Is Malnutrition Declining? an Analysis of Changes in Levels of Child Malnutrition since 1980

By de Onis, Mercedes; Frongillo, Edward A. et al. | Bulletin of the World Health Organization, October 2000 | Go to article overview

Is Malnutrition Declining? an Analysis of Changes in Levels of Child Malnutrition since 1980


de Onis, Mercedes, Frongillo, Edward A., Blossner, Monika, Bulletin of the World Health Organization


Voir page 1231 le resume en francais. En la pagina 1232 figura un resumen en espanol.

Introduction

The best global indicator of children's well-being is growth, because infections and unsatisfactory feeding practices, or more often a combination of the two, are major factors affecting their physical growth and mental development (1). Poor growth is attributable to a range of factors closely linked to overall standards of living and the ability of populations to meet their basic needs, such as access to food, housing and health care. The assessment of growth not only serves as a means of evaluating the health and nutritional status of children but also provides an excellent measurement of the inequalities in human development faced by populations.

Children who suffer from growth retardation as a result of poor diets and/or recurrent infections tend to have increased numbers of severe diarrhoeal episodes and a heightened susceptibility to certain infectious diseases, e.g. malaria, meningitis and pneumonia (2-4). There is an association between increasing severity of anthropometric deficits and mortality, and a substantial contribution is made by all degrees of malnutrition to child mortality (5-7). Strong evidence exists that poor growth is associated with delayed mental development (8, 9) and that there is a relationship between impaired growth status and both poor school performance and reduced intellectual achievement (10, 11). Growth retardation in early childhood is also associated with significant functional impairment in adult life (1, 10) and reduced work capacity (12), thus affecting economic productivity.

The lack of comparability between survey results has presented a major difficulty in monitoring trends in child malnutrition. Many nutritional surveys were conducted during the 1980s and 1990s but various anthropometric indicators, reporting systems, cut-off points and reference values were used, making comparison between the studies difficult. This prompted WHO in 1986 to begin the systematic collection and standardization of data on the nutritional status of children aged under 5 years. The initial results (13) were updated in 1997 and estimates of trends in child growth retardation in developing countries were derived (14). The present article provides further updating and describes trends in child malnutrition on the basis of the largest compilation ever assembled of nationally representative nutritional surveys.

Methods

Cross-sectional data on the prevalence of child malnutrition were obtained from nationally representative nutritional surveys included in the WHO Global Database on Child Growth and Malnutrition. This database was initiated in 1986 to compile, standardize and disseminate the results of nutritional surveys performed in both developing and developed countries (14). A distinct feature is the systematic analysis of raw data sets in a standard format so as to produce comparable results. The methodology used in the standard analysis of individual country surveys has been described elsewhere (13, 14). Low height-for-age, low weight-for-height and low weight-for-age are the anthropometric indicators traditionally used to assess child nutritional status. The present analysis focuses on low height-for-age, i.e. stunting, because this indicator best reflects long-term cumulative effects resulting from inadequate diet and/or recurrent illness (1, 13). The prevalence of low height-forage is defined as the proportion of children that fall below-2 standard deviations (SD) of the United States National Center for Health Statistics/WHO international reference median value.

Only nationally representative data derived from surveys conducted in developing countries were used. The sampling methods for each survey were reviewed to ensure national representativeness.(a) The survey results were checked for inconsistencies between the estimates based on height-for-age, weight-for-age and weight-for-height. …

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