1. Progress Toward Meeting Nutrition Targets in Africa
Presented by M. Ag Bendech,
19 October 2016, Accra (Ghana )

2. The scale of the problem of malnutrition in Africa (GNR 2016)
163.6 million children and women of reproductive age are anemic
58 million children under age five are too short for their age (stunting)
13.9 million under 5’s weigh too little for their height (wasting)
10.3 million under 5’s are overweight
8 percent of adults over 20 years are obese.

3. The Multiple Burdens of Malnutrition in African Countries
the nutrition problems Africa is facing are multiple and overlapping. The Figure shows that 8 of the 54 African countries (Botswana, Egypt, Equatorial Guinea, Lesotho, Libya, Namibia, South Africa and Swaziland) are facing serious public health issues on 3 key dimensions stunting, women’s anemia and overweight/obesity—a triple burden. Thirteen countries are facing a double burden of undernutrition and overweight/obesity. Only four countries are facing serious single burdens of stunting (Ethiopia and Rwanda) and women’s anemia (Ghana and Senegal).

4. The annual cost of undernutrition in 7 African countries (www
The annual cost of undernutrition in 7 African countries (
The burdens in terms of human suffering, mortality and disease are large (IFPRI 2015), but so too are the economic burdens. The African Union and the World Food Programme Cost of Hunger estimates are summarized in this Figure.

5. Investing in nutrition: a wise investment

6. Meeting the Malabo stunting target : the status (countries ranked on stunting prevalence in %)
To assess whether a country will attain the Malabo stunting target by 2025 we calculate the average annual rate of reduction (AARR) required for a country to get to 10% stunting from where it currently stands. We then compare the required AARR to the country’s recent performance in reducing rates (the current AARR as determined by the Joint Child Malnutrition Estimates from UNICEF/WHO/WB: JME 2015). If the current AARR ≥ the required AARR then the country is “on course”. If the current AARR is > 0 but < the required AARR then the country if designated as “off course but making progress” and if the current AARR is ≤0 (i.e. stunting rates are static or increasing) then the country is designated as “off course, no progress”.
The table lists the countries by their latest stunting estimate and the colours designate if they are on or off course. 49 countries have sufficient data to make the comparison while 5 do not. Of the 49 with data, only 4 are on course to meet the Malabo declaration target, 39 are off course but making some progress and only 6 are making no progress.

7. Countries ranked according to stunting (%), lowest to highest prevalence, and assessment of progress towards WHA Global Nutrition 2025 target (stunting)  
Rank
Country
Stuntinggg %
Stunting % 1
Seychelles
7.9 19
Togo
27.5 37
Tanzania
34.7 2
Tunisia
10.1 20
Zimbabwe
27.6 38
Sierra Leone
37.9 3
Algeria
11.7 21
Guinea-Bissau 39
Rwanda 4
Morocco
14.9 22
Angola
29.2 40
Sudan
38.2 5
Gabon
17.5 23
Cote d'Ivoire
29.6 41
Mali
38.5 6
Ghana
18.8 24
South Sudan
31.1 42
Chad
38.7 7
Senegal
19.4 25
Guinea
31.3 43
Zambia 8
Libya 26
Botswana
31.4 44
Ethiopia
40.4 9
Mauritania 27
Sao Tome and Principe
31.6 45
Central African Republic
40.7 10
Egypt
22.3 28
Comoros
32.1 46
Malawi
42.4 11
Namibia
23.1 29
Liberia 47
DRC
42.6 12
South Africa
23.9 30
Cameroon
32.6 48
Niger 13
Gambia
24.5 31
Burkina Faso
32.9 49
Mozambique
43.1 14
Congo 32
Nigeria 50
Madagascar
49.2 15
Swaziland
25.5 33
Lesotho
33.2 51
Eritrea
50.3 16
Somalia
25.9 34
Djibouti
33.5 52
Burundi
57.5 17
Kenya 35
Benin
Cape Verde
No data 18
Equatorial Guinea
26.2 36
Uganda
34.2
Mauritius
The table undertakes the same exercise, but instead the aim is to meet the more modest WHA target of a 40% reduction in the number of stunted children by 2025 applied to each country. The results show that 9 countries are on course, the same 6 are making no progress and that 34 are off course but making some progress.
On course, good progress
Off course, some progress
Off course, no progress
Insufficient data to make assessment

8. Countries ranked according to exclusive breastfeeding (EBF) of infants <6 months (%), highest to lowest prevalence, and assessment of progress towards WHA EBF target
Rank
Country
EBF 1
Rwanda 87 19
DRC
47.6 36
Algeria
25.7 2
Sao Tome & Principe
73.8 20
Gambia
46.8 37
Niger
23.3 3
Zambia
72.5 21
South Sudan
45.1 38
Mauritius 4
Malawi
70.2 22
Swaziland
44.1 39
Guinea
20.5 5
Burundi
69.3 23
Madagascar
41.9 40
Botswana
20.3 6
Eritrea
68.7 24
Benin
41.4 41
Nigeria
17.4 7
Lesotho
66.9 25
Tanzania
41.1 42
Comoros
12.1 8
Uganda
63.2 26
Mozambique
Cote d'Ivoire 9
Kenya
61.4
Zimbabwe 43
Tunisia
8.5 10
Cape Verde
59.6 27
Egypt
39.7 44
South Africa
8.3 11
Togo
57.5 28
Mali
37.8 45
Equatorial Guinea
7.4 12
Sudan
55.4 29
Central African Republic 34 46
Gabon 13
Liberia
55.2 30
Senegal 33 47
Somalia
5.3 14
Guinea-Bissau
52.5 31
Congo
32.9 48
Djibouti
1.3 15
Ghana
52.3 32
Sierra Leone 49
Chad
0.3 16
Ethiopia 52
Cameroon
28.2
Angola
 No data 17
Burkina Faso
50.1
Morocco
27.8
Libya 18
Namibia
48.5 35
Mauritania
26.9
Seychelles
Finally for exclusive breastfeeding (infants <6 months), so important for getting infants off to the best possible start in life, Table 5 shows that 23 countries are on course, 3 are off course but making some progress, while 12 are off course making no progress (and one of these 12, Egypt, is actually showing a worsening rate of exclusive breastfeeding rates). 16 countries do not have sufficient data to make an assessment.
On course
Off course, some progress
Off course, no progress
Insufficient data to make assessment

9. Countries ranked according to wasting (%), lowest to highest prevalence, and assessment of progress towards WHA target
Rank
Country
Wasting % 1
Swaziland 2 19
Senegal
5.8 37
Egypt
9.5
Rwanda
2.2 20
Cameroon 38
Guinea
9.9 3
Morocco
2.3 21
Congo
5.9 39
Burkina Faso
10.9 4
Tunisia
2.8 22
Bissau 6 40
Comoros
11.1 5
Lesotho 23
Mozambique
6.1 41
Sao Tome and Principe
11.2
Equatorial Guinea
3.1 24
Burundi 42
Gambia
11.5 7
Zimbabwe
3.3 25
Zambia
6.3 43
Mauritania
11.6 8
Gabon
3.4 26
Libya
6.5 44
Somalia
14.9 9
Tanzania
3.8 27
Togo
6.7 45
Eritrea
15.3 10
Malawi 28
Namibia
7.1 46
Mali 11
Kenya 29
Botswana
7.2 47
Chad
15.7 12
Algeria
4.1 30
Central African Republic
7.4 48
Sudan
16.3 13
Seychelles
4.3 31
Cote d'Ivoire
7.6 49
Niger
18.7 14
Uganda 32
Nigeria
7.9 50
Djibouti
21.5 15
Benin
4.5 33
DRC
8.1 51
South Sudan
22.7 16
Ghana
4.7 34
Angola
8.2
Cape Verde
No data 17
South Africa 35
Ethiopia
8.7
Madagascar 18
Liberia
5.6 36
Sierra Leone
9.4
Mauritius
The table summarises the country rankings and progress status for wasting. Here the WHA 2025 target is to be less than 5%. As the Table shows of 51 countries with data, 17 are on course and 34 are off course.
On course
Off course
Insufficient data to make assessment

10. Countries ranked according to anaemia (%), lowest to highest prevalence, and assessment of progress towards WHA target
The table summarises the rankings and progress for anaemia in women of reproductive age (15-49 years). Only one country, Burundi, is on track to meet this WHA target.

11. Underlying drivers of improved nutrition status

12. Thresholds for underlying drivers
Threshold corresponding to a prediction of stunting prevalence of <15%
Unit
Total per capita calories in food supply
2800
Kilocalories
Calories from non-staples in food supply 50
Percent
Access to piped water 69
Access to improved sanitation 76
Female secondary school enrollment rate 81
Ratio of female to male life expectancy
1.072
Ratio

13. Number of African countries by number of vulnerabilities
Names of countries
0/6 1
0/14 2
4/14
Algeria, Egypt, South Africa, Tunisia 3 4
3/4
Botswana, Morocco, Sao Tome and Principe 5
6/11
Benin, CAR, Ghana, Mauritania, Namibia, Uganda 6
27/35
Angola, Burkina Faso, Cameroon, Chad, Congo, Cote d’Ivoire, Djibouti, Ethiopia, Gabon, The Gambia, Guinea, Guinea-Bissau, Kenya, DRC, Liberia, Madagascar, Malawi, Mali, Mozambique, Niger, Nigeria, Rwanda, Senegal, Sierra Leone, Togo, Tanzania, Zimbabwe

14. Africa is off track to meet the
nutrition targets of Malabo
Declaration and Global targets
but there is hope

15. Strong implementation
Political leadership
& SMART commitment
Brazil
Ethiopia
Kenya
Maharashtra
Nutrition-
oriented development
Bangladesh
Colombia
Ghana
Tanzania
Data
Systems
Guatemala
Indonesia
Peru
Strong implementation
Argentina
Burkina Faso
Chile
The ingredients for success are well known…
...and can lead
to rapid improvements
in nutrition.
And political leadership is vital for progress in nutrition
In the past 3 GNRs we have highlighted several countries experiences on moving nutrition indicators. They are listed.
Many factors are responsible and we have listed 4 sets.
Central to these is political commitment.
Remember: Ghana & Maharashtra halved their stunting rates 12 years. When forces are aligned properly rapid change can happen.
SUGGEST YOU DO NOT REMOVE THIS SLIDE

16. Commitment by African Countries
Malabo Declaration:
Bring down stunting to 10%
and underweight to 5%
by 2025
2nd International Conference on Nutrition: Framework for Action and the UN Decade of Action on Nutrition
While the problem of food and nutrition security in Africa, and indeed the world, is one that may appear daunting, it is true that a problem can only be addressed when it is first recognized as a problem. In this regard, African countries have already recognized that food and nutrition security must be addressed and certain commitments have been made. Recognising the extent and consequences of the burdens, African leaders made this bold commitment within the Malabo Declaration of 2014: "To improve nutritional status, and in particular, the elimination of child under-nutrition in Africa with a view to bringing down stunting to 10% and underweight to 5% by 2025." In addition, African leaders have signed up to the World Health Assembly Targets to reach key targets for 6 nutrition outcomes by This is the Malabo Declaration on ”Nutrition Security for Inclusive Economic Growth and Sustainable Development”.
The Decade of Action is for everybody. What will each African country, professional Nutrition Association like the African Nutrition Society do to ensure that within 10 years we change positively the face of malnutrition in Africa? Initiative for Food and Nutrition Security in Africa (IFNA), which was launched at TICAD VI in Nairobi this August by the Government of Japan. IFNA aims to work with African Governments to accelerate the implementation of their food and nutrition security policies.
Initiative for Food and Nutrition Security in Africa (IFNA)
The African Leaders for Nutrition (ALN)

17. Conclusion
Make the right political choice—supported by SMART commitments for accountability
Current commitments do not match the need
we need a blend of nutrition specific, and nutrition sensitive actions, supported by an enabling environment
Predictable and dedicated nutrition financing is essential: Invest more and allocate better
Reject business as usual
Invested in more and better data

18. Thank you