Measuring Child Malnutrition
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Malnutrition during the first two years of life can lead to increased risk of child morbidity and mortality. Globally, malnutrition causes 45 percent of all deaths reported for children under the age of 5. In addition, malnutrition can cause suboptimal brain development, which negatively affects cognitive development and can lead to poor educational performance and low productivity in adulthood.

Africa South of the Sahara has some of the highest rates of child malnutrition in the world, accounting for 39 percent of global child stunting and 10 percent of global child wasting, according to the WHO. The 2016 Global Hunger Index (GHI) found that the region is home to five out of the seven countries around the world that are still at “alarming” levels of hunger. A recent study, written by a team of researchers from Western Sydney University and published in PLOS One looks at the distribution of malnutrition within four sub-regions of Africa South of the Sahara to identify the worst affected areas.

Using cross-sectional data from publically available Demographic and Health Surveys from 2006-2016, the study assesses 32 countries, grouped into the sub-regions of East Africa, West Africa, Southern Africa, and Central Africa. The study provides a meta-analysis of the prevalence of malnutrition indicators, such as stunting, wasting, and weight for each region. A random effect model, combined with a sensitivity analysis, was used to explore the heterogeneity of particular indicators within the region. . The results can help policymakers, global organizations, government and non-government organizations, private and public health sectors, and public health researchers to identify the most vulnerable sub-regions where urgent nutrition intervention is needed.

The results conclude that malnutrition is highest in East and West African countries. The most vulnerable countries in general are Burundi, Malawi, Comoros, Ethiopia, Niger, Mali, Nigeria, Burkina Faso, Sierra Leone, Namibia, Chad, and Congo DR.  In terms of particular indicators, stunting was the highest in East Africa, whereas wasting was highest in West Africa. West Africa also showed the highest percentages of underweight children. At the country level, Burundi and Malawi had the highest stunting rates, at 57.7 percent and 47.1 percent, respectively, whereas wasting was highest in Niger and Burkina Faso (18 percent and 15.50 percent, respectively).  Burundi and Ethiopia topped the list of percentage of underweight children, at 28.8 percent and 25.2 percent, respectively. For Africa South of the Sahara to meet the Sustainable Development Goal of ending all forms of malnutrition by 2030, appropriate nutritional interventions need to be prioritized in these countries and sub-regions.

According to the authors, East Africa has the potential and the capacity to produce enough food for its local consumption, in addition to a surplus that could be exported into the world market. In this region, however, financial constraints, weather conditions (drought), lack of access go agricultural land, and high transportation costs continue to contribute to food insecurity. In Burundi since 2005, nearly six in ten children have consistently been reported as being stunted. The authors suggest that programs prioritizing food security, improving agricultural productivity, and implementing climate change adaptation and mitigation techniques are urgently needed in the East African sub-region.

The highest rates of child wasting were found in West Africa, where there has been very slow progress in reducing childhood malnutrition over the past 30 years. Over 300 million people live in the sub-region, and rapid population growth, the rising cost of living, and desertification have all affected food availability. In addition, the region’s agricultural productivity has not kept up with its population growth.  There is also a need to diversify and increase food production and to create a comprehensive food-based distribution strategy to improve food security and child nutrition.

In Africa South of the Sahara as a whole, over 48 percent of the population lives on less than $1.25 per day, so poverty remains the principle cause of childhood undernutrition in the region. The major causes of poverty identified in the study are financial constraints due to poorly managed economic systems, population growth, and conflict, as well as environmental factors such as drought and climate change.

The authors encourage a multi-sectoral approach to address poverty and child malnutrition in the long run, calling for holistic inter-organizational and inter-agency efforts. Effective policies and political will are needed to support cost-effective family planning and nutrition and health education interventions; these programs also need to take into account the socio-cultural and environmental variables of each sub-region in order to truly be effective and reach the most vulnerable populations.

By: Jenn Campus

Photo credit:Albert González Farran, UNAMID