Priority areas


Chronic malnutrition and anemia are common problems in the Mesoamerican region, especially among children under five years of age and women in their reproductive years.

Approximately 2.5 million children under five in the region suffer from chronic malnutrition; almost half these children live in Guatemala and one quarter live in southern Mexico.

The prevalence of delayed growth as a result of malnutrition is a special challenge among rural and/or indigenous populations. When children in the poorest quintile of the Mesoamerican population reach the age of five, they are on average six centimeters shorter than their peers in the wealthiest quintile.

This critical situation is affected by low uptake of exclusive breastfeeding and complementary feeding of breastfed children. Although iron supplementation provided during pregnancy is considered to be a best practice, anemia rates during pregnancy among poor women indicate that the strategies currently used to administer nutrient supplements do not follow best practices.

To overcome this situation in the region, two intervention packages are proposed with a focus on areas where there is a high prevalence of stunting, micronutrient deficiencies, food insecurity and poverty. A third plan is provided for less affected areas:

  1. The first intervention package supports consumption through Conditional Cash Transfers (CCTs) and provision of complementary fortified foods.
  2. The second package includes provision of complementary fortified foods and micronutrients.

All interventions include education on breastfeeding, hygiene and immunization, and appropriate complementary feeding practices, vitamin A, zinc, and prenatal supplements.

Sustainable implementation of these interventions, along with coordinated, effective efforts, will help reduce the maternal and child malnutrition that prevails in the region and strengthen the region’s capacity to formulate and implement programs focused on malnutrition.


Although diseases that can be avoided through vaccination are close to being eliminated, complete, timely vaccination of children between 12 and 24 months of age in the poorest 20 percent of the population continues to be a significant challenge. Only 57 percent of children are fully vaccinated in a timely manner in Mesoamerica, and by country, the population ranges between 85 percent in Belize and Honduras and 54 percent in El Salvador and Guatemala.

The inclusion of new vaccines in national immunization schedules faces regulatory barriers and a lack of high-level agencies responsible for immunization policies in the Mesoamerican countries. Apart from Costa Rica, only Nicaragua and Honduras have begun to use pneumococcal conjugate and rotavirus vaccines. Six countries in the region continue to provide polio vaccine orally, in spite of the risks related with this method.

To broaden coverage and strengthen immunization systems, these high-impact actions have been proposed:

  1. Develop projects that allow knowledge gaps to be filled in the area of increasing coverage in hard to reach areas.
  2. Strengthen immunization policies.
  3. Implement evidence based best practices (such as integrating vaccination with other health-related services), which may be used for decision making.

Through these actions, we expect to increase the proportion of poor children that are vaccinated on a timely basis and assess the effective coverage of immunization determined by the access of the least fortunate population to these services. Similarly, we will assess the effectiveness in the use of new technologies to reduce mortality caused by vaccine preventable diseases.

Maternal child health / Reproductive health

There have been considerable improvements in the basic indicators in maternal, child, and reproductive health in the Mesoamerican region in the past ten years. However, the maternal mortality rates in the region have remained among the highest on the continent due to limited access to safe childbirth and emergency obstetric care, suitable handling of the complications associated with pregnancy and abortion, and contraceptive services for the poorest 20%.

Direct causes (mainly hemorrhages and hypertension) are believed to underlie 70 percent of maternal deaths.

It is highly likely that neonatal mortality is related to the limited, difficult access to services and qualified professionals providing prenatal and postnatal care.

In order to reduce maternal and neonatal deaths, especially among the poorest population in rural areas, the following interventions are recommended:

  1. Implementation of quality basic service in obstetric emergencies and interventions related to infections, eclampsia, hemorrhages, and miscarriages, as well as community training in these aspects.
  2. Basic services for newborns, especially those who are underweight at birth and/or have health complications.
  3. Providing at least six methods of family planning, as well as advisement and training in the implementation of the latest contraceptive methods for both men and women.

By 2015, as established in the Millennium Goals, we expect to reduce maternal mortality and morbidity and neonatal death by increasing access to competent professionals for childbirth services, especially in rural and marginal areas, increase access to reproductive health services, and to improve the quality of basic services provided for newborns, especially in areas distant from big cities.

Carlos Slim
Health Institute
international cooperation
Bill & Melinda Gates
Development Bank
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