A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

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1 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA AFRICAN UNION UNION AFRICAINE UNIÃO AFRICANA Addis Ababa, ETHIOPIA P. O. Box 3243 Telephone: Fax: Website:

2 ACKNOWLEDGEMENTS The 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 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: ; Fax: ; or UNICEF, Division of Policy and Practice, 3 United Nations Plaza, New York, 10017, USA; Tel: ; Fax: ; Printed in Nairobi, Kenya Photos and design: Giacomo Pirozzi

3 PREFACE Declining 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 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 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

4 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 ( ) 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

5 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 Countries showing progress on underweight reduction... 9 Facts and figures on chronic undernutrition in Africa Countries showing progress in key nutrition indicators Appendix Tables Table 1. Prevalence ranges for measures of nutrition status in children... 1 Table 2. Prevalence ranges for measures of per capita food supply... 2 Table 3. African Union geographic sub-regions... 2 Table 4. Summary of trends in selected child nutrition status indicators in Africa Table 5. Summary of trends in selected nutrition interventions in Africa Figures Figure 1. Global prevalence of underweight, children under five... 3 Figure 2. Trends in underweight prevalence worldwide, children under five, 1990 and Figure 3. Underweight prevalence in Africa, children under five... 4 Figure 4. Trends in underweight prevalence in the African Union, children under five... 4 Figure 5. Underweight prevalence and household wealth in Africa, children under five... 5 Figure 6. Proportion of population below minimum level of dietary energy consumption (undernourishment), worldwide... 6 Figure 7. Food energy consumption per capita... 7 Figure 8. Progress in Africa towards the MDG hunger and malnutrition target... 8 Figure 9. African countries where underweight prevalence has fallen at least 20 per cent... 9 Figure 10. Stunting prevalence among children under five worldwide Figure 11. Stunting prevalence among children under five in Africa Figure 12. Stunting prevalence among children under five in the African Union Figure 13. Incidence of low birthweight in Africa Figure 14. African countries where exclusive breastfeeding has increased at least 20 per cent Figure 15. Significant increases in iodized salt consumption in Africa Figure 16. Doubling of vitamin A supplementation coverage in Africa Annex Nutrition situation at a glance Table A.1. Current estimates of nutritional status of children under five: WHO child growth standards Table A.2. Current estimates of nutritional status of children under five: NCHS/WHO/CDC reference population Table A.3. Current estimates of infant and young child feeding indicators Table A.4. Current estimates of other nutrition indicators Food security situation at a glance Table A.5. Food security in Africa, Background note on databases and methodology CONTENTS iii

6 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA Introduction The 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 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/NEPAD 3 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: Prevalence of underweight children under five years of age; and 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 Measures of nutrition status in children Prevalence Low Medium Medium-High High Very High Underweight (weight for age) <10% 10-19% 20-29% >30% Stunting (height for age) <20% 20-29% 20-39% >40% Low birthweight (<2500 grams at birth) <5% 6-10% 11-15% 16-20% >20% 2 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. 3 New Partnership for Africa s Development. 4 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

7 Key Nutrition Interventions The key nutrition interventions that have proved effective in preventing underweight, stunting and low birthweight are: Pre-natal Prevention and appropriate nutritional management of infections (including diarrhoea, HIV, malaria, tuberculosis) Management of severe and moderate acute malnutrition Improved maternal nutrition and health before and during pregnancy to reduce low birthweight and stunting later in life, and also to enhance maternal survival. Prevention and control of selected micronutrient deficiencies: vitamin A, iodine, iron-folic acid, zinc Psychosocial stimulation Post-natal 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) Adequate complementary feeding (timing, amount, animal source foods); Healthy lifestyle nutritious food, physical exercise and health. 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 Proportion of population below minimum level of dietary energy consumption (undernourishment) Dietary energy supply per capita (kcal/day) Per cent of food energy from staples (per cent of kcal) Prevalence ranges and consumption levels Low Medium Med-High High Very High <5% 5-9% 10-19% 20-34% 35% < 2,200 2,200-2,600 2,600-3,000 3,000-3,400 >3,400 < 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

8 FACTS AND FIGURES ON UNDERNUTRITION AND HUNGER IN AFRICA Figure 1. Global prevalence of underweight, children under five Note: Key points Africa and South Asia have the highest prevalence of underweight in children under five years of age. African children make up one quarter of the estimated 148 million underweight children globally. 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. Figure 2. Trends in underweight prevalence worldwide, children under five, 1990 and 2007 Proportion of under five children Per cent who are underweight (%) Latin America/ Caribbean around 1990 around East Asia/ Pacific African Union South Asia Developing world Source: UNICEF Global Database 3 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

9 Figure 3. Underweight prevalence in Africa, children under five Source Note: Key points More than a quarter of African children under five are underweight (26 per cent). In eight countries at least 35 per cent of under-five children are underweight. Disparities are striking across Africa. The prevalence of underweight ranges from 6 per cent in northern Africa 5 to 35 per cent in eastern Africa. 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. Figure 4. Trends in underweight prevalence in the African Union, children under five Proportion of under five children Per cent who are underweight (%) around 1990 around 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

10 Figure 5. Underweight prevalence and household wealth in Africa, children under five Underweight prevalence by household wealth quintile in Africa Poorest Poorer Middle Richer Richest Note: Source Key points Underweight prevalence is closely associated with household wealth. 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. 5 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

11 Figure 6. Proportion of population below minimum level of dietary energy consumption (undernourishment), worldwide Key points Africa has the greatest number of countries with a high proportion of undernourished people (25 per cent and above). The African continent is home to 216 million people who are undernourished 30 per cent of the population. Sub-Saharan Africa is the most affected subregion. Though its proportion of undernourished has decreased from the 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. In 16 countries more than 35 per cent of the population is undernourished. In 3 countries 50 per cent or more of the population is undernourished. FACTS AND FIGURES ON UNDERNUTRITION AND HUNGER IN AFRICA 6

12 Figure 7. Food energy consumption per capita Statistics Key point 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). 7 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

13 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 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. Only nine countries in Africa are on track to meet the MDG 1 target. AFRICA IS NOT ON TRACK TO REACH MDG 1 8

14 COUNTRIES SHOWING PROGRESS ON UNDERWEIGHT REDUCTION Figure 9. African countries where underweight prevalence has fallen at least 20 per cent % Proportion of under-five children who are underweight Mauritania Rwanda Tanzania Malawi Zambia Ghana Congo Morocco São Tomé and Príncipe Around 1990 Around Egypt 4 Algeria Source Note: Key points Although progress is insufficient in Africa to meet the MDG 1 target, eleven countries have reduced underweight prevalence by at least 20 per cent. Algeria, Congo, Ghana, Mauritania and São Tomé and Príncipe have reduced underweight prevalence by more than one-third since A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

15 FACTS AND FIGURES ON CHRONIC UNDERNUTRITION IN AFRICA Figure 10. Stunting prevalence among children under five worldwide Note: Source Key points Around one-third of children under five in developing countries are stunted. Stunting is particularly high in sub-saharan Africa and South Asia. Of the 178 million children under 5 suffering from stunting in all developing countries, 57 million (32 per cent) are in Africa. 6 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 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

16 Figure 11. Stunting prevalence among children under five in Africa Note: Source Key points More than one-third of children under five (36 per cent) in Africa are stunted. Burundi, Niger and Zambia have the highest stunting prevalence 50 per cent or higher. Eastern Africa has seen the greatest improvement since 1990 (a reduction of 10 percentage points), followed by northern Africa (6 percentage points). Northern Africa has the lowest stunting prevalence, at 21 per cent. Figure 12. Stunting prevalence among children under five in the African Union Proportion of under five Per children cent who are stunted (%) around 1990 around 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

17 Figure 13. Incidence of low birthweight in Africa Source Key points Around 1 in 7 infants (15 per cent) weigh less than 2,500 grams at birth in Africa, affecting 5 million newborns every year. 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 Underweight in children < 5 years Stunting in children < 5 years Low birthweight (< 2,500 grams) Age group Birth-59 months Birth-59 months Newborn Year Number of children in age group (thousands) Proportion (per cent) Numbers of children affected , million , million , million , million , million , million Notes: (1) Trend analysis is based on a subset of countries with comparable data around the baseline year and 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 Source: UNICEF Global Database FACTS AND FIGURES ON CHRONIC UNDERNUTRITION IN AFRICA 12

18 COUNTRIES SHOWING PROGRESS IN KEY NUTRITION INTERVENTIONS Figure 14. African countries where exclusive breastfeeding has increased at least 20 per cent % Source Niger ('98, '06) Percentage of infants 0-5 months old exclusively breastfed Nigeria ('90, '03) Cameroon ('91, '06) Zimbabwe ('88, '06) Central African Rep. ('95, '06) Namibia ('92, '06) Togo ('98, '06) Senegal ('93, '05) Sudan ('90, '06) Lesotho ('96, '04) Congo, Dem. Rep. ('95, '07) Mali ('96, '06) Tanzania ('92, '04) Benin ('96, '06) Ghana ('93, '06) Malawi ('00, '06) Zambia ('92, '07) Madagascar ('92, '04) Rwanda ('92, '05) Key points In 19 African countries exclusive breastfeeding rates have risen by 20 per cent or more. Despite progress, the majority of countries in Africa still have exclusive breastfeeding rates below 50 per cent. As many as 70 per cent of infants in Africa face greater risk of morbidity and mortality due to nonexclusive breastfeeding. 13 A SNAPSHOT OF THE NUTRITION SITUATION IN AFRICA

19 Figure 15. Significant increases in iodized salt consumption in Africa % 100 around 1995 around Madagascar Egypt Mali Congo, Dem. Rep. Source 1 12 Swaziland Cote d'ivoire Key points 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. 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. 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

20 Figure 16. Doubling of vitamin A supplementation coverage in Africa % 6-59 month olds fully protected with 2 VA doses 2001 to 2007 in Per cent of children 6-59 months old fully protected with two doses of vitamin A, Africa % 6-59 mo olds fully Per cent protected with 2 VA doses Note Source Key points 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). 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 Exclusive breastfeeding (< 6 months) Vitamin A supplementation (two doses, age 6-59 months) Household consumption of iodized salt Year Proportion (per cent) Notes: (1) Trend analysis is based on a subset of countries that have comparable data around the baseline year and 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 (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

21 APPENDIX NUTRITION SITUATION AT A GLANCE Table A.1. Current estimates of nutritional status of children under five: WHO child growth standards Moderate and severe Underweight (%) Stunted (%) Wasted (%) Severe Moderate and severe Severe Moderate and severe African Union Western Eastern Southern Central Northern Note: Regional and sub-regional averages are based on latest estimates from a subset of African Union countries with data between 2003 and Countries with latest estimates before 2003 are excluded. Source: UNICEF Global Database. Severe Table A.2. Current estimates of nutritional status of children under five: NCHS/WHO/CDC reference population Underweight (%) Stunting (%) Wasting (%) Moderate and severe Severe Moderate and severe Severe Moderate and severe Severe African Union Western Eastern Southern Central Northern Note: Regional and sub-regional averages are based on latest estimates from a subset of African Union countries with data between 2003 and Countries with latest estimates before 2003 are excluded. Source: UNICEF Global Database Table A.3. Current estimates of infant and young child feeding indicators Early initiation of breastfeeding Exclusive breastfeeding Complementary breastfeeding Continued breastfeeding Continued breastfeeding At birth < 6 months 6-9 months months months African Union Western Eastern Southern Central Northern Note: Regional and sub-regional averages are based on latest estimates from a subset of AU countries with data between 2003 and Countries with latest estimates before 2003 are excluded. Source: UNICEF Global Database Table A.4. Current estimates of other nutrition indicators Low birthweight (%) Iodized salt consumption (%) Vitamin A supplementation (%) African Union Western Eastern Southern Central Northern 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 (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

22 FOOD SECURITY SITUATION AT A GLANCE Table A.5. Food security in Africa, Country Energy availability per capita Number of people undernourished (millions) Per cent of undernourished people Per cent of food energy from staples North Africa Algeria 3,100 n.s Egypt 3,320 n.s Libyan Arab Jamahiriya 3,020 n.s Morocco 3,190 n.s Tunisia 3,280 n.s Central Africa Cameroon 2, Central African Republic 1, Chad 1, Congo 2, Democratic Republic of Congo Gabon 2,760 n.s East Africa Burundi 1, Eritrea 1, Ethiopia 1, Kenya 2, Rwanda 1, Sudan 2, Uganda 2, Tanzania 2, Southern Africa Angola 1, Botswana 2, Lesotho 2, Madagascar 2, Malawi 2, Mauritius 2, Mozambique 2, Namibia 2, Swaziland 2, Zambia 1, Zimbabwe 2, West Africa Benin 2, Burkina Faso 2, Côte d Ivoire 2, Gambia 2, Ghana 2, Guinea 2, Liberia 2, Mali 2, Mauritania 2, Niger 2, Nigeria 2, Sierra Leone 1, Senegal 2, Togo 2, 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

23 BACKGROUND NOTE ON DATABASES AND METHODOLOGY Databases UNICEF 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. Methodology Regional average Regional 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 United Nations Population Division s World Population Prospects. Regional averages are based on data points from a specified time period. For example, current regional estimates are derived from data collected since 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) 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: Insufficient: No progress: 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. AARR is between 0.6 per cent and 2.5 per cent, inclusive. 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: 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. reporting and mis-reporting. APPENDIX 18

24 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: ; Fax: ; or UNICEF, Division of Policy and Practice, 3 United Nations Plaza, New York, 10017, USA; Tel: ; Fax: ;

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