Current Status + Progress
Undernutrition contributes to nearly half of all deaths in children under 5 and is widespread in Asia and Africa

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Nearly half of all deaths in children under 5 are attributable to undernutrition, translating into the loss of about 3 million young lives a year. Undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and contributes to delayed recovery. The interaction between undernutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance.

Measures of child undernutrition are used to track development progress. West and Central Africa has progressed least since the year 2000, when compared to other regions. Meanwhile, the number of overweight children worldwide – another aspect of malnutrition – is rising. In the post-2015 development era, estimates of child malnutrition will help determine whether the world is on track to achieve the Sustainable Development Goals – particularly, goal 2 to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture”.

Stunting

In 2016, 22.9 per cent, or just under one in four children under age 5 worldwide had stunted growth. That said, overall trends are positive. Between 2000 and 2016, stunting prevalence globally declined from 32.7 per cent to 22.9 per cent, and the number of children affected fell from 198 million to 155 million. In 2016, about one in two stunted children lived in South Asia and one in three in sub-Saharan Africa.

Globally, stunting declined from one in three to just under one in four between 2000 and 2016
Percentage of children under 5 who are stunted, by region, 2000 to 2016

* Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2016 estimate (interpret with caution). Estimates for Eastern Europe and Central Asia are based on a model fit for all of Europe and Central Asia, but for which data were mainly from Eastern Europe and Central Asia. **The Northern America regional average is based only on United States data only, hence confidence intervals are not available.

Source: UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, May 2017 edition.

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Between 2000 and 2016, the number of stunted children under 5 worldwide declined from 198 million to 155 million. At the same time, numbers have increased at an alarming rate in West and Central Africa - from 22.9 million to 28.1 million.
Number (millions) of children under 5 who are stunted, by region, 2000 and 2016

Notes: * Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2016 estimate (interpret with caution). Estimates for Eastern Europe and Central Asia are based on a model fit for all of Europe and Central Asia, but for which data were mainly from Eastern Europe and Central Asia.**The Northern America regional average is based only on United States data only, hence confidence intervals are not available.

Source:  UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, May 2017 edition.

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Overweight

Worldwide in 2016, 41 million, or 6 per cent, of children under age 5 were overweight. Eastern Europe and Central Asia had the highest overweight prevalence in 2016 with 12.8 per cent affected, followed by Middle East and North Africa at 10.7 per cent and North America at 7.8 per cent. The lowest overweight prevalence in 2016 was seen in West and Central Africa, at 3.7 per cent, followed by Eastern and Southern Africa at 4.2 per cent. East Asia and the Pacific had the highest number of overweight children in 2016 with 8.6 million affected, followed by South Asia with an estimated 7.4 million overweight. Overall these two Asian regions account for nearly two out of every five overweight children in the world. Eastern Europe and Central Asia is the only region that has seen a statistically significant increase in number of overweight children between 2000 and 2016.

The number of overweight under-fives has increased significantly between 2000 and 2016 in Eastern Europe and Central Asia
Number of children under 5 (in millions) who are overweight, by region, 2000 to 2016

Notes: * South Asia consecutive low population coverage for the 2016 estimate (interpret with caution). ** Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2016 estimate (interpret with caution). Estimates for Eastern Europe and Central Asia are based on a model fit for all of Europe and Central Asia, but for which data were mainly from Eastern Europe and Central Asia; ***The Northern America regional average is based only on United States data only, hence confidence intervals are not available.

Source:  UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2017 edition.

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The number of overweight under-fives has increased significantly between 2000 and 2016 in Eastern Europe and Central Asia
Number of children under 5 (in millions) who are overweight, by region, 2000 to 2016

Notes: * South Asia consecutive low population coverage for the 2016 estimate (interpret with caution). ** Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2016 estimate (interpret with caution). Estimates for Eastern Europe and Central Asia are based on a model fit for all of Europe and Central Asia, but for which data were mainly from Eastern Europe and Central Asia; ***The Northern America regional average is based only on United States data only, hence confidence intervals are not available.

Source:  UNICEF/WHO/World Bank Joint Child Malnutrition Estimates, 2017 edition.

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Wasting and Severe Wasting

In 2016 globally, 52 million children under five were wasted of which 17 million were severely wasted. This translates into a prevalence of 7.7 per cent and 2.5 per cent, respectively. In 2016, more than half of all wasted children lived in South Asia and about one quarter in sub-Saharan Africa, with similar proportions for severely wasted children. At 16.0 per cent, South Asia’s wasting prevalence represents a ‘critical’ public health problem; that of the Middle East and North Africa is approaching a ‘serious’ need for intervention with appropriate treatment programmes. Under-five wasting and severe wasting are highly sensitive to change. Thus, estimates for these indicators are only reported for current levels (2016).

The prevalence of wasting in South Asia is so severe, at 16.0 per cent, that it represents a critical public health emergency
Percentage of children under 5 who are wasted, by region, 2016

Notes: Data are the most recent available estimate between 2011 and 2016; exceptions where older data (2005-2010) are shown are denoted with an asterisk(*) and where only data prior to 2005 are available the dark grey color denoting no recent data is used. Eastern Europe and Central Asia region does not include Russian Federation due to missing data; consecutive low population coverage for the 2016 estimate (interpret with caution). Estimates for Eastern Europe and Central Asia are based on a model fit for all of Europe and Central Asia, but for which data were mainly from Eastern Europe and Central Asia.

Source:  UNICEF, WHO, World Bank Joint Child Malnutrition dataset, 2017 update

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Disparities

In almost all countries with available data, stunting rates are higher among boys than girls.  While analyses to determine underlying causes for this phenomenon are underway, an initial review of the literature suggests that the higher risk for preterm birth among boys (which is inextricably linked with lower birth weight) is a potential reason for this sex-based disparity in stunting.

Boys have slightly higher stunting rates than girls in most countries with data
Percentage of boys under 5 who are stunted (y-axis), vs percentage of girls under 5 who are stunted (x-axis), by region, 2012

Source: UNICEF global nutrition database, 2014, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative surveys.

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Children from the poorest 20 per cent of the population have stunting rates that are double the rate in comparison with the richest quintile. In South Asia, the absolute disparities between the richest and poorest children in regard to stunting are greater than in any other region. While the overall rates are lower, the relative disparities are greatest in Latin America and the Caribbean where the rate among the poorest is more than 4 times higher than among the richest.

The stunting rate is more than double among the poorest children when compared to the richest
Percentage of children under 5 who are stunted, by wealth quintile and by region, 2016

Notes: Analysis is based on a subset of 92 countries with recent (2011-2017) data by wealth quintile groupings covering 69 per cent of the global population. Regional estimates are presented only where adequate population coverage (≥50 per cent) is met. To meet adequate population coverage, *East Asia and the Pacific does not include China, **Latin America and Caribbean does not include Brazil and ***Eastern Europe and Central Asia does not include Russian Federation.

Source: UNICEF global database, 2017, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS) and other nationally representative surveys.

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An analysis of 54 countries with comparable trend data between around 2000 and around 2014 shows that gaps between the poorest 20 per cent and richest 20 per cent of children under five have closed by at least 20 per cent in the majority of upper-middle-income countries. However, in almost all low income countries, this gap has either remained the same or increased.

The rich poor gap is increasing or remaining the same in the majority of Low Income Countries with available trend data
Relative change in gap between richest and poorest for % of stunted children under-age five, between 2000 and 2014

Source: UNICEF (2015) Progress for Children: Beyond Averages – Learning from the MDGs: based on UNICEF global databases, 2015, based on Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), and other nationally representative sources.

REFERENCES

UNICEF, Progress for Children Beyond Averages: Learning from the MDGs, New York, 2015

Black, R.E., et al., ‘Maternal and Child Undernutrition and Overweight in Low-income and Middle-income Countries’, Lancet, vol. 382, no. 9890, 3 August 2013, pp. 427–451.

Blencowe H et al. (2013). Preterm birth–associated neurodevelopmental impairment estimates at regional and global levels for 2010. Pediatric Research Volume 74: No s1, December 2013.

de Onis, Mercedes, 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, vol. 9, no. 7, 2006, pp. 942–947.

de Onis, Mercedes, et al., ‘Estimates of Global Prevalence of Childhood Underweight in 1990 and 2015, JAMA, vol. 291, 2004, pp. 2600–2606.

UNICEF, Improving Child Nutrition: The achievable imperative for global progress, UNICEF, New York, 2013.

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

UNICEF, ‘Technical Note: How to calculate average annual rate of reduction (AARR) of underweight prevalence‘, UNICEF, New York, 2007.

Access The Data
Nutritional Status
Joint malnutrition country dataset, December 2017, UNICEF, WHO and World Bank Group Download Data
Joint malnutrition global and regional dataset, 2017 edition, UNICEF, WHO and World Bank Group Download Data
Recent Resources

Joint child malnutrition estimates – 2017 edition

May 16, 2017

UNICEF, WHO and the World Bank regularly update joint global and regional estimates of child malnutrition. These estimates of prevalence and numbers for child stunting, underweight, overweight, wasting and severe wasting are derived for the global population as well as by United Nations (UN), Millennium Development Goal (MDG), Sustainable Development Goal (SDG), UNICEF, WHO and World Bank regions, as well as World Bank income group classifications.

Download the brochure | Access the regional classifications | Explore the interactive dashboard | Access the global and regional datasets | Access the country-level dataset

Joint Child Malnutrition Estimates 2017 Edition – Interactive Dashboard

May 15, 2017

This interactive dashboard visualizes the latest child malnutrition estimates for the period 1990-2016. These estimates of prevalence and numbers for child stunting, overweight, wasting and severe wasting are derived by United Nations (UN), Millennium Development Goal (MDG), Sustainable Development Goal (SDG),UNICEF, WHO and World Bank regions, as well as World Bank income group classifications.

Open the dashboard | Access the regional classifications | Download the brochure | Access the global and regional dataset | Access the country-level dataset

Nutrition Targets Tracking Tool

Feb 9, 2017

The tracking tool allows users to explore scenarios taking into account different rates of progress for the six World Health Assembly (WHA) Nutrition targets and the time left to 2025 using the latest global databases such as the UNICEF-WHO-World Bank joint malnutrition estimates for stunting, wasting and overweight. The six WHO targets on nutrition were set at the global level as default national targets included in this tool, but countries can define their own national targets for contributing to each of the global targets.

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2016 Global Nutrition Report

Jun 15, 2016

The Global Nutrition Report is the only independent and comprehensive annual review of the state of the world’s nutrition. It is a multipartner initiative that holds a mirror up to our successes and failures at meeting intergovernmental nutrition targets. It documents progress on commitments made on the global scale, and it recommends actions to accelerate that progress.

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Notes on the Data

INDICATORS

Indicator name

Definition

Numerator

Denominator

Stunting Number 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 Children under 5 years of age in the surveyed population
Underweight Number 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 Children under 5 years of age in the surveyed population
Wasting Number 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 Children under 5 years of age in the surveyed population
Overweight Number of under-fives above 2 standard deviations from the median weight-for-height of the reference population Children under 5 years of age in the surveyed population

 

REFERENCE POPULATION

Prevalence of underweight, stunting and wasting among children under 5 is estimated by comparing actual measurements to an international standard reference population. In April 2006, the World Health Organization released the 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 of America. The new standards are the result of an intensive study project involving more than 8,000 children from Brazil, Ghana, India, Norway, Oman and the United States. Overcoming the technical and biological drawbacks of the old reference population, the new standards confirm that children born anywhere in the world and given the optimum start in life have the potential to reach the same range of height and weight. It follows that differences in children’s growth to age 5 are more influenced by nutrition, feeding practices, environment and health care than by genetics or ethnicity.

The new standards should be used in future assessments of child nutritional status. It should be noted that because of 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 that all estimates are based on the same reference population (preferably the new standards) when conducting trend analyses.

ADJUSTING COUNTRY-LEVEL ESTIMATES

Before conducting trend analyses of child nutritional status, it is important to ensure that estimates from various data sources are comparable over time. For example, household surveys in some countries in the early 1990s only collected child anthropometry information among children up to 47 months of age – or even up to only 35 months of age. Prevalence estimates based on such data only referred to children under 4 or under 3 years of age 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 WHO Child Growth Standards are not comparable to those calculated according to the NCHS/WHO reference population. For more information about the difference between the two references and its implications, please click here to read a technical note.

ESTIMATING COUNTRY-LEVEL PROGRESS

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.

ESTIMATING REGIONAL TRENDS BY MULTILEVEL MODELLING

Estimation of regional and global trends has been based on a multilevel modelling method (see de Onis et al. in JAMA, 2004). For the most recent trend analysis presented below, a total of 716 data points from 145 countries over the period 1985 to 2013 were included in the model. This set of trend data points was jointly reviewed by UNICEF and WHO in June and July 2014 to ensure that it is nationally representative of under-five children, processed using standard algorithms and comparable vertically and horizontally. Regional trend modelling and graphing were carried out using STATA 11 on two ‘do’ files (the data set and do files are available on request).

Model-based trend analysis of underweight prevalence (percentage), by region

Note: * CEE/CIS: Central and Eastern Europe and the Commonwealth of Independent States.

How to read this chart:

Each circle (bubble) represents a prevalence estimate from a country in a data year. The size of the circle is proportional to the under-five population in that country in the data year. For each region, a solid line indicates the regional trend as modelled by the multilevel logit regression on all the available data points in the region. The dashed lines in each region indicate the lower and upper bounds of the regional trend line corresponding to the confidence interval of the estimated trend.

Click here for a higher-resolution version of the above chart.