Hunger and malnutrition are at the center of economic development: malnutrition is an indicator
of poverty, social exclusion, and deprivation, and is a major constraint to national economic
development. For this reason, the reduction in hunger is part of the first Millennium
Development Goal (MDG). The Nutrition Analysis and Mapping Project, funded by the World
Food Programme and implemented by Tufts University, was undertaken to assist in identifying
areas of high malnutrition prevalence at a geographically disaggregated level, to assist in
understanding the determinants of nutrition problems in different geographic settings and in
targeting nutrition interventions, and to provide a basis for monitoring progress in the
achievement of the first MDG. The output is a series of maps that show, at the municipio level,
the estimated prevalence of childhood chronic malnutrition (low height-for-age of children 6 to
59 months), and that demonstrate associations with other geographic and economic
characteristics and with the provision of services. Growth retardation was chosen as the key
indicator of the nutrition situation in the Dominican Republic because it is the most commonly
occurring manifestation of childhood malnutrition (low weight for height, wasting, is much less
prevalent). Information on adult nutritional status, micronutrient nutrition, and diet was not
available.
Estimates of the prevalence of child malnutrition were developed by taking a nationally
representative sample survey, the Demographic and Health Survey (ENDESA) of 2002, and
using this to create a statistical model to predict the nutritional status of children. This model
was then applied to data from the 2002 National Census. The model, using variables common to
the two data sets and augmented with information from secondary sources, resulted in a
predicted anthropometric status for every child in the appropriate age group, and an estimated
prevalence of malnutrition (defined as height-for-age, weight-for-height, and weight-for-age
below -2 standard deviations of the NCHS/CDC/WHO standards for child growth)1
for each
municipio in the country.2
These prevalences were divided into quartiles, so that high-prevalence
municipios could be identified. Malnutrition indicators have been improving in the Dominican
Republic in recent decades. The DHS finds average national prevalence of child growth
retardation has fallen from 11 percent in 1996 to 8.9 percent in 2002. They found significant
variation among provinces, though, with prevalence reaching close to 19 percent in some
provinces. Our own provincial estimates also found great variation from one province to
another, but also very significant variation by municipio within provinces. Prevalence by
municipio varied from about 3.5 percent to over 46 percent of children under five, according to
our estimates, indicating some areas where, despite overall improvement in the nutrition
situation, a serious problem of malnutrition persists.