Overview of Population undernutrition in eastern and southern Africa

Christopher Auricht chris@auricht.com and Anne Marie Sanderson aifsc@aciar.gov.au

NAIROBI10 Sep 2012

Australian International Food Security Centre (AIFSC)

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OutlineElements and consequences of

maternal and child undernutrition and food security

Global and Regional SSA ContextEast and Southern Africa

Perspective

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Elements and consequences Maternal and undernutrtion responsible

for > one third of child deaths Undernutrition – includes:

Stunting Wasting Underweight Micronutrient deficiencies - deficiencies of

essential vitamins and minerals

Note - ‘malnutrition’ includes both undernutrion and overnutrition or obesity

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Undernourished children and those not optimally breastfed, or those suffering from micronutrient deficiencies have substantially lower chances of survival than those who are well nourished.

Undernutrition in children increased likelihood of: serious infection death from common childhood illnesses e.g.

diarrhoea, measles, pneumonia and malaraia, as well as HIV/AIDS

Consequences of undernutrition i.e. why is undernutrition important?

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Consequences of undernutrition cont.

Chronic undernutrion in early childhood Reduced cognitive and physical

development disadvantaged throughout lifeNutrition status affected prior to

conception Highly correlated to mother’s nutrition

status prior to and during pregnancyCyclical

chronically undernorhised woman give birth to undernourished child

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Importance of essential vitamins Micronutrients provide essential vitamins and

minerals Deficiencies occur when body doesn’t have

sufficient amounts due to dietary intake and/or insufficient absorption and/or suboptimal utilisation

Consequences include iron deficiency anaemia iodine deficiency disorders blindness

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Importance of dietLack of adequate diet for a couple

months or more between conception and 2 years of age deprives children of essential nutrients Micronutrient deficiencies Constrained development Stunting

Beyond two years of age most damage cannot be reversed

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Food security calendar and scale of rural hunger

Nearly one billion people experience debilitation, health-threatening hunger each year

4 out of 5 of these people are rural farmersTrends in maize shortage in ZambiaPercentage of farm households with maize shortage

The Hunger Period

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Measures and Indicators of undernutrition

A considerable body of work carried out at global, national and subnational levels addressing population nutrition

Demographic and Health Surveys include indicators / measures to help track trends over time. Involve key measurements of children, and

women of child-bearing age (15-49 years). Specific indicators include wasting, stunting

and underweight status amongst children under 5 (0-59 months), maternal thinness or body mass index (DMI) and prevalence of low birthweight babies ( < 2500 g)

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Child Undernutrition Measures and Indicators

WHO Child Growth Standards 2006Standard distribution of height and weight

of children < 5 years (0 – 59 months)Assessment of undernourishment based on

comparison with WHO growth standardsRates of undernutrition expressed in

standard deviations or Z-scores from the median of this distribution

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Child Undernutrition cont

Anthropometric measures in children < 5 yearsWasting – low weight for heightStunting – low height for ageUnderweight – low weight for age

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Child undernutrition metrics Severe % < - 3Z–

scores Moderate % <-2Z-

scores Population prevalence

– low, medium, high and very high

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Indicator Prevalence (% )

Low Medium High Very high

Underweight

(% with weight-for-age <-2 Z-scores)

<10 10 – 19 20 -29 ≥30

Wasting

(% with weight-for-height <-2 Z-scores)

<5 5-9 10 -14 ≥15

Stunting

(% with height-for-age <-2 Z-scores)

<20 20 - 29 30-39 ≥40

Source: www.who.org

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Maternal undernutritionWomen 15 – 49 years (child-

bearing age)Indicators include:

Body Mass Index (Thinness)Height (Stature)Micronutrient deficiencies (Iron,

Iodine, Vit A)

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Maternal undernutrition indicators

Short stature – increased risk of obstetric complications

Low pre-pregnancy BMI ( <18.5) – risk factor for child development and pregnancy outcomes

Low iodine – risk for child development

Low iron – risk for poor birth outcomes

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General context – setting the scene

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Food Security“Food security exists when all people,

at all times, have physical and economic access to sufficient, safe and nutritious food to meet their dietary needs and food preferences for an active and healthy life.”

World Food Summit 1996

18Global Temporal DimensionPercentage urban and urban agglomerations by size class

1960198020112025

Source: UN Pop Division World Urbanisation Prospects, 2011 Revision http://esa.un.org/unpd/wup/Maps/maps_overview.htm

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Population 2000 and 2040 Sub-Saharan Africa (Millions)

Population

2000 2005 2010 2015 2020 2030 2040

Total Pop 659 746 843 952 1,071 1,333 1,623

Rural Pop 447 491 537 586 635 724 795

Urban 212 255 306 366 436 609 828

Agric Pop 403 437 472 508 544

Females in Ag

78 87 97 109 121

Source: UN Pop Division World Urbanisation Prospects, 2011 Revision and FAOStat http://esa.un.org/unpd/wup/Maps/maps_overview.htm and http://

faostat.fao.org/site/550/DesktopDefault.aspx?PageID=550#ancor

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One Billion People Suffer Chronic Hunger and Poverty

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Trends in Stunting and underweight

Trends in mild, moderate, and severe stunting and underweight, and progress towards MDG 1 in 141 developing countries: a systematic analysis of population representative data. Gretchen A Stevens, Mariel M Finucane, Christopher J Paciorek, Seth R Flaxman, Richard A White, Abigail J Donner, Majid Ezzati, on behalf of Nutrition Impact Model Study Group (Child Growth). Lancet July 5,2012

Many African counties < 0.5 probability of meeting MDG

1 target (underweight)

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Population density of underweight children under five

Sources: CIESIN and Hunger Task Force (A and B, unpublished data)

And GAEZ database

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Region Total number of countries

Improving

No change

Deteriorating

Africa 29 12 6 11

Asia 20 13 6 1

S. & Central America and Caribbean

14 6 7 1

Total 63 31 19 13

SCN 6th World Nutrition Report. 2011

Number of countries where stunting rates are going up, down or are unchanged (latest survey minus the previous one)

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The Undernutrition Paradigm Close links exist amongst food security

(including agriculture), social protection and health

Links also exist between food security, nutrition and the broader determinants of poverty (including education, water supply, sanitation etc) and cross-cutting issues e.g. gender equity and governance

Such linkages between poverty, food insecurity and other causes and consequences often presented in frameworks

25Framework of relationships between poverty, food insecurity and undernutrition

Source: Black et al 2008

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AIFSC South and Eastern Africa Perspective

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AIFSC South and Eastern Africa Perspective Burundi Ethiopia Kenya Malawi Mozambique Rwanda Uganda Tanzania Zambia

Prevalence of undernutrition in children under the age of five years (percent)

Underweight Stunting Wasting

(Weight for age) (Height for age) (Weight-for-height)

Country Year <-2 Z-scores <-2 Z-scores <-2 Z-scores

Burundi 2010 28.8 57.7 5.8

Ethiopia 2011 28.7 44.4 9.7

Kenya 2008-09 16.0 35.0 7.0

Malawi 2010 12.8 47.1 4.0

Mozambique 2011 14.9 42.6 5.9

Rwanda 2010 11.4 44.2 2.8

Uganda 2006 15.9 38.1 6.1

United Republic of Tanzania 2010 15.8 42.0 4.8

Zambia 2007 14.6 45.4 5.2 Mean - 17.6 44.1 5.7

Child undernutrition rates

Source: National Surveys

Indicator Prevalence (% )

Low Medium High Very high

Underweight

(% with weight-for-age <-2 Z-scores)

<10 10 – 19 20 -29 ≥30

Wasting

(% with weight-for-height <-2 Z-scores)

<5 5-9 10 -14 ≥15

Stunting

(% with height-for-age <-2 Z-scores)

<20 20 - 29 30-39 ≥40

Children Wasting

Indicator Prevalence (% )

Low Medium High Very high

Underweight

(% with weight-for-age <-2 Z-scores)

<10 10 – 19 20 -29 ≥30

Wasting

(% with weight-for-height <-2 Z-scores)

<5 5-9 10 -14 ≥15

Stunting

(% with height-for-age <-2 Z-scores)

<20 20 - 29 30-39 ≥40

Children Underweight

Indicator Prevalence (% )

Low Medium High Very high

Underweight

(% with weight-for-age <-2 Z-scores)

<10 10 – 19 20 -29 ≥30

Wasting

(% with weight-for-height <-2 Z-scores)

<5 5-9 10 -14 ≥15

Stunting

(% with height-for-age <-2 Z-scores)

<20 20 - 29 30-39 ≥40

Children Stunting

Maternal undernutrition Latest

available data

Women 15 – 49 with height <145cm (%)

Women 15 – 49 with BMI

<18.5 (%) Burundi - - - Ethiopia 2011 3.4 26.9 Kenya 2008-09 1.2 12.3 Malawi 2010 2.4 8.8 Mozambique 2003 4.9 8.6 Rwanda 2010 1.8 8.2 Uganda 2006 1.9 12.1 United Republic of Tanzania

2010 3.4 11.4

Zambia 2007 2.6 9.6 Mean - 2.7 12.2

Vitamin A deficiency

Vitmain A - Women  Year Population with

serum retinol <0.7µmol/L (%)

Public health problem

Burundi - 12.2 Moderate

Ethiopia 1997 13.2 Moderate

Kenya 1998 17.3 Moderate

Malawi 1999 13.7 Moderate

Mozambique 2002 14.3 Moderate

Rwanda 1996 6.2 MildUganda 2001 23.3 SevereUnited Republic of Tanzania

2001 14.8 Moderate

Zambia 2001 14.0 Moderate

  Year Population with serum retinol <0.7µmol/L (%)

Public health problem

Burundi 2005 27.9 SevereEthiopia 1996/97 46.1 Severe

Kenya 1999 84.4 SevereMalawi 2001 59.2 Severe

Mozambique 2002 68.8 Severe

Rwanda 1996 6.4 MildUganda 2001 27.9 SevereUnited

Republic of Tanzania

1997 24.2 Severe

Zambia 2003 54.1 Severe

Vitamin A - Children

Iodine deficiency Needed from the mother during pregnancy

Deficiencies cause irreversible: Cretinism (mental retardation) Deaf-mutism Dwarfism Spastic palsy of the lower limbs

Spontaneous abortion and neontal deaths Goitre – enlargement of the thyroid

Iodine nutrition

  Date % population with UI <100 µg/L

Classification of iodine intake

Classification of iodine nutrition

Burundi        

Ethiopia 2000 68.4 Insufficient Mild iodine deficiency

Kenya 1994 36.7 Adequate Optimal iodine nutrition

Malawi No data in 2004 WHO database

     

Mozambique 1998 65.4 Insufficient Mild iodine deficiency

Rwanda 1996 0.0 More than adequate

Risk of IIH  in susceptible groups

Uganda 1999 11.9 Excessive Risk of adverse health consequences

United Republic of Tanzania

1996 37.7 Adequate Optimal iodine nutrition

Zambia 1993 72.0 Insufficient Mild iodine deficiency

Iron deficiency Most common nutritional disorder

Important micronutrient for oxygen transport

Low levels of consumption of meat, fish and poultry

Loss or destruction of red blood cells by hook worm and malaria

Measured by low levels of haemoglobin in the blood – low capacity to carry oxygen

Anaemia -Public health significance

Prevalence of any anaemia (%) Category of public health significance (WHO)

≤4.9 No public health problem

5.0 – 19.9 Mild

20.0 – 39.9 Moderate

≥40 Severe

Anaemia  % of children 6 – 59 months

with ‘any’ anaemia (<12.0 g/dl haemoglobin)

% Women 15 – 49 with ‘any’ anaemia (<12.0 g/dl

haemoglobin)

Burundi 44.6 18.5

Ethiopia 44.3 16.6

Kenya 69.0 46.4

Malawi 62.5 28.0

Mozambique 68.7 53.9

Rwanda 38.2 17.3

Uganda 72.6 49

Tanzania 58.6 40.1

Zambia 52.9 29.1

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Overview Findings Provided a snapshot of population nutrition

for selected countries using a series of standard indicators

Evidence indicates that stunting and anaemia are the most serious undernutrition issues

Relationships between poverty, food security and undernutrition are strong

Addressing poverty and food security (agriculture production) and improving livelihoods critical to solution

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Facts (Agriculture Perspective)According to CGIAR analysis

One billion of the worlds poor within Africa and Asia (those living on less than $1 per day) are fed primarily by:hundreds of millions of small-holder

farmers (often with less than 2 ha of land, several crops, and a cow or two), or

Herders (most with fewer than five large animals)

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Yield Gap – Aggregate of Major Crops

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Thanks Acknowledgements

ACIAR Questions & Discussion