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Nutrition Country Profiles – THE BAHAMAS August, 2003 FAO - NUTRITION COUNTRY PROFILES THE BAHAMAS FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED ...
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Nutrition Country Profiles – THE BAHAMAS August, 2003

FAO - NUTRITION COUNTRY PROFILES

THE BAHAMAS

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

Nutrition Country Profiles – THE BAHAMAS

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. The data used to prepare the maps are available in Excel upon request at: E-mail: [email protected]

Nutrition Country Profile of The Bahamas prepared by the Caribbean Food and Nutrition Institute (CFNI), Mrs. Adelma Penn (Bahamas) and Mr. Michael Ennis for the Food and Agriculture Organization of the United Nations (ESNA).

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

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Table of contents SUMMARY----------------------------------------------------------------------------------------------- 3 TABLE 1: GENERAL STATISTICS OF THE BAHAMAS ----------------------------------- 4 I. OVERVIEW ------------------------------------------------------------------------------------------- 5 1. 2. 3. 4. 5.

Geography ..........................................................................................................5 Population ...........................................................................................................5 Level of development: poverty, education and health .........................................6 Agricultural production, land use and food security.............................................7 Economy .............................................................................................................8

II. THE FOOD AND NUTRITION SITUATION -------------------------------------------------- 9 1. 2. 3. 4. 5.

Trends in energy requirements and energy supplies ..........................................9 Trends in food supplies ...................................................................................100 Food consumption...........................................................................................134 Anthropometric data........................................................................................146 Micronutrient deficiencies..................................................................................20

REFERENCES--------------------------------------------------------------------------------------- 172 MAPS are presented after the General Map of The Bahamas

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 – THE BAHAMAS

3 SUMMARY

Overweight and obesity have a greater effect on the nutritional status of the population in The Bahamas than underweight and nutritional deficiencies. Based on the 1994-95 Ministry of Health/CFNI report, among children 4-9 years old, 6.6% were underweight, 12.9% were stunted (a greater proportion of boys than girls) and 5.7% were wasting. In contrast, 14.9% of these children were overweight (the prevalence being the same for boys and girls) (Table 4a). It is not possible to say whether these levels represent an improvement or deterioration in the nutritional status of this particular age group as no data are available for comparison. In the 1988-89 National Health and Nutritional Survey (MOH, CFNI/PAHO, 1991), it was reported that the prevalence of undernutrition (< 5th percentile) among children 5-14 years was 16.7%. At the sub-national level, relatively high prevalence levels of undernutrition were found on Acklins (15.4%) and Crooked Islands (11.9%) among children > 5 years. The highest prevalence of undernutrition (< 3th percentile) was found on the Family Islands (12.3%) among children 95th percentile) among the 5-14 year old children, was 6.7%. However, the prevalence among females in New Providence was 16.0%. Among these 5-14 year olds, a relatively low prevalence was seen on Acklins (1.3%), while that seen on Crooked Island (15.8%) was relatively high. The prevalence of overweight (> 97th percentile) among children = 60 years Rural population Annual population growth rate, Total Annual population growth rate, Rural Projected total population in 2030 Agricultural population Population density

30.0%

2000 2000 2000 2000 2000 2000 2000-2005 2000-2005 2030 2000 1995

thousands % of total pop. % of total pop. % of total pop. % of total pop. % of total pop. % of total pop. % of rural pop. thousands % of total pop. pop. per km2

307 … … … 8.1 11.5 1.3 … 408 3.6 20.2

Sweeteners Pulses, nuts, oilcrops Fruits & Vegetables

18.3%

Vegetable oils Animal Fats Meat & offals Fish & seafood Milk & Eggs 4.7%

9.0%

GNP per capita, Atlas Method 2001 Human Development Index rating (new) 2000 Incidence of poverty, Total ... Incidence of poverty, Rural or Urban ... Life expectancy at birth (both sexes) 2000 Under-five mortality rate 2000

current US$ min[0] - max[1] % of population % of population years per 1,000 live births

14960 0.826 ... ... 17

E. Food Trade 1. Food Imports (US $) 2. Food Exports (US $) 3. Cereal Food Aid (100 t)

15.7%

3.6%

D. Level of Development 1. 2. 3. 4. 5. 6.

% of total imports % of total exports % of cereals imports

9.7 0.6 ...

1.6%

Other

Note: Value not indicated if below 1%

% Energy from: 2. Protein 3. Fat

1998-2000 1998-2000

% of total energy % of total energy

12.3 27.1

Proteins 5. Vegetable products 6. Animal products

1998-2000 1998-2000 1998-2000

g/caput/day % of total proteins % of total proteins

76.6 37.5 62.5

1995-97 1995-97

millions % of total pop.

4.

1996-98 1996-98 1996-98

Starchy roots

H. Food Inadequacy F. Indices of Food Production Food Production Index 2. Food Production Index Per Capita 1.

1996-98 1996-98

1989-91=100 1989-91=100

138.3 120.9

1. Total population "undernourished" 2. % population "undernourished" ... no data available

§ see References for data sources used

... ...

Nutrition Country Profiles – THE BAHAMAS

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BAHAMAS I. OVERVIEW

1. Geography The commonwealth of the Bahamas is an archipelago of 700 Islands and Cays in the Atlantic Ocean between latitudes 20º- 27ºnorth and longitude 72º- 79º west, or southeast of Florida, USA (General Map). Of these islands about 22 are inhabited, including New Providence where Nassau the capital is located, and Grand Bahama with Freeport, the second largest city. These two most populated islands are considered urban areas for statistical purposes. The rest of the islands are commonly referred to as the Family Islands. The total land area covers approximately 5,382 square miles scattered over 80,000 square miles. The Bahamas is low and flat and the long and flat islands are mainly composed of calcareous sand derived from marine shells. The highest point (Mt. Alvernia) is about 207 feet and is located at Cat Island. The Bahamas archipelago enjoys a moderate climate with temperatures varying between 78ºF and 90ºF at nights in New Providence (Statistical Abstract, 1997). 2. Population In 2000, the population of The Bahamas was 307,000, of which 88.3% lived in urban areas. Between 2000 and 2005, the population growth rate is expected to be 1.25%, and the population is projected to reach 408, 000 in 2030 (UN, 200I; 2002). According to the last population census in 1990, The Bahamas had 255,049 inhabitants, with an annual population growth rate of just under 2%. However according to the Department of Statistics (unpublished data) the total population was 288,467 in 1997 which represents a growth of 13.1% over 1990. In 2000, the crude birth rate was estimated at 21.7 per 1,000 persons, while the fertility rate was estimated at 2.6 children per woman. The crude death rate recorded in 2002 was 533.1 per 100,000 persons (PAHO, 2002). Nearly 90% of the total population live on three of the 40 inhabited islands and cays (PAHO, 2002). The largest proportion of the population (67.5%) lives on New Providence and mainly in the capital Nassau which has a population density of 2152.5 persons per square mile. Grand Bahama (primarily Freeport) hosts 16.1% of the total population with a density of 77.2 persons per square mile. The other islands and cays (collectively known as the Family Islands) are scarcely populated with a continuing migration flow from these Islands to New Providence and Grand Bahama (Statistical Abstract, 1997). An unknown number of Haitian immigrants arrive in The Bahamas on a regular basis. The registered Haitian population comprised approximately 14,000 persons during the last census (Dept. of Statistics). The total fertility rate was estimated at 2.4 for 1994 (Basic Health Information, 1996). Approximately 30% of the population are under the age of 15 years and 5% are over 65. More persons aged 65 years and older as well as children under 5 years live on the Family Islands, which are economically less developed compared with New Providence and Grand Bahama. Tourists account for an extra 8% in population size per annum, with 3,690,613 visitors in 1992 of which 1,398,895 were stop-over visitors (MOH, MAF, 1998).

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3. Level of development: poverty, education and health In the Bahamas no data on the poverty situation have been collected. However, the human development index (a composite measure of life expectancy, health, knowledge and living standard) rating in 2000 was 0.826, down from 0.851 in 1998, but still among the highest in the Caribbean (UNDP, 2002). In 2001, the per capita GNP was B$14,960 (World Bank, 2002). There are vast differences in average incomes between the various islands and between households within the islands. The Family Islands are less developed and less wealthy (average household income of B$ 14410.8) than the main economic centres of New Providence (average household income of B$ 31703.7) and Grand Bahama (average household income of B$ 27092.2). Unemployment was about 10% in 1997 (Dept. of Stat., 1997), but probably higher if the illegal immigrants are taken into account. This is the most vulnerable group with respect to poverty. There is universal access to all essential social services, including health, education and housing (PAHO, 2002). Education is compulsory between the ages of six and fourteen. Primary and secondary education is provided by public and private institution. Technical and vocational schools and the College of The Bahamas provide post-secondary education. Literacy rates have been estimated at 96% for persons 15 years of age and older during the period 1993-1999 (World Bank, 2000). However, according to the 1990 Population and Housing Census, 2% of persons over 15 years of age were without school education was 2.7%. The Bahamas experienced significant improvements in the health of its population over the past two decades. This is reflected in the life expectancy at birth, which increased from 72 years for females and 64 years for males in 1979-81 to 75 and 68 years respectively in 1989-90 (MOH, MAF, 1998). Life expectancy at birth was 71.0 years for males and 77.6 years for in 2000 (PAHO, 2002). Among the leading causes of death in The Bahamas are heart disease, HIV/AIDS, malignant neoplasm, accidents/violence and poisoning, and diabetes mellitus. The top four leading causes of death vary according to age group and gender. Among males 20-59 years old, the four leading causes of death are (in descending order) HIV/AIDS, homicide, land transport accident and ischemic heart disease. HIV/AIDS, breast cancer, diabetes mellitus and hypertensive disease are the top four causes of death among women 20-59 years old. In the case of males 60 years and older, the leading causes are ischemic heart disease, hypertensive disease, cerebrovascular disease and prostate cancer. Women in this age group die mainly from hypertensive disease, ischemic heart disease, diabetes mellitus and cerebrovascular disease, in that order (PAHO, 2002). Among the 15-64 year old population, a large percentage suffers from overweight (48.6% with BMI > 25) (MOH, PAHO/CFNI, 1991). Prevalence levels for chronic nutrition related diseases have not been, except for high blood pressure in adults, which was estimated to be 13% in the 1988-89 (MOH, PAHO/CFNI, 1991). In that same survey 14 % of adults were diagnosed with diabetes prior to the interview, and 50% were found to have abnormal levels for cholesterol (> 5.2 mmol/L) and/or HDL ( 3.4 mmol/L). HIV/AIDS is a serious health threat in The Bahamas. The number of new AIDS cases was growing until 1995, but seems to have stabilised since at 388 cases in total in 1997 (Health Information Unit, MOH). Child health improved significantly as well which is evident in the decline of the infant mortality rate from 30.2 in 1986 to 19.0 in 1995 with Certain Conditions Originating in the perinatal period as the main cause of infant death (PAHO, 1999). The mortality rate of children under 5 years old was 17 per 1000 live births, while that of infants was 15 per 1000 live births in 2000 (UNICEF, 2002), with accidents, violence and poisoning being the leading causes of death followed by HIV/AIDS and congenital anomalies (PAHO, 1999).

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Three public hospitals operate in The Bahamas, two in New Providence and one on Grand Bahama. On all the islands a total of 57 community clinics and 54 satellite clinics provide Public Health Care services. Free pre-natal and post-natal care is provided to all women who attend the government health centres. In addition, children enrolled in schools receive free medical and preventive care up to the age of eighteen years (MOH, MAF, 1998). In the fiscal year 1999-2000, a total of US$ 132.5 million was allocated to health, which represented 14.8% of the national budget. Annual health expenditure per capita increased steadily from US$ 362 in 1996 to US$ 420 in 2000 (PAHO, 2002). 4. Agricultural production, land use and food security Agricultural production In The Bahamas, most of the large commercial farms are located at Andros, Abaco and Grand Bahama and produce mainly vegetables and citrus crops for export to the North American market. Diary and poultry farms in New Providence and Grand Bahama produce for the local market. Numerous small farmers scattered over the islands produce staple crops for private consumption as well as a limited volume for the Nassau market (Dept. of Stat., 1997). In 1996 the contribution of Agriculture to GDP was only 1.4 %. Crops, especially citrus (grapefruit, Persian lime, lemon, sweet oranges), banana and avocado form about half of this value followed by poultry (meat and eggs) and seasonal crops such as cucumber, tomato and pigeon peas. The agricultural population as a percentage of total population has been on the decline, moving from 7.7% in 1969-71 to 3.6% in 2000 (FAOSTAT, 2002). A total of 6,695 people worked in agriculture in The Bahamas in 1994. This number includes land-owners, farm workers and family members that work on the farm and is 9.5 % of a total of 70,380 registered employed persons in all sectors. While Bahamian nationals in the agricultural labour force is declining, the number of Haitian nationals employed in the sector is expanding relatively. The Government is aiming at improving the self-sufficiency in agriculture (MAF, 1998). Land Use Approximately 2.6% or 89,565 acres of the total land area was used for agricultural holdings in 1978. According to the Second Census of Agriculture in 1994, agricultural land was distributed as follows: Permanent Crops: 9,684.08 Acres Pasture: 5506.64 Acres Temporary Crops: 3,443.26 Acres Pine/Coppice: 14,204.49 Acres Mixed Crops: 493.66 Acres Other lands: 1,483.89 Acres Other arable land: 15,433.55 Acres Average agricultural land holding in 1995 was 0.43 ha per person down from 0.052 in 1985, while for arable and permanent cropland it was 0.036 ha per person down from 0.043 in 1985 (FAOSTAT, 1999). The World Bank estimated that in the year 2000 the forest area of the whole country covered 8,420 Km2 (World Bank, 2002). Food Security No formal assessment of the level of food insecurity has been done in The Bahamas. The country paper prepared for the World Food Summit indicated that 90% of the food items consumed in The Bahamas are imported. These include most meats and all rice, wheat flours and other wheat and cereal products and sugar as well as the bulk of Irish potatoes. Interestingly, diary, fish and fish products are being imported even though they are produced in the country (MAF, 1996).

Nutrition Country Profiles – THE BAHAMAS

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Although food availability is not a problem in The Bahamas, high food prices make access to food problematic for the poorer segments in the population. In November 1995 the cost of a well-balanced 2400 Kcal/day diet was estimated at B$ 1.81 compared with the lowest wage per day of B$ 8.0. For a household with an average of 3.7 members and an average of 1.8 earners per household, food accounts for 62% of household earning potential, which implies an unfavourable access to food (MOH, MAF, 1998). Social assistance in the form of food coupons, cash assistance and work assistance is available for the socio-economically disadvantaged, such as the unemployed, disabled, the elderly, single parents and orphans. Some basic food items are placed under price regulation in order to remain accessible for persons with low purchasing power (MOH, MAF, 1998). 5. Economy The economy of The Bahamas is based on the Tourism Industry, which accounts for approximately 50% of GDP and 60% of employment (PAHO, 1999). The Bahamas is a popular destination for mainly American visitors, and cruise ships frequently visit the country. The Financial Services as well as Real Estate and the Retail Trade contribute considerably to the country's GDP. Fisheries (mainly export of crawfish/spiny lobster) and Agriculture contribute to a lesser extent. In 1995, the GDP was B$ 3,069.34 million and GDP per capita was B$ 10,692. Since 1972, the Bahamian dollar has been at par with the U.S. dollar. Unemployment rates continue to decrease from about 15% in 1992 to about 10% in 1997 (Dept. of Stat., 1997). In 1999, the overall unemployment rate was estimated at 7.8% (7.8% on New Providence and 9.5% on Grand Bahama). The service industries, including the public sector, tourism, banking, insurance, fishing and agriculture employ approximately 80% of the labour force. In 1999, the labour force was 157,640, an increase of 7.5% over 1996. Women were the main contributors to the growth in the labour force over the period 19961999, as female participation grew by 8.3% and that of males by 6.7% (PAHO, 2002). Inflation was 1.41 in New Providence in 1996 and peaked there at 7.29 in 1991 when it was as high as 17.96 for Grand Bahama (Dept. of Stat., 1997).

Nutrition Country Profiles – THE BAHAMAS

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II. THE FOOD AND NUTRITION SITUATION 1. Trends in energy requirements and energy supplies Table 2 shows that the population of the country increased by 119% between 1965 and 2000 and is projected to increase by approximately 33% over the 2000 figure in 2030. Accompanying the increase in population, between 1965 and 2000, was a 15.5% increase in the proportion of urban dwellers (Table 2). Table 2: Total population, urbanisation, energy requirements and dietary energy supplies (DES) per person and per day in 1965, 2000 and 2030

Ye ar

1965

2000

2030

Total population (thousands)

140

307

408

Percentage urban (%)

73.0

88.5

92.9

Per caput energy requirements (k cal/day)

2121

2195

2222

Per caput DES (k cal/day) * 2479 2486 * Three-year average calculated for 1964-66 and 1998-2000 (Source: FAOSTAT)

__

The per caput DES (Dietary Energy Supply) has been consistently higher than the energy requirements level over the period 1965-2000, although the former only increased by 0.3% during the interval. This suggests that food availability is not a problem in the Bahamas. DES of 2301 Kcal/caput/day was projected for rural residents compared to 2179 Kcal/caput/day for urban residents in the year 2000 (FAOSTAT,2002).

3500

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

DES kcal/caput/day

3000 2500 2000 1500

63.7

1000 500

12.3 24.0

60.0

12.2

58.9

58.9

11.8

12.3

12.2

12.3

28.8

27.1

1989-91

1998-2000

59.3

60.6

12.0

27.8

28.7

27.6

28.8

1969-71

1974-76

1979-81

1984-86

60.6

0 1964-66 The Bahamas

Fat

Protein

Carbohydrates

Source: FAOSTAT

Nutrition Country Profiles – THE BAHAMAS

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Figure 1 shows the contribution of three major food groups, fat, protein and carbohydrates, to dietary energy supply (DES) over the period 1964-66 to 1998-2000. The contribution of carbohydrate to DES has decreased slightly over the period, while that of protein (12.3%) has been relatively consistent over the period 1964-66 to1998-2000. Fat as a percentage of DES has increased from 24% to 27.1% over the period, peaking at 28.8% between 1984 and1991 (Figure 1). 2. Trends in food supplies Quantity: During the period 1964-66 to 1998-2000 the supplies (Kg/caput/year) of fruits and vegetables increased significantly. The increase was interrupted in1969-71, but resumed in1979-81 and continued (although at a reduced rate since 1984-86), during the last years for which figures are available (1998-2000). The milk and eggs group, although declining slightly over the period, experienced some fluctuation peaking at 121 Kg/caput/year in 1984-86. The supply of cereals decreased steadily between 1964 and 1981, but then remained fairly constant thereafter at about 89 Kg/caput/year. All the other groups remained relatively stable over the period (figure 2). Figure 2: Supplies of major food groups (in kg/caput/year) Trends from 1964-66 to 1998-2000 300 275 250

Cereals (excl. beer) Starchy roots

225

Sweeteners

kg/caput/year

200

Pulses, nuts, oilcrops Fruits & Vegetables

175

Vegetable oils

150

Animal Fats 125

Meat & offals Fish & seafood

100

Milk & Eggs

75

Other

50 25 0 1964-66 The Bahamas

1969-71

1974-76

1979-81

1984-86

1989-91

1998-2000 Source: FAOSTAT

Nutrition Country Profiles – THE BAHAMAS

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Energy: As shown in Figure 3 cereals have maintained the major share in DES over the period 1964 - 2000, although the quantity decreased from 801 Kcal/caput/day in 1964-66 to 748 Kcal/caput/day in 1998-2000. This was followed by the meat and offals group (ranged 370 - 458 Kcal/caput/day), which showed an increase in contribution over the period. There may be an association between this increase and the increase in the percentage contribution of fat to DES. The third largest contributor was sweeteners (334 - 445 Kcal/caput/day), which has increased over the period. These three groups account for most of the energy supply per caput per day, constituting 64% of the total daily energy per caput in 1998-2000. Fruits and vegetables increased slightly as a share of DES, as well as vegetable oils, partly at the expense of animal fats. This may have positive effects on the health of the population, assuming a similar shift in consumption pattern. The contribution of starchy roots was relatively low over the period and shows a decreasing trend. Milk and eggs, fish and seafoods all experienced a slight increase in contribution over the period, while pulses, nuts and oilcrops experienced a slight decrease.

Figure 3: Share of major food groups in Dietary Energy Supply Trends from 1964-66 to 1998-2000 3000

2500

Cereals (ex cl. beer) Starchy roots

2000

kcal/caput/day

Sweeteners Pulses, nuts, oilcrops Fruits & Vegetables 1500

Vegetable oils Animal Fats Meat & offals Fish & seafood

1000

Milk & Eggs Other

500

0 The Bahamas

1964-66

1969-71

1974-76

1979-81

1984-86

1989-91

1998-2000

Source: FAOSTAT

Nutrition Country Profiles – THE BAHAMAS

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Major food imports and exports: Figure 4 shows the pattern of food imports as a percentage of DES since 1964-66,which was approximately 100% or more between 1964 and 1998 (dominated by cereals, sweeteners, and meat and offals). Imports of animal fats decreased, while that of vegetable oils and fruits and vegetables increased slightly over the period. Alcohol, although its levels fluctuated, comprises a significant proportion of DES. Given that imported foods supply nearly all the energy available, international trade is vital to the Bahamas. Figure 4: Major food imports as a percentage of Dietary Energy Supply Trends from 1964-66 to 1996-98 120 Cereals (ex cl. beer) Sw eeteners Fruit (ex cl. w ine) Vegetable oils Animal Fats Meat & offals Milk & products Alcoholic Bev erages

100

% of DES

80 60 40 20 0

1964-66 The Bahamas

30

1969-71

1974-76

1979-81

1984-86

1989-91

1996-98 Source: FAOSTAT

Figure 5: Major food exports as a percentage of Dietary Energy Supply Trends from 1964-66 to 1996-98

25 20 % of DES

Sw eeteners

15

Fruit (ex cl. w ine) Alcoholic Bev erages

10 5 0 1964-66 The Bahamas

1969-71

1974-76

1979-81

1984-86

1989-91

1996-98

Source: FAOSTAT

Alcoholic beverages are the primary export food product from the Bahamas, and have been, in some years the only major component of food exports as a percentage of DES. Exports of this group have fluctuated, as a percentage of DES, during the period 1964-66 (2,024Mt) to 1996-98 (9,319Mt) reaching a peak value of 7.6% (10,543Mt) in 1974-76. The 1996-98 level reflects a 300% increase over the 1964-66 level. The export of sweeteners made a significant contribution as a percentage of DES in 1969-71 (22.2%), but has remained relatively low since then, the next highest contribution of 0.7% coming in 1986-86 (Figure 5). Other food groups that are exported by The Bahamas, but at relatively low levels (0.1-

Nutrition Country Profiles – THE BAHAMAS

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1.4% of DES), include fruits, vegetables, fish and seafood, and animal fats (FAOSTAT, 1999). 3. Food consumption Food consumption patterns in The Bahamas changed considerably during the last 2030 years as a result of socio-economic development that allowed for an increase in purchasing power in all sectors of the population. The patterns now closely resemble that of contemporary affluent societies and are far removed from the traditional diet. This is especially with respect to the availability of food from animal origin which has increased during the last decades. The bulk of the food is imported and often low in fibre and high in salt. The current food consumption patterns in combination with sedentary lifestyles and a lack of exercise predispose the population to obesity and the Nutrition-Related Chronic Diseases (MOH/MAF, 1998). According to the National Health and Nutrition Survey (1988-89), unhealthy habits of consuming excessive amounts of sugar, sugar products and fatty foods, accompanied by small intakes of fruits, vegetables and complex carbohydrates have been established very early in life. These habits have been reported among school children, adolescents, and a large percentage of adults. No national food consumption study has been carried out in The Bahamas. The closest to such a study is the National Health and Nutrition Survey (1988-89). However, there are several reports of the dietary intakes of groups in the population. Symonette (1995) found that the intakes in protein and fat as a percentage of energy were on the upper side of the recommended range. In addition, the intake of saturated fat was over the recommended daily intake (RDI) with 141% RDI among 13-17 year old girls. The survey was based on a 24 hours recall and a Health Habits Questionnaire (Symonette, 1995). Armstrong-Renwick (1997) reported on school children between the ages of 10-16 in New Providence for which a 24-hour food recall instrument was administered, using food models and various measuring implements to assist the recall of food items and portion sizes. Less than half the children consumed a breakfast daily. Most frequently consumed foods were low fibre cereals and bread. Ninety three per cent of the sample were consuming the RDA for energy. The majority of the children (58%) had fat and saturated fat intakes equal to or in excess of the recommended intake, while 52.5% consumed more than the recommended intake of saturated fat mainly from poultry and meats. The majority of the children of children were consuming less than the RDI for carbohydrates and vitamin A and E. Most children had a sufficient intake for iron. The National Health and Nutrition Survey (1988-89) reported that very few mothers practised full breastfeeding and that solid foods were introduced very early, sometimes as early as one month old. Fruit juice was introduced in the first month by 23.8% of mothers and 55.4% of new-borns received cereal before the fourth month. The Primary Health Care Monthly Reports indicated that in 1995 18.7 % of mothers exclusively breastfed their newborns until at least 4 weeks. This is an increase from the 5.8% reported in 1992 (Health Information and Research Unit). This increase was achieved through the Lactation Management project supported by UNICEF, which started in 1993.

Nutrition Country Profiles – THE BAHAMAS

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4. Anthropometric data In general the nutritional status of the population in The Bahamas is more reflective of overweight and obesity than by underweight and nutritional deficiencies. The change in food consumption patterns described in the previous section, combined with a low level of exercise contributes significantly to this problem of overweight and obesity. This increases the risk for the Nutrition-Related Chronic Diseases which are indeed widespread in The Bahamas. Infants with low birth weights (< 2,500g) were estimated at approximately 10.2 % in 1993 and 8.7% in 1999 (PAHO, 1999). In 1997 13.4% of all births were among teen mothers (Dep. of Stat 1998, unpublished data). Of all the babies born at the Princess Margaret Hospital in 1995, 9.8% had low birth weights (PAHO/WHO, 1999). Existing data on over- or undernutrition among children < 5 years suggest very few problems, with the exception of a 12.3 % reported underweight in the Family Islands, and higher prevalence of overweight among children in the Acklin and Crooked Islands. Among the school children 5-14 years, 16.7 % were reported to be underweight (BMI < 5th percentile) (MOH, 1988-89. In the 1994-95 MOH/CFNI report, 15% overweight was reported in children 4-9 years old and only 6.6% underweight. In that same sample the prevalence of stunting was relatively high in boys (15.8%) (Table 4a). Female adolescents were especially at risk for overweight and obesity as shown in the reports by Symonette (1995) and Armstrong-Renwick (1997). The female adolescents appear to be at greater risk for overweight and obesity compared with males (Table 4b). Approximately 20% of the females 15-16 years had a BMI of 24.8 or higher, while 16.2% of the males in the same age group had a BMI of 24.3 or higher. Among females 10-14 years, 17.9% had a BMI of 23.4 or higher, while among males at the same age 5.3% had a BMI of 23.0 or higher. The risk appears greater in the older age group for both males and females. An earlier survey found that, among females 13-17 years, 9.0% were obese, and another 16.7% were overweight. The few studies that reported on adult and elderly nutritional status raise concerns about overweight and obesity, especially in females (Table 4c). Among the adults 15-64 years, 21.3% were obese (significantly more females than males), while another 27.3% were overweight (29.1% males and 25.6% females). Among the elderly, over 65 years, 25.4% of the females and 15.2% of the males were obese. Since 1981 a school-feeding Programme has been in place which aims to provide approximately one third of energy, calcium and vitamin A and C requirements to school children in government schools where a need is established. School children are screened in first, sixth and tenth grade for nutrition status (weight, height and haemoglobin) and blood pressure and referred when necessary. The draft Food and Nutrition Policy recognises the Nutrition-Related Chronic Diseases as the first priority area for action. Dietary counselling for weight reduction and dietary management is available. However, programmes addressing the total population for the preventing overweight and obesity have not yet started.

Nutrition Country Profiles – THE BAHAMAS

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Table 4a: Anthropometric data on children Source/

Location

Sample

Year

Size

of survey

Number

Sex

Percentage of malnutrition Age Years Underweight

Stunting

% Weight/Age < -2SD < +2SD MOH/CFNI, 1994-1995

National

2400

MOH 1988-89

Nationala

National Health

New Providencea

773

Wasting

% Height/Age < -2SD < +2SD

% Weight/Height < -3SD < -2SD

Overweight

% Weight/Height > +2SD

M/F

4.0-9.0

6.6

8.1

12.9

1.9



5.7

14.9

M

4.0-9.0

7.3

7.6

15.8

1.6



6.4

14.9

F

4.0-9.0

5.9

8.6

9.8

2.3



5.0

14.9

95th

M/F

5.0-14.0

16.7

76.6

6.7

M/F

5.0-14.0





16.0

and Nutrition

Acklinsa

155

M/F

>5

15.4



1.3

Survey, 1976-80

Crookeda

101

M/F

>5

11.9



15.8

Nationalb

950

M/F

65





25.4

M

>65





15.2

Notes: ... data not available

5. Micronutrient deficiencies The only micronutrient deficiency known to be a public health problem in The Bahamas is iron deficiency anaemia. This problem is prevalent in children < 5 years, in adolescents of both sexes and in the elderly, especially in females. Mixed results were available on school age children, for which the School Health Programme recorded a low prevalence of 4.5% in 1994 (Hb < 12 g/dl) (MOH, MAF, 1998). This low level corroborates with the observation that iron intake in school children was sufficient in the majority of the sample of Armstrong-Renwick in 1997. Iron deficiency anaemia presents a more serious problem among pregnant women. Nineteen percent were found to be anaemic in 1994 with the low cut off point of 10 g/dl. Anaemia in pregnant women increases their risk of perinatal complications and death. In addition, this can result in low iron stores in the new-born. Anaemia is also prevalent in adult males ranging from 14% to 20% on the different islands, according to the 1988-89 health and nutrition survey. Iron supplements are provided only to pregnant women visiting antenatal clinics.

Nutrition Country Profiles – THE BAHAMAS

17

REFERENCES Armstrong-Renwick A. 1997. Thesis: Risk Factors for Coronary Heart Disease Howard University, Department of Nutrition Sciences CFNI, MOH, ME, (Ministry of Health, Ministry of Education). 1998. Nutritional Status of School Children. Bahamas. Department of Statistics. 1997. Common Wealth of The Bahamas Statistical Abstract. Department of Statistics, Ministry of Finance, Nassau, Bahamas Department of Statistics. 1997. The Bahamas in Figures 1997. Department of Statistics, Ministry of Finance, Nassau, Bahamas. Department of Statistics. 1998. Department of Statistics, Ministry of Finance, Nassau, Bahamas. Symonette P. L. 1995. Dissertation: The relationships of dietary patterns and exercise habits to risk factors for cardiovascular disease in Bahamian adolescent females. Howard University. MAF (Ministry of Agriculture and Fisheries). 1996. The Commonwealth of The Bahamas Country Paper Prepared for The World Food Summit. Nassau, The Bahamas. MAF. 1998. Agricultural Sector Report, final draft. Nassau, The Bahamas. MAF, Department of Statistics. 1996. Second Census of Agriculture 1994, Final Results. Nassau, The Bahamas. MOH, CFNI/PAHO. 1991. National Health and Nutrition Survey 1988-89. MOH, MAF. 1998. Draft Food and Nutrition Policy. Ministry of Health and Environment. 1994. Nutritional Assessment of Children in Acklins and Crooked Island. PAHO. 1999. Health Conditions of the Americas (1998)- Bahamas Country Chapter. PanAmerican Health Organization. Washington, D.C. PAHO. 2002. Health in the Americas. Volume II, 2002 Edition. Pan-American Health Organization. Washington, D.C. PAHO/WHO. 1999. The Bahamas: Basic Country Health Profiles, Summaries 1999. PAHO/WHO Web page. Country Health Profiles (http://www.paho.org). FAOSTAT. 2002. FAO Web page. Statistics database. FAO, Rome

Nutrition Country Profiles – THE BAHAMAS

18

FAO/WFS (World Food Summit). 2002. Mapping Undernutrition – five years later-. Poster for the World Food Summit 10-13 June 2002. FAO, Rome UN. 1999. World Population Prospects Database 1950-2050. The 1998. Revision. United Nations Population Division. New York. UN. 2001. World Population Prospects Database 1950-2050. The 2000 Revision. United Nations Population Division. New York. UN. 2002. World Urbanisation Prospects. 2001 Revision. United Nations Population Division. New York. UNDP (United Nations Development Programme). 2002. Human Development Report. Oxford University Press. New York. UNICEF. 2002. The State of the World’s Children 2002. United Nations Children’s Fund. Oxford University Press. New York. World Bank. 2000. The Bahamas At A Glance. World Bank Country Data. World Bank, Washington, D.C. World Bank. 2002. The World Development Indicators 2002 CD-ROM. Win*STARS System Version 4.0. World Bank, Washington, D.C. References of data presented in Table 1, unless otherwise stated: Source:

Indicator:

FAOSTAT. 1999/2002

A.1-2, B, C.10-11, E.1-3, F, G

UN. 1999/2000/2001 rev.

C.1-9, D.5

World Bank. 2002.

D.1

UNDP. 2002.

D.2

Tabatabai H. 1996.

D.3-4

UNICEF. 2002.

D.6

FAO/WFS. 2002.

H

Nutrition Country Profiles – THE BAHAMAS

NCP of The Bahamas MAPS

-General Map of The Bahamas

19

General Map of Bahamas

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Grand Bahama #

FREEPORT

\&

###

#

# #

#

#

#

#

#

Abaco

#

Spanish wells Bimini Islands

Berry Islands #

NASSAU #

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# ##

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#

# # # ## #

Harbour Island #

# # # # # ## # # #

\& #

New Providence

Eleuthera

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Cat Island # # # #

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Andros

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#

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San Salvador

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Exuma

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# #

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Rum Cay

# # Long Island # # #

Ragged Island

Crooked Island # # # ## # # # # # # Acklins Island #

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Mayaguana Island

Inagua Islands #

Main cities

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Capital city

# # #

#

Main roads

Lagoons and freshwater bodies

N

Islands and Cays

W

E S

Scale 1: 5 000 000 (approx.)

FAO-GIS/ESNA,

Geographic Projection (Lat/Long)

The designations employed and the presentation of the material in the maps do not imply the expression of any opinion whatsoever on the part of FAO concerning the legal or constitutional status of any country, territory or sea area, or concerning the delimitation of frontiers.

July, 2002 Bahamas