Malnutrition

MICS3 Data Analysis and Report Writing

Overview

• Background

• International goals

• Indicators

• Indicator calculations

• Methodological issues

• Data

Background

• Malnutrition is associated with more than half of all child deaths worldwide.

• Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth.

• 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.

International Goals & Targets

Reduction of child malnutrition among children

under five years of age by at least one-third,

with special attention to children under 2 years

of age

Halve, between 1990 and 2015, the proportion

of people who suffer from hunger

List of Indicators

• Underweight prevalence (weight-for-age)

• Stunting prevalence (height-for-age)

• Wasting prevalence (weight-for-height)

• Overweight prevalence (weight-for-height)

Definition of Indicators

% of children under five that fall below minus 2 standard deviations from the median weight for age

of the standard NCHS reference population (moderate & severe)

Numerator: Number of children under age five that fall below minus two standard deviations from the median weight for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)

Denominator: Total number of children under age five that were weighed

Underweight Prevalence

Definition of Indicators

% of children under five that fall below minus 2 standard deviations from the median height for age

of the standard NCHS reference population (moderate & severe)

Numerator: Number of children under age five that fall below minus two standard deviations from the median height for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)

Denominator: Total number of children under age five measured

Stunting Prevalence

Definition of Indicators

% of children under five that fall below minus 2 standard deviations from the median weight for height

of the standard NCHS reference population (moderate & severe)

Numerator: Number of children under age five that fall below minus two standard deviations from the median weight for height of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)

Denominator: Total number of children under age five that were weighed and measured

Wasting Prevalence

Methodological Issues

Measures of nutritional status

• Underweight (weight for age): reflects a child’s total body mass. It is a composite measure of stunting and wasting. It is useful for describing the overall level of malnutrition and for assessing changes over time

Methodological Issues

Measures of nutritional status

• Stunting (height for age): reflects a child’s stature in relation to his age. It is an indicator of cumulative deficient growth associated with chronic insufficient dietary intake, frequent infection, and poor feeding practices over a long period.

• Wasting (weight for height): indicates thinness or fatness. It is usually the result of recent nutritional deficiency. Affected by seasonal shifts associated with food availability and/or disease prevalence.

Methodological Issues

• Height (in centimeters)– measured lying down for children under 2 years old – measured standing up for children 2 or more years old

• Weight (in kilograms)• Age (in decimal (2) months)• Sex

Note that if height and weight data are missing for more than 10% of children under-five, caution should be exercised in the interpretation of the results.

Data used to assess nutritional status

Methodological Issues

• Undernourishment is gauged by comparing children to a reference standard.

• The NCHS/WHO reference standard represents the distribution of height and weight by age and sex in a well nourished population.

• WHO has developed a new reference population which will be released soon.

International standard reference population

Methodological Issues

• The distribution has been normalized so that the mean and median are equal.

• Z-scores measure the number of standard deviation units that a child’s measurement deviates from the reference population median for that age.

International standard reference population

Methodological Issues

International standard reference population

• In the reference population (i.e. in a well nourished population), 2.3 percent of children fall below minus 2 standard deviations and 0.1 percent fall below minus 3 standard deviations.

• Height for Age and Weight for Age depend on accurate age reporting. In MICS, only children whose mothers reported both their month and year of birth are included in the calculations.

• Children with out of range (i.e. highly improbable) z-scores are excluded.

Methodological Issues

Measurement issues

• Poor height and weight measurements– Measurement instruments

– Training of interviewers

– Response rates

• Accuracy in age estimation

• Age group reference: 0-36 months vs. 0-59 months

• Unexpected pattern

Tabulation PlanTable NU.1: Child malnourishment

Underweight prevalence

27

5

7

14

15

28

29

46

0 20 40 60 80 100

Developing countries

CEE/CIS

Latin America/Caribbean

Middle East/North Africa

East Asia/Pacific

West/Central Africa

East/Southern Africa

South Asia

% children aged 0-59 months who are underweight

Regional Data

Underweight (CEE/CIS)

5

11233333444678

111214

0 20 40 60 80 100

CEE/CIS

CroatiaUkraine

Serbia/MontenegroArmeniaGeorgia

Moldova, Rep ofRomania

Russian FederationBosnia/Herzegovina

KazakhstanTurkey

Macedonia, TFYRAzerbaijan

UzbekistanKyrgyzstan

TurkmenistanAlbania

% children aged 0-59 months who are underweight

14

1357

101010101212131313

2122

253436

0 20 40 60 80 100

CEE/CIS

CroatiaUkraine

Serbia/MontenegroMacedonia, TFYR

Moldova, Rep ofRomania

Bosnia/HerzegovinaKazakhstan

GeorgiaTurkey

ArmeniaRussian Federation

AzerbaijanUzbekistan

TurkmenistanKyrgyzstan

AlbaniaTajikistan

% children aged 0-59 months who are stunted

Stunting (CEE/CIS)

3

01122222334445667 11

0 20 40 60 80 100

CEE/CIS

CroatiaUkraine

Serbia/MontenegroMacedonia, TFYRMoldova, Rep of

RomaniaBosnia/Herzegovina

KazakhstanGeorgiaTurkey

ArmeniaRussian Federation

AzerbaijanUzbekistan

TurkmenistanKyrgyzstan

AlbaniaTajikistan

% children aged 0-59 months who are wasted

Wasting (CEE/CIS)

Underweight (ROSA)

46

19

29

30

38

39

47

48

48

0 20 40 60 80 100

South Asia

Bhutan

Sri Lanka

Maldives

Pakistan

Afghanistan

India

Bangladesh

Nepal

% children aged 0-59 months who are underweight

Underweight (TACRO)

7

14445555566778881010121314

1717

23

0 20 40 60 80 100

Latin America/Caribbean

ChileCuba

JamaicaVenezuelaArgentina

Costa RicaDR

ParaguayUruguay

BrazilTrinidad/Tobago

ColombiaPeru

BoliviaMexico

PanamaEl Salvador

NicaraguaEcuador

SurinameGuyana

HaitiHonduras

Guatemala

% children aged 0-59 months who are underweight

Underweight (MENA)

14

3444567

9910101011

1414

161818

4146

0 20 40 60 80 100

Middle East/North Africa

LebanonJordan

OPTTunisia

LibyaQatarSyria

BahrainEgypt

AlgeriaKuwait

MoroccoIran

Saudi ArabiaUAEIraq

DjiboutiOmanSudanYemen

% children aged 0-59 months who are underweight

Underweight (CEE/CIS)

5

11233333444678

111214

0 20 40 60 80 100

CEE/CIS

CroatiaUkraine

Serbia/MontenegroArmeniaGeorgia

Moldova, Rep ofRomania

Russian FederationBosnia/Herzegovina

KazakhstanTurkey

Macedonia, TFYRAzerbaijan

UzbekistanKyrgyzstan

TurkmenistanAlbania

% children aged 0-59 months who are underweight

Underweight (EAPRO)

15

3

8

11

13

18

23

28

28

28

32

40

45

46

0 20 40 60 80 100

East Asia/Pacific

Singapore

China

Malaysia

Mongolia

Thailand

Korea, Dem Rep

Indonesia

Philippines

Viet Nam

Myanmar

Lao, PDR

Cambodia

Timor-Leste

% children aged 0-59 months who are underweight

Underweight (ESARO)

29

1012131315

1820222223232424252627

314042

4547

0 20 40 60 80 100

East/Southern Africa

Swaziland

South AfricaBotswana

ZimbabweMauritius

LesothoKenya

MalawiTanzania

Uganda

ZambiaMozambique

NamibiaComoros

SomaliaRwanda

AngolaEritrea

MadagascarBurundi

Ethiopia

% children aged 0-59 months who are underweight

Underweight (WCARO)

28

121314

1717171819

22232425252626272829

313233

3840

0 20 40 60 80 100

West/Central Africa

GabonSao Tome/Principe

CongoCôte d'Ivoire

GambiaSenegal

CameroonEq. Guinea

GhanaBenin

CARGuinea-Bissau

TogoGuineaLiberia

Sierra LeoneChad

NigeriaCongo, Dem Rep of

MauritaniaMali

Burkina FasoNiger

% children aged 0-59 months who are underweight