1. Child Malnutrition in Sub-Saharan Africa: An Assessment of the Trend across Socio-economic Groups
Soumya Alva, ICF Macro
Loren Bausell, RTI
Amanda Pomeroy, JSI
APHA, November 2010

2. Presenter Disclosure
Soumya Alva – no relationships to disclose

3. Overview Child undernutrition: A concern Research questions
Data and methods
Findings
Discussion and implications

4. Child Undernutrition Associated with Child Mortality: Underweight in Sub-Saharan Africa

5. Child Undernutrition Associated with Child Mortality: Stunting in Sub-Saharan Africa

6. Child Undernutrition: A Concern
Child undernutrition is one of the most serious health and development issues
Responsible for more than half the under 5 deaths in low and middle income countries
Slows growth, perpetuates poverty through productivity loss, poor cognitive function, higher health care costs
Contributes to malaria survival, AIDS, diet related chronic diseases
High economic impact (UN Standing Committee on Nutrition - $20-30 billion per year)
Especially true in South Asia and Sub-Saharan Africa

7. Child Undernutrition: A Concern
Millennium Development Goal 1: to eradicate extreme poverty and hunger
By 2015, reduce by half the proportion of people who suffer from hunger
Target 1.8: Prevalence of underweight children under-five years of age
Important to assess trends and level of undernutrition
Important to compare extent of child undernutrition based on
New WHO Child Growth standard
NCHS/CDC/WHO international reference standard

8. Focus of this Analysis
Examine trends in undernutrition in Sub-Saharan Africa using both standards (new WHO Child Growth standard and NCHS/CDC/WHO reference population)
Examine the nutrition situation of the poorest socioeconomic groups over time
Urban-rural differences

9. Data: DHS from 19 countries in Sub-Saharan Africa

10. Data: DHS from 19 countries in Sub-Saharan Africa
Countries with two or more data points since 1990
East/Southern Africa: 10 countries
Kenya, Madagascar, Malawi, Mozambique, Namibia, Rwanda, Tanzania, Uganda, Zambia, Zimbabwe
West/Central Africa: 5 countries
Benin, Cameroon, Ghana, Guinea, Nigeria
Sahel: 3 countries
Mali, Niger, Senegal
Ethiopia

11. Data and Indicators Anthropometric Indicators: Sample:
Underweight (weight for age)
Stunting (height for age)
Moderate and severe (z scores below -<2 standard deviations from the mean)
Comparison to NCHS/CDC reference population and the new WHO Child Growth standard
Sample:
Among children under-five
All children under-five, poorest 40%, children in urban and rural areas

12. Methodology Median interval between DHS surveys: 5 years
Values calculated for each country for four time periods:
Calculated using Stata
, , , 2005-current
Missing time period imputed with annual country estimates for each indicator
Based on available survey data between 1990 and most recent data point using a linear trend line distribution
Sub-regional averages calculated over time
Weighted by the number of children 0-5 years/country

13. Trends in Percent Children Underweight (NCHS/CDC & WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
NCHS/CDC
WHO

14. Trends in Percent Children Stunted (NCHS/CDC & WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
NCHS/CDC
WHO

15. Trends in Percent Children Underweight & Stunted
Slowly declining levels of undernutrition in most countries, smaller declines for stunting (except Sahel – slow increase)
Undernutrition based on WHO std. as compared to CDC ref pop. is lower for underweight but not for stunting
Underweight levels lowest in East/Southern Africa and highest in Ethiopia
Stunting levels considerably higher than underweight and highest in Ethiopia

16. Percent Children Underweight: The Poorest 40% (WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
Poorest 40%
All children (WHO)

17. Percent Children Stunted: The Poorest 40% (WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
Poorest 40%
All children (WHO)

18. Trends in Percent Children Underweight & Stunted (Poorest 40%)
Overall, undernutrition levels are higher among the poorest groups although differences in Ethiopia are small
Among the poorest group, decline in stunting over time is small. Also, an increase in countries in the Sahel

19. Percent Children Underweight: Urban vs. Rural (WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
Urban (WHO)
Rural (WHO)

20. Percent Children Stunted: Urban vs. Rural (WHO)
East/Southern Africa
West/Central Africa
Sahel
Ethiopia
Urban (WHO)
Rural (WHO)

21. Trends in Percent Children Underweight & Stunted (Urban vs. Rural)
Overall, undernutrition levels are higher among the rural population
Very slow decline in stunting levels in both urban and rural areas
Urban-rural divide appears to be increasing particularly in Ethiopia and Sahel

22. Discussion and Implications
Given MDG1, important to assess trend and level of undernutrition
Undernutrition in SSA has declined over time but less so if measured in terms of stunting
If measured using WHO std., % underweight is low, but not so for stunting
Programs need to be targeted to certain countries e.g. certain regions such as the Sahel and Ethiopia have considerably lower nutrition levels
Special consideration for poorest groups, those in rural areas, and geographical disparities within a country