Levels and trends in child malnutrition UNICEF – WHO – World Bank Group joint child malnutrition estimates Key findings of the 2015 edition
The data in this 2015 edition supersede all historical data previously published by UNICEF, WHO and World Bank Group. © UNICEF/GHAA2015-01436/Quarmyne
Stunting rates are dropping but 159 million children around the world are still affected. There are 41 million overweight children in the world; about 10 million more than there were 2 decades ago.
The ultimate goal:
for all children to be free of malnutrition in all its forms.
Wasting still threatens the lives of 50 million children across the globe.
2
Global overview Stunting The global trend in stunting prevalence and numbers of children affected is decreasing...
Between 1990 and 2014, stunting prevalence declined from 39.6 per cent to 23.8 per cent...
- 96M
‌and numbers affected declined from 255 million to
159 million.
1990 2014
...but not fast enough.
Overweight The global trend in overweight prevalence and numbers of children affected is rising.
Overweight prevalence has gone up slightly between 1990 and 2014, from 4.8 per cent to 6.1 per cent‌
+ 10M
‌and numbers affected have risen from 31 million to
41 million.
1990 2014
Wasting In 2014, the global wasting rate was 7.5 per cent.
50M
Approximately 1 out of every 13 children in the world was wasted in 2014. 2014 Nearly a third of all wasted children were severely wasted, with a global prevalence in 2014 of 2.4 per cent.
In 2014, there were 667 million children under 5 in the world. An estimated:
Globally, 50 million children under 5 were wasted, of which 16 million were severely wasted in 2014.
159 million were stunted 41 million were overweight
20M
50 million were wasted (each pair of children represents 20 million children)
Notes on the updated joint malnutrition estimates In September 2015, UNICEF, WHO and World Bank Group released updated joint child malnutrition estimates for the 1990 to 2014 period, which represent the most recent global and regional figures after adding 62 new surveys from 57 countries to the joint dataset. This key findings report summarizes the new numbers, main messages and identifies some minor changes in methodology.
Additional materials include: (i) the latest country-level joint malnutrition dataset; and, (ii) interactive dashboards, which allow users to visualize and export the global and regional estimates.
UNICEF <uni.cf/jmedashboard2015> WHO <www.who.int/nutgrowthdb/estimates> World Bank Group <data.worldbank.org/child-malnutrition>
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Regional overview – prevalence Africa has seen slow progress in reducing stunting Percentage of children under 5 stunted and percentage of children under 5 overweight, by United Nations region, 1990 – 2014
Asia
70
Africa
Asia*
Latin America and Caribbean Latin America
Oceania*
Oceania**
and Caribbean
60
per cent
50
47.6
42.3
40
32.0
25.1
30
stunting overweight 95% confidence interval
38.1
35.9
24.5
20
11.7
8.9
6.6
3.4
2010
2005
2000
1995
1990
2014
2010
2005
2000
7.2 1995
1990
2010
2005
2000
1995
1990
2014
5.7
4.9
2014
2010
2005
2000
1995
0
5.4
4.0 1990
10
2014
Africa
*Asia (excluding Japan); **Oceania (excluding Australia and New Zealand) 1990 and 1995 estimates had consecutive low population coverage. Source: UNICEF, WHO, World Bank Group joint malnutrition estimates, 2015 edition.
Unequal progress in stunting reduction since 1990
-24% Africa
...progress among subregions has been uneven.
While Asia as a whole has cut stunting by almost half...
-47% Asia
Eastern Asia
- 82%
2x reduction
- 41%
Southern Asia
In 2014, one subregion was above the public health emergency line for wasting Percentage of children under 5 wasted, by United Nations subregion, 2014
3.9
1.1
Poor 5 - < 10% Serious 10 - < 15% Critical ≥ 15% No data
Public health emergency range
Central America
3.1 Caribbean 1.4 South America
2.1
Central Asia 14.2
7.5
Acceptable < 5%
Not even one subregion in Africa has an acceptable level of wasting.
Eastern 4.0 Asia* Northern Africa Southern Western 9.3 9.0 Asia Asia 6.7 Western 7.9 Southeastern Africa Eastern Asia Middle Africa Africa 5.4
9.0 Oceania
Three subregions are approaching the public health emergency line.
Southern Africa *Eastern Asia, excluding Japan **Oceania, excluding Australia and New Zealand Source: UNICEF, WHO, World Bank Group joint malnutrition estimates, 2015 edition.
This map is stylized and not to scale. It does not reflect a position by UNICEF, WHO or World Bank Group on the legal status of any country or territory or the delimitation of any frontiers.
Forms of malnutrition* highlighted in this key findings report Stunting refers to a child who is too short for his/her age. Stunting is the failure to grow both physically and cognitively and is the result of chronic or recurrent malnutrition. Its effects often last a lifetime.
Wasting refers to a child who is too thin for his/her height. Wasting is the result of sudden or acute malnutrition, where the child is not getting enough calories from food and faces an immediate risk of death.
*Note it is possible for a child to show combinations of malnutrition, such as be stunted and overweight or stunted and wasted.
Overweight refers to a child who is too heavy for his/her height. This form of malnutrition results from expending too few calories for the amount consumed, and increases the risk of noncommunicable disease later in life.
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Regional overview â&#x20AC;&#x201C; numbers affected In Africa, the number of stunted children is rising
The number of overweight children is on the rise in all regions
Number of children under 5 stunted, by United Nations region, 1990 and 2014
Number of children under 5 overweight, by United Nations region, 1990 and 2014 +22%
200
1990
2014
1990
increase
15
+23%
100
2014
nearly 3x
+91%
20
-52%
150
25
+67%
-57%
10
+5%
50
5
190
0
47
91
58
14
6
0.5
0.3
0
16.0 19.6
10.3
3.9
0.03 0.12
*Asia (excluding Japan); **Oceania (excluding Australia and New Zealand) 1990 estimate had consecutive low population coverage. Source: UNICEF, WHO, World Bank Group joint malnutrition estimates 2015 edition.
In 2014, more than half of all stunted children under 5 lived in Asia and more than one third lived in Africa.
In 2014, almost half of all overweight children under 5 lived in Asia and one quarter lived in Africa.
Asia 57%
Asia 48%
Africal.37%
Three out of five sub-regions in Africa, Eastern Africa, Middle Africa and Western Africa, have rising numbers of stunted children under 5.
Africal.25%
The number of overweight children under 5 in Africa has nearly doubled since 1990.
The majority of children under 5 suffering from wasting live in Asia (each child silhouette represents 1 million children)
In 2014, almost all wasted children under 5 lived in Asia and Africa.
Asia 34.3 M Africa 13.9 M Latin America and Caribbean 0.7 M
Oceania 0.1 M
Southern Asia is home to more than half of all wasted children under 5 globally.
Asia 68%
Africal.28%
Strengths and weaknesses of malnutrition data Prevalence estimates for stunting and overweight are relatively robust. Hence it is possible to generate reliable time trends.
Trends are not informative for wasting and severe wasting given that these are acute conditions, which can change rapidly. Thus only 2014 global and regional estimates are presented.
The underlying data for global and regional estimates are from country-level household surveys. Such country data are collected infrequently and measure malnutrition at one point in time. This makes it difficult to capture the rapid fluctuations of wasting and severe wasting over time. For programme purposes, incidence data (i.e., the number of new cases that occur during an entire calendar year) would be ideal, however, these currently do not exist.
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Country income groupings overview Low-income countries have made the least progress towards stunting reductions since 1990 Percentage of children under 5 stunted and percentage of children under 5 overweight, by country income classification, 1990 â&#x20AC;&#x201C; 2014
Low-income
70 60
54.6
55.3
Lower-middleincome
Upper-middle-income stunting overweight 95% confidence interval
37.6
40
33.5
32.6
Only a 32% decrease in low-income countries...
30 20
7.5
4.9
Source: UNICEF, WHO, World Bank Group joint malnutrition estimates, 2015 edition.
2010
2005
2000
6.8 1995
1990
2014
2010
2005
2000
1995
6.8
2014
2.7 1990
2014
2010
2005
2000
0
3.4
3.1 1995
10
1990
per cent
50
Unequal progress in stunting reduction since 1990
-32%
-77%
... and a 77% decrease in upper-middle-income countries.
Overweight numbers have doubled in lower-middle-income countries since 1990 The number of overweight children in lowermiddle-income countries has more than doubled since 1990, from 7.5 million to 15.5 million.
1990
2x as high
2014
Low-income and lower-middle-income countries now account for almost all stunted children worldwide The share of all stunted children that live in lowincome and lower-middle-income countries has shifted from 7 in 10 to 9 in 10 between 1990 and 2014.
1990
2014
Lower-income countries bear a disproportionate share of stunted children relative to the total population distribution Less than half of all children under 5 lived in lowermiddle-income countries in 2014, yet these countries accounted for two thirds of all stunted children globally. 47% 26%
66%
24%
15%
8%
Share of under-5 population in 2014
Share of stunted children under 5 in 2014
Low-income countries only accounted for 15 per cent of the global under-5 population in 2014, but nearly one quarter of all stunted children live in these countries. In 2014, one quarter of all children under 5 lived in uppermiddle-income countries, yet these countries only accounted for 8 per cent of all stunted children globally. Note: the numbers do not add up to 100 per cent; the residual is for high-income countries.
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Notes on methodology The analysis methods have remained unchanged from the 2012 report, except for some minor refinements detailed below: 1. Year assigned to each survey When data collection begins in one calendar year and continues into the next, the survey year assigned is the one in which most of the fieldwork took place. For example, if a survey was conducted between 1 September 2009 and 28 February 2010, the year 2009 would be assigned, since the majority of data collection took place in that year (i.e., four months in 2009 versus two months in 2010). This method has been used since the 2013 edition (prior to that, the latter year was used by default – e.g., 2010 in the example above).
FINAL
Spain
Niue
Suriname Zambia
Belgium
The former Yugoslav Republic of Macedonia Saint Vincent and the Grenadines
Madagascar
Iran (Islamic Republic of)
Brazil
Antigua and Barbuda Libya
Uzbekistan
China
Senegal Morocco Saudi Arabia Samoa Holy See Mozambique Mongolia Slovakia Malaysia Bolivia (Plurinational State of) Namibia Jordan State of Palestine Uganda Democratic Republic of the Congo Kuwait United Arab Emirates Nepal Peru Mauritania Nauru Saint Lucia Croatia Mali Nicaragua Bahrain Costa Rica Cuba Albania Sri Lanka Turkmenistan Montenegro Saint Kitts and Nevis Hungary Portugal Bulgaria Afghanistan United Kingdom Togo Myanmar Slovenia Republic of Moldova Tunisia Pakistan Honduras Kenya Zimbabwe Belize Algeria Bosnia and Herzegovina Finland Tajikistan Sao Tome and Principe Italy Rwanda South Sudan Micronesia (Federated States of) Tonga Australia Qatar Djibouti Timor-Leste Estonia Thailand Kazakhstan Paraguay Armenia Guinea Bangladesh Azerbaijan Cabo Verde Cameroon Kiribati Gabon Kyrgyzstan Ghana South Africa Uruguay Switzerland Sudan Malawi Palau
United States
Nigeria
India
Mexico
Jamaica
Benin Belarus
Russian Federation
Romania Côte d'Ivoire
Ireland
Singapore Burundi Haiti Canada Ethiopia Indonesia Israel Austria Guatemala Guyana Equatorial Guinea Iraq Chad Chile Angola Trinidad and Tobago Ukraine Norway Sweden Tuvalu
Bahamas Yemen
Monaco
Germany Eritrea
Lithuania
Turkey
Barbados
Marshall Islands
Cyprus
Mauritius
Fiji Dominica
Iceland
Lebanon Netherlands Niger
Oman
Botswana Central African Republic
Cambodia Democratic People's Republic of Korea Egypt Cook Islands Brunei Darussalam Poland El Salvador Greece Papua New Guinea Burkina Faso Grenada Philippines Denmark Seychelles San Marino Viet Nam Liberia Ecuador Vanuatu Luxembourg Dominican Republic Guinea-Bissau Lesotho Latvia Colombia Lao People's Democratic Republic Somalia
Japan
Bhutan
Argentina
Swaziland
Gambia
Maldives
SEPT
OCT
NOV
DEC
2010 JAN
FEB
2. Final reports only As of the 2014 edition, the dataset used to generate the global and regional estimates is based only on final survey results. Preliminary survey results are no longer included in the dataset due to situations where they had been cancelled or significantly changed before release.
V 0.1
Sierra Leone
2009
Panama
Venezuela (Bolivarian Republic of)
Andorra
Georgia
Serbia
Comoros
Liechtenstein
France Solomon Islands Czech Republic Congo Republic of Korea
United Republic of Tanzania
New Zealand
Syrian Arab Republic
3. Updated data sources i. The updated joint dataset which includes: • 778 national surveys (62 new) • data from 150 countries and territories (representing more than 90 per cent of all children under 5 globally (population coverage varies by regions and periods)). ii. The under 5 population estimates The United Nations World Population Prospects, 2015 Revision, were used as weighting factors for each country survey to derive the regional and global prevalence estimates and calculate the numbers affected. iii. Regional and country income classifications as per July 2015 countries with data
countries without data
4. Footnotes on population coverage As in the 2014 edition, a separate exercise was conducted to assess population coverage. This was important in order to alert the reader, via footnotes, to instances where the data should be interpreted with caution due to low population coverage (defined as less than 50 per cent). A conservative method was applied looking at available data within mutually exclusive five-year periods around the projected years. Population coverage was calculated as: the sum of country five-year average populations (for which surveys are available in the dataset) the total of country five-year average population for all countries in the region
This brochure was prepared by the Data and Analytics Section of the Division of Data, Research and Policy, UNICEF New York, the Department of Nutrition for Health and Development, WHO Geneva and the Development Data Group, World Bank Group Washington DC. September 2015. Email: data@unicef.org data.unicef.org
Email: nutrition@who.int www.who.int/nutrition
Email: data@worldbank.org data.worldbank.org