malnutrition mics3 data analysis and report writing
TRANSCRIPT
Malnutrition
MICS3 Data Analysis and Report Writing
Overview
• Background
• International goals
• Indicators
• Indicator calculations
• Methodological issues
• Data
Background
• Malnutrition is associated with more than half of all child deaths worldwide.
• Undernourished children are more likely to die from common childhood ailments, and for those who survive, have recurring sicknesses and faltering growth.
• Three-quarters of the children who die from causes related to malnutrition were only mildly or moderately undernourished – showing no outward sign of their vulnerability.
International Goals & Targets
Reduction of child malnutrition among children
under five years of age by at least one-third,
with special attention to children under 2 years
of age
Halve, between 1990 and 2015, the proportion
of people who suffer from hunger
List of Indicators
• Underweight prevalence (weight-for-age)
• Stunting prevalence (height-for-age)
• Wasting prevalence (weight-for-height)
• Overweight prevalence (weight-for-height)
Definition of Indicators
% of children under five that fall below minus 2 standard deviations from the median weight for age
of the standard NCHS reference population (moderate & severe)
Numerator: Number of children under age five that fall below minus two standard deviations from the median weight for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)
Denominator: Total number of children under age five that were weighed
Underweight Prevalence
Definition of Indicators
% of children under five that fall below minus 2 standard deviations from the median height for age
of the standard NCHS reference population (moderate & severe)
Numerator: Number of children under age five that fall below minus two standard deviations from the median height for age of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)
Denominator: Total number of children under age five measured
Stunting Prevalence
Definition of Indicators
% of children under five that fall below minus 2 standard deviations from the median weight for height
of the standard NCHS reference population (moderate & severe)
Numerator: Number of children under age five that fall below minus two standard deviations from the median weight for height of the NCHS/WHO standard (moderate and severe); number that fall below minus three standard deviations (severe)
Denominator: Total number of children under age five that were weighed and measured
Wasting Prevalence
Methodological Issues
Measures of nutritional status
• Underweight (weight for age): reflects a child’s total body mass. It is a composite measure of stunting and wasting. It is useful for describing the overall level of malnutrition and for assessing changes over time
Methodological Issues
Measures of nutritional status
• Stunting (height for age): reflects a child’s stature in relation to his age. It is an indicator of cumulative deficient growth associated with chronic insufficient dietary intake, frequent infection, and poor feeding practices over a long period.
• Wasting (weight for height): indicates thinness or fatness. It is usually the result of recent nutritional deficiency. Affected by seasonal shifts associated with food availability and/or disease prevalence.
Methodological Issues
• Height (in centimeters)– measured lying down for children under 2 years old – measured standing up for children 2 or more years old
• Weight (in kilograms)• Age (in decimal (2) months)• Sex
Note that if height and weight data are missing for more than 10% of children under-five, caution should be exercised in the interpretation of the results.
Data used to assess nutritional status
Methodological Issues
• Undernourishment is gauged by comparing children to a reference standard.
• The NCHS/WHO reference standard represents the distribution of height and weight by age and sex in a well nourished population.
• WHO has developed a new reference population which will be released soon.
International standard reference population
Methodological Issues
• The distribution has been normalized so that the mean and median are equal.
• Z-scores measure the number of standard deviation units that a child’s measurement deviates from the reference population median for that age.
International standard reference population
Methodological Issues
International standard reference population
• In the reference population (i.e. in a well nourished population), 2.3 percent of children fall below minus 2 standard deviations and 0.1 percent fall below minus 3 standard deviations.
• Height for Age and Weight for Age depend on accurate age reporting. In MICS, only children whose mothers reported both their month and year of birth are included in the calculations.
• Children with out of range (i.e. highly improbable) z-scores are excluded.
Methodological Issues
Measurement issues
• Poor height and weight measurements– Measurement instruments
– Training of interviewers
– Response rates
• Accuracy in age estimation
• Age group reference: 0-36 months vs. 0-59 months
• Unexpected pattern
Tabulation PlanTable NU.1: Child malnourishment
Underweight prevalence
27
5
7
14
15
28
29
46
0 20 40 60 80 100
Developing countries
CEE/CIS
Latin America/Caribbean
Middle East/North Africa
East Asia/Pacific
West/Central Africa
East/Southern Africa
South Asia
% children aged 0-59 months who are underweight
Regional Data
Underweight (CEE/CIS)
5
11233333444678
111214
0 20 40 60 80 100
CEE/CIS
CroatiaUkraine
Serbia/MontenegroArmeniaGeorgia
Moldova, Rep ofRomania
Russian FederationBosnia/Herzegovina
KazakhstanTurkey
Macedonia, TFYRAzerbaijan
UzbekistanKyrgyzstan
TurkmenistanAlbania
% children aged 0-59 months who are underweight
14
1357
101010101212131313
2122
253436
0 20 40 60 80 100
CEE/CIS
CroatiaUkraine
Serbia/MontenegroMacedonia, TFYR
Moldova, Rep ofRomania
Bosnia/HerzegovinaKazakhstan
GeorgiaTurkey
ArmeniaRussian Federation
AzerbaijanUzbekistan
TurkmenistanKyrgyzstan
AlbaniaTajikistan
% children aged 0-59 months who are stunted
Stunting (CEE/CIS)
3
01122222334445667 11
0 20 40 60 80 100
CEE/CIS
CroatiaUkraine
Serbia/MontenegroMacedonia, TFYRMoldova, Rep of
RomaniaBosnia/Herzegovina
KazakhstanGeorgiaTurkey
ArmeniaRussian Federation
AzerbaijanUzbekistan
TurkmenistanKyrgyzstan
AlbaniaTajikistan
% children aged 0-59 months who are wasted
Wasting (CEE/CIS)
Underweight (ROSA)
46
19
29
30
38
39
47
48
48
0 20 40 60 80 100
South Asia
Bhutan
Sri Lanka
Maldives
Pakistan
Afghanistan
India
Bangladesh
Nepal
% children aged 0-59 months who are underweight
Underweight (TACRO)
7
14445555566778881010121314
1717
23
0 20 40 60 80 100
Latin America/Caribbean
ChileCuba
JamaicaVenezuelaArgentina
Costa RicaDR
ParaguayUruguay
BrazilTrinidad/Tobago
ColombiaPeru
BoliviaMexico
PanamaEl Salvador
NicaraguaEcuador
SurinameGuyana
HaitiHonduras
Guatemala
% children aged 0-59 months who are underweight
Underweight (MENA)
14
3444567
9910101011
1414
161818
4146
0 20 40 60 80 100
Middle East/North Africa
LebanonJordan
OPTTunisia
LibyaQatarSyria
BahrainEgypt
AlgeriaKuwait
MoroccoIran
Saudi ArabiaUAEIraq
DjiboutiOmanSudanYemen
% children aged 0-59 months who are underweight
Underweight (CEE/CIS)
5
11233333444678
111214
0 20 40 60 80 100
CEE/CIS
CroatiaUkraine
Serbia/MontenegroArmeniaGeorgia
Moldova, Rep ofRomania
Russian FederationBosnia/Herzegovina
KazakhstanTurkey
Macedonia, TFYRAzerbaijan
UzbekistanKyrgyzstan
TurkmenistanAlbania
% children aged 0-59 months who are underweight
Underweight (EAPRO)
15
3
8
11
13
18
23
28
28
28
32
40
45
46
0 20 40 60 80 100
East Asia/Pacific
Singapore
China
Malaysia
Mongolia
Thailand
Korea, Dem Rep
Indonesia
Philippines
Viet Nam
Myanmar
Lao, PDR
Cambodia
Timor-Leste
% children aged 0-59 months who are underweight
Underweight (ESARO)
29
1012131315
1820222223232424252627
314042
4547
0 20 40 60 80 100
East/Southern Africa
Swaziland
South AfricaBotswana
ZimbabweMauritius
LesothoKenya
MalawiTanzania
Uganda
ZambiaMozambique
NamibiaComoros
SomaliaRwanda
AngolaEritrea
MadagascarBurundi
Ethiopia
% children aged 0-59 months who are underweight
Underweight (WCARO)
28
121314
1717171819
22232425252626272829
313233
3840
0 20 40 60 80 100
West/Central Africa
GabonSao Tome/Principe
CongoCôte d'Ivoire
GambiaSenegal
CameroonEq. Guinea
GhanaBenin
CARGuinea-Bissau
TogoGuineaLiberia
Sierra LeoneChad
NigeriaCongo, Dem Rep of
MauritaniaMali
Burkina FasoNiger
% children aged 0-59 months who are underweight