Overview of Hidden Hunger in Latin America and Caribbean

In recent years, countries in Latin America and the Caribbean have made progress in reducing hunger and undernutrition, though inequality remains high as some regions do relatively better than others. Some countries may struggle with the “double burden” of malnutrition, which includes both undernutrition and overweight, while other countries face a high burden of undernutrition for specific populations only.

Still, 53 million people continue to lack enough food, and 16 per cent of children under 5 years are chronically undernourished, with significant stunting inequalities across countries: Guatemala, Peru, Honduras, Bolivia and Nicaragua have the highest disparity between the wealthy and poorer populations, especially those living in rural areas. To further compound these issues, monitoring and evaluation, along with up-to-date nutrition information, is urgently needed.

Policy across much of the region now needs to give priority to reducing micronutrient deficiencies among young children; to reducing anaemia among mothers; and to consolidating deficiency control programs, including the surveillance of vitamin A and iodine deficiencies.

Several countries have made sustained efforts to improving micronutrient deficiencies by a combination of fortifying commonly consumed foods, and providing supplements. However, countries in this region – particularly Haiti – still have much ground to make up.

Read further about our ongoing work in Haiti.


Nutrition International conducted a pilot project in San Marcos, Guatemala to determine the best way to deliver combined zinc supplements and oral rehydration salts (ORS) to children suffering from diarrhoea.

The pilot project was funded through a Grand Challenges Canada grant, and implemented in collaboration with CeSSIAM, the Graphic Design Unit and Water Transmissible Disease and Respiratory Infection Team of the Guatemalan Ministry of Public Health. This project built on previous Nutrition International work with the government to scale up zinc in health centres.

The project tested the effectiveness of co-packaging zinc and oral rehydration salts (ORS) together at the health facility to increase the provision of zinc and the adherence to the recommended treatment.

The project addressed legitimate concerns in both Guatemala and other countries rolling out combined zinc and ORS treatment to ensure that providers are giving the recommended dose, and also ensuring that caregivers know how to use them.

Through the use of formative research and social marketing principles, we developed a co-pack that addressed behaviour change challenges by giving pictorial descriptions of how to use zinc and ORS, with reminders of giving it for 10 days.

We tested the effectiveness in a randomized community trial and were able to show an increase in adherence to diarrhoea treatment. The assumption tested by the research was that physical and visible co-packaging could not only generate interest in the product but also create awareness of the need for the combined treatment among health care providers and caregivers.

The co-packaging was also highly appreciated by mothers. The data generated from the pilot project was provided to the Ministry of Health to help in decisions on future national investments in the co-packaging of zinc and ORS as well as contributing to the global evidence base of co-packaging of Zinc & ORS within the public sector treatment of diarrhea.

Diarrhoea continues to be the number two killer of children in the developing world and this project has shown potential to shift behaviours to increase the number of children receiving life-saving treatment.

Bolivia, one of the poorest countries in Latin America, has a population of 9.5 million people, with approximately 80 percent living in poverty in rural areas. Malnutrition and food insecurity is a considerable issue, with access the main reason why people cannot meet basic food needs.

The Government of Bolivia is committed to ending malnutrition and since 2006 has been implementing its Programa Multisectorial Desnutrición Cero (PMDC) or Multi-Sectoral Zero Malnutrition Program, the cornerstone of its National Development Plan.

Through the Zero Hidden Hunger project, Nutrition International has been supporting the Government of Bolivia with the micronutrient component of the PMCD, through funding from the Government of Canada’s Global Affairs Canada (GAC), and in part from with the Izumi Foundation. Since 2008, Nutrition International has worked with the Government of Bolivia and other partners to advocate for, design, and implement the micronutrient component of the PMDC and ensure it remains a priority. Nutrition International’s role focuses on advocacy, facilitation, and technical and financial support.  The project focuses on the following micronutrient interventions:

The Government of Bolivia’s PMDC reached over one million women and children in 2013 with these important micronutrient interventions, to help them survive, thrive and reach their full potential. Nutrition International is proud to be one of the supporting partners.

The Zero Hidden Hunger project achieved many successes in 2013, including:
  • Development and dissemination of a national communications strategy promoting the importance of micronutrient supplements, that reached over 3.5 million people.
  • Conducted research on prenatal iron-folic acid supplementation to guide policy and program decisions.
  • Provided technical assistance for the development of micronutrient supplementation indicators for the new electronic health information system.
  • Supported community outreach strategies to educate opinion leaders and families on the importance of micronutrient supplements, how to use them, and where to get them and provide micronutrient supplements to women and children who may otherwise not receive them. As part of this we:
    • Reached over 50,000 families with home visits on the importance of nutrition and use of micronutrient supplements.
    • Trained medical students, community volunteers, day care teachers and community leaders to increase their knowledge about micronutrient deficiencies and supplements, allowing them to participate in nutrition outreach events
    • Reached over 33,000 children with life-saving vitamin A supplements
    • Provided Chispitas to close to 10,000 children
    • Reached 18,000 children with iron syrup to reduce anaemia
    • Ensured over 9,600 children suffering from diarrhoea were treated with zinc to recover faster
    • Provided iron-folic acid supplements to 3,200 women who were pregnant or breastfeeding, to reduce anaemia