Nutrition Country Profiles – BELIZE August, 2003 Rome, FAO.

FAO - NUTRITION COUNTRY PROFILES

BELIZE

FOOD AND AGRICULTURE ORGANIZATION

OF THE UNITED NATIONS
Nutrition Country Profiles – BELIZE 1

Note for the reader

The objective of the Nutrition Country Profiles (NCP) is to

provide concise analytical summaries describing the food and
nutrition situation in individual countries with background statistics on
food-related factors. The profiles present consistent and comparable
statistics in a standard format. This pre-defined format combines a set
of graphics, tables and maps each supported by a short explanatory
text. Information regarding the agricultural production, demography
and socio-economic level of the country are also presented.

In general, data presented in the NCP are derived from national

sources as well as from international databases (FAO, WHO...).

Technical notes giving detailed information on the definition

and use of the indicators provided in the profile can be obtained from
ESNA upon request. An information note describing the objectives of
the NCP is also available.

Useful suggestions or observations to improve the quality of this

product are welcome.

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Nutrition Country Profile of Belize

prepared for the Food and Agriculture Organization of the United Nations by Ms.
Gilda Richardson from the Caribbean Food and Nutrition Institute (CFNI) in
collaboration with Rosanne Marchesich (ESNA-FAO).

The designations employed and the presentation of material in this publication do not imply the expression of any opinion whatsoever on
the part of the Food and Agriculture Organization of the United Nations concerning the legal status of any country, territory, city or area or
of its authorities, or concerning the delimitation of its frontiers .

FAO, 2003
Nutrition Country Profiles – BELIZE 2

Table of contents

SUMMARY------------------------------------------------------------------------------------------------------- 3

TABLE 1: GENERAL STATISTICS OF BELIZE ----------------------------------------------------- 4

I. OVERVIEW --------------------------------------------------------------------------------------------------- 5
1. Geography ....................................................................................................................... 5
2. Population........................................................................................................................ 5
3. Level of development: poverty, education and health.................................................. 6
4. Agricultural production, land use and food security..................................................... 7
5. Economy .......................................................................................................................... 8

II. THE FOOD AND NUTRITION SITUATION ---------------------------------------------------------- 9

1. Trends in energy requirements and energy supplies .................................................. 9
2. Trends in food supplies ................................................................................................10
3. Food consumption......................................................................................................12
4. Infant feeding practices.................................................................................................13
5. Anthropometric data .....................................................................................................14
6. Micronutrient deficiencies .............................................................................................16

REFERENCES ---------------------------------------------------------------------------------------------- 18

MAPS are presented after the <REFERENCES>

General Map
Map 1: Prevalence of stunting in school children (6 to 9 years) by district (1996).
Map 2: Prevalence of anaemia among pregnant women by district (1984).

Graphs, tables and maps can be visualised by clicking on the words in bold and underline,
only in the “Full profile” pdf file.
Nutrition Country Profiles – BELIZE 3

SUMMARY
Food availability is not a problem in Belize, but large numbers of households
living in poverty are prone to food insecurity, due to a lack of access to food because
purchasing power is low (Palacio et al., 1997). It is estimated that 25% of Belizean
households live in poverty (KAIRA, 1996).
Although little is known about the actual food consumption pattern of Belizeans,
it is clear that marked differences exist between the consumption patterns of different
ethnic groups and classes. Lifestyle changes in Belize have also had a significant
impact on how and what people eat.
Regarding infant feeding practices, in the Toledo district, the late introduction
of complementary foods for infants was reported in 1994. A 1997 study found that
breast-feeding is more practiced in the rural areas than in the urban areas
(PAHO/WHO, 1997). Recently, an infant and young child feeding programme has
been initiated (PAHO/WHO, 2001).
National data on nutritional status are lacking. A 1992 National Survey showed
that 6% of children less than 5 years were underweight (MOH, 1992). According to
WHO classification the prevalence of stunting and wasting are low, however special
attention should be directed to the district of Toledo with has a high prevalence of
stunting among under fives (39%) (MOE, 1996).
However, in 1996, the National Height Census reported that 15% of male and
female children aged 6 to 9 years were stunted (MOE, 1996) (Table 5 and Map 1).
Regarding micronutrient deficiencies, high prevalences of both anaemia and vitamin
A deficiency (VAD) were reported. The prevalence of anaemia (Hb<11µg/dL) at the
national level was 19% among children (2 to 8 years) and 52% among pregnant
women (Map 2 and Table 6) (Makdani et al. 1996; McDonald, 1996). The prevalence
of VAD among children (2 to 8 years) at the national level was 24% based on serum
retinol levels. In the district of Toledo prevalences of both VAD among children (2 to 8
years) and anaemia among pregnant women are high.
The prevalence of iodine deficiency is low.
 TABLE 1: GENERAL STATISTICS OF BELIZE
Last updated: ########
Indicator (§) Year Unit Indicator (§) Year Unit
A. Land in use for agriculture G. Average Food Supply
1. Agricultural land 2000 ha per person 0.615
2. Arable and permanent crop land 2000 ha per person 0.394 1. Dietary Energy Supply (DES) 1998-2000 kcal/caput/day 2886
B. Livestock
1. Cattle 1998-2000 thousands 59 Percentage of DES by major food groups
2. Sheep & goats 1998-2000 thousands 4 2.4%
3. Pigs 1998-2000 thousands 24 7.7%
4. Chickens 1998-2000 millions 1
6.7% Cereals (excl. beer)
C. Population 30.9% Starchy roots
1. Total population 2000 thousands 241 Sweeteners
2. 0-4 years 2000 % of total pop. 12.9
Pulses, nuts, oilcrops
3. 5-14 years 2000 % of total pop. 25.4 7.0%
4. 15-24 years 2000 % of total pop. 21.5 Fruits & Vegetables
5. >= 60 years 2000 % of total pop. 6.0 3.3% Vegetable oils
6. Rural population 2000 % of total pop. 45.8 Animal Fats
7. Annual population growth rate, Total 2000-2005 % of total pop. 2.1 Meat & offals
8. Annual population growth rate, Rural 2000-2005 % of rural pop. 0.5 8.8% 1.6% Fish & seafood
9. Projected total population in 2030 2030 thousands 396
Milk & Eggs
10. Agricultural population 2000 % of total pop. 30.5
Other
11. Population density 2000 pop. per km2 9.8
7.2%
D. Level of Development 24.1%
1. GNP per capita, Atlas Method 1998 current US$ 2660
Note: Value not indicated if below 1%
2. Human Development Index rating (new) 1999 min[0] - max[1] 0.776
3. Incidence of poverty, Total 1996 % of population 33.0
4. Incidence of poverty, Rural 1996 % of population 42.5 % Energy from:
5. Life expectancy at birth (both sexes) 200-2005 years 74.4 2. Protein 1998-2000 % of total energy 9.4
6. Under-five mortality rate 2000 per 1,000 live births 41 3. Fat 1998-2000 % of total energy 21.1
E. Food Trade 4. Proteins 1998-2000 g/caput/day 66.0
1. Food Imports (US $) 1998-2000 % of total imports 9.2 5. Vegetable products 1998-2000 % of total proteins 60.1
2. Food Exports (US $) 1998-2000 % of total exports 64.4 6. Animal products 1998-2000 % of total proteins 39.9
3. Cereal Food Aid (100 t) 1998-2000 % of cereals imports NA
H. Food Inadequacy

F. Indices of Food Production 1. Total population "undernourished" 1997-99 millions NA

1. Food Production Index 1998-2000 1989-91=100 158.8 2. % population "undernourished" 1997-99 % of total pop. NA
2. Food Production Index Per Capita 1998-2000 1989-91=100 133.0 NA Data not available. § see References for data sources used
Nutrition Country Profiles – BELIZE 5

BELIZE
I. OVERVIEW

1. Geography

Belize is located on the eastern Caribbean coast of Central America, bounded by Mexico to the
north, and Guatemala to the west. Its landmass includes 450 tiny islands called cays that are located
in the inner coastal waters. Belize’s total land area is 22 963 km2 (EIU, 2003) (General Map).
The country has low coastal plains in the north and south, with mangrove swamps. The
Maya Mountains stand in the south, taking up much of the country. The highest point is Victoria
Peak at 1128 m. The Mountain Pine Ridge in the west ranges from 305 to 914 m. Sixty five percent
of the land is forested, of which 36% are protected areas.
The climate is sub-tropical, tempered by trade winds. Temperatures in coastal areas range
from 10oC to about 35oC. The average mean rainfall varies from 1295 mm in the north to 4445 mm
in the extreme south. The dry season usually extends from February to May, with an occasional dry
spell in August.
The country is divided into six administrative districts: Belize, Cayo, Corozal, Orange Walk,
Stann Creek and Toledo. The capital city is Belmopan.

2. Population
The total population was estimated at 241 000 in 2000 and is growing at an annual rate of 2.1%
projected for the period 2000-2005 (Table 1) (UN, 2001). In 2000, 45.8% of the population lived
in rural areas and 54.2% in urban areas. The population density in 2000 was 9.8 persons per km2
(up from 5.4 in 1970 and 8.2 in 1990), which reflects one of the lowest population densities in the
world and the lowest in Central America. However, the total fertility rate of 3.4 children per women
in 1995-2000 implies that there will be a population increase (EIU, 2003). In 2030, the projected
total population is estimated at 396 000 (UN, 2001). Most of the population lives on the coast
which includes one half of the Belize City population and its surrounding districts. Plus, one half of the
rural population live in villages in the north. Inland areas in the centre and south are sparsely
inhabited (EIU, 2003). Belize is made up of a young population with 8% of its population below the
age of 14. Only 6% of the total population is more than 60 years (UN, 2001) (Table 1). The
official language is English but Creole and Spanish are commonly spoken. Belize's population is
multi-ethnic. According to the 2000 census the traditionally dominant ethnic group of Creoles now
comprise 30% of the total population, while the Mestizo represent 44%, Maya represent 11% and
the Garifuna and others represent 7 % (EIU, 2003). From 1995 to 2000 the crude birth rate and
crude death rate were 28 and 5 per 1000 population, respectively (UN, 2001).
Nutrition Country Profiles – BELIZE 6

Population Pyramid

Source: UNAIDS/ WHO, 2002.

3. Level of development: poverty, education and health

The Poverty Assessment Report of 1996 was based on both food and non-food item expenditure. It
concluded that 25% of the Belizean households and 33% of the individuals were living in poverty. Of
those, 10% and 13% of the households and individuals, respectively, where considered to be
extremely poor. Female-headed households were found to be more vulnerable to poverty (KAIRA,
1996). Toledo and Cayo where the poorest districts. Forty three percent of the poor live in rural
areas. They are mainly Mayan and/or immigrants. Poverty in urban areas had a prevalence of 21% in
1996 ( Table 1).
In Belize, the education system provides 2-3 years of pre-school, 8 years of primary school,
4 years of secondary school and a range of options for tertiary education, including two universities.
It is estimated that 36% of the population does not complete primary education (MED, 1996). The
literacy rate for the population group of 14 years and above was of 90% in the 1980's but due to the
influx of Central American immigrants, it was reduced to 75% in 1996 (Palacio et al., 1997) In urban
areas the literacy rate was of 87%, with the Belize district showing a literacy rate of 92%. This
difference may have been due to the low literacy of the majority of immigrants in rural areas. In these
areas, the lowest literacy rate was registered in Toledo (59%) and the highest in Orange Walk
(72%) (MED, 1996). However, in 2000, the adult literacy rate recovered to 93% with the same
percentage for both males and females (UNICEF, 2003; EIU, 2003).
Like many Caribbean countries Belize is experiencing an epidemiological transition. The
Government of Belize is the main provider of health services, and efforts by the Ministry of Health to
control diarrhoea, respiratory and communicable diseases have had a considerable impact in
reducing infant mortality and under-five mortality rates, which are respectively 34 per 1000 live births
for the period 1995-2000 and 40 per 1000 live births in 2001 (UNICEF, 2003) (Table 1). Life
expectancy increased from 71.9 years in 1991 to 74.4 years in 2000-2005 (UN, 2001). Maternal
mortality rate in 1995 was 140 per 100 000 live births (UNAIDS/WHO, 2002).
According to UNICEF, 100% of routine EPI (expanded programme on immunization)
vaccines were financed by the government in 2001. The percentage of children under one year,
immunized against TB, DPT3, polio3, measles and HepB3 in 2001 were 95%, 89%, 89% 96% and
75%, respectively (UNICEF, 2003).
Nutrition Country Profiles – BELIZE 7

Asphyxia accounted for 36% of deaths in 1996 and was the most common cause of death
during the peri-natal period, followed by low birth weight (28%) and infectious diseases (24%), with
12% of deaths due to respiratory diseases. Respiratory and intestinal diseases were responsible for
63% and 32% of admissions in hospitals, among children under one year, respectively. The leading
cause of death among children under four years old was road traffic accidents (24%), followed by
infectious diseases (22%); 65% accounting for respiratory diseases. Among older children (5 to 9
years) respiratory diseases were the leading cause of morbidity for both males and females (21%).
Respiratory infections, cerebro-vascular diseases and neoplasms were the leading causes of death
for adults 50 years and older (Department of Statistics, 1997). According to UNICEF, 96% of
women received antenatal care from 1995 to 2001 (UNICEF, 2003).
Communicable diseases such as malaria, gastro-enteritis, gonococcal infection, syphilis and
tuberculosis, are still major contributors to morbidity. However, chronic diseases were the leading
causes of death in Belize in 1996, with heart disease being the main cause, followed by accidents,
pneumonia, cardiovascular diseases and cancers. Gastro-enteritis and Diabetes Mellitus are among
the ten leading causes for hospitalisation (Department of Statistics, 1997). The incidence of AIDS is
high. The estimated number of adults and children living with HIV/AIDS at the end of 2001 was
2200 adults (15-49 years) with 1000 being women. One hundred and eighty were children under 15
years (UNAIDS/WHO, 2002).

4. Agricultural production, land use and food security

Agriculture accounted for 11% of GDP in 2000 (EIU, 2003). The agricultural population
represented 31% of the total population in 2000 (FAOSTAT, 2003) (Table 1). There has been an
increased production of citrus fruits (213 414 t/year), bananas (43 030 t/year) and farmed shrimp
(value unknown). The production of sugar cane (1 150 656 t/year) has decreased due to low
productivity and low world prices (FAOSTAT, 2003). Also, Hurricane Keith in October 2000
caused damage to sugar crops and to the marine environment. Hurricane Iris, which hit in 2001,
caused further damage to the banana industry (EIU, 2003). Moreover, since the export earning of
these products are decreasing, efforts to diversify into non-traditional crops such as papaya,
soybean, cashew and chilli peppers are being made (EIU, 2003).
The food production index was 154 in the period 1996-98 and increased to 159 in 1998-
2000 from a set base of 100 in the period 1989-91 (FAOSTAT, 2003) (Table 1).
Belize has a low rate of land cultivation but it is rising due to the imposition of taxes on land
not used for agricultural purposes (EIU, 2003). In 2000, agricultural land consisted of 0.615 ha per
person of which 0.394 ha per person was arable and permanent cropland (FAOSTAT, 2003)
(Table 1). Large commercial farmers cultivated 85% of the agricultural land for export. They are
responsible for the major part of the food supply for the internal market (Palacio et al., 1997).
Food insecurity is largely determined by household income and food prices. As far as food
prices are concerned, the annual national inflation rates averaged 3% over the period 1991–1995.
Food prices in relation to minimum wage are not monitored in Belize. The large numbers of
households living in poverty are prone to food insecurity, especially indigent households. On this
basis, several population groups were identified as being particularly at risk of food insecurity, i.e.
rural residents of Toledo and Cayo districts, single income and/or women headed households in
urban centres, the Maya people, pregnant women, as well as Garifuna women in Stann Creek
(Palacio et al., 1997).
Nutrition Country Profiles – BELIZE 8

5. Economy
Reduced agricultural and industrial production contributed to a decrease in GDP in 1998 However,
the results of the government’s expansion policies have contributed to an increase of 11% and 5% in
2000 and 2001, respectively. One policy encourages investment in non-traditional areas of
production and the export of bananas, citrus, and marine products, as well as sugar (EIU, 2003).
Compared to other Caribbean countries the overall growth in Belize's economy since 1980 has
been significant, with a GNP per capita in 2001 of US$2730 ( EIU, 2003). The country started a
process of structural change in 1991 in order to move towards a more open competitive economy.
In 1999, the Value Added Tax (VAT), which was introduced in 1996, was replaced by a sales tax
(8%). Basic food, medicines, public transport, electricity and water services are exempt from the tax,
along with small businesses. This change was implemented to stimulate business activity (EIU, 2003).
Nutrition Country Profiles – BELIZE 9

II. THE FOOD AND NUTRITION SITUATION

1. Trends in energy requirements and energy supplies

Per caput energy requirements1 increased from 1965 to 2000 and are expected to increase further
by 2030. In the year 2000, the per capita energy requirement in rural areas was 2187 kcal/day and
in urban areas it was 2086 kcal/day. Trends in food requirements reflect the changes in population
structure and in particular the age, sex and urban-rural distribution. The percentage of people living
in urban centres has increased slightly between 1965 and 2000 and the total population more than
doubled in the same time period. The per caput dietary energy supply (DES) has followed
population growth and the trends in energy requirements, increasing from 2236 kcal/day in 1965 to
2886 kcal/day in 2000, exceeding per caput energy requirements (FAOSTAT, 2003) (Table 2).

Table 2: Total population, urbanisation, energy requirements and dietary energy supplies
(DES) per person and per day in 1965, 2000 and 2030
Year 1965 2000 2030
Total population (thousands) 107 241 396
Percentage urban (%) 52.5 54.2 59.7
Per caput energy requirements (kcal/day) 2090 2135 2185
Per caput DES (kcal/day) * 2236 2886 __
Note: The DES is expressed for an average-person of the country.
Source: FAOSTAT, 2003

The share of fat in total DES has decreased slightly from 23% to 21% in the period 1964-
2000 while the percentage of carbohydrates increased slightly from 67% to 70% during the same
period (Figure 1). The share of protein in total DES has decreased slightly from 10% to 9% over
the 36 year period (FAOSTAT, 2003).

1
Per caput energy requirements are calculated on the basis of the sex and age distribution of the
population, using references for body size, physical activity levels (higher among the rural population, lower
among the urban), energy needs for pregnancy and lactation. The method of calculation is derived from James &
Schofield (1990). The requirements are expressed per average person of the country. Thus requirements are low in
young and/or urbanized populations and higher in older or rural populations.
Nutrition Country Profiles – BELIZE 10

Figure 1: Share of protein, fat and carbohydrate in Dietary Energy Supply Trends from 1964-66 to
1998-2000
3000

2500 21.1
23.1
DES kcal/caput/day

24.8 23.1
22.6 9.4
2000 23.0 23.4 10.2
10.3 10.9 10.7
10.3 10.2
1500

1000 66.6 69.6

66.7 66.4 67.0 64.3 66.2
500

0
1964-66 1969-71 1974-76 1979-81 1984-86 1989-91 1998-2000

Carbohydrates Protein Fat

Belize Source: FAOSTAT

2. Trends in food supplies

Quantity: During the 1964–2000 time period, the supply of fruit and vegetables, showed a sharp
increase from 1969–71 to 1979–81 from 84 kg/caput/year to 183 kg/caput/year and again from
1984–1986 to 1998–2000 from 165 kg/caput/year to 326 kg/caput/year. This increase can be
attributed to the government expansion policies mentioned earlier. Figure 2 also shows that the
supply of sweeteners increased from 1989–91 to 1998–2000 from 47 kg/caput/year to 71
kg/caput/year despite the decline in the production of sugar cane since 1997. This increase could be
attributed to the low cost and therefore increased consumption. The supply of the milk and eggs food
group remained the same when comparing 1964–66 and 1998–2000, however, it gradually
increased until 1979–81 and then gradually decreased again. The supply of all other food groups
remained relatively constant for the time period.

Figure 2: Supplies of major food groups (in kg/caput/year)

Trends from 1964-66 to 1998-2000
350

325

300
Cereals (excl. beer)
275
Starchy roots
250
Sweeteners
225
Pulses, nuts, oilcrops
kg/caput/year

200 Fruits & Vegetables

175 Vegetable oils

150 Animal Fats

Meat & offals
125
Fish & seafood
100
Milk & Eggs
75
Other
50

25

0
1964-66 1969-71 1974-76 1979-81 1984-86 1989-91 1998-2000

Belize Source: FAOSTAT

Nutrition Country Profiles – BELIZE 11

Energy: Figure 3 shows that cereals have been the major share of total DES over the 36 year time
period. The cereals group, consists mostly of wheat, which is not produced in Belize, followed by
rice (one third is imported). Belize produces most of the maize consumed. The second largest group
in terms of contribution to total DES is sweeteners, which increased from 14 % to 24 % of the total
DES, for the same time period. In addition, the share of total DES for fruits and vegetables grew
from 5 % to 9 %. This can be attributed to the economic policy to increase the production of
bananas and citrus fruits (oranges and grapefruit), along with other non-traditional crops, in order to
increase total domestic export earnings (EIU, 2003). Vegetable oil, as a share of total DES, also
increased, while animal fat decreased.

Figure 3: Share of major food groups in Dietary Energy Supply

Trends from 1964-66 to 1998-2000
3000

2500

Cereals (excl. beer)

Starchy roots
2000
Sweeteners
Pulses, nuts, oilcrops
kcal/caput/day

Fruits & Vegetables

1500 Vegetable oils
Animal Fats
Meat & offals
Fish & seafood
1000
Milk & Eggs
Other

500

0
1964-66 1969-71 1974-76 1979-81 1984-86 1989-91 1998-2000
Belize Source: FAOSTAT

Major food imports and exports: Belize has a high degree of dependence on imported
goods that supply the population with 60% of its food. Since the 90s, attempts to decrease imports
in order to decrease the deficit have only had moderate success because farmers are reluctant to
change and because of poor marketing strategies. Belize imports most of its cereal (21 849 t/year in
1998–2000), although as a proportion of total imports it decreased from 22% in 1964-66 to 9% in
1998-2000. Imports of animal fat as a percentage of total DES decreased steadily, while vegetable
oil imports increased after 1989–91. Meat and offals imports decreased slightly. The import of milk
and milk products peaked in 1979-81 (16% of total DES) but decreased to 6% of total DES in
1998-2000 (Figure 4) (FAOSTAT, 2003).
Nutrition Country Profiles – BELIZE 12

Figure 4: Major food imports as a percentage of Dietary Energy Supply

Trends from 1964-66 to 1998-2000
70

60

50 Cereals (excl. beer)

% of DES

40 Vegetable oils

30 Animal fat

20 Meat & offals

10 Milk & products

0
1964-66 1969-71 1974-76 1979-81 1984-86 1989-91 1998-2000
Belize Source: FAOSTAT

Food export as a percentage of total DES has varied over the period 1964–2000 (Figure
5), with sweeteners being the primary export food product,. The export of sweeteners has increased
from 37 148 t/year in 1964–1966 to 99 343 t/year in 1998–2000. However, the decrease between
1984-86 and 1989-91 can be attributed to the decreased productivity and low world prices for
these foods (EIU, 2003). Fruit, mainly citrus (oranges and grapefruit) and bananas, showed an
increase from 37 328 t/year in 1964-66 to 196 260 t/year in 1998-2000. Since 2000, citrus and
banana export earnings have exceeded sugar crop export earnings, as a result of an economic policy
to diversify fruit export-orientated production. Although, marine products (lobster and shrimp)
accounted for less than 1 percent of DES in 1998–2000 they are still an important export earning
product in Belize (EIU, 2003).

Figure 5: Major food exports as a percentage of Dietary Energy Supply

Trends from 1964-66 to 1998-2000
300
275
250
225
200
% of DES

175
Sweeteners
150
125 Fruit (excl. Wine)
100
75
50
25
0
1964-66 1969-71 1974-76 1979-81 1984-86 1989-91 1998-2000
Belize Source: FAOSTAT

3. Food consumption
Data were collected in 1967–68, based on 24-hour recalls from 141 households of agricultural
families, mainly Mayans. Average daily intake per capita was 2960 kcal, for energy, and 84 g, for
protein. However, the age and sex composition of the sample was not stated. Wheat contributed
33% of total DES and 33% of protein. Corn supplied 22% of total DES and 19% of protein. On
Nutrition Country Profiles – BELIZE 13

average, fish or meat was eaten daily, and vegetable intake was low. Vitamin A and C intakes were
also reported to be low, which could be a result of low fruit consumption (Grant, 1974).
A 1975 study, carried out by the Caribbean Food and Nutrition Institute (CFNI) found that
individuals from all districts were at risk of Vitamin A and C deficiency, while in Toledo and Stann
Creek intake of Calcium, Iron, Thiamine, Riboflavin and Niacin were also low. Wheat flower was
the main provider of energy, followed by rice. Cereals which are not produced in the country and
must be imported account for half of the DES. However, the National Household Survey carried
out by CFNI should be interpreted carefully, since the survey was limited to less than 20 households
per district (CFNI, 1975).
Government figures indicated that the average household spent at least 29% of its budget on
imported food during the 1980s. Urban and upper-income groups averaged higher percentages.
Food consumption from imported foods include items such as dairy products, canned meats, and
vegetables, but also staples such as rice and red kidney beans, which are also produced locally. Diet
varied by culture as well as class, with Maya and rural Mestizos consuming large amounts of corn,
and Garifunas consuming large quantities of fish. The national dish, however, consisted of rice and
beans.
Lifestyle changes in Belize have had a significant impact on how and what people eat. Fast
foods and the ready availability of prepared foods have compounded these problems. Currently a
Gender Analysis of Diet, Exercise and Lifestyles Practices in Belize are being conducted in order to
establish guidelines for the development of health promotion strategies to encourage healthy lifestyle
practices. Also, a Nutrition Surveillance System is being developed to improve data collection for
nutrition information at the local level (PAHO/WHO, 2003).

4. Infant feeding practices

Food patterns in the weaning period vary among the different ethnic groups. The Mayans breast-
feed longer, and their infants typically receive tortillas as their first solid food. Garifuna infants were
first offered porridge, made from cassava starch. Some Mayans, Mestizo and Creole omitted the
semi-solid step in weaning. The most common first solid food was mashed potato. Bottle-feeding
also included cereal gruels, custard or juice. Complementary food was usually introduced between 3
to 6 months (Foster, 1982).
Common weaning foods are rice, white corn tortilla, beans and beef soup. Diets were
deficient in Vitamins A and C, followed by deficiencies in riboflavin, iron and calcium. The main iron
sources were from vegetable origin and therefore had a low bioavailability (Government of Belize,
1997).
According to UNICEF, the percentage of all infants aged 0-4 months who were exclusively
breast-fed in 1993 was only 24% (UNICEF, 1999). A 1997 study on breast-feeding and infant
feeding, found that breast-feeding is more practiced in the rural areas than in the urban areas, and
that “mixed” feeding (breast-feeding combined with bottle-feeding) is practiced among infants under
six months (PAHO/WHO, 1997).
Currently none of the eight hospitals or maternities have officially been designated by
UNICEF as “Baby Friendly” (having fulfilled 10 criteria supportive of breast-feeding). The length of
maternity leave is 12 weeks and social security pays 80% of wage as cash benefit for maternity leave
(ILO, 1998). In 2002-2003, the infant and young child feeding program was initiated which includes
the promotion of breast-feeding, training of breast-feeding, baby-friendly hospital initiative and the
development of national guidelines for young child feeding (PAHO/WHO, 2001).
Nutrition Country Profiles – BELIZE 14

Women’s share of the adult labour force (15 years and above) is 23% (UNDP, 1998).

5. Anthropometric data
In 1992, the Assessment of the Food Nutrition and Health Situation of Belize study was
carried out on 8516 children under 5 years. It found that the national prevalence of underweight
among male and female children was 6%. In Toledo, the surveys found a 16% prevalence of
underweight among male and female pre-school children in 1992 (MOH, 2002; PAHO/WHO,
2001) (Table 5).
In 1996, the National Height Census was carried out on school children, both males and
females from 6 to 9 years, and found that the prevalence of stunting at the national level was 15%,
(18% for males and 13% for females). The national prevalence of stunting is considered to be low
according to WHO international classification (WHO, 1996). However; the prevalence is much
higher in rural areas (23%) than in urban areas (7%). It is important to note that the Toledo district
had a stunting prevalence of 39%, while the lowest prevalence was in the Belize District (4%)
(MOE, 1996) (Table 5 and Map 1).
In 2002-2003 special efforts are being made to facilitate the flow of nutrition information
from local and national levels, which will provide policy makers with nutrition information necessary
for programmatic action via the Nutrition Surveillance System (PAHO/WHO, 2001).
Nutrition Country Profiles – BELIZE 15

Table 5: Anthropometric data on children

Source/ Location Sample Percentage of malnutrition

Year Size Sex Age
of survey Numbe Years
r

Underweight Stunting Wasting Overweight

% Weight/Age % Height/Age % Weight/Height % Weight/Height
< -3SD < -2SD* < -3SD < -2SD* < -3SD < -2SD* > +2SD

MOH, 1992 National 8516 M/F 1.3 6.2 NA NA NA NA NA

1992
District:
Corazal 1815 M/F 0.4.99 1.8 6.9 NA NA NA NA NA
Orange Walk 1172 M/F 0.4.99 0.6 6.1 NA NA NA NA NA
Belize 2454 M/F 0.4.99 1.1 3.9 NA NA NA NA NA
Cayo 2384 M/F 0.4.99 1.4 6.5 NA NA NA NA NA
Toledo 369 M/F 0.4.99 2.2 15.5 NA NA NA NA NA
Stann Creek 619 M/F 0.4.99 1.8 7.6 NA NA NA NA NA

MOE, 1996 National** 22436 M/F 6.0-9.0 NA NA NA 15.4 NA NA NA

NHCSC, 1996 Urban NA M/F 6.0-9.0 NA NA NA 7.0 NA NA NA
Rural NA M/F 6.0-9.0 NA NA NA 23.0 NA NA NA
National** 11370 M 6.0-9.0 NA NA NA 18.2 NA NA NA
National** 11056 F 6.0-9.0 NA NA NA 12.5 NA NA NA

District:
Corazal NA M/F 6.0-9.0 NA NA NA 15.8 NA NA NA
Orange Walk NA M/F 6.0-9.0 NA NA NA 16.8 NA NA NA
Belize NA M/F 6.0-9.0 NA NA NA 4.1 NA NA NA
Cayo NA M/F 6.0-9.0 NA NA NA 17.8 NA NA NA
Toledo NA M/F 6.0-9.0 NA NA NA 39.0 NA NA NA
Stann Creek NA M/F 6.0-9.0 NA NA NA 13.5 NA NA NA
Source for 1992 data: available at http://www.who.int/nutgrowthdb/
Notes: NA Data not available. Each index is expressed in terms of the number of standard deviations (SD) units
from the median of the NCHS/CDC/WHO international reference population.
* Includes children who are below -3 SD.
** National Census in schools.
Nutrition Country Profiles – BELIZE 16

6. Micronutrient deficiencies

Iodine Deficiency Disorders

A National Iodine Survey was carried out in 1994-95 among male and female school children (7 to
14 years), which assessed the levels of urinary iodine, using a cut-off point of 5 µg/dL. The results
reported in Table 6 indicate a national prevalence of 6%, with a slight difference between rural (7%)
and urban (5%) areas. Although the cut-off point used was not the one internationally recommended
(10 µg/dL) (WHO, 1993), the prevalence of IDD appears to be low. Interestingly, over-
consumption of iodine was of greater concern, as stated in the final report of the National Iodine
Survey. In 1994, one hundred percent of Belize’s salt was imported and 98% of salt consumed was
iodised (MOH/MOE, 1995) (Table 6).
Vitamin A deficiency
Vitamin A deficiency (VAD) is of concern in Belize as indicated by the results of a national survey
(1989–90) conducted among male and female children aged 2 to 8 years. In this study a fasting
serum retinol level was measured, and a cut-off point of 0.87 µmol/L. A serum retinol concentration
of < 20µg/dL (0.70 µmol/L) was used to determine the prevalence of VAD (Makdani et al, 1996).
Still, a national prevalence of 24% indicates a public health problem (WHO, 1995). Among children,
the highest prevalence of VAD was found in the district of Toledo (28%) and the lowest in Cayo and
Corozal (20%) (Table 6).
In 1999, a Vitamin A supplementation programme was initiated for children under 5 years
(PAHO/WHO, 2001).
Iron Deficiency Anaemia

In 1984 and 1994-95, the IDA (Iron Deficiency Anaemia) status of 1379 and 6402 pregnant
women attending health clinics, was assessed using a haemoglobin cut-off point of less than 11 g/dL.
Among pregnant women, the national prevalence of anaemia was 43% in 1984 and it rose to 52% in
the 1994-95 (Farnum, 1984; McDonald, 1996). According to WHO/UNICEF when a prevalence
of anaemia among pregnant women is greater than 30% supplementation programmes for
communities are recommended. At the district level, the highest prevalence in 1984 was found in
Stann Creek (78 %), followed by Toledo (67 %) (Map 2). However, this data presents limitations
since it does not include women who are unable to access clinics in Toledo, Cayo and Stann Creek
(due to far distances and lack of transportation). Moreover, the study does not include women in
the Orange Walk and Corozal District, who are crossing the border over to Mexico for their
antenatal care (Farnum, 1984) (Table 6).
In 1989-90 a national survey was carried out on 503 male and female children between the
ages of 2 and 8 years, using a haemoglobin cut-off point of less than 11 g/dL. The prevalence of
anaemia among children was 19% (Makdani et al, 1996) (Table 6). In 1999, an iron
supplementation programme was initiated for children under 5 years (PAHO/WHO, 2001).
Nutrition Country Profiles – BELIZE 17

Table 6: Surveys on micronutrient deficiencies

Source/ Deficiency Location Sample Percentage

Year Size Sex Age
of survey Number Years

Iodine
MOH/ MOE, 1995 Urinary Iodine National 1656 M/F 7.0-14.0 5.5
1994-1995 < 5µg/dL Rural 696 M/F 7.0-14.0 6.5
Urban 960 M/F 7.0-14.0 4.8

Vitamin A
Makdani et al, 1996 < 0.87 µmol/L National 503 M/F 2.0-8.0 24.0
1989-90 District:
Corazal NA M/F 2.0-8.0 20
Orange Walk NA M/F 2.0-8.0 25
Belize NA M/F 2.0-8.0 24
Cayo NA M/F 2.0-8.0 20
Toledo NA M/F 2.0-8.0 28
Stann Creek NA M/F 2.0-8.0 23

Iron
Antenatal clinics:
McDonald, 1996 Hb < 11 g/dL Total 6402 F Pregnant 51.7
1994-95

Makdani et al, 1996 Hb < 11 g/dL National 503 M/F 2.0-8.0 19.0
1989-90
Antenatal clinics:
Farnum, 1984 Hb < 11 g/dL Total 1379 F Pregnant 42.5
1984 Belize 296 F Pregnant 58.3
Corazal 296 F Pregnant 25.6
Orange Walk 308 F Pregnant 34.0
Cayo 319 F Pregnant 39.8
Stann Creek 106 F Pregnant 78.3
Toledo 81 F Pregnant 67

Notes: NA Data not available.

Nutrition Country Profiles – BELIZE 18

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Development, Government of Belize. Belmopan (unpublished data).
Nutrition Country Profiles – BELIZE 19

MOE. 1996. Closing the Gap, National Height Census of School Children in Belize 1996,
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MOH/MOE. 1995. National Iodine Survey Belize 1994-1995. Ministry of Health/Ministry of

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PAHO/WHO. 1997. Breast-feeding and Infant Feeding: A Qualitative Study on the current Breast-
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PAHO/WHO. 2003. Nutrition. Belize. Website at: http://www.paho.org.bz/nutbz.htm

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Nutrition Country Profiles – BELIZE 20

WHO. 1993. Global Prevalence of Iodine Deficiency Disorders - MDIS Working Paper #1.
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Source: Indicator:

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UN. 1999/2000 rev. C.1 to 9, D.5

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KAIRA. 1996. D.3 and 4

UNICEF. 2002. D.6

FAO/WFS. 2002. H
Nutrition Country Profiles – BELIZE 21

NCP of BELIZE
MAPS

General Map

Map 1: Prevalence of stunting in school children (6 to 9 years) by district

(1996).

Map 2: Prevalence of anaemia among pregnant women (*) by district (1985).