Abstract
In 2016, undernutrition, as manifested in childhood stunting, wasting, and underweight were estimated to cause over 1.0 million deaths, 3.9% of years of life lost, and 3.8% of disability-adjusted life years globally. The objective of this study is to estimate the prevalence of undernutrition in low- and middle-income countries (LMICs) using the 2006–2018 cross-sectional nationally representative demographic and health surveys (DHS) data and to explore the sources of regional variations. Anthropometric measurements of children 0–59 months of age from DHS in 62 LMICs worldwide were used. Complete information was available for height-for-age (n = 624,734), weight-for-height (n = 625,230) and weight-for-age (n = 626,130). Random-effects models were fit to estimate the pooled prevalence of stunting, wasting, and underweight. Sources of heterogeneity in the prevalence estimates were explored through subgroup meta-analyses and meta-regression using generalized linear mixed-effects models. Human development index (a country-specific composite index based on life expectancy, literacy, access to education and per capita gross domestic product) and the United Nations region were explored as potential sources of variation in undernutrition. The overall prevalence was 29.1% (95% CI 26.7%, 31.6%) for stunting, 6.3% (95% CI 4.6%, 8.2%) for wasting, and 13.7% (95% CI 10.9%, 16.9%) for underweight. Subgroup analyses suggested that Western Africa, Southern Asia, and Southeastern Asia had a substantially higher estimated prevalence of undernutrition than global average estimates. In multivariable meta-regression, a combination of human development index and United Nations region (a proxy for geographical variation) explained 54%, 56%, and 66% of the variation in stunting, wasting, and underweight prevalence, respectively. Our findings demonstrate that regional, subregional, and country disparities in undernutrition remain, and the residual gaps to close towards achieving the second sustainable development goal—ending undernutrition by 2030.
Highlights
Abbreviations low- and middle-income countries (LMICs) Low- and middle-income countries WHO World Health Organization sub-Saharan Africa (SSA) Sub-Saharan Africa demographic and health surveys (DHS) Demographic and health surveys UN United Nations CI Confidence Interval GDP Gross domestic product HDI Human development index
We are unaware of prior studies of the combined influence of human development index on all three undernutrition forms, at the global, regional and country-level
The present study focuses on the spatial distribution of childhood stunting, wasting and underweight prevalence in 62 LMICs
Summary
Abbreviations LMICs Low- and middle-income countries WHO World Health Organization SSA Sub-Saharan Africa DHS Demographic and health surveys UN United Nations CI Confidence Interval GDP Gross domestic product HDI Human development index. Stunting (height-for-age z-score below − 2 standard deviations (SD) from the global median, as defined by the 2006 World Health Organization Child Growth Standards), wasting (weight-for-height z-score below − 2 SD from the global median) and underweight (weight-for-age z-score below − 2 SD from the global median) are indicators of a child’s u ndernutrition[7] These anthropometric measures on a country level are updated regularly through the demographic and health surveys (DHS) program, which collects nationally representative health data to monitor and evaluate population health and nutrition programs in low- and middle-income countries (LMICs)[8]. These standards replaced the National Center for Health Statistics/ World Health Organization (NCHS/WHO) growth reference, which had been in international use since the late 1970s but underestimated the prevalence of undernutrition, especially for infants
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