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Timor Leste ‐ Food and Nutrition Security Profiles
Key Indicators
• Timor‐Leste has experienced a slight increase in per‐capita GDP and, paradoxically, an increase in undernourishment in recent years. Dietary Energy Supply (DES) has slightly increased, but the dietary quality remains poor, based on cereals and starchy roots. • This poor quality of diet is largely responsible for persistent, and even rising, high levels of stunting and underweight, high levels of anaemia, high levels of Low Birth Weight, and Vitamin A deficiencies.
• A contributing factor to poor nutritional outcomes is the insufficient access to improved sanitation and water sources, particularly in rural areas. Although the country has made recent progress in this area, improved water and sanitation continue to be far from internationally acceptable levels. GDP per person, PPP (constant 2011 dollars)
Undernourished in total population
International $
Percent
43
2000
41.8
1815
41
1800
39
106
128.5
61.7
51.5
1200
287
1164
36.2
31
29
Source: Inter‐agency Group for CME (2013)
Infant
24.4
25.8
1990
33
Neonatal
Under fives
2015
47.1
47.8
2012
37
35
223
56.7
83.4
1400
1837
MDG
Target
57
2010
38.3
170.7
2005
1600
2083
2000
Figure 1.4 Child Mortality From 1990 to 2012:
• Under‐5 mortality reduced 67% and already achieved the MDG target
• Infant mortality reduced 63%
• Neonatal mortality reduced 48%
2000
2500
Figure 1.2 Undernourishment and economic growth • From 2000 to 2012 GDP increased 56%, with more accelerated growth from 2005‐2012
• From 1990 to 2012, Undernourishment increased 8%
1995
Figure 1.1 Food Availability From 1990 to 2011: •DES increased 13% •Animal‐origin supply decreased 22% •Vegetal‐origin products increased 20% and remained the major DES source
1000
27
1000
1860
Figure 1.5 Anaemia • Anaemia is a public health issue, high among under‐5 children (38%), pregnant women (28%) and non‐
pregnant women alike (21%) • Deworming and iron supplementation are effective for reducing anaemia in pregnant women as well as Total <2 yr
children. 25
2012
2010
2008
2006
2004
2002
2000
1998
1996
1994
1992
800
1990
Kcal per person per day
1500
Source: GDP: WDI 2014 / Undernourished: FAO FSI_2013
Figure 1.3 Child Malnutrition From 2002 to 2013
• Stunting levels are very high, having increased 4%, and now stand at 58% • Underweight increased 9.8%, to 49% with underweight
• Wasting stood at 19% in 2009, a critical situation • Overweight remained at 6%
Low Birth Weight was 12%
1550
500
Children <5 years
63
Non ‐ pregnant women
of reproductive age
39
Pregnant women
28
0
Overweight
Stunting
Underweight
56
55
54
58
2011
Animal Origin
49
41
42
38
19
Vegetal Origin
6
6
Total Dietary Energy
Supply (DES)
11
Source: FOOD AND NUTRITION SURVEY 2013, TIMOR LESTE
2013
2009
2007
2003
2
2002
Source : FAOSTAT FBS: 2014 update
100
Source: Timor Leste Food and Nutrition Survey 2013
Wasting
50
0
1990
20
40
60
80
Prevalence of Anaemia (%)
Anthropometry (Table 1.1)
Underweight adult women (BMI < 18.5 kg/m2)
Overweight female adults (BMI >= 25 kg/m2)
24.3 %
2013
10.5 %
2013
* BMI values calculated using adult cut off points, population < 20 should be analyzed using WHO growth reference for school aged children and adolescents
Proportion of infants with low birth weight
Source: 12 %
Timor Leste Food and Nutrition Survey 2013
2003
Timor Leste ‐ Food and Nutrition Security Profiles
Food Availability / Food Access
Access to food
Figure 2.2 Economic access to food
General and food inflation
Food Availability
No Data
Figure 2.1 Food supply by food group ‐ main food commodities contributing in aggregate to more than 80 percent of the dietary energy (kcal/person/year) Total dietary energy supply= 2,083 (2011)
2011
1990
1312
1076
Cereals
638
500
Rice
77
Wheat
53
204
Meat & Milk & Eggs
276
102
33
Sugars and syrups
49
Fruits & vegetables
52
156
26
Vegetable oils
8
Fish & Fish products
0
12
Animal fats
10
Figure 2.3 Share of food expenditure
85
25
Pulses
100
129
Starchy roots
289
0
400
800
1,200
1,600
(2009)
Non food
items
Cereals
Source: UN_FAO Food Balance Sheets_2014 Update
80
• Vegetable oils (500%) and pulses (240%) have surged in their contribution to DES, but still are not significant overall contributors
• Meat, milk, and eggs decreased by 26%
• Rice contributes 45% of the cereal intake, and Maize to the 42% • Cereals remain the most important source of food energy (63%)
Percent
Fruits and
vegetables
60
63
Fish
Sugars
40
2
Veg oils
0
3
6
20
Meat, milk
and eggs
9
Other
17
0
% Total expenditure per person per
day
% Dietry energy Consumption
Source: UN FAO RAP based on national HIES, ECS, SES, HLSS 2013 Update, Timor Leste
Timor Leste ‐ Food and Nutrition Security Profiles
Food Utilization
Food utilization refers both 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. In Timor‐Leste, water and sanitation conditions have improving only slightly during the past 20 years. These poor improvements have contributed to the increased malnutrition among under‐5 children shown in Fig 1.3.
Water and Sanitation
Figure 3.1 Access to Improved Sanitation
From 1995 to 2012:
• Access to improved sanitation increased just 5% in 17 years and covers just 39% of the population
• Disparities between rural and urban areas widened • 63% of people in rural areas do not have access to improved sanitation Figure 3.2 Open Defecation • Open defecation remained prevalent in 27 % of the total population in 2012
• In rural areas, open defecation is practiced by 36% of the population, compared to 7 % in urban areas
Figure 3.3 Access to Improved Water Sources From 1995 to 2012:
Access to improved water sources increased by 34% during 17 years
Disparities in such access between urban and rural areas have increased. At least 71 % of people have has sustainable access to improved water sources
100
100
95
100
20
26
80
71
67
60
53
40
49
61
27
Rural
Urban
Total
Rural
Total
Urban
Source: WHO‐UNICEF Joint Monitoring Programme, 2014
Rural
2011
2009
2007
2005
2003
0
2001
2011
2009
2007
2005
2011
2009
2007
2005
2003
2001
1999
1997
Total
Source: WHO‐UNICEF Joint Monitoring Programme, 2014
2003
0
0
20
1999
7
1997
27
1995
33
1995
% Population
40
36
2001
20
39
37
50
1999
40
51
1997
60
57
60
1995
% Population
69
% Population
80
80
Urban
Source: WHO‐UNICEF Joint Monitoring Programme, 2014
Food Safety
Quality and food safety efforts cover the entire complex chain of agriculture production, processing, transport, food production
and consumption. On the consumption side, the prevalence of diarrhoea among under‐5 children is high for all wealth quintiles –
paradoxically, particularly for the highest quintiles.
Figure 3.4 Diarrhoea Among Under‐5 Children
• Diarrhoea is most common among the poorest quintile, although prevalence is high in all of them, reflecting the priority that must be accorded to improved sanitation, hygiene and food safety • Diarrhoea treatment with zinc has been achieved in 33% of cases
25
21.4
Percent
20
Management of Diarrhoea (Table 3.1)
Zinc
Wealth quintile
15.2
15.9
16
15
Share of children under age 5 with diarrhoea receiving zinc treatment
10
Existing policy framework
14.9
5
33.3 %
Zinc Supplementation and Reformulated Oral Rehydration Salt in the Management of Diarrhea
0
Lowest
Second
Middle
Source: Timor Leste Food and Nutrition Survey 2013
Fourth
Highest
Source:
Timor Leste Food and Nutrition Survey 2013
Timor Leste ‐ Food and Nutrition Security Profiles
Food Utilization
Nutrition and Health
Figure 3.5 Exclusive Breastfeeding • Exclusive breastfeeding has more than doubled from 2003 to 2013
•Early initiation of breastfeeding increased 98% during the same period
Figure 3.6 Complementary Feeding • Introduction of complementary feeding is timely for 82% of children
• 71% of children aged 6‐23 months meet the minimum meal frequency
• Meeting the recommended quality of diet remains a challenge
93
82
Introduction of solid, semi‐solid or soft
food…
47
82
Minimum dietary diversity
30.7
Source: Timor Leste Food and Nutrition Survey 2013
28
62.3
51.5
Minimum meal frequency
2013
2009‐2010
100
80
60
40
20
0
2003
Percent
Early initiation of breastfeeding
79
Minimum acceptable diet
Percent
18
0
20
40
60
80
100
Source: TLS_DHS 2009‐2010, Nutrition survey 2013
100%
Figure 3.7 Duration of Breastfeeding
• Duration and frequency of breastfeeding affect the health and 80%
nutritional status of both mother and child 60%
•Exclusive breastfeeding is recommended up to age 6 months, and continued breastfeeding with 40%
complementary feeding is recommended from age 6 months until 20%
2 years and beyond Exclusively breastfed
•At least 80% of children still breastfeed 0%
at age 1 year
0‐1 mo
2‐3 mo
4‐5 mo
Breast milk and plain water only
Not breastfeeding
Breast milk and complementary foods
6‐8 mo
9‐11 mo
12‐17 mo
18‐23 mo
24‐35 mo
Breast milk and non‐milk liquids
Breast milk and other milk
Source: TLS_DHS 2009‐2010_2010
Figure 3.8 Child Malnutrition and Poverty Children in the wealthiest quintile have 25% less stunting and 29% fewer weight deficits than children in the lower quintiles
Children in all quintiles experience critical levels of wasting regardless of wealth, although this is more prevalent in the lower quintiles
Overweight
59.3
60
Stunting
Underweight
Wasting
Micronutrient Status
Figure 3.9 Vitamin A • Vitamin A supplementation covers 59% of children •Vitamin A deficiencies (46% of pre‐schoolers) are severely high, indicating that Vitamin A is lacking in the daily diet and that food‐
based interventions, including food fortification, deserve ongoing attention. 57.3
100
52.7
42.6
39.1
40
36.7
34.9
Percent
44
Vitamin A Supplementation Coverage ‐ full – children 6‐59 months /a
75
46.9
50
50
59
25
45.8
32.2
Vitamin A Deficiency
(Pre‐School Aged Children)
<0.7umoL /b
0
30
* VAD is a severe public health problem if >20% of preschool children (6‐71 months) have low serum retinol (<0.7µmol/L)
20
11
13.4
11.4
9.4
9.3
Iodine (Table 3.2)
10
1.1
1.7
Lowest
Second
1.6
0.7
2.1
0
Middle
Source: Timor Leste Food and Nutrition Survey 2013
Fourth
Source: a/ UNICEF, State of the World's Children 2012,
b/ WHO Global prevalence of vitamin A deficiency in population at risk 1995‐
2005 report.
Households consuming iodized salt /a
59.9 %
Iodine deficiency (Urinary Iodine Concentration <100ug/L) among school‐age children *Optimal UIE 100 ‐ 199ug/L
Highest
Source: a/ UNICEF State of the World’s Children 2014.
‐
Timor Leste ‐ Food and Nutrition Security Profiles
Policy Table ‐ 1
Enabling environment for Nutrition and Food security ‐ Policy documents 1. National Nutrition Strategy (2004) 2. Timor‐Leste Breast‐feeding Promotion Policy (2009) Nutrition related issues covered in these policies
Maternal and Child Undernutrition
Child undernutrition
??
Low Birth Weight
??
Maternal undernutrition
??
Child obesity
Obesity and diet related Adult obesity
NCDs
Diet related NCDs
Infant and Young Child Nutrition
Vitamins and Minerals
Underlying and contextual factors
Covered
??
yes
Complementary feeding
??
Int’l Code of Marketing of BMS
yes
both
??
yes
Child
Food fortification
yes
Food Safety
??
Food security
??
Food Aid
??
Nutrition and Infection
??
Gender
??
Maternal leave Community‐Based Management of Acute Malnutrition (CMAM) programme implemented Adults
??
Breastfeeding
Supplementation:
Vitamin A children/women
Iron Folate children/women
Zinc children
Other vitamins & min child/women
Comments
Infant and Young Child Feeding in emergencies policies drafted in July 2006 Int’l Code on Breastmilk Substitutes is still under study Zinc is used in treatment of some diarrhoea cases
Voluntary: Salt (60%), Maternity leave is paid at a rate of two‐thirds of salary.
Provisions for Nursing breaks after return to work (paid)?
12 weeks
Social Protection policies or legislation including food or nutrition component
Food safety policies or legislation
1. Decree‐Law No. 21/2003 regulating quarantine and sanitary control on goods imported and exported (2005) Regulates quarantine and sanitary control on goods imported and exported. The aim is preventing and controlling the introduction, establishment and propagation of exotic plagues and diseases and other harmful organisms in the national territory; protecting the environment; regulates monitoring procedures and defines competent authorities Other policies addressing food security
1. Agriculture Development Framework and Food Security Policy (2004) Policy focusses on five priority areas: (1) improve food security and raise self‐reliance; (2) increase value‐added production and marketing; (3) achieve sustainable production and management of natural resources; (4) strengthen the balance of trade by promoting commodity exports, and (5) increase income and employment in rural areas.
It underlines the importance of sustainability and capacity development as well as the involvement of the private sector as important elements of development
Timor Leste ‐ Food and Nutrition Security Profiles
Policy Table ‐ 2
Demographic Indicators (Table ‐ 5.1)
Year
Economic Indicators (Table ‐ 5.3)
Year
Population size (thousands) /a
1,210
2012
GDP annual growth rate /c
0.59 %
2012
Average annual population growth
2.88 %
2012
1,815
2012
Proportion of population urbanised
28.7 %
2012
GDP per capita (PPP) (constant 2011 international dollars) /c
201
2012
39.5
2001
‐
‐
Gini index /c
(100= complete inequality; 0= complete equality)
31.9
2007
66
2012
Unemployment rate /c
3.9 %
2010
68.6
2012
37.44
2007
Agriculture population density(people/ ha of arable land /b)
3.7
2006‐2008
Population below US $ 1.25 (PPP) per day /c (%)
Employment in agriculture sector (% of total employment) /c
50.6 %
2010
Poverty gap ratio /e
8.9
2007
Women employed in agriculture sector (% of total female employment) /c)
50.2 %
2010
Income share held by households /a
Poorest 20%
8.95 %
2007
Richest 20%
41.27 %
2007
Number of children <5 years (thousand)
Education level of mothers of under‐fives: None (%)
Male
Life expectancy at birth (Years) /c
Female
Adolescents (Table ‐ 5.2)
Year
Adolescent birth rate (number of births per 1,000 adolescent girls aged 15‐19) /a
55
2011
Adolescent girls aged 15‐19 currently married or in union /f
7.7 %
2009‐2011
9
2005–2012
Women aged 20‐24 who gave birth before age 18 /d (%)
Sources:
a/ UN Department of Economic and Social Affairs, World Population Prospects 2010 (for Adolescent Birth Rate: 2012 Update for the MDG database);
b/ FAOSTAT 2012 Update; c/ World Bank, World Development Indicators Database, 2013 Update; d/ UNICEF, State of the World Children 2014 (data refer to the most recent year available during the period specified) e/ UN Statistics Division, MDG database 2012 Update.
f/ Timor‐Leste Demographic and Health Survey 2009‐2011
The information inlcuded in this Food Security and Nutrition profile, is backed by recognized, validated and properlty published information available untill June 2014. 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.