Anemia in Eastern Cuba Reflects Inequality

Computer technician Gladys Pavón with her son Irving in Bayamo, in the eastern Cuban province of Granma. Credit: Jorge Luis Baños IPS

BAYAMO, Cuba, Jan 14 2015 (IPS) – Cuba has met the United Nations goal of reducing hunger. But anemia caused by malnutrition is still a problem among infants, small children and pregnant women in this Caribbean island nation, which has been in the grip of an economic crisis for over two decades.

“Meat is the hardest thing to get,” said Gladys Pavón from the city of Bayamo, 730 km east of Havana. “The fruit and vegetables that we buy for the children are also difficult to get. We buy milk at the store [through the ration card system],” the 32-year-old mother of two small boys told IPS.

Pavón, a computer technician, is introducing new foods into the diet of nine-month-old Irving. “My little one is now eating fruit, tubers, pasta and all kinds of meat. I try to give him a balanced diet, like I do with two-year-old Javier Alejandro,” she said.

“My kids have never suffered from anemia,” the young mother said proudly, holding the chunky Irving, who is free of an ailment that still affects vulnerable parts of the population in the east – Cuba’s poorest region despite the National Plan for the Prevention and Control of Anemia and constant support from the international community to eradicate the problem.

“Nutritional deficiency anemia is among the main nutritional problems in the province of Granma [whose capital is Bayamo], as it is in the rest of eastern Cuba,” Dr. Margarita Cruz, who heads the local Food and Nutrition Monitoring System, told IPS.

“The main cause is iron deficiency in the diet,” Cruz said. “Children and pregnant women don’t consume the iron their bodies need.”

“There are problems with availability of and access to an adequate diet, but there are also bad nutritional habits, including a taste for junk food, which has begun to have a negative impact,” she said.

There are an estimated two billion people worldwide with micronutrient deficiencies, which undermine a healthy, productive life, according to the first ever Global Nutrition Report, published in November 2014 by the U.N. Food and Agriculture Organisation (FAO).“Nutritional deficiency anemia is among the main nutritional problems in the province of Granma, as it is in the rest of eastern Cuba.” — Dr. Margarita Cruz

And under-nutrition kills nearly 1.5 million women and children a year around the world.

In Cuba, which has met the U.N. Millennium Development Goal (MDG) of halving the number of people who live in hunger, from 1990 levels, less than five percent of the population of 11.2 million is undernourished.

Every inhabitant receives a set quota of food purchased at subsidised prices through the “libreta” or ration book. The system is widely criticised, but it is essential for lower-income segments of the population. And pregnant women and children up to the age of 13 receive a special diet with extra supplies of meat, fortified milk, fruit compote and yoghurt.

But to put food on the table all month long, families have no choice but to pay the high prices charged for food in the farmers’ markets, state-run stores that only accept hard currency, and the black market, which survives despite police raids and prison sentences of up to three years for contraband.

Statistics from the state-run Centre of Studies on the Cuban Economy show that food absorbs between 59 and 75 percent of the family budget, in a country where the state, by far the largest employer, pays an average salary of 19 dollars a month.

Eastern Cuba, which includes five provinces Las Tunas, Granma, Holguín, Santiago de Cuba and Guantánamo has the worst development indicators in the country.

According to the latest population and housing census, from 2012, many more people leave the eastern provinces than arrive. In the remaining 10 provinces, more than 75 percent of outsiders have traditionally been from the east.

Although anemia is still a health problem, the situation has improved in recent years.

A study carried out in eastern Cuba from 2005 to 2011 found that the prevalence of anemia among children under five fell from 31.8 to 26 percent. The highest rates were found among babies and toddlers between six and 23 months of age, according to an article published in 2014 in the Cuban magazine MEDICC Review.

In Granma, which has 830,600 inhabitants, the prevalence of anemia among children under five has dropped below 25 percent and among pregnant women to under 20 percent, said Cruz, one of the authors of the article in MEDICC Review.

“An effort has been made, which is why we have seen results,” she said. “People are eating more vegetables and have learned how to combine certain foods to maximise the nutrients.”

The World Food Programme (WFP) financed two major projects, consecutively, from 2002 to 2014 in the five eastern provinces, in support of the Public Health Ministry’s National Plan for the Prevention and Control of Anemia.

The projects, carried out in conjunction with local institutions, included communicational and educational strategies targeting families; the setting up of anemia monitoring systems in the public health sector; the free distribution of cereals fortified with micronutrients; and measures to boost local production of the cereals.
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Cuba and the WFP launched a new programme this month. It will run through 2018, and puts a priority on nutritional monitoring and aid for agriculture in Cuba, in line with the Raúl Castro government’s emphasis on agriculture and empowerment at a local level to reduce the country’s food imports, which total two billion dollars a year.

Using rice grown in Cuba, the state-run Dairy Products Company of Bayamo began this month to produce fortified rice, Nutriarroz. Rice is the most widely consumed cereal in this country.

“The product has been accepted well in the trials that have been carried out,” said Rauel Medina, director of the factory.

The company, the largest of its kind in the country, is to deliver 1,200 tons a year for free distribution among small children and pregnant women in the eastern provinces that still have a high prevalence of anemia, as part of the cooperation between the WFP and Cuba.

“This problem must be detected among women of childbearing age,” said Dr. Mariela Velis, head of the Maternal and Child Health Programme in Granma. “An anemic mother can have a child with the same problem, and a cycle is created.”

For that reason, hemoglobin screening for anemia is carried out among women in the province, starting in adolescence, she explained.

Edited by Verónica Firme/Translated by Stephanie Wildes