Last update: Jun 2008


Reduction of child malnutrition among children under five years of age by at least one third, with special attention to children under two years of age	Eradicate extreme poverty and hunger Target: Halve, between 1990 and 2015, the proportion of people who suffer from hunger

Indicators

Underweight

Proportion of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median weight-for-age of the reference population*

Stunting

Proportion of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median height-for-age of the reference population*

Wasting

Proportion of under-fives falling below minus 2 standard deviations (moderate and severe) and minus 3 standard deviations (severe) from the median weight-for-height of the reference population*

^* See Note on the Reference Population at the bottom of this page.

The challenge

Good nutrition is the cornerstone for survival, health and development. Well-nourished children perform better in school, grow into healthy adults and in turn give their children a better start in life. Well-nourished women face fewer risks during pregnancy and childbirth, and their children set off on firmer developmental paths, both physically and mentally.

Undernutrition, conversely, has been estimated to be an underlying cause for around half of all child deaths worldwide. Undernourished children have lowered resistance to infection and are more likely to die from common childhood ailments like diarrhoeal disease and respiratory infection. Frequent illness saps the nutritional status of those who survive, locking them into a vicious cycle of recurring sickness and faltering growth. Their plight is largely invisible: Three quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished, showing no outward sign of their vulnerability.

Poverty, low levels of education, and poor access to health services are major contributors to childhood malnutrition, a complex issue that requires tackling on a wide number of fronts.

To name only a few:

Ensuring food security for poor households, in both quantity and nutrition

Educating families on the nutritional needs of young children, including the value of breastfeeding and the importance of introducing suitable complementary foods at the right age

Protecting children from infection by immunizing them against common childhood diseases and by providing safe water and sanitation

Ensuring that children receive quality care when they fall ill

Shielding children from micronutrient deficiencies, especially in iodine, iron and vitamin A, that can bring death and disabilities

Paying special attention to the nutritional needs of girls and women, since chronically undernourished women tend to bear low-birthweight babies, perpetuating the vicious cycle of undernutrition

Factors vary among regions. In many Asian countries, poverty and the low status of women, poor care during pregnancy, high rates of low birth weight, high population densities, unfavorable child caring practices, and poor access to health care are underlying causes. In Sub-Saharan Africa, extreme poverty, inadequate caring practices for children, low education levels and poor access to health services are among the major factors causing undernutrition.

Conflicts and natural disasters have worsened the situation in many countries. The increase in the number of undernourished children in Africa reflects a rapid rate of population growth. In many countries in Africa, the devastating effects of HIV/AIDS, particularly in the second half of the past decade, have reversed some of the gains made in the decade's early years.

Underweight prevalence is a key indicator for monitoring progress toward the Millennium Development Goal 1, therefore more effort has been put in collecting, analyzing and publishing statistics on this indicator than the other two indicators of undernutrition, namely, stunting prevalence and wasting prevalence. The rest of this page presents information on underweight prevalence only. Statistics on stunting and wasting prevalence can be found in other parts of the Undernutrtion section by clicking the relevant links on the navigation menu at left.

Current status

SOUTH ASIA HAS THE HIGHEST UNDERWEIGHT PREVALENCE: Underweight prevalence in children under five, by region (2000–2006)

More than one-quarter of all under fives in the developing world are underweight. This accounts for about 143 million underweight children in developing countries. Of these 143 million underweight children, nearly three-quarters live in just 10 countries.

Significant variation in underweight prevalence exists among children under five of the developing world. The highest levels of underweight prevalence are found in South Asia, where more than 40 per cent of children under five are underweight. In Sub-Saharan Africa more than one-quarter of all children under five are underweight. The lowest levels are found in Latin America and the Caribbean and Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS).

South Asia has staggeringly high levels of underweight prevalence, with more than 40 per cent of all under-five children underweight. Three countries in this region — India, Bangladesh and Pakistan — account for almost half the world's total underweight children, even though they are home to just 29 per cent of the developing world's under-five population.

In Sub-Saharan Africa more than one-quarter of children under five are underweight. Nigeria and Ethiopia alone account for more than one-third of all underweight children in Sub-Saharan Africa.

143 million children are underweight in the developing world: More than half of these children live in South Asia

Disparities

Urban and rural: On average, children in rural areas are twice as likely to be underweight as children in urban areas.

Rich and poor: On average, poor children are more than twice as likely to be underweight as rich children. The greatest disparities between rich and poor are found in Latin America and the Caribbean, where children in the poorest quintile are more than five times as likely to be undernourished as children from the richest. The smallest disparities are found in East Asia and the Pacific, followed by Middle East and North Africa and Sub-Saharan Africa.

Boys and girls: have a similar prevalence in every region.

Note: A ratio of 1.0 indicates that the prevalence of underweight in the two groups is equal. Ratios above 1.0 indicate that prevalence is higher in females than in males, or higher in children from poor households than in children from rich households, or higher in children living in rural areas than in urban areas; ratios below 1.0 indicate that prevalence is lower in females than in males, or lower in children from poor households than in children from rich households, or lower in children living in rural areas than in urban areas.

Source for figures: UNICEF global databases, 2007.

Note on Reference Population: Prevalence of underweight, stunting and wasting among children under five years of age is estimated by comparing actual measurements to an international standard reference population. In April 2006, the World Health Organization (WHO) released WHO Child Growth Standards to replace the widely used National Center for Health Statistics (NCHS)/WHO reference population, which was based on a limited sample of children from the United States. The new Standards are the result of an intensive study project involving more than eight thousand children from Brazil, Ghana, India, Norway, Oman and the United States. Overcoming the technical and biological drawbacks of the old reference, the new Standards confirm that children born anywhere in the world and given the optimum start in life have the potential to develop to within the same range of height and weight, i.e., differences in children's growth to age five are more influenced by nutrition, feeding practices, environment, and health care than genetics or ethnicity.

The new Standards should be used in future assessments of child nutritional status. Several Demographic and Health Surveys have already adopted the Standards and published results based on them. It should be noted that due to the differences between the old reference population and the new Standards, prevalence estimates of child anthropometry indicators based on these two references are not readily comparable. It is essential to have all estimates based on the same reference population (preferably the new Standards) when conducting trend analysis.

UNICEF is in transition toward reporting prevalence estimates based on the WHO Standards. Country data reported in the undernutrition pages currently are based on the NCHS Reference Population.

Source: World Health Organization

Reference

UNICEF, Progress for Children, 2007.