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close this bookOvercoming Child Malnutrition in Developing Countries - Past Achievements and Future Choices. 2020 Vision for Food, Agriculture, and the Environment. Discussion Paper 30 (IFPRI, 2000, 73 p.)
View the document(introduction...)
View the documentForeword
View the documentAcknowledgments
View the document1. Exploring the Causes of Malnutrition
View the document2. Determinants of the Nutritional Status of Children
View the document3. Data and Methods
View the document4. New Evidence from Cross-Country Data, 1970-95
View the document5. How Has Child Malnutrition Been Reduced in the Past?: A Retrospective
View the document6. Projections of Child Malnutrition in the Year 2020
View the document7. Priorities for the Future
View the document8. Conclusions
View the documentAppendix: Cross-Country Studies: Methodological Issues and Past Findings
View the documentReferences
View the documentRecent Food, Agriculture and the Environment Discussion Papers

1. Exploring the Causes of Malnutrition

Although the share of children who are malnourished has gradually been declining over the past 25 years, the actual number of malnourished children is still rising in many countries. In 1995, 167 million children under five years old - almost one-third of developing-country children - were estimated to be underweight. Malnutrition 1 causes a great deal of human suffering-both physical and emotional. It is a violation of a child’s human rights (Oshaug, W. Eide, and A. Eide 1994). It is associated with more than half of all deaths of children worldwide (Pelletier et al. 1995). And it is a major waste of human energy. Adults who survive malnutrition as children are less physically and intellectually productive and suffer from more chronic illness and disability (UNICEF 1998). The personal and social costs of continuing malnutrition on its current scale are enormous.

1 Malnutrition is associated with both undernutrition and overnutrition. In this paper the term refers to undernutrition as measured by underweight rates. A child is considered underweight if he or she falls below an anthropometric cutoff of -2 standard deviation below the median weight-for-age Z-score of the National Center for Health Statistics/World Health Organization international reference.

But in order to reduce malnutrition, one must understand its causes. It seems obvious that a child will be underweight if he or she does not have enough food, but the causes are much more complex and interrelated than that. They range from factors as broad as political instability to those as specific as diarrheal disease. And the solutions proposed are just as wide-ranging. Policy-makers and researchers endlessly debate which of the many causes of malnutrition are most important, and which areas of intervention will be most successful in reducing it. The overall objective of the study that underlies this paper is to answer those questions.

While the prevalence of malnutrition in the developing world as a whole fell from 46.5 percent to 31 percent between 1970 and 1995, about 15 percentage points in all, progress in reducing malnutrition has varied greatly from one region to another (Table 1). Malnutrition has declined the fastest in South Asia (by 23 percentage points) and the slowest in Sub-Saharan Africa (4 percentage points), but the pace of change is decelerating. During 1970-85 the prevalence of malnutrition fell by 0.8 percentage points per year; during 1985-95, it fell by only 0.3 points. The situation is particularly troubling in Sub-Saharan Africa where the prevalence of underweight children actually increased from almost 29 percent in 1990 to 31 percent in 1995. Since 1970, the prevalence of underweight children has decreased in 35 developing countries, held steady in 15, and increased in 12, with most of the countries with increases in Sub-Saharan Africa (WHO 1997).

Why have some countries and regions done better than others in combating child malnutrition? The study uses cross-country data to determine which of the various broad determinants of child malnutrition are most important in each region and the developing world. It also aims to unravel the answers to a number of puzzling questions that are currently under debate: (1) Why has child malnutrition been rising in Sub-Saharan Africa? (ACC/SCN 1997); (2) Why are child malnutrition rates in South Asia so much higher than those in Sub-Saharan Africa (in other words, what explains the so-called “Asian enigma”) (Ramalingaswami, Jonsson, and Rohde 1996; Osmani 1997)? 2 (3) How important a determinant of child malnutrition is food availability at a national level? (Smith et al. 1999; Haddad, Webb, and Slack 1997a); (4) How important are women’s status and education? (Quisumbing et al. 1995; Osmani 1997; Subbarao and Raney 1995); (5) How important are national political factors (such as democracy) and national incomes, and through what pathways do they affect child malnutrition? (Anand and Ravallion 1993; Pritchett and Summers 1996). Addressing these questions should help policymakers use resources wisely to reduce child malnutrition as quickly as possible between now and 2020.

2 Indicators such as per capita food availability, health environment quality, and national income - which are thought to be key factors influencing children’s nutrition - are much higher in South Asia than in Sub-Saharan Africa, but a much larger share of children in South Asia are malnourished. Why? This is the Asian enigma.

Table 1 - Trends in child malnutrition in developing countries, by region, 1970-95

Region

1970

1975

1980

1985

1990

1995

Change, 1970 to 1995


(percent)

(percentage points)

Percent of children malnourished


South Asia

72.3

67.7

63.7

61.1

53.4

49.3

-23.0


Sub-Saharan Africa

35.0

31.4

28.9

29.9

28.8

31.1

-3.9


East Asia

39.5

33.3

30.0

26.5

23.5

22.9

-16.6


Near East and North Africa

20.7

19.8

17.2

15.1

n.a.

14.6

-6.1


Latin America and the Caribbean

21.0

17.0

12.2

10.6

11.4

9.5

-11.5


All regions

46.5

41.6

37.8

36.1

32.3

31.0

-15.5


(millions)

(millions)

Number of children malnourished


South Asia

92.2

90.6

89.9

100.1

95.4

86.0

-6.2


Sub-Saharan Africa

18.5

18.5

19.9

24.1

25.7

31.4

+12.9


East Asia

77.6

45.1

43.3

42.8

42.5

38.2

-39.4


Near East and North Africa

5.9

5.2

5.0

5.0

n.a.

6.3

+0.4


Latin America and the Caribbean

9.5

8.2

6.2

5.7

6.2

5.2

-4.3


All regions

203.8

167.6

164.3

177.7

176.7

167.1

-36.7

Sources: 1975, 1980, and 1985 prevalences and numbers of malnourished children are from Table 1.2 of ACC/SCN 1992; 1990 and 1995 estimates are from WHO 1997, Table 6. Where the regions differ in these sources from the five listed, population estimates were used to make appropriate region-specific approximations. The 1970 figures are predicted using the underlying-determinant model regression results presented in this paper. The source for the population data used to calculate the numbers of underweight children for 1970 is United Nations 1996. Large jumps in numbers of underweight children between successive five-year periods (for example, East Asia in 1970 and 1975) may be explained by the use of differing sources of population estimates.

Notes: A child under five (0-59 months) is considered malnourished if the child falls below an anthropometric cut-off of -2 standard deviations below the median weight-for-age Z-score of the National Center for Health Statistics/World Health Organization international reference, n.a. is not available.

The study employs the highest quality, nationally representative data on child underweight currently available for the period 1970-95 to undertake a cross-country regression analysis of the determinants of child malnutrition. Although a number of cross-country studies have been undertaken in recent years, this study differs from past studies in four important ways. First, extreme care has been taken in assembling, cleaning, and documenting the data used. For the conclusions to be credible, the quality of the child malnutrition data must be of high quality. However, little attention has been paid to this issue outside of the World Health Organization’s excellent WHO Global Database on Child Growth and Malnutrition (WHO 1997), from which most of the data are drawn. Second, the econometric techniques are more rigorous than those in most other studies. Third, in drawing out the implications of the empirical analysis, the study goes beyond the simple generation of elasticities to estimate the contribution of each nutrition determinant to reductions in child malnutrition over the past 25 years. Fourth, national food availability projections from IFPRI’s IMPACT model (Rosegrant, Agcaoili-Sombilla, and Perez 1995), together with assumptions about future values of other child malnutrition determinants, are used to project levels of malnutrition in the year 2020 under pessimistic, optimistic, and status quo scenarios. Key policy priorities for each developing region are laid out.

This paper summarizes the findings of the study and reviews the current state of child malnutrition in the developing world. For a comprehensive discussion of the analysis and methodology used to analyze the relative importance of the various causes of malnutrition, the reader should see the companion volume to this paper Explaining Child Malnutrition in Developing Countries: A Cross-Country Analysis, IFPRI Research Report 111, by Lisa C. Smith and Lawrence Haddad, February 2000.