A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
AFRICAN UNION
UNION AFRICAINE
UNIÃO AFRICANA
Addis Ababa, ETHIOPIA P. O. Box 3243 Telephone: +251115-517700 Fax: +251115-517844
Website: www.africa-union.org
ACKNOWLEDGEMENTS
T
he Snapshot has been prepared by the African Union with the support of members of the African Task Force
on Food and Nutrition Development (ATFFND), including FAO, UNICEF, WFP, UNAIDS and WHO. Special
appreciation is expressed to UNICEF for providing funding, researching the data and serving as the primary drafter
of the document.
© 2009 The African Union and the United Nation Children’s Fund
The materials presented and the designations used in this document do not imply the expression of any opinion
on the part of UNICEF or the African Union concerning the legal status of any country, territory or area or of its
authorities, or concerning the delimitation of its frontiers or boundaries. The maps represent approximate border
lines for which there may not yet be full agreement.
Indicator definitions and population estimates for nutrition related to Millennium Development Goal monitoring
sometimes differ from those used by national governments, so the coverage estimates presented in this report may
differ from those used nationally, even when based on common data sources.
UNICEF and the African Union do not warrant that the information contained in this document is complete and
correct, and they shall not be liable for any damages incurred as a result of its use.
Estimated data presented in this document are subject to revision.
For further information please contact:
The African Union Commission, P.O. Box 3243, Addis Ababa, Ethiopia; Tel: +251115-517700; Fax: +251115-517844;
www.africa-union.org; or UNICEF, Division of Policy and Practice, 3 United Nations Plaza, New York, 10017, USA;
Tel: + 1 212 326 7000; Fax: +1 212 303 7895; Email: [email protected]; www.unicef.org.
Printed in Nairobi, Kenya
Photos and design: Giacomo Pirozzi
PREFACE
D
eclining food security and nutrition in Africa continue to present a very worrisome picture. Hunger is on the
increase; Africa together with Asia and the Pacific accounts for 750 million (89 per cent) of the world’s hungry
people. According to the latest FAO estimates, the increase in food prices between 2007 and 2009 has plunged
an additional 24 million people into hunger in sub-Saharan Africa alone. Africa is home to 15 of the 16 countries
where prevalence of hunger already exceeded 35 per cent. The affected populations are particularly vulnerable to
soaring food prices, and their situation is being worsened by the financial crisis and economic slow down. Without
a coherent and coordinated strategy, the progress made towards achievement of Millennium Development Goal 1
will be reversed.
The latest data show that only nine countries on the continent are on track to reach the MDG target of cutting
hunger and malnutrition in half by 2015. The nutrition status of children under five is generally accepted as one of
the best indicators of extreme poverty, and improved nutrition is a prerequisite for reaching other MDG targets in
education and health. Therefore, nutrition status is a priority area needing urgent policy attention for socio-economic
development in Africa.
Ending hunger and malnutrition will require decisive actions in several areas. One important area is to engage
the general population – and especially the poor, women, children, the elderly, people living with HIV and other
vulnerable populations – in successful food and nutrition security programmes. Such programmes can help them
diversify their diets through improved agriculture (growing a variety of food crops) and livestock production. This
should be accompanied by strengthening nutrition education and nutrition actions in primary health care settings,
schools and youth programmes. Governments are urged to initiate and scale up social protection programmes
focused on food and nutrition security for the most vulnerable and to institute micronutrient supplementation
and fortification schemes. Efforts aimed at sustainable food and nutrition security specifically targeting the most
vulnerable groups must remain a priority in emergencies. New and effective therapeutic and supplementary feeding
techniques should be used.
Despite the overall limited improvement in nutrition status, progress is being made in several communities in a few
countries on the continent. Eleven countries have managed to reduce underweight more than 20 per cent since
1990. Additionally, Algeria, Congo, Ghana and Sao Tome and Principe have shown improvements of more than
one-third. Nineteen countries in Africa have achieved a 20 per cent increase in exclusive breastfeeding rates –
which can lead to a significant reduction in child mortality. At the same time, many more countries have managed
to control vitamin A and iodine deficiencies through large-scale supplementation and fortification programmes. A
number of countries are managing acute malnutrition through wide use of ‘ready-to-use therapeutic foods’; this has
led to a decline in child mortality from undernutrition. Thus, successes are evident – and so are the capacities and
the potentials in Africa to end hunger and malnutrition.
This document has been prepared to provide decision-makers with the latest available information to facilitate a
common understanding of what the problems are and what could and should be done to change the situation.
Nutrition – A new and urgent initiative by the African Union Commission
In order to end hunger and malnutrition, the African Union Commission has initiated accelerated action from two
crucial perspectives:
1. Ensuring sustainable access to food and nutrition security requires government investments in agriculture
and food production. Implementation should include all communities, especially the poorest and most
vulnerable. This will enhance their capacity to end hunger and malnutrition in their families and communities.
This is a core objective of the Comprehensive African Agriculture Development Programme (2002), which is
further articulated in its Framework for African Food Security (2008).
2. Building up and strengthening health services and social protection systems, with the aim of addressing
constraints to elimination of hunger and undernutrition. These objectives are articulated in the African
Regional Nutrition Strategy (2005) and anchored in the African Health Strategy (2007) and the Social Policy
Framework (2008).
These two perspectives are both critical, since food that is not consumed by adults and children in need will not
1
FAO, 2008, ‘The State of Food Insecurity in the World: High food prices and food security – threats and opportunities’.
PREFACE
i
improve their nutritional condition. Likewise, medicines given to starving patients and children will not make them
healthy. Food and timely delivery of health services are together essential for children’s well-being. Neither by itself
is sufficient for good nutrition. Hence, both need to be supported by caring families and communities to ensure
that the food and the health services are used to end hunger and malnutrition. To solve the problems of hunger and
malnutrition requires food, health and care, and they must be properly coordinated. Hence, both the Framework for
African Food Security (FAFS) and the African Regional Nutrition Strategy (ARNS) emphasize the critical importance
of coordination to successfully address food and nutrition security in Africa. This will require leadership action at
country as well as regional levels.
Due to the worsening nutrition status in Africa, the African Union revitalized the African Task Force on Food and
Nutrition Development (ATFFND). Its main objective is to assist African Union Member States in implementing
the African Nutrition Strategy (2005-2015) and achieving the food- and nutrition-related Millennium Development
Goals – which requires sensitizing Africa’s policymakers on the importance of food and nutrition security for optimal
health, human development and societal well-being.
In this context, at its first meeting (26-27 February 2009) ATFFND decided to develop a Snapshot of the Nutrition
Situation in Africa to be presented as information during the African Union Executive Council and the Summit of
Heads of State and Government (Libya, 24 June to 3 July 2009). The aim is to alert Africa’s leaders about the need
to mainstream food and nutrition in national socio-economic planning. At ATFFND’s request, UNICEF prepared
this snapshot, which brings together the latest authoritative data available on the nutrition situation in Africa. With
the Summit’s special theme of ‘Investing in Agriculture for Economic Growth and Food Security’, the Snapshot is a
timely reminder of the need to raise nutrition security high on the political agenda.
ii
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
CONTENTS
Introduction .............................................................................................................................................................. 1
Definition of hunger and undernutrition .................................................................................................................... 1
Key nutrition interventions ........................................................................................................................................ 2
Facts and figures on undernutrition and hunger in Africa ........................................................................................ 3
Africa is not on track to reach MDG 1 ...................................................................................................................... 8
Countries showing progress on underweight reduction .......................................................................................... 9
Facts and figures on chronic undernutrition in Africa .............................................................................................. 10
Countries showing progress in key nutrition indicators ........................................................................................... 13
Appendix .................................................................................................................................................................. 16
Tables
Table
Table
Table
Table
Table
1.
2.
3.
4.
5.
Prevalence ranges for measures of nutrition status in children ....................................................... 1
Prevalence ranges for measures of per capita food supply ............................................................ 2
African Union geographic sub-regions ............................................................................................ 2
Summary of trends in selected child nutrition status indicators in Africa ....................................... 12
Summary of trends in selected nutrition interventions in Africa ...................................................... 15
Figure
Figure
Figure
Figure
Figure
Figure
1.
2.
3.
4.
5.
6.
Figure
Figure
Figure
Figure
Figure
Figure
Figure
Figure
Figure
Figure
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Global prevalence of underweight, children under five .................................................................. 3
Trends in underweight prevalence worldwide, children under five, 1990 and 2007 ....................... 3
Underweight prevalence in Africa, children under five .................................................................... 4
Trends in underweight prevalence in the African Union, children under five .................................. 4
Underweight prevalence and household wealth in Africa, children under five ................................ 5
Proportion of population below minimum level of dietary energy consumption
(undernourishment), worldwide ....................................................................................................... 6
Food energy consumption per capita ............................................................................................. 7
Progress in Africa towards the MDG hunger and malnutrition target ............................................. 8
African countries where underweight prevalence has fallen at least 20 per cent ........................... 9
Stunting prevalence among children under five worldwide ............................................................ 10
Stunting prevalence among children under five in Africa ................................................................ 11
Stunting prevalence among children under five in the African Union ............................................. 11
Incidence of low birthweight in Africa ............................................................................................. 12
African countries where exclusive breastfeeding has increased at least 20 per cent .................... 13
Significant increases in iodized salt consumption in Africa ............................................................ 14
Doubling of vitamin A supplementation coverage in Africa ............................................................ 15
Figures
Annex
Nutrition situation at a glance
Table A.1.
Current estimates of nutritional status of children under five: WHO child growth standards ......... 16
Table A.2.
Current estimates of nutritional status of children under five: NCHS/WHO/CDC reference
population ........................................................................................................................................ 16
Table A.3.
Current estimates of infant and young child feeding indicators ...................................................... 16
Table A.4.
Current estimates of other nutrition indicators ................................................................................ 16
Food security situation at a glance
Table A.5.
Food security in Africa, 2003-2005 .................................................................................................. 17
Background note on databases and methodology .................................................................................................. 18
CONTENTS
iii
A SNAPSHOT OF THE NUTRITION
SITUATION IN AFRICA
Introduction
T
he African Union has called for the revitalization
of the African Task Force on Food and Nutrition
Development (ATFFND). It was established in 1987 by
the OAU (the precursor of the African Union), WHO,
UNICEF and FAO. Its main objective was to advocate
for and sensitize Africa’s policymakers on food
and nutrition security as a basic input in the socioeconomic development of the continent. The ATFFND
held its first meeting in Addis Ababa 26-27 February
2009, with participation by UNICEF, FAO, WFP, WHO,
UNAIDS and GAIN,2 among others.
During this meeting, UNICEF was requested to
prepare a snapshot of the nutrition situation in Africa,
in close coordination with agencies represented in the
ATFFND, especially FAO, WFP, WHO and UNAIDS. The
theme of this year’s African Union Summit of Heads
of State and Government – Investing in Agriculture for
Economic Growth and Food Security – presents an
important opportunity to urge Member States to raise
food security and nutrition high on the political agenda.
It was agreed that the Summit would be followed by a
regional meeting to harmonize African Union/NEPAD3
regional food security and nutrition strategies, policy
frameworks, initiatives, global instruments and tools.
The aim is to assure coordinated and harmonized
support to Member States to review and update
national policies and strategies based on the latest
evidence and analysis, and ultimately to accelerate
achievement of Millennium Development Goal 1 related
to hunger and malnutrition.
The snapshot presents the latest nutrition statistics
from the UNICEF global nutrition database. It is based
on information collected by national statistics offices
and other relevant institutions through nationally
representative household surveys, including the
Demographic and Health Surveys and Multiple
Indicator Cluster Surveys. The nutrition assessment is
supplemented by the latest data on the food situation,
extracted from the 2008 edition of FAO’s State of Food
Insecurity in the World.
The snapshot highlights the nutrition situation among
one of the most vulnerable population groups –
children under five years of age – in all of the African
Union Member States. It also details African progress
towards the achievement of MDG 1 target for hunger
and malnutrition.
Definition of Hunger and Undernutrition
MDG 1 (Target 1.C) calls on countries to ‘halve,
between 1990 and 2015, the proportion of people
who suffer from hunger’. The indicators for hunger and
malnutrition include:
t Prevalence of underweight children under five
years of age; and
t Proportion of the population below the
minimum level of dietary energy consumption
(undernourishment).
Along with these two MDG indicators, this document
uses core nutrition and food security indicators, namely:
prevalence of stunting in children under five years of
age; proportion of infants that have low birthweight;4
dietary energy supply per capita; and per cent of food
energy from staples (see tables 1 and 2).
Table 1. Prevalence ranges for measures of nutrition status in children
2
3
4
Prevalence
Measures of nutrition
status in children
Low
Medium
Underweight (weight for age)
<10%
Stunting (height for age)
Low birthweight (<2500 grams
at birth)
Medium-High
High
Very High
10-19%
20-29%
>30%
<20%
20-29%
20-39%
>40%
<5%
6-10%
16-20%
>20%
11-15%
United Nations Children’s Fund, Food and Agriculture Organization of the United Nations, World Food Programme, World Health Organization, Joint United Nations Programme on HIV/AIDS and Global Alliance for Improved Nutrition.
New Partnership for Africa’s Development.
Draft Statement from the March 2008 recommendation of the SCN Task Force on Assessment, Monitoring & Evaluation, to establish stunting
as an additional indicator of endemic poverty to monitor progress towards the achievement of MDG 1. This was based on recent studies in
36 low- and middle-income countries, which have shown a strong link between poverty and stunting. Furthermore, women with short stature
tend to have babies with lower birthweights, contributing to inter-generational transmission of poverty. Children who become stunted during
the first two years of life and who put on weight rapidly later in childhood are at high risk of chronic nutrition-related diseases.
1
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Key Nutrition Interventions
The key nutrition interventions that have proved effective in
preventing underweight, stunting and low birthweight are:
t Prevention and appropriate nutritional management
of infections (including diarrhoea, HIV, malaria,
tuberculosis)
t Management of severe and moderate acute
malnutrition
™ Pre-natal
t Improved maternal nutrition and health before and
during pregnancy to reduce low birthweight and
stunting later in life, and also to enhance maternal
survival.
t Prevention and control of selected micronutrient
deficiencies: vitamin A, iodine, iron-folic acid, zinc
™ Post-natal
t Healthy lifestyle – nutritious food, physical exercise
and health.
t Protection, promotion and support of optimal
breastfeeding (initiation of breastfeeding within
the first hour, exclusive breastfeeding for the first
six months, continued breastfeeding for up to two
years)
t Adequate complementary feeding (timing, amount,
animal source foods);
t Psychosocial stimulation
As such, based on the latest available data, this
snapshot provides an assessment of coverage for
the three core nutrition interventions: exclusive
breastfeeding at six months, vitamin A supplementation
to children 6-59 months of age and household use of
adequately iodized salt.
Table 2. Prevalence ranges for measures of per capita food supply
Measures of per capita
food supply
Prevalence ranges and consumption levels
Low
Medium
Med-High
High
Very High
Proportion of population
below minimum level of
dietary energy consumption
(undernourishment)
<5%
5-9%
10-19%
20-34%
≥35%
Dietary energy supply per capita
(kcal/day)
< 2,200
2,200-2,600
2,600-3,000
3,000-3,400
>3,400
Per cent of food energy from
staples (per cent of kcal)
< 55%
> 55% and < 75%
(within recommended range)
> 75%
Table 3. African Union geographic sub-regions
Central Africa
Eastern Africa
Northern Africa
Southern Africa
Western Africa
Burundi
Cameroon
Central African
Republic
Chad
Congo
Congo, Democratic
Republic of the
Equatorial Guinea
Gabon
Sao Tome and
Principe
Comoros
Djibouti
Eritrea
Ethiopia
Kenya
Madagascar
Mauritius
Rwanda
Seychelles
Somalia
Sudan
Tanzania, United
Republic of
Uganda
Algeria
Egypt
Libyan Arab
Jamahiriya
Mauritania
Tunisia
Saharawi Arab
Democratic
Republic
Angola
Botswana
Lesotho
Malawi
Mozambique
Namibia
South Africa
Swaziland
Zambia
Zimbabwe
Benin
Burkina Faso
Cape Verde
Côte d’Ivoire
Gambia
Ghana
Guinea
Guinea-Bissau
Liberia
Mali
Niger
Nigeria
Senegal
Sierra Leone
Togo
KEY NUTRITION INTERVENTIONS
2
FACTS AND FIGURES ON UNDERNUTRITION AND HUNGER IN AFRICA
Figure 1. Global prevalence of underweight, children under five
Note:
WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ ƉŽƉƵůĂƚŝŽŶ
dŚŝƐ ŵĂƉ ĂŶĚ Ăůů ƐƵďƐĞƋƵĞŶƚ ŵĂƉƐ ŝŶ ƚŚŝƐ ĚŽĐƵŵĞŶƚ ĂƌĞ ƐƚLJůŝnjĞĚ ĂŶĚ
ŶŽƚ ƚŽ ƐĐĂůĞ͘ dŚĞLJ ĚŽ ŶŽƚ ƌĞĨůĞĐƚ Ă ƉŽƐŝƚŝŽŶ ďLJ hE/& ŽŶ ƚŚĞ ůĞŐĂů
ƐƚĂƚƵƐ ŽĨ ĂŶLJ ĐŽƵŶƚƌLJ Žƌ ƚĞƌƌŝƚŽƌLJ Žƌ ƚŚĞ ĚĞůŝŵŝƚĂƚŝŽŶ ŽĨ ĂŶLJ ĨƌŽŶƚŝĞƌƐ͘
^ŽƵƌĐĞ͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
t Of all regions, Africa has shown the least
improvement since 1990; underweight prevalence
decreased slightly (from 29 per cent around 1990 to
26 per cent around 2007), but the absolute number
of underweight children increased by 8 million over
this period. This means that the rate of decline has
not keep pace with population growth.
Key points
t Africa and South Asia have the highest prevalence
of underweight in children under five years of age.
t African children make up one quarter of the
estimated 148 million underweight children
globally.
Proportion of under five children
Per centwho are underweight (%)
Figure 2. Trends in underweight prevalence worldwide, children under five, 1990 and 2007
60
54
50
around 1990
around 2007
46
40
30
31
29
26
26
23
20
10
14
11
6
0
Latin America/
Caribbean
East Asia/
Pacific
African Union
South Asia
Source: UNICEF Global Database
3
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Developing
world
Figure 3. Underweight prevalence in Africa, children under five
Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
Note: WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ ƉŽƉƵůĂƚŝŽŶ
Key points
t More than a quarter of African children under five
are underweight (26 per cent).
t In eight countries at least 35 per cent of under-five
children are underweight.
t Disparities are striking across Africa. The prevalence
of underweight ranges from 6 per cent in northern
Africa5 to 35 per cent in eastern Africa.
t The eastern, northern and western Africa regions
have shown more improvement since 1990 than
other regions; in southern Africa the situation has
not improved or has worsened.
Proportion of under five children
Per centwho are underweight (%)
Figure 4. Trends in underweight prevalence in the African Union, children under five
60
around 1990
around 2007
50
40
35
33
30
28
30 29
29
29
26
20
17 18
10
11
6
0
Northern
Southern
Western
Central
Eastern
African
Union
Note: The trend analysis is based on a subset of 35 countries, covering 92 per cent of the under-five population in
the African Union. Prevalence estimates are based on NCHS reference population.
Source: UNICEF Global Database
5
The estimated underweight prevalence of 6 per cent for northern Africa is derived from the trend analysis, which includes a subset of countries
for which trend data are available. The current estimate for the region is 7 per cent.
FACTS AND FIGURES ON UNDERNUTRITION AND HUNGER IN AFRICA
4
Figure 5. Underweight prevalence and household wealth in Africa, children under five
й
ϰϬ
ϯϬ
Underweight prevalence by household wealth quintile in Africa
31
28
26
ϮϬ
21
15
ϭϬ
Ϭ
Poorest
Poorer
Middle
Richer
Richest
Note:
WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ
ƐƚŝŵĂƚĞƐ ďĂƐĞĚ ŽŶ ĚŝƌĞĐƚ ĂǀĞƌĂŐĞ ĨƌŽŵ ϯϰ ĐŽƵŶƚƌŝĞƐ ǁŚĞƌĞ ŚŽƵƐĞŚŽůĚ ǁĞĂůƚŚ ŝŶĨŽƌŵĂƚŝŽŶ ŝƐ ĂǀĂŝůĂďůĞ
Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
Key points
t Underweight prevalence is closely associated with
household wealth.
5
t Children in the poorest families are twice as likely to
be underweight as children in the richest families.
Disparities are even more pronounced in certain
countries.
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Figure 6. Proportion of population below minimum level of dietary energy consumption (undernourishment), worldwide
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Key points
t Africa has the greatest number of countries with a
high proportion of undernourished people (25 per
cent and above).
t The African continent is home to 216 million
people who are undernourished – 30 per cent of
the population.
t Sub-Saharan Africa is the most affected subregion. Though its proportion of undernourished
has decreased from the 1990-92 level of 34 per
cent, the numbers have increased by 43 million.
This means that progress in reducing hunger is not
keeping pace with population growth.
t In 16 countries more than 35 per cent of the
population is undernourished.
t In 3 countries 50 per cent or more of the population
is undernourished.
FACTS AND FIGURES ON UNDERNUTRITION AND HUNGER IN AFRICA
6
Figure 7. Food energy consumption per capita
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Statistics
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Key point
t
7
Africa has the greatest number of countries – 19 –
with dietary energy consumption per capita below
the minimum level for optimal health (less than
2,200 Kcal per capita per day).
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
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AFRICA IS NOT ON TRACK TO REACH MDG 1
Figure 8. Progress in Africa towards the MDG hunger and malnutrition target
Source: UNICEF Global Database
Key points
t Africa as a whole is not on track to meet the
MDG 1 target – to halve by 2015 the proportion
of population suffering from hunger, measured
by the proportion of children under five who are
underweight.
t Only nine countries in Africa are on track to meet
the MDG 1 target.
AFRICA IS NOT ON TRACK TO REACH MDG 1
8
COUNTRIES SHOWING PROGRESS ON UNDERWEIGHT REDUCTION
Figure 9. African countries where underweight prevalence has fallen at least 20 per cent
%
50
Proportion of under-five children who are underweight
48
40
Around 1990
Around 2007
30
30
20
29
29
23
27
22
27
25
21
19
24
18
10
14
17
15
10
9
10 8
0
Mauritania Rwanda
Tanzania
Malawi
Zambia
Ghana
Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
Note: WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ ƉŽƉƵůĂƚŝŽŶ
Key points
t Although progress is insufficient in Africa to meet
the MDG 1 target, eleven countries have reduced
underweight prevalence by at least 20 per cent.
t Algeria, Congo, Ghana, Mauritania and São Tomé
and Príncipe have reduced underweight prevalence
by more than one-third since 1990.
9
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Congo
Morocco
São Tomé
and
Príncipe
Egypt
9
4
Algeria
FACTS AND FIGURES ON CHRONIC UNDERNUTRITION IN AFRICA
Figure 10. Stunting prevalence among children under five worldwide
Note: WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ ƉŽƉƵůĂƚŝŽŶ
Source͗hE/&'ůŽďĂůĂƚĂďĂƐĞ
Key points
t Around one-third of children under five in developing countries are stunted.
t Stunting is particularly high in sub-Saharan Africa
and South Asia.
t Of the 178 million children under 5 suffering from
stunting in all developing countries, 57 million (32
per cent) are in Africa.6
t In Africa 36 per cent of children under five are
stunted. This represents a decline from 40 per
cent around 1990, but the absolute number has
increased by 9 million. The rate of decline is not
keeping up with population growth.
6
Source: R.E. Black, et al., 2008, ‘Maternal and child undernutrition: Global and regional exposures and health consequences’, The Lancet,
371:9608, pp. 243-260. The global and Africa stunting estimates are not based on the UNICEF global database; UNICEF has not yet calculated
global estimates and these figures differ from the current UNICEF estimates for Africa.
FACTS AND FIGURES ON CHRONIC UNDERNUTRITION IN AFRICA
10
Figure 11. Stunting prevalence among children under five in Africa
Note: WƌĞǀĂůĞŶĐĞ ďĂƐĞĚ ŽŶ E,^ ƌĞĨĞƌĞŶĐĞ ƉŽƉƵůĂƚŝŽŶ
Source͗hE/&'ůŽďĂůĂƚĂďĂƐĞ
Key points
t More than one-third of children under five (36 per
cent) in Africa are stunted.
t Burundi, Niger and Zambia have the highest
stunting prevalence – 50 per cent or higher.
t Eastern Africa has seen the greatest improvement
since 1990 (a reduction of 10 percentage points),
followed by northern Africa (6 percentage points).
t Northern Africa has the lowest stunting prevalence,
at 21 per cent.
Proportion of under five
Perchildren
cent who are stunted (%)
Figure 12. Stunting prevalence among children under five in the African Union
60
around 1990
around 2007
50
49
40
41
38
38
35
30
39
39
36
40
36
27
20
21
10
0
Northern
Western
Southern
Central
Eastern
African
Union
Note: The trend analysis is based on a subset of 35 countries covering 92 per cent of the under-five population in
the African Union. Prevalence estimates are based on NCHS reference population.
Source: UNICEF Global Database
11
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Figure 13. Incidence of low birthweight in Africa
Source͗hE/&'ůŽďĂůĂƚĂďĂƐĞ
Key points
t Around 1 in 7 infants (15 per cent) weigh less than
2,500 grams at birth in Africa, affecting 5 million
newborns every year.
t Two-thirds of infants (65 per cent) are not weighed
at birth in Africa.
Table 4. Summary of trends in selected child nutrition status indicators in Africa
Child nutrition
status
Age group
Underweight in
children
< 5 years
Birth-59 months
Stunting in
children
< 5 years
Birth-59 months
Low birthweight
(< 2,500 grams)
Newborn
Year
Number
of children
in age group
(thousands)
Proportion
(per cent)
Numbers
of children
affected
1990
107,829
29
31 million
2007
146,752
26
38 million
1990
107,829
40
43 million
2007
146,752
36
52 million
1995
27,966
14
4 million
2007
34,196
15
5 million
Notes: (1) Trend analysis is based on a subset of countries with comparable data around the baseline year and
2007. Trend analyses of different indicators may include different subsets of countries. (2) Underweight and stunting
prevalence are based on NCHS/WHO/CDC reference population. (3) The baseline year for low birthweight differs
from 1990 due to inadequate data around 1990.
Source: UNICEF Global Database
FACTS AND FIGURES ON CHRONIC UNDERNUTRITION IN AFRICA
12
COUNTRIES SHOWING PROGRESS IN KEY NUTRITION INTERVENTIONS
Figure 14. African countries where exclusive breastfeeding has increased at least 20 per cent
Percentage of infants 0-5 months old exclusively breastfed
%
ϭϬϬ Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
88
83
ϴϬ
54
ϲϬ
ϰϬ
1
21
17
14
ϮϬ
1
7
23
22
10
3
24
14
34
28
10
34
36
38
36
24
13
61
44
43
67
38
23
16
8
6
41
57
10
7
10
Ca
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ge
r ia
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Key points
t In 19 African countries exclusive breastfeeding
rates have risen by 20 per cent or more.
t As many as 70 per cent of infants in Africa face
greater risk of morbidity and mortality due to nonexclusive breastfeeding.
t Despite progress, the majority of countries in Africa
still have exclusive breastfeeding rates below 50
per cent.
13
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
Figure 15. Significant increases in iodized salt consumption in Africa
%
100
around 1995
around 2005
84
80
79
78
75
80
79
60
40
31
28
26
20
12
1
1
0
Madagascar
Egypt
Mali
Congo, Dem.
Rep.
Swaziland
Cote d'Ivoire
Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
Key points
t Six African countries have increased household
consumption of adequately iodized salt by 20
percentage points or more and currently have
coverage of at least 75 per cent.
t Seven African countries have reached the
universal salt iodization (USI) goal of 90 per cent
of households consuming iodized salt: Burundi,
Kenya, Lesotho, Nigeria, Tunisia, Uganda and
Zimbabwe.
t Though household consumption of iodized salt in
Africa increased from 42 per cent in 1995 to 63
per cent by 2007, 13 million newborns remain
unprotected from risk of brain damage due to
iodine deficiency.
COUNTRIES SHOWING PROGRESS IN KEY NUTRITION INTERVENTIONS
14
Figure 16. Doubling of vitamin A supplementation coverage in Africa
% 6-59 month olds fully protected with 2 VA doses 2001 to 2007 in
Africa
Per cent
% 6-59 mo olds fully
protected with 2 VA
doses
Per cent of children 6-59 months old fully protected with two doses of vitamin A, 2001-2007
ϭϬϬ
ϴϬ
ϲϬ
ϰϬ
ϮϬ
Ϭ
2001
2003
2005
2007
Note͗ƚƌĞŶĚĂŶĂůLJƐŝƐďĂƐĞĚŽŶĂƐƵďƐĞƚŽĨĐŽƵŶƚƌŝĞƐƚŚĂƚŚĂǀĞĐŽŵƉĂƌĂďůĞĞƐƚŝŵĂƚĞƐŽǀĞƌϮϬϬϭͲϮϬϬϳ
Source͗ hE/& 'ůŽďĂů ĂƚĂďĂƐĞ
Key points
t The percentage of children 6 to 59 months fully
protected with two doses of vitamin A almost doubled
from 2001 (39 per cent) to 2007 (71 per cent).
t Yet around 30 per cent (38 million) of children
aged 6-59 months remain unprotected from
risk of morbidity and mortality due to vitamin A
deficiency.
Table 5. Summary of trends in selected nutrition interventions in Africa
Nutrition intervention indicators
Proportion
(per cent)
Year
1995
25
2007
31
2001
39
2007
71
1995
42
2007
63
Exclusive breastfeeding (< 6 months)
Vitamin A supplementation (two doses, age 6-59 months)
Household consumption of iodized salt
Notes: (1) Trend analysis is based on a subset of countries that have comparable data around the baseline year
and 2007. Trend analyses of different indicators may include different subsets of countries. (2) Baseline year for
exclusive breastfeeding and iodized salt consumption are different from 1990 due to inadequate data around 1990.
(3) Vitamin A supplementation programs started in 1999, but the baseline year for this trend analysis is set at 2001
due to issues of data availability.
Source: UNICEF Global Database
15
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
APPENDIX
NUTRITION SITUATION AT A GLANCE
Table A.1. Current estimates of nutritional status of children under five: WHO child growth standards
African Union
Western
Eastern
Southern
Central
Northern
Underweight (%)
Moderate and
Severe
severe
22
7
24
8
25
8
16
5
24
6
6
1
Stunted (%)
Moderate and
Severe
severe
41
20
40
21
44
22
41
19
43
23
25
12
Wasted (%)
Moderate and
Severe
severe
10
4
12
5
11
4
6
2
10
4
7
3
Note: Regional and sub-regional averages are based on latest estimates from a subset of African Union countries with data between 2003 and 2008. Countries with
latest estimates before 2003 are excluded.
Source: UNICEF Global Database.
Table A.2. Current estimates of nutritional status of children under five: NCHS/WHO/CDC reference population
Underweight (%)
African Union
Western
Eastern
Southern
Central
Northern
Stunting (%)
Wasting (%)
Moderate and severe
Severe
Moderate and severe
Severe
Moderate and severe
Severe
26
28
29
18
30
7
7
8
7
4
9
1
36
36
39
36
39
21
17
17
18
15
19
9
8
10
8
5
9
6
2
2
2
1
2
1
Note: Regional and sub-regional averages are based on latest estimates from a subset of African Union countries with data between 2003 and 2008. Countries with
latest estimates before 2003 are excluded.
Source: UNICEF Global Database
Table A.3. Current estimates of infant and young child feeding indicators
African Union
Western
Eastern
Southern
Central
Northern
Early initiation of
breastfeeding
At birth
46
32
58
62
41
45
Exclusive breastfeeding
< 6 months
32
21
43
32
30
36
Complementary
breastfeeding
6-9 months
67
59
69
74
78
61
Continued breastfeeding Continued breastfeeding
12-15 months
88
91
88
84
89
52
20-23 months
48
44
53
50
55
24
Note: Regional and sub-regional averages are based on latest estimates from a subset of AU countries with data between 2003 and 2008. Countries with latest
estimates before 2003 are excluded.
Source: UNICEF Global Database
Table A.4. Current estimates of other nutrition indicators
African Union
Western
Eastern
Southern
Central
Northern
Low birthweight
(%)
14
16
15
12
Iodized salt consumption
(%)
62
75
40
72
71
Vitamin A supplementation
(%)
70
64
73
62
76
87
Notes: (1) Regional and sub-regional averages are based on latest estimates from a subset of African Union countries with data between 2003 and 2008 (except
vitamin A supplementation). Countries with latest estimates before 2003 are excluded. (2) Vitamin A supplementation estimates are for 2007. (3) Averages of low
birthweight incidence for southern and central Africa are not reported due to insufficient data. (4) Average of iodized salt consumption for Southern Africa is not
reported due to insufficient data.
Source: UNICEF Global Database
APPENDIX
16
FOOD SECURITY SITUATION AT A GLANCE
Table A.5. Food security in Africa, 2003-2005
Country
Energy availability per capita
Number of people
undernourished (millions)
North Africa
4.6
Per cent of undernourished
people
Per cent of food energy
from staples
-
Algeria
3,100
n.s.
-
59
Egypt
3,320
n.s.
-
66
Libyan Arab Jamahiriya
3,020
n.s.
-
45
Morocco
3,190
n.s.
-
64
Tunisia
3,280
n.s.
-
51
53.3
57
Central Africa
Cameroon
2,230
4.0
23
56
Central African Republic
1,900
1.8
43
54
Chad
1,980
3.8
39
61
Congo
2,330
0.8
22
60
43.0
76
76
n.s.
-
51
Democratic Republic of Congo
Gabon
2,760
86.0
35
Burundi
East Africa
1,630
4.8
63
53
Eritrea
1,530
3.0
68
72
Ethiopia
1,810
35.2
46
80
Kenya
2,040
11.0
32
56
Rwanda
1,940
3.6
40
55
Sudan
2,290
7.4
21
50
Uganda
2,380
4.1
15
43
Tanzania
2,010
13.0
35
70
36.8
37
Angola
Southern Africa
1,880
7.1
46
64
Botswana
2,200
0.5
26
52
Lesotho
2,430
0.3
15
82
Madagascar
2,010
6.6
37
78
Malawi
2,130
3.8
29
74
Mauritius
2,880
0.1
6
48
Mozambique
2,070
7.5
38
79
Namibia
2,290
0.4
19
59
Swaziland
2,320
0.2
18
51
Zambia
1,890
5.1
45
76
Zimbabwe
2,040
5.2
40
58
36.0
14
West Africa
Benin
2,290
1.6
19
71
Burkina Faso
2,620
1.3
10
74
Côte d’Ivoire
2,520
2.6
14
64
Gambia
2,140
0.5
30
54
Ghana
2,690
1.9
9
70
Guinea
2,540
1.5
17
61
Liberia
2,010
1.3
40
64
Mali
2,570
1.2
11
69
Mauritania
2,790
0.2
8
48
Niger
2,140
3.7
29
68
Nigeria
2,600
12.5
9
63
Sierra Leone
1,910
3.0
47
60
Senegal
2,150
2.5
26
65
Togo
2,020
2.3
37
75
216.7
30
All Africa
n.s. = not statistically significant
Source: FAO 2008, ‘State of food insecurity in the world: High food prices and food security – threats and opportunities’,. Rome, Food and Agriculture Organization
of the United Nations.
17
A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA
BACKGROUND NOTE ON DATABASES AND METHODOLOGY
Databases
United Nations Population Division’s World Population
Prospects.
U
NICEF’s global databases on child nutrition
include internationally comparable and statistically
sound evidence. They are updated annually, drawing
on the wealth of statistical information from UNICEF’s
more than 140 field offices. The data are assessed for
quality based on objective criteria to ensure inclusion
of only the most recent and reliable information. Date
are derived from national household surveys such as
Demographic and Health Surveys, Multiple Indicator
Cluster Surveys and other national nutrition surveys,
as well as data from administrative sources.
Regional averages are based on data points from a
specified time period. For example, current regional
estimates are derived from data collected since
2003. Regional trend analysis is based on a subset of
countries in a region that have comparable estimates
around the baseline year and the follow-up year.
Regional averages are then calculated for these two
points in time to show the trend.
Progress toward MDG 1 (Target 1.C: Reducing child
underweight prevalence by half by 2015)
Methodology
Regional average
R
egional estimates are calculated as populationweighted averages based on data from countries
in a region. When the available estimates cover less
than 50 per cent of the population, the regional average
is not reported. Population information comes from the
To reduce underweight prevalence by half from 1990
to 2015 requires an annualized reduction rate of 2.8
per cent. All prevalence estimates from a country since
around 1990 are included in a regression analysis to
estimate the average annual reduction rate (AARR).
Country progress towards the goal is categorized into
three groups:
On Track:
AARR is 2.6 per cent or more, or latest available estimate of underweight prevalence (from
2000 or later) is 5 per cent or less, regardless of AARR.
Insufficient:
AARR is between 0.6 per cent and 2.5 per cent, inclusive.
No progress:
AARR is 0.5 per cent or less.
Reference population for estimating child
nutritional status
Prevalence of underweight, stunting and wasting
among children under five years is estimated by
comparing height and weight measurements to an
international standard reference population. In April
2006, WHO released the new Child Growth Standards
to replace the widely used NCHS/WHO reference
population. The new standards should be used in
assessing child nutritional status. Demographic and
Health Surveys have already adopted the standards
and published results based on them. Prevalence
estimates of child nutritional status based on these two
references are not readily comparable because of the
differences between the old reference population and
the new standards. It is essential to base all estimates
on the same reference population (preferably the new
standards) when conducting trend analysis. UNICEF
is in the process of converting all child nutritional
status estimates in global databases into the new
WHO standards. In this document, current estimates
are based on both the new WHO standards and the
old NCHS reference population, while trend analysis is
based on estimates by the NCHS reference.
Differences with national estimates
Estimates from UNICEF’s global databases may differ
from national estimates because:
t *O DIJME OVUSJUJPOBM TUBUVT FTUJNBUFT EJGGFSFOU
reference populations may be used. For example,
the country may be using an underweight
prevalence based on the NCHS/WHO reference
population whereas UNICEF may report a reanalysed estimate based on the new WHO Child
Growth Standards.
t 6/*$&' BEKVTUT MPX CJSUIXFJHIU EBUB GPS VOEFS
reporting and mis-reporting.
APPENDIX
18
© 2009 The African Union and the United Nation Children’s Fund
For further information please contact:
The African Union Commission, P.O. Box 3243, Addis Ababa, Ethiopia; Tel: +251115-517700; Fax: +251115-517844;
www.africa-union.org; or UNICEF, Division of Policy and Practice, 3 United Nations Plaza, New York, 10017, USA;
Tel: + 1 212 326 7000; Fax: +1 212 303 7895; Email: [email protected]; www.unicef.org.