2 At this time it is not possible to assess whether sufficient progress is being made on a country-by-country basis toward the global goals on low birth weight and exclusive breastfeeding because the rules for determining such progress have not yet been finalized by UNICEF, WHO, and the World Bank.
3 Stunting is defined as being below minus two standard deviations from the median height-for-age of the WHO Child Growth Stan- dards for children 0–59 months old.
4 In part this reflects the fact that a given percentage-point change generates a larger average annual rate of reduction or increase at lower prevalences.
5 Overweight is defined as being above two standard deviations from the median weight-for-height of the WHO Child Growth Standards for children 0–59 months old.
6 Wasting is defined as being below minus two standard deviations from the median weight-for-height of the WHO Child Growth Stan- dards for children 0–59 months old.
7 Exclusive breastfeeding is defined as the practice of feeding infants younger than six months old only breastmilk.
8 We cannot report on UN regions Europe and Northern America because of missing data. No internationally comparable data are available for Northern America, and for Europe only 10 of 43 coun- tries have data, covering only 14 percent of the region’s population.
9 Low birth weight is defined as weight at birth of less than 2,500 grams.
10 The majority of babies born in low- and low-middle-income coun- tries are not weighed. To help account for the large proportion of unweighed births, survey data undergo a number of adjustments (see Technical Note 9, available at
www.globalnutritionreport.org). While the methods were applicable when originally proposed, yield- ing plausible values for low birth weight in countries with available data at that time, shifts in various factors (such as the proportion of weighed births and the proportion of recorded birth weights from maternal recall versus from a health card) seem to have rendered the adjustments less robust in some cases. This has raised questions re- lated to the time series in a number of countries. Therefore, UNICEF, WHO, Johns Hopkins University, and the London School of Hygiene and Tropical Medicine are undertaking methodological work to determine if revision to the adjustment procedures is required. Until that time, time series are not available from UNICEF and WHO.
11 Anemia is defined as hemoglobin levels below 12 g/dL for nonpreg- nant women of reproductive age (15–49 years) and below 11 g/dL for pregnant women.
12 The Global Nutrition Report Independent Expert Group alone is re- sponsible for the classification of countries in this report, which does not necessarily represent the view or assessment of WHO. WHO will report on progress made toward the achievement of the WHA global nutrition targets at its 68th WHA session in May 2015.
13 Countries in each category are listed in Appendix 2.
14 Given their time sensitivity, wasting trends between surveys that are several years apart are not considered meaningful by WHO, and so the average annual rate of reduction is not used as a rule for deter- mining whether countries are on or off course. Nevertheless, this is not a universal view and not all wasting trends are shock related— hence the value of Table 3.2.
15 Appendix 3 lists the on- or off-course status for all countries and indicators.
16 1,000 Days and the Bill & Melinda Gates Foundation, two mem- bers of this report’s Stakeholder Group, are developing WHA policy briefs, and we will endeavor to collaborate on the development
of these briefs, making them as useful to national policymakers as possible.
CHAPTER 4 1 Thinness and short stature of women of reproductive age and female obesity coexist for only one country, Yemen.
Panel 4.4 1 American Indian and Alaskan Native is the official classification for this population group in the United States census (United States Census Bureau 2014).
2 The nutrition and weight status objectives can be found at United States Department of Health and Human Services (2014).
CHAPTER 5 1 Water and sanitation coverage are described in Chapter 6.
2 Other indicators of iron–folic acid supplementation are available; we chose the one likely to have the largest effect on nutrition status.
3 Minimum dietary diversity is the proportion of children 6–23 months of age who receive foods from four or more food groups. Minimum acceptable diet is a composite indicator calculated from (1) the pro- portion of breastfed children aged 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day and (2) the proportion of nonbreastfed children aged 6–23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feedings and the minimum meal frequency during the previous day (WHO 2008b).
4 In 2007 WHO introduced changes to indicator definitions of infant and young child feeding practices (WHO 2008b). The criterion for minimum dietary diversity was changed to four or more food groups for all children aged 6–23 months, rather than separate criteria for breastfed children (three or more food groups) and nonbreastfed children (four or more food groups), to reflect the quality of comple- mentary feeding. In addition, “eggs” were counted as a food group separate from poultry. Demographic and Health Surveys where these two changes were not adequately reported were excluded from the database, even if they were conducted after 2007 (WHO 2008a), in an effort to present only data that used the most up-to-date definition and criteria. Since minimum acceptable diet is a compos- ite indicator incorporating minimum dietary diversity, similar criteria were applied. Surveys from 27 countries met these two criteria.
5 The limited availability of national coverage rates for vitamin A supplementation for some UN subregions means we can only report on the subregions where data are reported for at least 50 percent of the subregional population.
6 The most common method used in household surveys to assess io- dine in salt is the rapid test kit (RTK). Although RTKs have long been used to assess whether salt has “adequate” iodine (> 15 parts per million) or “inadequate” iodine (0–15 parts per million), the most recent guidelines indicate that RTKs can only provide information on the presence or absence of iodine. Alternative methods like titration are required to determine the quantity of iodine in salt and therefore for measurement of the standard indicator (WHO, UNICEF, ICDD 2007). The apparent lack of precision of RTK-based estimates could lead to questions about comparability over time, and thus UNICEF finds it inappropriate to provide trends at present.
7 We would not expect to have data on all of these interventions for the higher-income countries because some interventions would be self-supplemented (such as iron–folic acid) and therefore not cap- tured in the data, and some are not recommended for all countries (such as vitamin A supplementation).
92
GLOBAL NUTRITION REPORT 2014
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68 |
Page 69 |
Page 70 |
Page 71 |
Page 72 |
Page 73 |
Page 74 |
Page 75 |
Page 76 |
Page 77 |
Page 78 |
Page 79 |
Page 80 |
Page 81 |
Page 82 |
Page 83 |
Page 84 |
Page 85 |
Page 86 |
Page 87 |
Page 88 |
Page 89 |
Page 90 |
Page 91 |
Page 92 |
Page 93 |
Page 94 |
Page 95 |
Page 96 |
Page 97 |
Page 98 |
Page 99 |
Page 100 |
Page 101 |
Page 102 |
Page 103 |
Page 104 |
Page 105 |
Page 106 |
Page 107 |
Page 108 |
Page 109 |
Page 110 |
Page 111 |
Page 112 |
Page 113 |
Page 114 |
Page 115 |
Page 116 |
Page 117 |
Page 118