OVERLAPS OF DIFFERENT FORMS OF MALNUTRITION
Many countries have overlapping burdens of stunting, wasting, and overweight in children under age five. For the 117 countries that have data on all three indicators (stunting, wasting, and overweight), Table 4.1 creates eight mutually exclusive and ex- haustive categories. A ninth category is constructed of countries that are missing data for at least one of the three indicators.
Of the 117 countries, 64 countries have multiple types of
under-five anthropometry malnutrition. Only 43 countries have single-issue child growth problems. Seventeen countries have all three types of under-five growth problems. Only 10 countries are below the cutoffs for each indicator—that is, they do not have stunting, wasting, and overweight levels that are a serious public health concern.
Multiple malnutrition burdens also affect women. Table 4.2
overlays three indicators of malnutrition: thinness and short stature for women of reproductive age (WRA) and overweight of adult females. One-third of the countries (22 of 67) for which data are available on all three indicators do not have any of the three malnutrition conditions as specified by the cutoffs (including several large African countries). The South Asian countries predominate in the short stature and thinness group. One country, Yemen, is experiencing all three forms of female malnutrition. Double burdens of overweight and short stature/ thinness affect only 7 countries, with a combined total popula- tion of 71 million.
Table 4.3 combines three indicators generated using differ- ent methodologies: under-five stunting rates, anemia among women of reproductive age, and adult overweight for both sexes. Twenty-four countries have all three forms of malnutri- tion. Seventy-eight countries have two forms of malnutrition. Eighteen countries have only one of the three forms of malnu- trition burden (less than 20 percent of the population living in countries that have a malnutrition burden).
Only two countries (China and Republic of Korea) of the 122 countries for which we have comparable data on all three indi- cators are below the stated cutoffs for all three, but only just— China’s anemia rate is 19.6 percent and Republic of Korea’s is 19.4 percent. If the anemia rate in these two countries were just 0.6 percent higher, all countries in the world would be classified as experiencing one of these three forms of malnutrition. Of course, China has such a large population that its 9.4 percent stunting, 19.6 percent anemia, and 25 percent overweight rates represent serious national and global burdens.
These analyses of overlaps in malnutrition represent a simple way of exploring multiple burdens and taking a fresh look at malnutrition in any context. Two broad conclusions can be drawn: (1) the vast majority of countries have more than one malnutrition burden, and (2) many countries experience three types of malnutrition at the same time. Seventeen countries ex- perience under-five stunting, wasting, and overweight, and 24 countries experience stunting, anemia, and adult overweight.1
Given these multiple burdens and their complexities, the
TABLE 4.1 COUNTRIES WITH OVERLAPPING STUNTING, WASTING, AND OVERWEIGHT IN CHILDREN UNDER AGE FIVE Overlap/indicator group
Stunting only Wasting only Overweight only
Number of countries 12
6 25
Total population (millions) 212
68 603 Countries
Democratic People’s Republic of Korea, El Salvador, Guatemala, Honduras, Liberia, Nauru, Nicaragua, Solomon Islands, Togo, Uganda, Viet Nam, Zimbabwe
Guyana, Oman, Saudi Arabia, Senegal, Sri Lanka, Suriname
Algeria, Argentina, Belarus, Belize, Bosnia and Herzegovina, Brazil, Chile, Costa Rica, Dominican Republic, Gabon, Georgia, Kazakhstan, Kuwait, Kyrgyzstan, Mexico, Mongolia, Montenegro, Morocco, Paraguay, Peru, Serbia, The former Yugoslav Republic of Macedonia, Tunisia, Uruguay, Uzbekistan
Stunting and wasting only 38 2,462
Bangladesh, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Eritrea, Ethiopia, Gambia, Ghana, Guinea, Guinea-Bissau, Haiti, India, Kenya, Lao People’s Democratic Republic, Maldives, Mali, Mauritania, Myanmar, Namibia, Nepal, Niger, Nigeria, Pakistan, Philippines, Somalia, South Sudan, Sudan, Tajikistan, Timor-Leste, United Republic of Tanzania, Vanuatu, Yemen
Stunting and overweight only Wasting and overweight only Stunting, wasting, and overweight
Below cutoff for all three indicators Total with data
Missing data for at least one indicator Total
7 2
17 10
117 76
193 Source: Indicator data are from UNICEF, WHO, and World Bank (2014). Data are from 2005–2013. Population data are from United Nations (2013b).
Note: The cutoffs for placing countries in each indicator category are as follows: under-five stunting ≥ 20 percent, under-five wasting ≥ 5 percent, and under-five over- weight ≥ 7 percent. These cutoffs were selected because they are considered to indicate public health significance by WHO (2010a).
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION 23
45 70
468 1,914 5,842
Armenia, Bolivia, Equatorial Guinea, Lesotho, Malawi, Rwanda, Swaziland Republic of Moldova, Thailand
Albania, Azerbaijan, Benin, Bhutan, Botswana, Comoros, Djibouti, Egypt, Indonesia, Iraq, Libya, Mozambique, Papua New Guinea, Sao Tome and Principe, Sierra Leone, Syrian Arab Republic, Zambia
China, Colombia, Germany, Jamaica, Jordan, Republic of Korea, Saint Lucia, Tuvalu, United States, Venezuela
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