Republic of Zambia
The Republic of Zambia is a landlocked country in South-central Africa with a mild tropical climate. It is sparsely populated compared to some of the neighbouring countries. The population is young and predominantly rural. Zambia is severely affected by the HIV/AIDS pandemic, which compromises social and economic gains the country is striving to attain. Mostly as a result of pandemic, life expectancy at birth has dropped sharply.
Zambia's economy has been traditionally dominated by the copper mining industry. However, following a sharp decline in copper earnings, the contribution of the agricultural sector to GDP has increased. Zambia has a huge agricultural potential, still largely untapped. The majority of the population is engaged in rain-fed subsistence farming. Reduced state support in the 1990s has led to a shift in crop production from maize, the staple food crop, to other crops (cassava and cash crops), but maize is still largely predominant. Livestock production remains far below its potential, notably due to recurrent drought and outbreaks of diseases.
Following nearly two decades of decline, Zambia has experienced uninterrupted economic growth since 1999. The incidence of poverty has decreased since the beginning of the current decade, but poverty remains widespread.
The high incidence of infectious diseases and of nutritional deficiencies, the somewhat declining immunization coverage and the limited access to improved water sources in rural areas are the major factors contributing to high morbidity and mortality among young children. Access to health services remains limited, the lack of material and human resources in the health system further constraining the quality of services. Although some progress has been recorded, infant and under-five mortality rates remain high. The maternal mortality ratio is still very high.
The Zambian diet is mainly composed of cereals, predominantly maize, starchy roots and, to a lesser extent, fruit and vegetables. Cereals provide almost two-thirds of the dietary energy supply. Although other food crops are becoming increasingly important, such as cassava, Zambia’s dependence on maize remains very high which contributes to making it vulnerable to climatic shocks. In urban areas food consumption patterns are changing: rice and sweet potatoes are gaining importance. A consistent decline in maize production, inadequate production of alternative staple crops, climatic constraints, and poverty contribute to widespread food insecurity. The dietary energy supply is not sufficient to meet population energy requirements; the prevalence of undernourishment has increased to reach 45% in 2003-2005. Quantitatively insufficient, food supplies also lack diversity and are poor in essential micronutrients.
Young child feeding practices are improving. Breastfeeding is universal. The rate of exclusive breastfeeding, although still insufficient, has increased sharply since the early 2000s. The timely complementary feeding rate is high and complementary feeding is relatively diversified. High morbidity, limited access to health services, poverty and food insecurity are the main determinants of malnutrition in children. Stunting (i.e. chronic malnutrition) affects 39% of children under five years of age. The prevalence of stunting has decreased since the early 2000s but remains high. Undernutrition also affects women of childbearing age. At the same time, the country is undergoing a nutrition transition, particularly evident in urban areas where almost a third of women are overweight or obese.
In the early 1990s, iodine deficiency was a severe public health problem in the country. Since the enforcement of legislation on salt iodization in 1996, the percentage of children with low urinary iodine level has decreased considerably. The most recent estimates of the level of urinary iodine are indicative of more than adequate iodine intake among the population. Thanks especially to the up-scaling of vitamin A supplementation coverage, prevalence of sub-clinical vitamin A deficiency has decreased among women. Nevertheless only about half of mothers receive vitamin A supplements during the post-partum period. Among children, prevalence of sub-clinical vitamin A deficiency is decreasing but is still at a very high level despite the coverage by supplementation of almost two thirds of the children. In recent years, coverage seems to have declined slightly. Supplementation needs to be expanded for both mothers and children. Anemia affects more than half of preschool children and almost a third of non-pregnant women. Iron supplementation coverage among pregnant women is very wide but compliance has not been assessed. Various public health programmes are implemented to reduce the high incidence of malaria and of some parasitic infections which contribute to the high prevalence of anemia.
Although short-term interventions such as supplementation still need to be reinforced, investment in sustainable food-based strategies is urgently needed to combat hunger and micronutrient deficiencies.