Only one country, Cambodia, has coverage greater than 50 per- cent for all five interventions. No countries are below 50 percent for all five interventions. Most countries have coverage greater than 50 percent in two or three areas.
Which intervention or practice are countries weakest on?
Table 5.5 highlights the intervention for which each country has the lowest coverage rate. Most countries are weakest on iron– folic acid supplementation for 90 days or more, seven countries are weakest on vitamin A supplementation, and nine countries are weakest on breastfeeding practices. Analyses like these at the country level can help pinpoint priority areas for action.
Acute malnutrition
The world has made little progress in reducing the global bur- den of moderate acute malnutrition (MAM) and severe acute malnutrition (SAM).9
combined, rates of child wasting10
As Chapter 3 showed, for MAM and SAM are static at the global level.
Globally, severe wasting prevalence, one indicator of SAM, is estimated at just under 3 percent (equal to 17 million children under age five) (UNICEF, WHO, and World Bank 2014). Children with SAM have a risk of death nine times higher than that of children without SAM (WHO and UNICEF 2009). Currently 7.8 percent of deaths of children under age five are attributable to severe wasting (Black et al. 2013). Although MAM presents a lower mortality risk, it affects a larger absolute number of chil-
dren, underscoring the importance of addressing MAM globally. If nutrition-specific interventions were scaled up to 90 percent coverage, they could reduce the prevalence of severe wasting by an estimated 61 percent (Bhutta et al. 2013a).
Once a child develops SAM, however, follow-up treatment often includes treatment for MAM to prevent relapse. Data on treatment coverage for MAM and SAM are limited. A 2013 review examined available data on SAM treatment coverage from three methods of coverage estimation: (1) indirect geographic coverage estimates (the percentage of the total number of health care facilities in a country that are delivering treatment for SAM), (2) indirect treatment coverage estimates (the percentage of total admissions as a share of the estimated SAM burden), and (3) direct subnational estimates of treatment coverage where admis- sions and burden can be directly observed (UNICEF, CMN, and ACF International 2013). This review of SAM treatment coverage made it clear that each method of estimation has its limitations. Further efforts are needed to develop viable systems that can as- sess coverage in real time and are tailored to individual countries to help them better manage SAM programming and scale-up of treatment. For this report, we use data on geographic coverage.
Figure 5.8 plots severe wasting against geographic cov- erage of SAM treatment programming. It is clear that some large countries with high levels of SAM, as measured by severe wasting, have low geographic coverage rates (such as India and
FIGURE 5.8 GEOGRAPHIC COVERAGE OF SAM TREATMENT BY UNDER-FIVE SEVERE WASTING RATES 10 South Sudan Djibouti 8 Timor-Leste India 6 Mali Sudan Angola 4 Pakistan Nepal 2 Congo 0 0
Cambodia Sri Lanka
Côte d’Ivoire
Gambia Uganda
Swaziland Rep. of Korea 20 40 Bangladesh Comoros Yemen Benin DRC Mozambique Senegal Haiti
Guinea-Bissau Liberia
60 GEOGRAPHIC COVERAGE OF SAM TREATMENT (%)
Source: Data on wasting and SAM treatment are from UNICEF, WHO, and World Bank (2014; data from 2005–2013) and UNICEF, CMN, and ACF International (2013). Population data are from United Nations (2013b).
Note: Circle sizes are proportionate to the number of severely wasted children. SAM = severe acute malnutrition. Ghana Zimbabwe 80
Rwanda Malawi
Ethiopia Kenya Mauritantia
Burundi Togo
Honduras Guatemala 100
Sierra Leone Iraq
Eritrea Niger
Papua New Guinea Chad
Syrian Arab Rep.
ACTIONS & ACCOUNTABILITY TO ACCELERATE THE WORLD’S PROGRESS ON NUTRITION
35
SEVERE WASTING BASELINE RATE (%)
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