evidence-based blog of Filippo Dibari

Posts Tagged ‘wasting’

UNICEF/WHO/WB: Levels and Trends in Child Malnutrition

In Over-nutrition, Under-nutrition on June 7, 2017 at 7:02 pm

source: World Bank webpage



In May 2017, UNICEF, WHO and World Bank Group released the 2017 edition of the joint child malnutrition estimates for the 1990–2016 period, representing the most recent global and regional figures. A suite of on-line interactive dashboards were developed to enable users to explore the entire time-series (1990 – 2016) of global and regional estimates of prevalence and number affected for stunting, overweight, wasting and severe wasting. These estimates are presented by various regional and income group country classifications used by various agencies including the United Nations, UNICEF, WHO and The World Bank Group.

Note: Global estimates refer to the aggregate of the UN regions.

Unmissable – The 2017 Atlas of Sustainable Development Goals: a new visual guide to data and development

In Over-nutrition, Under-nutrition on April 20, 2017 at 7:48 am

from the World Bank website


The 2017 Atlas of Sustainable Development Goals: a new visual guide to data and development.

<!– /sites/all/themes/blogs/templates/header/js/jquery-1.4.4.min.js –>The World Bank is pleased to release the 2017 Atlas of Sustainable Development Goals. With over 150 maps and data visualizations, the new publication charts the progress societies are making towards the 17 SDGs.

The Atlas is part of the World Development Indicators (WDI) family of products that offer high-quality, cross-country comparable statistics about development and people’s lives around the globe. You can:

The 17 Sustainable Development Goals and their associated 169 targets are ambitious. They will be challenging to implement, and challenging to measure. The Atlas offers the perspective of experts in the World Bank on each of the SDGs.

Is Middle-Upper Arm Circumference “normally” distributed? Secondary data analysis of 852 nutrition surveys

In Under-nutrition on November 27, 2016 at 3:25 am

by Frison S1, Checchi F2, Kerac M1, Nicholas J3.

Emerg Themes Epidemiol. 2016 May 4;13:7. doi: 10.1186/s12982-016-0048-9. eCollection 2016.

(download here)


Wasting is a major public health issue throughout the developing world. Out of the 6.9 million estimated deaths among children under five annually, over 800,000 deaths (11.6 %) are attributed to wasting. Wasting is quantified as low Weight-For-Height (WFH) and/or low Mid-Upper Arm Circumference (MUAC) (since 2005). Many statistical procedures are based on the assumption that the data used are normally distributed. Analyses have been conducted on the distribution of WFH but there are no equivalent studies on the distribution of MUAC.


This secondary data analysis assesses the normality of the MUAC distributions of 852 nutrition cross-sectional survey datasets of children from 6 to 59 months old and examines different approaches to normalise “non-normal” distributions.


The distribution of MUAC showed no departure from a normal distribution in 319 (37.7 %) distributions using the Shapiro–Wilk test. Out of the 533 surveys showing departure from a normal distribution, 183 (34.3 %) were skewed (D’Agostino test) and 196 (36.8 %) had a kurtosis different to the one observed in the normal distribution (Anscombe–Glynn test). Testing for normality can be sensitive to data quality, design effect and sample size. Out of the 533 surveys showing departure from a normal distribution, 294 (55.2 %) showed high digit preference, 164 (30.8 %) had a large design effect, and 204 (38.3 %) a large sample size. Spline and LOESS smoothing techniques were explored and both techniques work well. After Spline smoothing, 56.7 % of the MUAC distributions showing departure from normality were “normalised” and 59.7 % after LOESS. Box-Cox power transformation had similar results on distributions showing departure from normality with 57 % of distributions approximating “normal” after transformation. Applying Box-Cox transformation after Spline or Loess smoothing techniques increased that proportion to 82.4 and 82.7 % respectively.


This suggests that statistical approaches relying on the normal distribution assumption can be successfully applied to MUAC. In light of this promising finding, further research is ongoing to evaluate the performance of a normal distribution based approach to estimating the prevalence of wasting using MUAC.

1Department of Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.

2Faculty of Public Health and Policy, LSHTM and Humanitarian Technical Unit, Save the Children, 207 Old Street, London, EC1V 9NR UK.

3Department of Medical Statistics, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT UK.

Food systems and diets: facing the challenges of the 21st century

In Over-nutrition, Under-nutrition on September 27, 2016 at 7:26 am

from the webpage of the Global Panel on Agriculture and Food Systems for Nutrition

(download the report here)


The Global Panel on Agriculture and Food Systems for Nutrition published its new Report, Food systems and diets: Facing the challenges of the 21st century on the 23rd September 2016.

This evidence-based Report is designed to help policymakers make their food systems more supportive of high quality diets.

The need for action on malnutrition

Poor diet is the number one risk factor driving the world’s disease burden.

Three billion people from 193 countries now have low quality diets and nearly half of all countries are experiencing the simultaneous problem of serious levels of undernutrition, overweight and obesity. Yet our global understanding about the quality of our diets is limited.

The Report

Using modelling and trend analysis, the Report generates a new understanding of diets and food systems, and how they could change by 2030.

The analysis shows that if current trends continue, by 2030 nearly half of the world’s adult population will be overweight or obese, up from one third today. The poorest countries are not immune to these trends.

It also shows how these trends have enormous economic impacts at the macro and micro levels, as well major consequences for mortality and morbidity. For example, at the macro level, cost are estimated to represent an annual loss of 10% global GDP, equivalent to a global financial crisis every year.

Drawing on over 250 data sources and peer-reviewed articles, the Report lists a series of recommendations for policymakers in low and middle income countries through a ‘Call to Action’.

The Report presents evidence showing that the risk that poor diets pose to mortality and morbidity is now greater than the combined risks of unsafe sex, alcohol, drug and tobacco use.

But, as the Report shows that there are many opportunities for action within the food system.

A Call to Action

This Report identifies decisions that policymakers need to take in the coming decade, particularly for women and children, to invest in effective policies to reduce all forms of malnutrition, repositioning food systems from feeding people to nourishing people.

Actions which go beyond agriculture to encompass trade, the environment and health, harnessing the power of the private sector and empowering consumers to demand better diets.

Enhancing the ability of food systems to deliver high quality diets is a choice that is well within the grasp of policymakers.  It is a choice that will help achieve the SDG goal of ending malnutrition in all its forms by 2030. It is a choice that will reap benefits for decades to come, for all people, in all countries.

Only a response on the scale and commitment used to tackle HIV/AIDS and malaria will be sufficient to meet the challenge, particularly in low- and middle-income countries.

“This Report makes clear the enormous challenge posed by malnutrition and poor diets generally to the detriment of many millions of individuals and indeed whole economies.”

Sir John Beddington, Co-Chair of the Global Panel, and former UK Chief Scientific Advisor

The Effect of Adding Ready-to-Use Supplementary Food to a General Food Distribution on Child Nutritional Status and Morbidity: A Cluster-Randomized Controlled Trial

In Under-nutrition on February 5, 2014 at 11:18 am

by Lieven Huybregts, Freddy Houngbé, Cécile Salpéteur, Rebecca Brown, Dominique Roberfroid, Myriam Ait-Aissa, Patrick Kolsteren.

PLOS Medicine | 1 September 2012 | Volume 9 | Issue 9

(download the paper)




Recently, operational organizations active in child nutrition in developing countries have suggested that blanket feeding strategies be adopted to enable the prevention of child wasting. A new range of nutritional supplements is now available, with claims that they can prevent wasting in populations at risk of periodic food shortages. Evidence is lacking as to the effectiveness of such preventive interventions. This study examined the effect of a ready-to-use supplementary food (RUSF) on the prevention of wasting in 6- to 36-mo-old children within the framework of a general food distribution program.

Methods and Findings

We conducted a two-arm cluster-randomized controlled pragmatic intervention study in a sample of 1,038 children aged 6 to 36 mo in the city of Abeche, Chad. Both arms were included in a general food distribution program providing staple foods. The intervention group was given a daily 46 g of RUSF for 4 mo. Anthropometric measurements and morbidity were recorded monthly. Adding RUSF to a package of monthly household food rations for households containing a child assigned to the intervention group did not result in a reduction in cumulative incidence of wasting (incidence risk ratio: 0.86; 95% CI: 0.67, 1.11; p = 0.25). However, the intervention group had a modestly higher gain in height-for-age (+0.03 Z-score/mo; 95% CI: 0.01, 0.04; p<0.001). In addition, children in the intervention group had a significantly higher hemoglobin concentration at the end of the study than children in the control group (+3.8 g/l; 95% CI: 0.6, 7.0; p = 0.02), thereby reducing the odds of anemia (odds ratio: 0.52; 95% CI: 0.34, 0.82; p = 0.004). Adding RUSF also resulted in a significantly lower risk of self-reported diarrhea (−29.3%; 95% CI: 20.5, 37.2; p<0.001) and fever episodes (−22.5%; 95% CI: 14.0, 30.2; p<0.001). Limitations of this study include that the projected sample size was not fully attained and that significantly fewer children from the control group were present at follow-up sessions.


Providing RUSF as part of a general food distribution resulted in improvements in hemoglobin status and small improvements in linear growth, accompanied by an apparent reduction in morbidity.


– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Why Is Child Malnutrition Lower in Urban Than in Rural Areas? Evidence from 36 Developing Countries

In Under-nutrition on June 23, 2013 at 8:01 pm


World Development – Vol. 33, No. 8, pp. 1285–1305, 2005
(download the paper)
This study asks whether key socioeconomic determinants of child nutritional status differ across urban and rural areas to investigate why urban malnutrition rates are lower. Little evidence of urban–rural differences in the nature of the determinants or the strength of their associations with nutritional status is found. However, marked differences in the levels of the determinants and in caring practices for children and women in favor of urban areas are documented. The study results suggest that lower urban malnutrition is due to a series of more favorable socioeconomic conditions, in turn leading to better caring practices for children and their mothers.
– – –
NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Lipid-based, ready-to-use foods to fight undernutrition: the state of the art (UCDAVIS)

In Under-nutrition on October 16, 2012 at 8:10 am

Lipid-Based Nutrient Supplements: How Can They Combat Child Malnutrition?

Kathryn G. Dewey, Mary Arimond

PLOS Medicine  September 18, 2012

This paper (download entirely) is particularly relevant for anybody interested in the current knowledge achievements and gaps about management of undernutrition with lipid-based, ready-to-use foods.

The same paper offers also an updated list of references on this topic.

– – –

NB – To follow up this topic (or others), enter your email in the rectangle at the bottom/right side of this page (you can un-subscribe any time).

Undernutrition among Kenyan children: contribution of child, maternal and household factors

In Under-nutrition on May 7, 2012 at 7:45 am

Constance A Gewa and Nanette Yandell

Public Health Nutrition June 2012 15 : pp 1029-1038  


Objective To examine the contribution of selected child-, maternal- and household-related factors to child undernutrition across two different age groups of Kenyan under-5s.

“Design Demographic and Health Survey data, multistage stratified cluster sampling methodology.

“Setting Rural and urban areas of Kenya.

“Subjects A total of 1851 children between the ages of 0 and 24 months and 1942 children between the ages of 25 and 59 months in Kenya.

“Results Thirty per cent of the younger children were stunted, 13 % were underweight and 8 % were wasted. Forty per cent of the older children were stunted, 17 % were underweight and 4 % were wasted. Longer breast-feeding duration, small birth size, childhood diarrhoea and/or cough, poor maternal nutritional status and urban residence were associated with higher odds of at least one form of undernutrition, while female gender, large birth size, up-to-date immunization, higher maternal age at first birth, BMI and education level at the time of the survey and higher household wealth were each associated with lower odds of at least one form of undernutrition among Kenyan children. The more proximal child factors had the strongest impact on the younger group of children while the intermediate and more distal maternal and household factors had the strongest impact on child undernutrition among the older group of children.

“Conclusions The present analysis identifies determinants of undernutrition among two age groups of Kenyan pre-school children and demonstrates that the contribution of child, maternal and household factors on children’s nutritional status varies with children’s age.”

%d bloggers like this: