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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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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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