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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
Open accessAbstract
Background There is little information on country trends in the complete distributions of children's anthropometric status, which are needed to assess all levels of mild to severe undernutrition. We aimed to estimate trends in the distributions of children's anthropometric status and assess progress towards the Millennium Development Goal 1 (MDG 1) target of halving the prevalence of weight-for-age Z score (WAZ) below -2 between 1990 and 2015 or reaching a prevalence of 2·3% or lower.Methods We collated population-representative data on height-for-age Z score (HAZ) and WAZ calculated with the 2006 WHO child growth standards. Our data sources were health and nutrition surveys, summary statistics from the WHO Global Database on Child Growth and Malnutrition, and summary statistics from reports of other national and international agencies. We used a Bayesian hierarchical mixture model to estimate Z-score distributions. We quantified the uncertainty of our estimates, assessed their validity, compared their performance to alternative models, and assessed sensitivity to key modelling choices.Findings In developing countries, mean HAZ improved from -1·86 (95% uncertainty interval -2·01 to -1·72) in 1985 to -1·16 (-1·29 to -1·04) in 2011; mean WAZ improved from -1·31 (-1·41 to -1·20) to -0·84 (-0·93 to -0·74). Over this period, prevalences of moderate-and-severe stunting declined from 47·2% (44·0 to 50·3) to 29·9% (27·1 to 32·9) and underweight from 30·1% (26·7 to 33·3) to 19·4% (16·5 to 22·2). The largest absolute improvements were in Asia and the largest relative reductions in prevalence in southern and tropical Latin America. Anthropometric status worsened in sub-Saharan Africa until the late 1990s and improved thereafter. In 2011, 314 (296 to 331) million children younger than 5 years were mildly, moderately, or severely stunted and 258 (240 to 274) million were mildly, moderately, or severely underweight. Developing countries as a whole have less than a 5% chance of meeting the MDG 1 target; but 61 of these 141 countries have a 50-100% chance.Interpretation Macroeconomic shocks, structural adjustment, and trade policy reforms in the 1980s and 1990s might have been responsible for worsening child nutritional status in sub-Saharan Africa. Further progress in the improvement of children's growth and nutrition needs equitable economic growth and investment in pro-poor food and primary care programmes, especially relevant in the context of the global economic crisis.Funding The Bill & Melinda Gates Foundation and the UK Medical Research Council.
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“Reductions in underweight and measles (because of immunisation programmes) might have contributed to falls in deaths from diarrhoea and pneumonia.101”
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The Economics of Health Care Delivery
Winter, H. S., Mossialos, E. A., Naci, H., Chandra, A., Saloojee, H., Yamashiro, Y., Bhutta, Z. A., Uauy, R. D., & Corvalán, C. (2012) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0b013e318272af3b · Cited by 18
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Dinku, Y., Fielding, D., & Genç, M. (2019) · Review of Development Economics · doi:10.1111/rode.12587 · Cited by 17
“Stevens et al. (2012) compare trends in children's bmi-for-age across 141 developing countries, showing that Ethiopia's figures are among the worst in the world.”
BackgroundNutrition Policies in Developing Countries: Challenges and HighlightsPreprint
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“Abbreviations used: COD, cause of death; DALY, disability-adjusted life-year; DHS, Demographic and Health Surveys; GBD, Global Burden of Disease study; GPR, Gaussian process regression; ICD, International Classification of Diseases; IHME, Institute for Health Metrics and Evaluation; LBS, Lancet Breastfeeding Series Gr…”
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“based studies in 141 developing countries reported mean HAZ and WAZ as −1·16 and −0·84, respectively, among under-5s((21)).”
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“Currently, the problem of child obesity has been highlighted in developed countries but factors related to child growth and development in developing countries are less noticed [10–12].”
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An Agricultural Wealth Index for Multidimensional Wealth Assessments
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“Undernutrition rates remain high, particularly in subSaharan Africa, and may even have risen during the last decades in some African countries((1)).”
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Shahid, M., Liu, Y., Ameer, W., Qureshi, M. G., Ahmed, F., & Tang, K. (2022) · Children · doi:10.3390/children9071096 · Cited by 15
“Introduction Globally, 19% (110 million) of children below the age of five are severely underweight, while 30% (170 million) are stunted [1].”
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“4 % respectively over the past 25 year (1985-2011), those countries as a whole have still less than 5% chance of meeting MDG 1 targets [4].”
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“The factors and pathways leading to maternal malnutrition are diverse, complex, and most often interconnected (Dattijo et al., 2016; Gebre & Mulugeta, 2015; Ismail et al., 2017; Obai et al., 2016; Stevens et al., 2012).”
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“Although the prevalence of undernutrition is declining globally, it remains a major public health problem in many countries((6,7)).”
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“154 The survey was implemented by the National Statistics Directorate of the Directorate General for Analysis 155 and Research of the Ministry of Finance with technical assistance from ICF Macro, and financial support 156 by several international donors such from USAID and WHO.”
MethodInfluentialNutritional paradox in Ethiopian women: Multilevel multinomial analysis
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Psychosocial effects of poverty on the academic performance of the girl child in Zimbabwe
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“India experiences high levels of maternal and child malnutrition (underweight, stunting, and wasting), in part related to high levels of exposure to infection (Black et al. 2013; Gragnolati et al. 2005; Stevens et al. 2012).”
BackgroundBella, A., Dartanto, T., Nurshadrina, D. S., Kusnadi, G., Moeis, F. R., Nurhasana, R., Satrya, A., & Thabrany, H. (2022) · Journal of Family and Economic Issues · doi:10.1007/s10834-022-09864-x · Cited by 18
Puett, C., Anderson, J. D., Bagamian, K. H., Muhib, F., Scheele, S. K., Hausdorff, W. P., & Pecenka, C. J. (2023) · The Lancet Global Health · doi:10.1016/s2214-109x(23)00050-5 · Cited by 12
Causes of school drop-out among ordinary level learners in a resettlement area in Masvingo, Zimbabwe
Chinyoka, K. (2014) · Journal of Emerging Trends in Educational Research and Policy Studies · Cited by 12
Metadata
- Authors
- Stevens, G. A., Finucane, M. M., Paciorek, C. J., Flaxman, S. R., White, R. A., Donner, A. J., & Ezzati, M.
- Affiliations
- World Health Organization (CH)
- Harvard University (US)
- University of California, Berkeley (US)
- Carnegie Mellon University (US)
- Imperial College London (GB)
- Corresponding author
- Ezzati, Majid
- Venue
- The Lancet
- Publisher
- Elsevier BV
- Published
- 2012-09
- Volume
- 380
- Issue
- 9844
- Pages
- 824-834
- ISSN
- 0099-5355 (ISSN-L)
- 0140-6736
- PMC
- PMC3443900
- OpenAlex
- W2130638487
- Cited by
- 384
- References
- 41
- Citations by year
- 2026: 9 · 2025: 7 · 2024: 23 · 2023: 19 · 2022: 21 · 2021: 20 · 2020: 36 · 2019: 28 · 2018: 40 · 2017: 22 · 2016: 43 · 2015: 29 · 2014: 40 · 2013: 36 · 2012: 11
- FWCI
- 34.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- Locations
- The Lancet (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Dépôt institutionnel de l'Université libre de Bruxelles (Université Libre de Bruxelles) (submittedVersion)
- Funders
- Medical Research Council (MR/K005901/1)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Child Nutrition and Water Access
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Public Health and Nutrition
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- child stunting, underweight children, child undernutrition, anthropometric status, height-for-age z-score, weight-for-age z-score, Millennium Development Goal 1, developing countries, sub-Saharan Africa, Latin America, Asia, child mortality reduction, childhood vaccination coverage
- MeSH terms
- Anthropometry, Child Nutritional Physiological Phenomena, Child, Preschool, Developing Countries, Female, Goals, Growth Disorders, Humans, Infant, Infant, Newborn, International Cooperation, Male, Thinness, Global Health, Prevalence, Malnutrition
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