Progress

Underweight

Efforts must intensify to meet goals

Globally, underweight prevalence in children under five declined from 31 per cent to 26 per cent between 1990 and 2008; the rate of reduction is insufficient for achievement of the Millennium Development Goal (MDG) target. Efforts to treat children who are underweight need to be rapidly scaled up if the target is to be met.

All regions have made progress in reducing underweight prevalence
Underweight (moderate and severe) prevalence among children under five, around 1990, 2000 and 2008

Note: The trend analysis is based on data from 84 countries with trend, covering 83 per cent of the under-five population in the developing world. For Central and Eastern Europe/Commonwealth of Independent States (CEE/CIS), the baseline year is 1996; data availability was limited for the period around 1990. All trend estimates are based on the National Center for Health Statistics (NCHS) reference population.
Source: UNICEF global databases, from Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other national surveys, around 1990, 2000 and 2008.

Less than half of all countries (58 of 118) are on track to achieve the MDG target, the majority of them middle-income countries. Most countries making insufficient or no progress are in sub-Saharan Africa or South Asia.

58 countries are on track to meet the MDG 1 target
Progress is insufficient in 40 countries and 20 countries have made no progress

Rate of progress varies by region

The greatest declines in underweight prevalence are in the regions of CEE/CIS and East Asia and the Pacific. In CEE/CIS, prevalence decreased from 8 to 4 per cent between 1996 and 2008 (prior to that, trend data were not available for most countries in the region). In East Asia and the Pacific, prevalence dropped from 23 to 14 per cent between 1990 and 2008. This improvement was driven by gains in China, where underweight prevalence declined by more than half. Other countries in East Asia and the Pacific are making striking progress as well. For these countries, the prevalence dropped from 37 to 25 per cent between 1990 and 2008, a decline of almost one third. The region is on track to meet the MDG target, whether or not China is counted in.

Latin America and the Caribbean also made significant progress, with levels declining from 11 to 6 per cent between 1990 and 2008. And like CEE/CIS and East Asia and the Pacific, Latin America and the Caribbean is on track to meet the MDG target.

In South Asia, underweight prevalence declined from 53 to 47 per cent between 1990 and 2008, although current levels remain high. But little improvement was seen in the Middle East and North Africa, where prevalence remained roughly the same (from 16 per cent around 1990 to 14 per cent around 2008). Progress in these regions, as well as in East and Southern Africa and West and Central Africa, is insufficient to meet the MDG target.

Disparity in trend

Progress in reducing underweight prevalence is often unequal between rich and poor. In India, for example, there was no significant improvement among children in the poorest households, while underweight prevalence in the richest 20 per cent of households decreased by about a third between 1990 and 2008. Undernutrition is the result of a combination of factors: lack of food in terms of quantity and quality; inadequate water, sanitation and health services; and suboptimal care and feeding practices. Until improvements are made in these three aspects of nutrition, progress will be limited.

In India, a greater reduction in underweight prevalence occurred in the richest 20 per cent of households than in the poorest 20 per cent
Trend in the percentage of children 0–59 months old who are underweight in India, by household wealth quintile

Note: Prevalence trend estimates are calculated according to the NCHS reference population, as there were insufficient data to calculate trend estimates according to World Health Organization Child Growth Standards. Estimates are age-adjusted to represent children 0–59 months old in each survey. Information on household wealth quintiles was not originally published in the 1992–1993 and 1998–1999 National Family Health Surveys (NFHS). Data sets with household wealth quintile information for these surveys were later released by Measure DHS. For the analysis here, the NFHS 1992–1993 and 1998–1999 data sets were re-analysed in order to estimate child underweight prevalence by household wealth quintile. Estimates from these two earlier rounds of surveys were age-adjusted so that they would all refer to children 0–59 months old and would thus be comparable with estimates from the 2005–2006 NFHS.
Source: National Family Health Surveys, 1992–1993, 1998–1999 and 2005–2006.

A note on methodology of trend analysis

When conducting trend analysis of child nutritional status, it is very important to ensure that estimates from various data sources are comparable over time. For example, household surveys in some countries in early 1990s only collected child anthropometry information among children up to 47 months of age or even only up to 35 months of age. Prevalence estimates based on such data only referred to children under four or under three and are not comparable to prevalence estimates based on data collected from children up to 59 months of age. Some age-adjustment needs to be applied to make these estimates based on non-standard age groups comparable to those based on the standard age range. For more information about age-adjustment, please click here to read a technical note. In addition, prevalence estimates need to be calculated according to the same reference population. Those calculated according to the World Health Organization (WHO) Child Growth Standards are not comparable to those calculated according to the National Center for Health Statistics (NCHS) reference population. For more information about the difference between two reference and its implications, please click here  to read a technical note.

Country level progress in reducing undernutrition prevalence is evaluated by calculating the Average Annual Rate of Reduction (AARR) and comparing this to the AARR needed in order to be able to reduce prevalence by half over 25 years. For more information about how to calculate country level AARR, please click here  to read a technical note.

References

UNICEF, Technical Note: Age-adjustment of child anthropometry estimates, UNICEF, New York, 2010

Mercedes de Onis et al, Comparison of the World Health Organization (WHO) Child Growth Standards and the National Center for Health Statistics/WHO international growth reference: implications for child health programmes, Public Health Nutrition: 2006: 9(7), 942–947

UNICEF, Technical Note: How to calculate Average Annual Rate of Reduction (AARR) of Underweight Prevalence, UNICEF, New York, 2007