An assessment of the causes of malnutrition in Ethiopia: A ...

• Malnutrition also leads to fewer years of completed schooling on average due to late
enrollment, increased grade repetition, absenteeism, and earlier dropout. This, as well
as the impaired cognitive development mentioned above, means that malnourished
children end up as less productive adults.
• There are additional productivity losses arising from the direct link between stunted
physical stature and reduced physical productivity.
Each of these channels can have considerable costs. For example, children born with
low birthweight – reflecting, in part, the nutritional status of their mother – have a three-fold
increase in infant mortality. Similarly, globally, malnutrition is associated with more than half
of all child deaths through increasing the risk factors of other child illnesses. While any
attempt to assign an economic cost to this excess loss of life is futile, it is readily apparent that
the achievement of the MDG for child mortality is hampered by the slow pace of
improvement in nutrition.
The economic costs of increased health care required for malnourished children
includes both the increased number of days for hospitalization, where these services are
available, and the costs of outpatient care. In Brazil, for example, malnutrition leads to a
doubling of the rate of hospitalization for dehydration and a 50 percent increase in
hospitalization for pneumonia. While estimates of excess health costs due to malnutrition are
not available for Ethiopia, preventing malnutrition with effective low costs measures can free
health resources to address other pressing needs, including HIV/AIDS and malaria.
There is considerable global evidence to allow estimates to be made of the loss of
lifetime earnings due to the impact of malnutrition on years of schooling, affecting both the
schooling MDG as well as future earnings. For example, if the average child in Zimbabwe
were to have the same nutritional status as those in the well-nourished international reference
population for child growth, they would earn 12 percent more income in their lifetime due to
increased schooling. An additional consequence of malnutrition is lower IQ, which not only
affects the years of schooling a child receives but also the quality of learning in school. In
addition, studies in East Africa as well as in higher income countries have shown that on
average workers with low cognitive abilities receive lower wages than other workers with
similar levels of schooling do. From a range of international estimates, the economic
consequences of decreased cognitive abilities due to malnutrition can be estimated to result in
about a 10 percent loss of lifetime earnings for each malnourished child.
Ethiopia, with its comparatively high rates of malnutrition, loses hundreds of millions
of dollars of productivity every year to these types of nutritionally-related cognitive
impairments. This is not just a consequence of stunting or of low birthweight. Iodine
deficiency, which results in irreversible impairment of intellectual capacities, is widespread in
Ethiopia. This single micronutrient deficiency has been estimated to cost the Ethiopia
economy 1.35 billion birr annually. 2
1.2.2. The benefits that accrue from combating malnutrition
Given these consequences of malnutrition, programs that prevent malnutrition can be
shown to have high economic rates of returns. For example, every dollar spent on including
nutrition in integrated child health promotion will lead to a return of 10 dollars in terms of
increased earnings and lower medical costs, even when future earnings are discounted using
standard economic accounting procedures. Promotion of proper breastfeeding has similar high
rates of return. Returns to micronutrient interventions are generally even higher, reflecting the
comparatively low cost of providing such nutritional supplements. There is an extensive
2 As reported by the Ethiopian nutrition PROFILES analysis (Ethiopian PROFILES Team &
AED/Linkages 2005).
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