The haunting image of an emaciated Sudanese child struggling to reach a United Nations feeding centre while being watched by a vulture shocked the world in 1993. It centred global attention on famine in Africa and the plight of children in the region.
Has child undernutrition in Africa changed since the early 1990s? Are things better or worse?
This factsheet looks at four measures of child nutrition: underweight, stunting, wasting and minimum acceptable diet.
What is undernutrition?
According to the UN Children’s Fund (Unicef), undernutrition results from insufficient food intake and repeated infectious diseases. An undernourished person could be:
- underweight for their age
- too short for their age (stunted)
- too thin for their height (wasted)
- lacking enough vitamins and minerals (malnourished)
Undernourished people don’t get all the macro- and micronutrients needed for the normal healthy functioning of the body, Prof Joanne Katz of the department of international health at the Johns Hopkins Bloomberg School of Public Health told Africa Check.
Macronutrients provide the body with energy and are needed in large amounts. Micronutrients – such as calcium and zinc – are needed in smaller amounts but enable the body to produce hormones, which are essential for proper growth and development.
The “joint estimates”, as they are known, are calculated from nationally representative household surveys, carried out every three to five years. The current data includes 854 surveys from 152 countries, representing 90% of the world’s children aged under five.
Fifty-four African countries are represented, 37 of which have survey data from 2013 to 2018.
Prof Linda Richter, distinguished professor in the Centre of Excellence in Human Development at Wits University, told Africa Check the estimates are “the most authoritative source, derived from nationally representative household surveys and agreed by governments to be accurate.”
Children are underweight when, according to standards developed by the WHO, their weight is lower than would be statistically expected for their age.
According to Unicef, a child who is even slightly underweight has an increased risk of death and slower cognitive development. And the problem can carry across generations as underweight women are more likely to have low-birth-weight babies.
Estimates show that in 2018, 17.1% of children under the age of five in the WHO’s Africa region were underweight. This was 29 million children. (Note: The region includes 49 of 54 African countries. It excludes Somalia, Eritrea, Sudan, Egypt and Libya. They fall under the WHO’s Eastern Mediterranean region.) Worldwide, underweight prevalence in 2018 was 13.4%.
Have these figures changed over time? The table below shows that the prevalence of underweight children in the WHO Africa region has steadily declined since 1990, when it was estimated at 28.2%.
Stunting is impaired growth and development of children as a result of poor nutrition. A child is considered stunted when, according to standards developed by the WHO, their height is lower than would be statistically expected for their age.
Stunting – particularly in the first 1,000 days of a child’s life – can have adverse effects such as poor educational performance and low productivity.
The joint estimates show that 33.1% of children under the age of five in the WHO’s Africa region were stunted in 2018. This is nearly one in three children or around 56.1 million children under the age of five. Global prevalence was 22.1% in 2018.
The prevalence of stunting has also steadily declined since 1990, when 47.6% of children under the age of five were stunted.
When it comes to undernutrition, stunting statistics for children under five are preferred to other age groups. “This is because some children experience a physical catch up in terms of height” later in life, Prof Julian May, director of the DST-NRF Centre of Excellence in Food Security, told Africa Check.
Children suffering from wasting
A child is considered wasted when they are too thin for their height. It’s usually the result of poor nutrient intake or disease. It is also caused by a child rapidly losing weight or failing to gain weight.
According to Unicef, the WHO and the World Bank, children suffering from wasting have weakened immunity and their development may be delayed over the long term. Wasted children need urgent feeding and care.
As with the underweight and stunting estimates, the prevalence of wasting is given as a percentage of children under the age of five. The joint estimates show that in 2018, 7% or 11.9 million under-five children in the WHO’s Africa region suffered from wasting. The worldwide prevalence was 7.3%.
But the inter-agency team notes that wasting is an acute condition that can change rapidly and often, making it difficult to capture fluctuations over the course of a year.
How many children in Africa eat a minimum acceptable diet?
The minimum acceptable diet (MAD) for children aged from six to 23 months is an indicator developed by the WHO. It has two parts: the number of food groups available to a child (minimum dietary diversity) and the number of times a child is fed (minimum meal frequency).
The MAD is a fairly new indicator, not yet included in many countries’ national surveys, Prof Sheryl Hendriks, head of the department of agricultural economics, extension and rural development at the University of Pretoria, told Africa Check.
For example, a 2017 WHO report showed that the median consumption of a minimum acceptable diet in Africa is 8.6%. (This means in half the countries where data is available, fewer than 8.6% receive a MAD and in the other half, more than 8.6% receive a MAD.)
But this is according to data covering just 32 African countries, from 2010 to 2015.
Hendricks sent Africa Check her department’s collection of MAD data1, which includes figures from as recent as 2018 for 37 countries. (For a breakdown of countries and sources, see here.)
This data indicates that the median consumption of a minimum acceptable diet for children aged six to 23 months is 11.3%.
But Hendriks cautioned that this median figure “only accounts for 37 out of 55 countries”.
Global estimates are slightly higher. A 2018 report using data collected from 2013 to 2018 by Unicef, the WHO and the World Bank estimates that worldwide, 15.6% of children aged six to 23 months receive a MAD.
1Extracted by Ms Nosipho Mabuza, Dr Elizabeth Mkandawire, Mr Madalitso Kamenya and Ms Emmillian Kasililika Mlagha from the University of Pretoria.
© Copyright Africa Check 2020. Read our republishing guidelines. You may reproduce this piece or content from it for the purpose of reporting and/or discussing news and current events. This is subject to: Crediting Africa Check in the byline, keeping all hyperlinks to the sources used and adding this sentence at the end of your publication: “This report was written by Africa Check, a non-partisan fact-checking organisation. View the original piece on their website", with a link back to this page.