8.2 % 212 Average annual population growth /a 1.89 % 212 Proportion of population urbanised /c 34.3 % 211 GDP per capita (PPP) (constant 211 international dollars) /c 4,388 212 Number of children <5 years (thousand) /a 86 212 Education level of mothers of under-fives: None (%) /f 32 211 Gini index /c (1= complete inequality; = complete equality) 36.74 28 32.63 22 Male 66 212 Life expectancy at birth (Years) /c Female 69.2 212 Agriculture population density(people/ ha of arable land /b) 3.7 26-28 Unemployment rate /c 1.3 % 212 Population below US $ 1.25 (PPP) per day /c (%) 33.88 28 Employment in agriculture sector (% of total employment) /c 85.4 % 1995 Poverty gap ratio /e 9 28 Women employed in agriculture sector (% of total female employment) /c) Adolescents (Table - 5.2) 89.3 % 1995 Year Income share held by households /c Poorest 2% Richest 2% 7.64 % 28 44.84 % 28 Adolescent birth rate (number of births per 1, adolescent girls aged 15-19) /a 65 212 Adolescent girls aged 15-19 currently married or in union /d 25 % 25 212 Women aged 2-24 who gave birth before age 18 /d (%) 18 28 212 Sources: a/ World Bank Health Nutrition and Population Statistics 213 b/ FAOSTAT 213 Update; c/ World Bank, World Development Indicators Database, 214 Update; d/ UNICEF, State of the World Children 214 (data refer to the most recent year available during the period specified) e/ UN Statistics Division, MDG database 213 Update. f/ LAO_Lao Social Indicator Survey 211-212 The information inlcuded in this Food Security and Nutrition profile, is backed by recognized, validated and properlty published information available untill June 214. Although updated information might be available at national level form different sources, until requirements of quality, validity and proper publication are met, it has not been inlcuded in this profile.