This document discusses nutrition in the Arab world and provides recommendations to improve food security. It finds that 1 in 5 children in the Arab world are malnourished, with even higher rates in some countries. Economic growth has not effectively reduced malnutrition rates. Public spending on nutrition and related services needs to increase to address this issue. The document recommends scaling up investments in nutrition and integrating food/nutrition security into national programs based on Brazil's successful approach.

1. Positioning Nutrition as
Central for a Food
Secure Arab world
Clemens Breisinger, Olivier Ecker, Marc Nene and Perrihan
Al-Riffai, International Food Policy Research Institute (IFPRI)
Convener: The World Bank
Session - Food Security: Beyond Food Production
14 November, 14.30 – 16.00

2. 1
Contents
Summary................................................................................................................................................2
1. Introduction......................................................................................................................................3
2. Nutrition in the Arab world............................................................................................................5
3. Highlights of nutrition interventions .........................................................................................10
4. Summary..........................................................................................................................................12
References ..........................................................................................................................................14

3. 2
Summary
Food insecurity is a multi-dimensional challenge and nutrition is a central part of
achieving food security. Overcoming malnutrition, especially among children, is not
only important for achieving food security, but also important for realizing
successful future economic development. However, in the Arab world, on average
every fifth child younger than five is malnourished, while in Egypt and Sudan about
every third and in Yemen almost two thirds of children are stunted. To overcome
this unacceptable situation, this paper has raised a couple of important policy
questions and provided two initial suggestions for action that are based on global
experiences. Questions that need to be urgently addressed are: why is it that
economic growth (and rising incomes) does not seem to improve nutrition in Arab
countries? How can public resources be better targeted at improving food and
nutrition security? Global experiences show that the nutrition part of food security
tends to be underfunded in government budgets and in the budgets of the
international development assistance community relative to the size of the
problem, suggesting that investments in nutrition need to be scaled-up. The case
of Brazil shows the importance of integrating food and nutrition security into
national programs and demonstrates how well-crafted nutrition policies under
strong political leadership can engender a substantial reduction in chronic
malnutrition.

4. 3
1. Introduction
Food and nutrition insecurity is a multi-dimensional challenge. The World Food
Summit in 1996 defined food security as a situation ‚when all people, at all times,
have physical, social and economic access to sufficient, safe and nutritious food to
meet their dietary needs and food preferences for an active and healthy life‛ (FAO
1996, par. 1). At the World Summit of Food Security in 2009, this definition was
reconfirmed, and the concept was extended and specified by adding that the ‚four
pillars of food security are availability, access, utilization, and stability‛ and stated
that ‚the nutritional dimension is integral to the concept‛ (FAO 2009b, p. 1, fn. 1).
To conceptualize the multiple dimensions of food and nutrition security, Ecker and
Breisinger (2012) have developed a framework that builds on the World Summit
definition and integrates the four pillars of food security into a system approach. It
links food security and nutrition acknowledging that food security at the household
(and individual) level is a necessary but not sufficient condition for adequate
nutrition and that food and nutrient intake interacts with the individual health
status (Figure 1).
Figure 1: Overview of the Food Security System
Source: Ecker O. and C. Breisinger. 2012.

5. 4
Nutrition is an important part of food security. Nutrition of all members of a
household is subject to the household’s economic (and physical) access to food and
to basic household assets and (public) services that affect individuals’ health
conditions. A major factor of food access is household (real) income and the lack of
income does not only limit the access to food of sufficient quantity and quality but
also increases the vulnerability to food price shocks (Barrett 2002). Formal
education and nutritional knowledge of parents, especially mothers (Behrman and
Wolfe 1984; Glewwe 1999; Semba et al. 2008), and gender equality in decision
making on household resource allocation (Behrman and Deolalikar 1990; Kennedy
and Peters 1992; Thomas 1994) are also crucial factors of the nutritional status of
young children in particular. Children’s nutritional status is directly determined by
the mother’s nutritional and health status through the physiological and social
mother-child relationship. Finally, a person’s nutritional status is determined by her
individual health status (and vice versa), influencing physiological nutrient
requirements and interacting with the utilization of nutrients from food. For
example, parasitic and diarrheal diseases cause nutrient losses through blood and
stool and reduce nutrient absorption necessitating higher nutrient intake and thus
more food to cover the losses, if such compensation is possible at all (Katona and
Katona-Apte 2008; Stephenson et al. 2000). At the same time, poor nutrition
weakens the human immune system and therewith increases the risk of disease
and illness (Black et al. 2003). Thus, access to clean drinking water, hygienic
sanitation, proper shelter, basic health care for disease and illness treatment and
prevention including immunization, and related information and education
campaigns all determine people’s nutritional status indirectly through the link with
health (Fay et al. 2005; Frongillo et al. 1997; Smith et al. 2005).
Malnutrition, especially among children, negatively affects productivity and
economic development. Good nutrition is fundamental for individuals to realize
both their physical and intellectual potential. It is the basis for individual and family
well-being and human capital formation and, as such, key to economic and social
development (Horton et al. 2010; Victoria et al. 2008). Malnutrition has serious
consequences at the micro and macro level in the current generation and, even
more so, for future generations. At the micro level, undernutrition reduces the
individuals’ income generation potential, lowers children’s schooling performance,
increases the risk of disability, morbidity, and mortality, and thus contributes to the
intergenerational transmission of poverty and illness (Black et al. 2008; Grantham-
McGregor et al. 2007). Even temporary malnutrition such as during food crises or
the (pre-harvest) rainy season (frequently referred to as ‘hunger season’) can cause
irreversible health impairments especially in children (Hadley et al. 2007). At the
macro level, malnutrition slows economic growth and deepens poverty through
three routes: (1) direct losses in productivity from poor physical and mental
performance (or death) of the work force, (2) indirect losses from reduced working
and cognitive capacity of the working population at present and in the future, and
(3) losses in resources due to increased health care costs (World Bank 2006). The

6. 5
economic costs of malnutrition are substantial; only productivity losses to
individuals are conservatively estimated at more than 10 percent of lifetime
earnings and losses to gross domestic product (GDP) at 2 to 3 percent on average
(Horton 1999; World Bank 2006). Substantial losses in income and GDP are due to
impaired cognitive abilities, which are particularly relevant in more advanced
economies (Hoddinott et al. 2008; Horton and Ross 2003; Selowsky and Taylor
1973).
2. Nutrition in the Arab world
A key indicator for food insecurity at the household level is the prevalence of
child malnutrition. Young children’s nutritional status tends to be most responsive
to changes in living conditions and to be particularly vulnerable to food shortages
and diseases, due to their high physiological nutrient requirements for growth,
their special dietary needs, their often more direct exposure to adverse health
conditions, and their dependency on adults. Among the three common child
anthropometric measures (that is, height for age, weight for age, weight for
height), height-for-age scores (or, stunting), best reflect the cumulative effects of
chronic food deficits and illness and are therefore good overall, long-term nutrition
indicators. Focusing on young children, who are typically the weakest household
members, captures aspects of unequal intrahousehold resource distribution that
are ignored when using household-level indicators such as income poverty or
household food and nutrient consumption measures. Furthermore, at the country
level, high prevalence rates of stunted children are usually associated with poor
delivery of public services, especially in the health and education sector, and poor
development of water and sanitation infrastructure; rapidly growing populations;
low literacy rates and low educational attainment rates; and gender inequality.

7. 6
Figure 2: Prevalence of malnutrition among children in Arab countries, Turkey and Iran
Source: Breisinger C., O. Ecker, P. Al-Riffai and B. Yu. 2012.
Note: In general, the latest estimate since 2006 is used. If no observations were
available after 2006, the prevalence of child undernutrition is projected using a
general nutrition–growth elasticity of 0.11, estimated from a global cross-country
regression model and country specific GDP per capita growth rates. High-income
countries have a low food insecurity risk. Low- and middle-income countries (LMICs)
are classified into five groups (quintiles) by level of food insecurity risk: low,
moderate, serious, alarming, and extremely alarming. The classification is carried
out for all LMICs with respective data. Thus, the nutrition situation in Arab-TI
countries is compared with the food-security situation in LMICs worldwide (130
countries in total).
In the Arab world, every fifth child younger than five is stunted, while in
Comoros, Djibouti, Egypt, Somalia, Sudan and Yemen about every third child or
more is stunted. The map in Figure 2 classifies Arab countries into five categories.
The countries with a low prevalence of child stunting are Bahrain, Oman, Saudi
Arabia, the United Arab Emirates, Tunisia, Qatar, Kuwait and the West Bank and
Gaza. In Algeria, Morocco and Libya between 15.6 and 21.6 percent of children are
stunted; in all other countries the situation is serious, alarming or even extremely
alarming.

8. 7
Unlike in the rest of the world, overall growth does not improve child
malnutrition in the Arab world. One percent in overall growth in the rest of the
world leads to a reduction in the prevalence of child stunting by 0.12 percentage
points, but the relationship in the Arab region is statistically insignificant
(Breisinger et al. 2012). The plotted graph in Figure 3 suggests that the relationship
between the prevalence of child malnutrition and GDP per capita in the Arab-TI
region is somewhat similar to the global relationship until about the $5,000 level,
at which GDP continues to climb steadily while child malnutrition levels off. In
individual countries the relationship between child malnutrition and GDP per capita
is even more negative: for example, Egypt’s prevalence of child malnutrition spiked
significantly from 2003–08, though GDP per capita continued to rise. Taking the
child malnutrition levels as reference, this difference suggests that additional
factors play a role for determining malnutrition levels.
Figure 3: Relationship between child malnutrition and GDP
Source: Breisinger C., O. Ecker, P. Al-Riffai and B. Yu. 2012.
Public spending in the Arab world needs to be reviewed in terms of its food
and nutrition security focus. Public spending is one of the key tools for
governments to improve food security, yet no comprehensive database exists on

9. 8
food security-related public spending in Arab countries. One of the most
informative databases to date is IFPRI’s Statistics of Public Expenditure for
Economic Development (SPEED), which disaggregates expenditure into agriculture,
education, health, infrastructure, and social protection. Table 1 shows a summary
of statistics from this database for the Arab world.
Table 1. Public spending (percent of GDP), 2007
Agricult
ure
Educati
on
Healt
h
Infrastruc
ture
Social
protect
ion
Total
Ag.
exp. /
ag.
VA
Food secure
countries
0.7 2.9 2.5 0.9 4.7 26.6 6.9
Oil exporters 0.8 2.8 1.7 1.9 6.7 28.1 7.9
Algeria 0.7 4.4 1.2 3.8 4.7 30.2 8.4
Iran 0.8 2.1 1.8 1.3 7.8 26.6 8.0
Yemen 0.4 5.8 1.4 0.1 0.0 40.3 3.9
Oil importers 0.7 3.0 3.1 0.3 3.5 25.7 6.4
Djibouti 0.1 3.2 1.1 0.0 0.0 22.9 3.0
Egypt 0.8 3.7 3.7 0.5 7.3 26.9 5.8
Jordan 0.6 5.3 2.7 1.6 10.6 38.0 20.6
Lebanon 0.1 2.3 0.7 0.5 2.5 33.6 1.2
Morocco 0.6 5.6 0.8 0.2 4.5 30.1 4.4
Syria 1.6 2.9 0.2 1.6 0.4 29.1 8.9
Tunisia 1.5 6.4 1.5 0.8 7.5 24.9 14.6
Turkey 0.5 2.0 3.6 0.0 1.5 23.5 6.1
Food secure
countries
0.2 3.7 1.7 0.7 6.1 35.6 29.2
Oil exporters 0.2 3.7 1.7 0.7 6.1 35.6 29.2
Bahrain 0.1 3.4 2.3 0.6 0.7 25.3 20.5
Kuwait 0.2 3.3 1.7 0.2 9.2 36.7 72.9
Oman 0.2 4.7 1.5 1.8 1.7 37.3 13.6
Arab countries
(plus Iran and
Turkey)
0.7 3.0 2.5 0.9 4.8 27.3 7.0
Arab countries
(all)
0.7 4.2 2.0 1.3 5.5 30.4 7.1
LMICs 0.8 2.3 1.3 0.5 1.8 18.9 7.2
Arab-TI 0.7 2.9 2.5 0.9 4.7 26.6 6.9
Arab 0.8 4.3 2.1 1.4 5.3 29.3 6.9
A&P 1.1 2.0 0.6 0.3 1.4 17.8 7.9
EE&CA 0.4 1.2 0.9 1.1 1.9 21.3 7.6
LAC 0.3 3.6 2.7 0.3 1.3 15.7 4.7
SSA 0.8 2.8 1.2 0.6 0.8 17.5 2.6
Source: Breisinger et al. 2012 based on SPEED database (2011).
Note: Averages of aggregates are weighted by population size.

10. 9
Some of the key messages are:
 Arab countries allocate about the same amount of resources to agriculture
as all LMICs on average but significantly more than Latin America and the
Caribbean and Sub-Saharan Africa Yet, there are substantial differences
among Arab countries. The agricultural expenditure intensity is relatively
low in several FSC countries, including Yemen (3.9 percent), Lebanon (1.2
percent), and Morocco (4.4 percent), indicating potential underspending.
 Arab countries devote 4.2 percent of GDP to education. This share is even
higher when excluding high-income countries from the average (Table 1),
thus no world region spends a greater share than the Arab region LMICs (4.3
percent). Countries that spent more than 5 percent of GDP on education
include Yemen, Jordan, Morocco, and Tunisia; Iran, Lebanon, Syria, and
Turkey spent less than 2 percent in 2007.
 Arab countries spend about 2.0 percent of GDP on health, which is less than
in Latin America and the Caribbean region but more than in other regions.
There are large differences between countries: In 2007, Jordan and Bahrain
plus Egypt and Turkey spent more than 2 percent of their GDP on health,
and Lebanon and Morocco plus Syria and UAE spent less than 1 percent.
 Spending on infrastructure, which refers here to transportation and
communication, in the Arab LMICs is high according to global standards;
however, the Arab-TI region is the only region where infrastructure budgets
have shrunk, where the decline in infrastructure spending is particularly
pronounced in oil-importing FSC countries, where spending has declined by
2.6 percent per capita and per year, while spending has sharply increased by
12.4 percent in (oil-exporting) FS countries (Breisinger et al. 2012).
 Arab LMICs in particular have by far the highest spending on social
protection: more than double the size of Eastern Europe and Central Asia
and more than four times the size of Sub-Saharan Africa. In the Arab-TI
region, social protection expenditures are also by far the highest single
spending account, amounting to 4.7 percent of GDP on average, and 5.3
percent in Arab LMICs.
While there are no specific numbers available for Arab countries, in general the
nutrition subsector tends to be underfunded in government budgets and in the
budgets of the international development assistance community relative to
the size of the problem (Ecker and Nene, 2012). Although the amount of financial
resources allocated to nutrition is difficult to estimate precisely (especially given
the responsibilities scattered across government sectors), the poor progress in
reducing malnutrition in most developing countries demonstrates meaningful
evidence. For example, each stunted child in the 20 countries accounting for 80
percent of the global burden of child stunting received only $2 out of the $5-10

11. 10
Box 1: Cost-benefit ratios of large-scale
nutrition interventions (aggregates)
Micronutrient supplementation 17.3
Micronutrient fortification 9.5
Biofortification (plant breeding) 16.7
Deworming preschoolers 6.0
Community-based nutrition promotion 12.5
Source: Horton et al. (2008).
required to scale up community-based nutrition programs in 2006 (Horton et al.
2010, Morris et al. 2008).
It is not only the size but also the quality of public spending that matters for
food and nutrition security. At the country level, high prevalence rates of stunted
children are often associated with poor delivery of public services, especially in the
health and education sector, and poor development of water and sanitation
infrastructure; rapidly growing populations; low literacy rates and low educational
attainment rates; and gender inequality. For example, much like agricultural
spending, spending a large portion of GDP on education does not necessarily yield
results: youth literacy rates, for instance, show no clear relationship between
expenditures and educational achievements. Similar to the patterns for education
expenditure, comparisons of health expenditure and performance in terms of
MDGs 4 to 6 reveal no clear relationship, implying that there are also big
differences in the amounts spent per person and the quality of health services. One
reason may be that public spending is not well targeted to the food insecure. For
example, fuel and, in some countries, food subsidies are often higher than more
targeted social spending. In Egypt and Syria, for example, food and fuel subsidies
(accounting for about 20 percent of public spending) are more than two-fold higher
than spending on social protection programs and health combined.
3. Highlights of nutrition interventions
Nutrition interventions have very favorable cost-benefit ratios. Maybe the
most convincing argument for a stronger political commitment to nutrition, though,
is the high cost-effectiveness of direct nutrition interventions (Box 1). Asked to
rank 30 solutions to the ten great
global challenges primarily based
on economic costs and benefits,
the 2008 Copenhagen Consensus
listed five solutions addressing
the ‘malnutrition and hunger’
challenge directly and another
four indirectly through the link
with health and education in the
top ten solutions (CC 2008). The
proposed interventions include micronutrient supplementation and (bio)
fortification, nutrition and hygiene education programs, and immunization, of
which most of them are targeted toward women in reproductive age and young
children.
The case of a Bajil District in Yemen shows how costs for nutrition
interventions can be estimated on a case-by case basis. Child health and

12. 11
nutrition programs are widely needed in Bajil District. The low use of birth control
methods (only 15 percent of non-pregnant woman) in spite of the widespread wish
of not having more children clearly indicates the need for implementing and
expanding birth control programs. There is also a pressing need for reproductive
health and child nutrition and health programs of various type (including mother
counseling). Table 2 shows the estimated annual costs of different health and
nutrition programs in order to increase coverage to 50 percent, 90 percent, and
100 percent of the population in need. In addition to that, information and
education campaigns targeted to the broader society can be an effective
mechanism for raising awareness and knowledge on diverse aspects related to
family health, nutrition, and social development. These campaigns should include
common issues such as qat consumption, healthy nutrition, child feeding practices,
hygiene, family planning, and women’s empowerment. Cost estimates for such
campaigns are reported in Table 2.
Table 2. Annual costs health and nutrition programs and information and
education campaigns in Bajil District
Proportio
n of
individual
s in need
(%)
Annual costs (thousand
US$)
50%
covera
ge
90%
covera
ge
Full
covera
ge
Reproductive health
Antenatal, delivery, and postpartum
care program (for pregnant women)
58 3.1 18.8 22.7
Birth control program for women in
reproductive age wishing no
additional children
46 20.4 36.7 40.8
Child nutrition
Mother counseling program for
pregnant women (breastfeeding,
child health and nutrition)
100 2.2 3.9 4.4
Feeding program for small-sized
newborns
52 4.0 7.2 8.0
Child growth monitoring program for
severely stunted children (aged 6-59
months)
39 25.6 46.1 51.2
Information and education
General campaign (qat consumption,
healthy nutrition, child feeding
practices, hygiene, family planning,
and women’s empowerment, etc.) for
total population
100 85.1
Source: Own estimation based on CSO (2004), 2005-06 HBS data, and 2006 MICS data

13. 12
The case of Brazil shows how nutrition can be successfully integrated into
national programs and demonstrates that well-crafted nutrition policies under
strong political leadership can engender a substantial reduction in chronic
malnutrition. In one decade Brazil managed to almost halve the prevalence of
stunting among children under the age of five from an estimated 13.5 percent in
1996 to 6.8 percent in 2007 (Monteiro et al. 2010). Thanks to the poverty reduction
program and its health and nutrition components, the trend of declining child
stunting since the mid-1970s has been accelerated considerably. Trend analyses of
the determinants of child stunting suggest that nationwide two-thirds of the
reduction is attributable primarily to decline in poverty and increase in mothers’
education and secondarily to expansion of healthcare coverage and improvements
in sanitation (Monteiro et al. 2009, Monteiro et al. 2010). Food security had already
been part of Brazil’s policy agenda since the early 1990s, championed by a network
of civil society organizations. In 2003 the engagement culminated by a declaration
to combat hungers—a national priority by President Luiz Inácio Lula da Silva
(Kepple et al. 2012). Today, the resulting ‘Zero Hunger’ strategy coordinates
programs from 11 ministries and provides a framework for several initiatives
including the flagship conditional cash transfer program ‘Bolsa Família’, which is
considered the ‚cornerstone program for the promotion of food and nutrition
security‛ in the country (Ananias 2008, Chmielewska & Souza 2011). The success of
the ‘Zero Hunger’ strategy rests on its manifold integration in Brazil’s institutional
and legal framework. The National Council on Food and Nutrition Security
(CONSEA), which monitors the country’s food and nutrition situation, has broad
representation from the federal government and civil society and is institutionally
linked to the presidency. The food and nutrition security secretariat and social
protection secretariat—managing the ‘Bolsa Família’ program—are housed in the
Ministry of Social Development and Fight against Hunger, which has the mandate
to oversee the integration of food and nutrition security actions with the activities
of other relevant ministries. And third, the ‘Right to Food’—incorporated into
Brazil’s constitution in 2009—grants the status of public policy to food and
nutrition security and requires the federal states to enforce the universal right
guaranteeing regular and permanent access to food in sufficient quantity and
quality.
4. Summary
Food insecurity is a multi-dimensional challenge and nutrition is an integral part of
achieving food security. Overcoming malnutrition, especially among children, is not
only an issue of achieving food security, but also important for realizing successful
economic development. However, in the Arab world, on average every fifth child
younger than five is malnourished, while in Egypt and Sudan about every third and

14. 13
in Yemen almost two thirds of children are stunted. To overcome this unacceptable
situation, this paper has raised a couple of important policy questions and provided
two initial suggestions for action that are based on global experiences. Questions
that need to be urgently addressed are: why is it that economic growth (and rising
incomes) does not seem to improve nutrition in Arab countries? How can public
resources be better targeted at improving food and nutrition security? Global
experiences show that the nutrition part of food security tends to be underfunded
in government budgets and in the budgets of the international development
assistance community relative to the size of the problem, suggesting that
investments in nutrition need to be scaled-up. The case of Brazil shows the
importance of integrating food and nutrition security into national programs and
demonstrates how well-crafted nutrition policies under strong political leadership
can engender a substantial reduction in chronic malnutrition.

15. 14
References
Ananias, P. (2008). Accelerating the Reduction of Maternal and Child Malnutrition:
Contributions to the Debate Based on the Brazilian Experience. SCN News, 36,
8-11.
Barrett, C. B. (2002) Food security and food assistance programs, in: Gardner, B. L. &
Rausser, G. C. (Eds.), Handbook of Agricultural Economics, vol. 2B, pp.2103-2190
(Amsterdam: Elsevier).
Behrman, J. R. & Wolfe, B. L. (1984) More evidence on nutrition demand: Income
seems overrated and women's schooling underemphasized, Journal of
Development Economics, 14(1), pp. 105-128.
Behrman, J. R. & Deolalikar A. B. (1990) The intrahousehold demand for nutrients in
rural South India: Individual estimates, fixed effects, and permanent income,
Journal of Human Resources, 15(4), pp. 665-696.
Black, R. E., Morris, S. S. & Bryce, J. (2003) Where and why are 10 million children
dying every year? The Lancet, 361(9376), pp. 2226-2234.
Black, R. E., Allen, L. H., Bhutta, Z. A., Caulfield, L. E., de Onis, M., Ezzati, M., Mathers,
C. & Rivera, J. (2008) Maternal and child undernutrition: Global and regional
exposures and health consequences, The Lancet, 371(9608), pp. 243-260.
Breisinger C., O. Ecker, P. Al-Riffai and B. Yu. 2012. Beyond the Arab Awakening:
Policies and Investments for Poverty Reduction and Food Security. IFPRI Food
Policy Report. Washington, DC: International Food Policy Research Institute.
CC (2008). Copenhagen Consensus 2008 – Results.
http://www.copenhagenconsensus.com/Default.aspx?ID=1315. Accessed
September 21, 2012.
Chmielewska, D. & Souza, D. (2011). The Food Security Policy Context In Brazil.
Country Study. Brasilia: United Nations Development Programme.
Ecker O. and C. Breisinger. 2012. The Food security system: a new conceptual
framework. IFPRI Discussion Paper 1166. International Food Policy Research
Institute (IFPRI). Washington D.C.
Ecker and Nene, 2012. Nutrition policies in developing countries: challenges and
highlights. IFPRI Policy Note. Forthcoming.
FAO (1996) Rome Declaration on World Food Security and World Food Summit Plan
of Action, http://www.fao.org/DOCREP/003/W3613E/W3613E00.HTM.
Accessed 3 January 2012.
FAO (2009b) Declaration of the World Summit on Food Security, WSFS 2009/2
(Rome: Food and Agriculture Organization of the United Nations).
Fay, M., Leipziger, D., Wodon, Q. & Yepes, T. (2005) Achieving child-health related
Millennium Development Goals: The role of infrastructure, World Development,
33(8), pp. 1267-1248.

16. 15
Frongillo, E. A. Jr., de Onis, M. & Hanson, K. M. (1997) Socioeconomic and
demographic factors are associated with worldwide patterns of stunting and
wasting of children, Journal of Nutrition, 127(12), pp. 2302-2309.
Glewwe, P. (1999). Why does mother’s schooling raise child health in developing
countries? Evidence from Morocco. Journal of Human Resources, 34(1), pp. 125-
159.
Grantham-McGregor, S., Cheung, Y. B., Cuerto, S., Glewwe, P., Richter, L., Strupp, B.
& the International Child Development Steering Group (2007) Developmental
potential in the first 5 years for children in developing countries, The Lancet,
369(9555), pp. 60-70.
Hadley, C., Borgerhoff-Mulder, M. & Fitzherbert, E. (2007) Seasonal food insecurity
and perceived social support in rural Tanzania, Public Health Nutrition, 10(6), pp.
544-551.
Hoddinott, J., Maluccio, J. A., Behrman, J. R., Flores, R. & Martorell, R. (2008) Effect
of a nutrition intervention during early childhood on economic productivity in
Guatemalan adults, The Lancet, 371(9610), pp. 411-416.
Horton, S. & Ross, J. (2003) The economics of iron deficiency, Food Policy, 28(1), pp.
51-75Horton, S. (1999). Opportunities for investments in nutrition in low-income
Asia. Asia Development Review, 17(1-2), pp. 246-273.
Horton, S., Alderman, H., & Rivera, J. (2008). Hunger and Malnutrition. Copenhagen
Consensus 2008 Challenge Paper. Draft.
Horton, S., Shekar, M., McDonald, C., Mahal, A. & Brooks, J. K. (2010) Scaling Up
Nutrition: What Will It Cost? (Washington DC: World Bank).
Katona, P. & Katona-Apte, J. (2008) The interaction between nutrition and
infection, Clinical Infectious Diseases, 46(10), pp. 1582-1588.
Kennedy, E. & Peters, P. (1992) Household food security and child nutrition: The
interaction of income and gender of household head, World Development, 20(8),
pp. 1077-1085.
Monteiro, C., Benicio, M., Conde, W., Konno, S., Lovadino, A., Barros, A., & Victora, C.
(2010). Narrowing Socioeconomic Inequality in Child Stunting: the Brazilian
Experience, 1974-2007. Bulletin of the World Health Organization, 88, 305-311.
Monteiro, C., Benicio, M., Konno, S., Silva, A., Lima, A., & Conde, W. (2009). Causes
for the Decline in Child Undernutrition in Brazil, 1996-2007. Revista de Saude
Publica, 43, 35-43.
Semba, R. D., de Pee, S., Sun, K., Sari, M. Akhter, N. & Bloem, M. W. (2008) Effect of
parental formal education on risk of child stunting in Indonesia and Bangladesh:
A cross-sectional study, The Lancet, 371(9609), pp. 322-328.
Smith, L. C., Ruel, M. T. & Ndiaye, A. (2005) Why is child malnutrition lower in urban
than in rural areas? Evidence from 36 developing countries, World Development,
33(8), pp. 1285-1305.
Stephenson, L. S., Latham, M. C. & Ottesen, A. (2000) Malnutrition and parasitic
helminth infections, Parasitology, 121(Suppl), pp. S23-S38.

17. 16
Thomas, D. (1994) Like father, like son; like mother, like daughter: Parental
resource and child height, Journal of Human Resources, 29(4), pp. 951-988.
Victoria, C. G., Adair, L., Fall, C., Hallal, P. C., Martorell, R., Richter, L. & Sachdev, H. S.
(2008) Maternal and child undernutrition: Consequences for adult health and
human capital, The Lancet, 371(9609), pp. 340-357.
World Bank (2006) Repositioning Nutrition as Central to Development: A Strategy
for Large-Scale Action. (Washington, DC: World Bank).