CR10

MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate population, health,
and nutrition programs. Funded by the U.S. Agency for International Development (USAID), MEASURE DHS is implemented by ORC Macro in Calverton, Maryland. The main objectives of the MEASURE DHS project are: 1) to provide decisionmakers in survey countries with information useful for informed policy choices, 2) to expand the international population and health database, 3) to advance survey methodology, and 4) to develop in participating countries the skills and resources necessary to conduct high-quality demographic and health surveys. Information about the MEASURE DHS project or the status of MEASURE DHS surveys is available on the Internet at http://www.measuredhs.com or by contacting: ORC Macro 11785 Beltsville Drive Suite 300 Calverton, MD 20705 USA Telephone: 301-572-0200 Fax: 301-572-0999 E-mail: reports@orcmacro.com
DHS Comparative Reports No. 10
Nutritional Status of Children: Results from the Demographic and Health Surveys 1994-2001
Altrena Mukuria Jeanne Cushing Jasbir Sangha
ORC Macro Calverton, Maryland, USA
December 2005
This publication was made possible through support provided by the U.S. Agency for International Development under the terms of Contract No. HRN-C-00-9700019-00. The opinions expressed herein are those of the authors and do not necessarily reflect the views of the U.S. Agency for International Development. Editor: Sidney Moore Report production: John Chang
Recommended citation: Mukuria, Altrena, Jeanne Cushing, and Jasbir Sangha. 2005. Nutritional Status of Children: Results from the Demographic and Health Surveys 1994-2001. DHS Comparative Reports No. 10. Calverton, Maryland: ORC Macro.
Contents
Tables and Figures ........................................................................................................................................ v Preface.......................................................................................................................................................... ix Acknowledgements...................................................................................................................................... xi Executive Summary ................................................................................................................................... xiii Introduction .................................................................................................................................................. 1 Data and Methods ........................................................................................................................................ 3 2.1 Sample of Children ................................................................................................................. 4
Findings ........................................................................................................................................................ 7 3.1 3.2 3.3 Infant and Under-Five Mortality............................................................................................ 7 Contribution of Undernutrition to Mortality ......................................................................... 9 Malnutrition Rates.................................................................................................................. 9 3.3.1 3.3.2 3.3.3 3.3.4 3.3.5 3.3.6 3.4 Levels of Undernutrition............................................................................................ 9 Patterns of Undernutrition ........................................................................................ 9 Severity of Undernutrition ....................................................................................... 12 Distribution of Z-scores .......................................................................................... 12 Age Distribution of Undernutrition ........................................................................ 18 Levels of Overnutrition............................................................................................ 19
Influences on the Nutritional Status of Children ................................................................. 26 Basic Influences........................................................................................................ 26 Underlying Social and Economic Influences ........................................................... 29 Mothers Education ................................................................................................. 31 Mothers Work Status.............................................................................................. 35 House Flooring Status ............................................................................................. 39 Sanitation Facilities.................................................................................................. 43 Source of Drinking Water ....................................................................................... 47 3.4.3 Underlying Biological and Behavioral Influences .................................................... 51 3.4.3.1 Characteristics of Mothers....................................................................................... 51 3.4.3.2 Child Characteristics ............................................................................................... 62 3.4.3.3 Immediate Influences............................................................................................... 92 3.4.1 3.4.2 3.4.2.1 3.4.2.2 3.4.2.3 3.4.2.4 3.4.2.5
Summary and Conclusions ....................................................................................................................... 101 References ................................................................................................................................................. 103 Appendix A............................................................................................................................................... 107
Contents
iii
Tables and Figures

Table 2.1 Table 2.2 Figure 3.1 Figure 3.2 Figure 3.3 Figure 3.4 Figure 3.5 Figure 3.6 Figure 3.7 Figure 3.8 Figure 3.9 Figure 3.10 Figure 3.11 Figure 3.12 Figure 3.13 Figure 3.14 Figure 3.15 Figure 3.16 Figure 3.17 Figure 3.18 Figure 3.19 Figure 3.20 Figure 3.21 Figure 3.22 Demographic and Health Surveys included in this report ........................................... 3 DHS indicators used in this report .............................................................................. 4 Infant and Under-Five Mortality Rates ....................................................................... 8 Levels of stunting and underweight among children age 0-35 months, Demographic and Health Surveys, 1994-2001.......................................................... 10 Levels of wasting among children age 0-35 months .................................................. 11 Percentage of children age 0-35 months who are moderately stunted and severely stunted.................................................................................................... 13 Percentage of children age 0-35 months who are moderately wasted and severely wasted..................................................................................................... 14 Percentage of children age 0-35 months who are moderately underweight and severely underweight ........................................................................................... 15 Distribution of height-for-age, weight-for-height, and weight-for-age Z-scores among children age 3-35 months................................................................ 16 Levels of stunting by childs age group....................................................................... 20 Levels of wasting by childs age group........................................................................ 21 Levels of underweight by childs age group................................................................ 22 Distribution of mean Z-scores for height-for-age, weight-for-height, and weight-for-age among children age 3-35 months............................................... 23 Percentage of overweight (weight-for-height) children age 035 months ................ 25 Conceptual framework for child nutritional status .................................................... 27 Levels of stunting by urban-rural residence ............................................................... 28 Levels of wasting by urban-rural residence ................................................................ 30 Levels of underweight by urban-rural residence ........................................................ 31 Levels of stunting among children age 0-35 months by mothers education............. 32 Levels of wasting among children age 0-35 months by mothers education.............. 33 Levels of underweight among children age 0-35 months by mothers education...... 34 Levels of stunting among children age 0-35 months by mothers work status .......... 36 Levels of wasting among children age 0-35 months by mothers work status ........... 37 Levels of underweight among children age 0-35 months by mothers work status ... 38
Tables and Figures
Figure 3.23 Figure 3.24 Figure 3.25 Figure 3.26 Figure 3.27 Figure 3.28 Figure 3.29 Figure 3.30 Figure 3.31 Figure 3.32 Figure 3.33 Figure 3.34 Figure 3.35 Figure 3.36 Figure 3.37 Figure 3.38 Figure 3.39 Figure 3.40 Figure 3.41 Figure 3.42
Levels of stunting among children age 0-35 months by flooring status .................... 40 Levels of wasting among children age 0-35 months by flooring status ..................... 41 Levels of underweight among children age 0-35 months by flooring status ............. 42 Percentage of children age 0-35 months who are stunted, by type of household sanitation facility ........................................................................................................ 44 Percentage of children age 0-35 months who are wasted by type of sanitation facility ......................................................................................................................... 45 Percentage of children age 0-35 months who are underweight by type of household sanitation facility....................................................................................... 46 Percentage of children age 0-35 months who are stunted, by source of drinking water ............................................................................................................ 48 Percentage of children age 0-35 months who are wasted, by source of drinking water ............................................................................................................ 49 Percentage of children age 0-35 months who are underweight, by source of drinking water ............................................................................................................ 50 Percentage of children age 0-35 months who are stunted, by mothers nutritional status......................................................................................................... 52 Percentage of children age 0-35 months who are wasted, by mothers nutritional status......................................................................................................... 53 Percentage of children age 0-35 months who are underweight, by mothers nutritional status......................................................................................................... 54 Percentage of children age 0-35 months who are stunted, by antenatal care visits............................................................................................................................ 56 Percentage of children age 0-35 months who are wasted, by antenatal care visits............................................................................................................................ 57 Percentage of children age 0-35 months who are underweight, by antenatal care visits..................................................................................................... 58 Levels of stunting among children age 0-35 months by mothers age at delivery ................................................................................................................... 59 Levels of wasting among children age 0-35 months by mothers age at delivery ................................................................................................................... 60 Levels of underweight among children age 0-35 months by mothers age at delivery ............................................................................................................. 61 Levels of stunting among children age 0-35 months by mothers perceived size of child at birth .................................................................................................... 63 Levels of wasting among children age 0-35 months by mothers perceived size of child at birth .................................................................................................... 64
vi
Tables and Figures
Figure 3.43 Figure 3.44 Figure 3.45 Figure 3.46 Figure 3.47 Figure 3.48 Figure 3.49 Figure 3.50 Figure 3.51 Figure 3.52 Figure 3.53 Figure 3.54 Figure 3.55 Figure 3.56 Figure 3.57 Figure 3.58 Figure 3.59 Figure 3.60 Figure 3.61 Figure 3.62 Figure 3.63 Figure 3.64 Figure 3.65 Figure 3.66 Figure 3.67
Levels of underweight among children age 0-35 months by mothers perceived size of child at birth .................................................................................................... 65 Levels of stunting among children age 0-35 months by sex of a child ...................... 66 Levels of wasting among children age 0-35 months by sex of child .......................... 67 Levels of underweight among children age 0-35 months by sex of child .................. 68 Levels of stunting among children age 0-35 months by birth order.......................... 70 Levels of wasting among children age 0-35 months by birth order........................... 71 Levels of underweight among children age 0-35 months by birth order ................... 73 Levels of stunting among children age 0-35 months by length of preceding birth interval ............................................................................................................... 75 Levels of wasting among children age 0-35 months by length of preceding birth interval ............................................................................................................... 76 Levels of underweight among children age 0-35 months by length of preceding birth interval .............................................................................................. 77 Percentage of children age 12-23 months with a measles vaccination....................... 79 Levels of stunting among children age 0-35 months by measles vaccination status........................................................................................................ 80 Levels of wasting among children age 0-35 months by measles vaccination status........................................................................................................ 81 Levels of underweight among children age 0-35 months by measles vaccination status........................................................................................................ 82 Levels of stunting among children age 0-35 months by vaccination status ............... 84 Levels of wasting among children age 0-35 months by vaccination status ................ 85 Levels of underweight among children age 0-35 months by vaccination status ........ 86 Exclusive Breastfeeding status of children under 6 months....................................... 88 Complementary feeding status of children age 6-9 months ...................................... 89 Median duration of exclusive breastfeeding, predominant breastfeeding, and any breastfeeding ........................................................................................................ 91 Prevalence of ARI among children age 4-23 months by stunting ............................. 93 Prevalence of ARI among children age 4-23 months by wasting .............................. 94 Prevalence of ARI among children age 4-23 months by underweight ...................... 95 Prevalence of diarrhea among children age 4-23 months by stunting ....................... 97 Prevalence of diarrhea among children age 4-23 months by wasting ........................ 98
Tables and Figures
vii
Figure 3.68 Table A.3.1 Table A.3.2 Table A.3.3 Table A.3.4 Table A.3.5 Table A.3.6 Table A.3.7 Table A.3.8 Table A.3.9 Table A.3.10 Table A.3.11 Table A.3.12 Table A.3.13 Table A.3.14 Table A.3.15 Table A.3.16 Table A.3.17 Table A.3.18 Table A.3.19 Table A.3.20 Table A.3.21 Table A.3.22 Table A.3.23 Table A.3.24 Table A.3.25 Table A.3.26 Table A.3.27 Table A.3.28 Table A.3.29
Prevalence of diarrhea among children age 4-23 months by underweight ................ 99 Infant and under-five mortality rates ....................................................................... 107 Contribution of undernutrition to under-five mortality .......................................... 108 Undernutrition among young children .................................................................... 109 Height-for-age Z-scores among young children ..................................................... 110 Weight-for-height Z-scores among young children................................................ 111 Weight-for-age Z-scores among young children..................................................... 112 Undernutrition by child's age group......................................................................... 113 Nutritional status of young children......................................................................... 114 Overweight children age 035 months .................................................................... 115 Undernutrition by urban-rural residence.................................................................. 116 Undernutrition by mother's education ..................................................................... 117 Undernutrition by mother's work status .................................................................. 118 Undernutrition by flooring status............................................................................. 119 Undernutrition by type of sanitation facility ............................................................ 120 Undernutrition by source of drinking water............................................................. 121 Undernutrition by mother's nutritional status.......................................................... 122 Undernutrition by antenatal care visits..................................................................... 123 Undernutrition by mother's age at delivery .............................................................. 124 Undernutrition by mother's perceived size of child at birth..................................... 125 Undernutrition by sex of child ................................................................................. 126 Undernutrition by birth order .................................................................................. 127 Undernutrition by length of preceding birth interval............................................... 128 Undernutrition by measles vaccination status .......................................................... 129 Undernutrition by vaccination status ....................................................................... 130 Breastfeeding status of children under 6 months ..................................................... 131 Breastfeeding status of children age 6-9 months ..................................................... 132 Median duration and frequency of breastfeeding..................................................... 133 Undernutrition by ARI status .................................................................................. 134 Undernutrition by diarrhea status ............................................................................ 135
viii
Tables and Figures
Preface
One of the most significant contributions of the MEASURE DHS program is the creation of an internationally comparable body of data on the demographic and health characteristics of populations in developing countries. The DHS Comparative Reports series examines these data across countries in a comparative framework. The DHS Analytical Studies series focuses on specific topics. The principal objectives of both series are to provide information for policy formulation at the international level and to examine individual country results in an international context. Whereas Comparative Reports are primarily descriptive, Analytical Studies take a more analytical approach. The Comparative Reports series covers a variable number of countries, depending on the availability of data sets. Where possible, data from previous DHS surveys are used to evaluate trends over time. Each report provides detailed tables and graphs organized by region. Survey-related issues such as questionnaire comparability, survey procedures, data quality, and methodological approaches are addressed as needed. The topics covered in Comparative Reports are selected by MEASURE DHS staff in conjunction with the U.S. Agency for Internationl Development. Some reports are updates of previously published reports. It is anticipated that the availability of comparable information for a large number of developing countries will enhance the understanding of important issues in the fields of international population and health by analysts and policymakers.
Martin Vaessen Project Director
Preface
ix
Acknowledgements
The authors would like to thank Fred Arnold, Noah Bartlett, Monica Kothari, Robert Johnston, Shea Rutstein, and Vinod Mishra for their work in reviewing the data for the report. The editing and production assistance of Sidney Moore, John Chang, Justin Faulkenburg, and Katherine Senzee is appreciated.
Acknowledgements
xi
Executive Summary
This report reviews the nutritional status of children under 3 years of age in 41 developing countries. Nutritional status is based on anthropometric measurements of height and weight of children taken during household interviews conducted by the Demographic and Health Surveys (DHS) program between 1994 and 2001. Five regions are included in this report: sub-Saharan Africa (23 countries), North Africa/West Asia/Europe (4 countries), Latin America and the Caribbean (7 countries), Central Asia (3 countries), and South/Southeast Asia (4 countries). Malnutrition includes both under- and overnutrition. Although this report focuses primarily on undernutrition (stunting, wasting, and underweight), the prevalence of overweight is also reported. Important differentials of undernutrition, such as age, are presented. Using a conceptual framework for child nutritional status adapted from UNICEF, this report explores variables representing four key influences (basic; underlying social and economic; underlying biological and behavioral; and immediate). As background to the report, tables on infant and under-five mortality rates and the contribution of undernutrition to mortality are included. DHS continues to find high levels of undernutrition in all the countries surveyed. In 31 of the 41 countries, more than 20 percent of the children are stunted, with 9 of the countries having stunting rates of 40 percent or more. The South/Southeast Asia region has the highest rates of stunting and underweight (40 percent or more), followed by sub-Saharan Africa (about 30 percent). The remaining three regions have stunting rates around 20 percent and underweight rates between 10 percent and 15 percent. Although undernutrition is of much concern in developing countries, childhood obesity is increasing worldwide. The prevalence of overweight (weight-for-height) in children under three years is particularly noticeable in the Latin America and Caribbean region (almost 6 percent) and Central Asia (5 percent). South/Southeast Asia has the lowest level of overweight among the regions (2 percent). Differentials in background variables provide insights into patterns of undernutrition. Undernutrition is age dependent. Children younger than 6 months and those age 24-35 months have lower rates of undernutrition than children age 6-23 months. Undernutrition accelerates from 4 to 23 months of age. Undernutrition is more prevalent in rural than urban areas. This differential may be due to differences in social and economic conditions in urban and rural areas, such as mothers education, work status, and availability of water and sanitation facilities. These underlying influences operate to predict higher rates of stunting and underweight but are not strongly associated with wasting rates. Children of working mothers and mothers with primary or less education have higher rates of undernutrition. Likewise, children living in households with unfinished floors, without flush toilets, and without access to piped water have higher rates of undernutrition. Biological and behavioral influences related to mother and child are also important for child nutrition. Higher rates of undernutrition are found for children whose mothers are undernourished. Antenatal care (at least one clinic visit) is negatively related to child nutrition (stunting and underweight). The influence of mothers age at delivery varies by region and undernutrition indicator. Children of younger mothers (under 20 years) have higher rates of stunting and underweight in sub-Saharan Africa and North Africa/West Asia/Europe, but children of older mothers (35 years or more) have higher rates of stunting and underweight in Latin America and the Caribbean, Central Asia, and South/Southeast Asia. Wasting rates show no consistent pattern by region or mothers age. Executive Summary xiii
Prevalence of undernutrition by childs characteristics, such as size at birth, sex, birth order, and preceding birth interval, was also examined. Babies being very small at birth (as perceived by the mother) is related to poor nutritional status. Females tend to have better nutritional status than males in most regions. However in South/Southeast Asia, males are somewhat less likely to be stunted or underweight than females. Higher birth order is related to poor nutritional status (particularly stunting). A preceding birth interval of less than 24 months is related to poor nutritional status, but first births and intervals of 48 months or longer are associated with lower rates of stunting and underweight. Other biological and behavioral factors include vaccination history and feeding practices. Children age 12-23 months who are vaccinated against measles have lower rates of undernutrition than those who are not; and children age 12-23 months who have completed other vaccinations have lower rates of undernutrition than children who have not received any vaccinations. However, having completed one or more measles vaccinations is the best predictor of lower undernutrition rates. Feeding practices were used only as descriptors of behaviors across countries and regions. In children under six months of age, the prevalence of exclusive breastfeeding is highest in South/Southeast Asia (45 percent) and lowest in subSaharan Africa (22 percent). The North Africa/West Asia/Europe and Central Asia regions do not have DHS data on infant feeding practices in some of the countries. Bottle-feeding is low among breastfed babies in all of the regions except Latin America and the Caribbean, where 60 percent or more of breastfed infants under six months are also bottle-fed. Children age 6-9 months are expected to be fed solids in addition to breast milk (complementary feeding). Sub-Saharan Africa has the highest rates of complementary feeding at age 6-9 months (71 percent), and the Latin America and Caribbean region has the lowest (about 54 percent). The median duration of breastfeeding is about 15 months in Latin America and the Caribbean and in North Africa/West Asia/Europe. South/Southeast Asia and sub-Saharan Africa have the longest breastfeeding durations, 27 and 21 months, respectively. The international recommendation is that children continue to breastfeed through two years of age. This report examines the association between undernutrition and two major childhood diseasesacute respiratory infection (ARI) and diarrhea. Higher rates of ARI and diarrhea were expected among undernourished children. However, a weak association was found between undernutrition and the prevalence of ARI and diarrhea in children. Moreover, the results are not consistent across countries and regions. The results are more consistent for diarrhea than ARI, with higher rates of diarrhea among children who are wasted or underweight. To conclude, improved health services, water sources, and sanitation facilities, as well as immunizations, are important for the prevention and treatment of childhood illnesses and the improvement of the nutritional status of children. Policies and programs that impact basic and underlying social and economic influences should improve conditions that support chronic undernutrition. Although the developing regions of the world share similar problems related to poverty, there are significant country and regional differences in the prevalence of undernutrition and the factors that influence child nutritional status. Therefore, policies and program interventions need to be tailored to the needs of each country and region. This report provides country and regional comparative data that can be used for policymaking, program planning, and monitoring purposes.
xiv
Executive Summary
1
Introduction
hild malnutrition continues to be a major public health problem in developing countries around the world. This report presents data on the status of child nutrition in 41 countries included in the Demographic and Health Surveys (DHS) program between 1994 and 2001. DHS collects anthropometric and related data that enable a comparative exploration of key indicators that influence the nutritional status of children. Nutritional status is primarily determined by a childs growth in height and weight and is directly influenced by food intake and the occurrence of infections. Food intake is not only a result of food availability at the household level but also of dietary quality and quantity and feeding practices. Optimal infant feeding practices, which include breastfeeding and timely complementary feeding, contribute to the level of food intake in infants and young children (Brown et al., 1998). In addition, acute and chronic infections have a major impact on nutritional status because they impair growth by limiting macro- and micronutrient intake and utilization (Stephensen, 1999). Nutritional anthropometrythe measurement of size, weight, and proportions of the bodyprovides the primary indicators of past and present nutritional and health status of children. Anthropometric measures used in this report include weight, standing height, and recumbent length (used for children under two years of age). In combination, anthropometric indices can distinguish between stunting (low stature), wasting (thinness), and under- and overweight. Each indicator gives a different perspective on the nutritional status of children. Chronic (stunting) and acute (wasting) nutritional problems and general health and nutritional status (under- and overweight) can be assessed at the population level through these measures. The assessment of nutritional status is based on the rationale that in a well-nourished population, there are statistically predictable distributions of childrens height and weight at a given age. The variations in height and weight approximate a normal distribution. To examine differences in the anthropometric status of various populations and subpopulations, a standard reference population is used for comparison. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) recommend the international reference population that is based on the United States National Center for Health Statistics (NCHS) standard. The use of this reference population is based on the premise that young children of all population groups have similar genetic potential for growth. Each of the three indicators for undernutrition is expressed in standard deviations (Z-scores) from the mean of the reference population. Deviations of the indicators below -2 standard deviations (SD) indicate that the children are moderately or severely affected, while deviations below -3 SD indicate that the children are severely affected. The prevalence and severity of undernutrition among children age 0-35 months, regional differences, infant and under-five mortality, infant feeding patterns, and infectious diseases are reported here. In addition, important differentials in maternal and child demographic characteristics, child health care, and ma-
Introduction
ternal nutritional status are explored by child nutritional status. Basic and underlying social and economic differentials, including urban and rural residence, water and sanitation, mothers work status, and household flooring, are examined as proxies for household economic status.
Introduction
2
Data and Methods
Demographic and Health (DHS) is the Theorlds largest survey program,Surveysyears,nationally w collecting representative data on women age 15-49 men age 15-59 years, and children under 5 years of age. More than 160 surveys have been conducted in over 70 countries of sub-Saharan Africa, North Africa/West Asia/Europe, South/Southeast and Central Asia, and Latin America and the Caribbean. Some countries have conducted two or more surveys at intervals of three to six years. The United States Agency for International Development has provided most of the funding for these surveys. Because of funding priorities, surveys are conducted in selected countries. Data presented in this report are based on the results of surveys conducted in 41 countries between 1994 and 2001 (Table 2.1). Sub-Saharan Africa has the largest number of countries with completed surveys (23), followed by Latin America and the Caribbean (7), South/Southeast Asia (4) and North Africa/West Asia/Europe (4), and Central Asia (3). Since the data are not representative in all regions, this report can provide only limited comparisons within regions and suggested differences across regions. The main purpose of this report is to update information on the indicators of child nutrition in the developing regions of the world. In each country, information is collected at the household level and the individual level. At the household level, information is collected on basic characteristics of members of the household, structure of the dwelling, anthropometric measures of women and children, anemia testing of women and children, salt testing for iodization, and water supply and sanitation facilities, among others. The individual questionnaire for women allows for the collection of information on marriage, fertility, fertility preferences, family planning, infant and under-five mortality, maternal mortality, maternal and child health,
Table 2.1 Demographic and Health Surveys included in this report
Country Year of survey
Sub-Saharan Africa Benin Burkina Faso Cameroon Central African Republic Chad Comoros Cte dIvoire Eritrea Ethiopia Gabon Ghana Guinea Kenya Madagascar Malawi Mali Mozambique Niger Tanzania Togo Uganda Zambia Zimbabwe North Africa/West Asia/Europe Egypt Jordan Turkey Yemen Central Asia Kazakhstan Kyrgyz Republic Uzbekistan South/Southeast Asia Bangladesh Cambodia India Nepal Latin America/Caribbean Bolivia Brazil Colombia Dominican Republic Guatemala Haiti Peru
1996 1998-99 1998 1994-95 1996-97 1996 1994 1995 2000 2000 1998 1999 1998 1997 2000 1995-96 1997 1998 1999 1998 2000-01 1996 1999 2000 1997 1998 1997 1999 1997 1996 2000 2000 1998-99 1996 1998 1996 2000 1996 1998-99 2000 2000
Data and Methods
infant and young child feeding, childhood diseases, vaccinations, womens status, and womens attitudes and practices regarding the prevention of sexually transmitted diseases and HIV/AIDS. The indicators included in this report are shown in Table 2.2.
Table 2.2 DHS indicators used in this report
Key child survival and nutrition indicators x x Basic influences Underlying social and economic influences Underlying biological and behavioral influences Immediate influences
Indicator
Child survival Infant and under-5 mortality Contribution of malnutrition to mortality Nutritional status Malnutrition rates (stunting, wasting, underweight, and overweight) Age distribution of undernutrition Residence Urban-rural Education Maternal education Employment Maternal work status Household assets House flooring status Water sanitation Sanitation facilities Source of drinking water Maternal characteristics Maternal nutritional status Antenatal care Mothers age at delivery Child characteristics Size at birth Sex Birth order Preceding birth interval Feeding practices Vaccination history Recent illnesses
x x DIFFERENTIALS IN UNDERNUTRITION x x x x x x x x x x x x x x x x
Nutritional status indicators used in this report are based on anthropometric measurements of children. Vaccination data are derived from inspection of immunization cards or mothers reports for those children whose cards were not seen. Calculations for other health indicators are based on questions asked of mothers for each child. The infant and under-five mortality rates and demographic factors are derived from birth histories of the mothers interviewed.
2.1
Sample of Children
The sample comprises children born between the date of interview and three to six years preceding the survey in each country. All children in households selected to be surveyed were less than five years of age for most surveys and less than three years of age for some countries prior to 1996. For the countries surveyed since 1999, the children were under six years of age. To make the data comparable and to include as
Data and Methods
many countries as possible, analyses were carried out on data for children under three years of age at the time of the survey. The results are based on children for whom height and weight measurements were recorded. Sample sizes ranged from 354 in the 1999 DHS survey in Kazakhstan to 24,600 in the 1998-99 National Family Health Survey in India. The average sample size is about 3,500 children.
Data and Methods
3
Findings
hildren in developing countries make up a large proportion of the deaths among children under five years of age around the world. Infectious diseases such as acute respiratory infection, diarrhea, malaria, and measles account for over 50 percent of childhood deaths (UNICEF, 1998). Undernutrition compromises child health, making children susceptible to illness and death. This synergistic relationship between undernutrition and infection is widely recognized (Scrimshaw et al., 1968; Tomkins and Watson, 1993). Even if a child is mildly undernourished, the mortality risk is increased. Infant mortality (under-one-year rate) is commonly used as a measure of infant health and is a sensitive indicator of the socioeconomic conditions of a country. Under-five mortality is largely a result of infectious diseases and neonatal deaths in developing countries and is related to the availability and accessibility of health services (Mahy, 2003).
3.1
Infant and Under-Five Mortality
Although mortality among infants and children has decreased in most countries since the mid-1980s, the decline has recently slowed, stopped, or reversed itself in sub-Saharan Africa (Rutstein, 2000). All of the countries in Africa have infant mortality rates above 50 deaths per 1,000 live births (Table A.3.1 and Fig1 ure 3.1) . Infant mortality runs from 57 per 1,000 in Gabon and Ghana to 135 per 1,000 in Mozambique. Under-five mortality runs from 89 per 1,000 in Gabon to 274 per 1,000 in Niger (Table A.3.1). Countries in North Africa/West Asia/Europe have lower infant mortality rates than countries in subSaharan Africa. Jordan has the lowest rate in the region (29 per 1,000) and Yemen has the highest rate (75 per 1,000). Under-five mortality is also somewhat lower in this region than in sub-Saharan Africa, with Jordan again having the lowest rate (34 per 1,000) and Yemen having the highest rate (105 per 1,000) (Figure 3.1). Infant and child mortality rates vary considerably in the Latin America and the Caribbean region. Colombia has the lowest rates for both infant (21 per 1,000) and under-five mortality (25 per 1,000). Haiti has the highest rates for both infant and under-five mortality (80 and 119 per 1,000, respectively) (Figure 3.1). As a region, Central Asia has some of the lowest rates of infant and child mortality. Uzbekistan has an infant mortality rate of 49 per 1,000, and the Kyrgyz Republic and Kazakhstan have rates of 61 and 62 per 1,000, respectively. Unlike other regions, the infant and under-five mortality rates in Central Asia do not vary much across countries. Uzbekistan has the lowest rate of under-five mortality (59 per 1,000), and the Kyrgyz Republic has the highest rate (72 per 1,000) (Figure 3.1). South/Southeast Asia has rates similar to those at the lower end of the range in Africa. Bangladesh has the lowest infant mortality rate (66 per 1,000), and Cambodia has the highest rate (95 per 1,000). Under-
Tables mentioned in Chapters 3 and 4 are located in Appendix A.
Findings
8
Deaths per 1,000
Deaths per 1,000
100
120
140
100
150
200
250
300
20
40
60
80
50
North Africa/West Asia/ Europe Central Asia
Figure 3.1 Infant and Under-Five Mortality Rates, Demographic and Health Surveys, 1994-2001
five mortality rates run from a low of 94 per 1,000 in Bangladesh to a high of 124 per 1,000 in Cambodia (Figure 3.1).
Infant Mortality
South/ Southeast Asia Latin America/ Caribbean
Sub-Saharan Africa
Under-five Mortality
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Findings
3.2
Contribution of Undernutrition to Mortality
Undernutrition plays an important role in mortality. Almost 50 percent of all deaths among children are associated with undernutrition (Rice et al., 2000). Even if a child is only mildly undernourished, the mortality risk is increased. Because the prevalence of mild to moderate undernutrition is high, it contributes to a larger proportion of deaths than severe undernutrition. Table A.3.2 shows the contribution of undernutrition to under-five mortality based on the Pelletier model (Pelletier et al., 1994). In sub-Saharan Africa, undernutrition contributes substantially to under-five mortality, from 28 percent in Zimbabwe to 61 percent in Eritrea. Overall for the region, about 42 percent of early childhood deaths are related to undernutrition. As seen in Table A.3.2, the majority of this effect is not due to severe undernutrition as would be expected, but is mostly due to the effects of mild to moderate undernutrition. With only four countries represented in North Africa/West Asia/Europe the contribution of undernutrition to under-five mortality shows a wide mix, from a low of 9 percent in Egypt to a high of 56 percent in Yemen, demonstrating the broad differences in living standards among the countries in the region. In Central Asia there is a range of more than 20 percentage points between Kazakhstan (10 percent) and Uzbekistan (32 percent) in the contribution of undernutrition to under-five mortality. The Kyrgyz Republic is in between (18 percent). South/Southeast Asia is consistently high: undernutrition contributes to over half of all deaths among children under five years. Overall, India has the highest rate, with undernutrition contributing to 72 percent of under-five deaths. The Latin America and Caribbean region shows two patterns: in one group of countries, undernutrition contributes to 11 to 16 percent of under-five deaths, and in the second group, which is made up of Haiti and Guatemala, undernutrition contributes to 30 and 37 percent of under-five deaths, respectively.
3.3
Malnutrition Rates
3.3.1 Levels of Undernutrition DHS surveys indicate that high levels of undernutrition continue to exist among young children in all the countries represented (Table A.3.3). In 31 of the 41 countries, more than 20 percent of children are stunted (too short for their age). The median level of stunting across all countries is 30 percent, and 9 out of 41 countries have stunting rates higher than 40 percent. In sub-Saharan Africa, stunting prevalence ranges from 20 percent in Ghana to 48 percent in Madagascar. North Africa/West Asia/Europe has prevalence rates that vary from 7 percent in Jordan to 46 percent in Yemen. In Central Asia, stunting prevalence ranges from 10 percent in Kazakhstan to 31 percent in Uzbekistan. In South/Southeast Asia, the variation is not as wide: from 37 percent of children in Cambodia to 48 percent in Nepal. The Latin America and Caribbean region also shows a wide variation in stunting rates, from 10 percent in Brazil to 42 percent in Guatemala. 3.3.2 Patterns of Undernutrition Undernutrition (stunting and underweight) among young children is compared by region in Figure 3.2 and Table A.3.3. While patterns are discernible, comparisons between regions need to be viewed with caution because of the large number of African countries and the small number of countries in the other regions. Nevertheless, two patterns emerge. Sub-Saharan Africa and South/Southeast Asia, for the most part, have about equally high rates of stunting and underweight in most countries. Latin America and the Caribbean and Central Asia have rates of underweight that are about half the stunting rates in most countries. There is no discernible pattern in the North Africa/West Asia/Europe region, other than higher rates of stunting than underweight.
Findings
Figure 3.2 Levels of stunting and underweight among children age 0-35 months, Demographic and Health Surveys, 1994-2001
Sub-Saharan Africa
60 50
Percent
40 30 20 10 0
Percent
Stunted
Underweight
Figure 3.3 shows childrens levels of wasting, a measure of weight-for-height that is a seasonally affected indicator of current nutritional status. This indicator is influenced by illness, food availability, and feeding patterns. With lower rates of underweight accompanying moderately high rates of stunting, for the most part, children are short although not necessarily thin. However, Asian and African countries surveyed
10
Br in ic az il an 19 R 9 Co ep. 6 19 lo m bi 96 a 2 Pe 00 0 ru 20 Bo 00 liv ia G 19 ua H 9 te m aiti 8 al 20 a 1 9 00 98 -9 99
Eg yp t2 Jo rd 000 an 1 Tu rk 997 ey Ye 1 m 998 en 19 97 Ka za kh Ky s rg ta n yz 19 R 99 U zb ep ek . 1 9 is ta 97 n 19 96 Ca m b Ba od ng ia 2 la de 00 0 sh In 20 di 0 a 19 0 98 N ep -99 al 19 96
om
Zi abo m ba n 2 bw 00 e 0 Ke 19 9 Ca n m ya 9 C er 19 te oo 98 d n 1 U Ivo 99 ga ir 8 nd e 1 99 a 2 4 G 000 ha -0 na 1 To 199 8 g Za o 1 m 99 b 8 G ia 1 ui 99 Ce Co nea 6 nt ra Mo mo 199 l A za ro 9 s fr m bi 1 9 ic an qu 96 Re e 1 9 p. 1 97 M 99 a l 4aw 95 Be i 20 Bu Ta nin 00 rk nz 1 in an 99 a 6 Fa ia 1 so 99 Ch 199 9 ad 81 99 M 99 6 M al a d i 1 -97 ag 99 as 5-9 ca 6 Er r 1 99 it Et rea 7 hi 1 op 9 9 ia 5 N 20 ig 0 er 0 19 98
North Africa/ West Asia Europe
Central Asia
South/ Southeast Asia
Latin America/ Caribbean
60 50 40 30 20 10 0
Findings
Percent
U
10 15 20 25 30 0 5
Percent
Findings
G
10
12
14
16
18
0
North Africa/ West Asia/ Europe Central Asia
Jo rd an Tu 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 000 en 19 Ka 97 za kh Ky s rg ta n yz 19 R 99 U zb ep .1 ek 9 is ta 97 n 19 96
Sub-Saharan Africa
Figure 3.3 Levels of wasting among children age 0-35 months, Demographic and Health Surveys, 1994-2001
Ba Nep ng a la l 19 de 96 In s h 20 di Ca a 1 00 9 m bo 98di 99 a 20 00 Co lo m bi D a om 2 Pe 00 0 in ic ru an 2 Re 0 0 p. 0 19 Bo 9 liv ia 6 G 19 u a Br te az 98 il m 19 al a 9 19 6 98 H ai 99 ti 20 00
a ga bo nd n 2 a 0 2 0 Za 00 0 0Ca mb 0 m ia 1 er 1 9 Ce Ta oon 96 nt nz 19 ra an lA ia 98 fr Ke 19 ic an n 9 Re y a 9 p. 19 Zi m 1 9 98 M bab 94 a d w -9 ag e 5 as 199 ca 9 r M M oz a l 199 aw am 7 bi i 20 qu 00 C C om e 1 te oro 997 d s Iv 1 9 oi 9 G re 6 ui 19 ne 9 a 4 To 19 9 Et go 9 hi 19 op 98 G ia 2 ha 0 na 00 Be 19 ni 98 Bu n rk in Erit 199 a r Fa ea 6 so 19 Ch 19 95 ad 981 9 99 N 96ig 9 M er 7 a l 19 i 1 98 99 596
have short and thin children as a result of high rates of stunting and wasting. In countries with rates of underweight exceeding rates of stunting by more than 2 percent, there are exceptionally high (over 10 percent) rates of wasting. In these countries, there are probably many children who are very thin but not too short for their age (Table A.3.3).
11
3.3.3
Severity of Undernutrition
Tables A.3.4 through A.3.6 show the Z-score distributions for the indices of undernutritionstunting (height-for-age), wasting (weight-for-height), and underweight (weight-for-age)in all the countries surveyed. Figures 3.4 through 3.6 show the percentage of children with moderate undernutrition (Zscores of -2.01 to -3.00 SD from the mean) and severe undernutrition (Z-score below -3.00 SD) for stunting, wasting, and underweight, respectively. In most countries and in all regions, moderate stunting occurs at a higher rate than severe stunting. However, there is a difference of two percentage points or less between the rates of severe stunting and the rates of moderate stunting in 8 of 23 countries in subSaharan Africa, Yemen in North Africa/West Asia/Europe, and India in South/Southeast Asia. In 7 countries, severe stunting is 20 percent or higher. Table A.3.5 and Figure 3.5 show that moderate wasting is much more prevalent than severe wasting in all of the regions. A similar pattern is observed for underweight (Table A.3.6 and Figure 3.6), except that for underweight, the differences between severe and moderate are not so large. 3.3.4 Distribution of Z-scores
Providing another picture of childrens nutritional status, Figure 3.7 shows the distribution of the three Z-scores for selected countries in each region. Ethiopia, Ghana, Mali, and Zimbabwe were chosen as examples for sub-Saharan Africa. In these countries, all measures of undernutrition are shifted to the left of the normal curve; however, the degree of shift varies. In Ethiopia, the weight-for-age and height-for-age curves are shifted farther to the left than is the weight-for-height curve. Since the data indicate that the children are short and thin for their ages, it appears that for their heights their weights are not as skewed. Nevertheless, undernutrition is very serious; a large percentage of Ethiopian children are stunted and underweight. Zimbabwe has a bimodal distribution, with a group of children falling within the normal distribution, and another group with high rates of stunting, wasting, and underweight falling just to the left of the normal curve. Further investigation is required to determine the characteristics of these two groups of children. In North Africa/West Asia/Europe (Figure 3.7), curves for Egypt are similar to the normal curve, but the weight-for-height curve is skewed to the right, indicating a larger proportion of overweight children (A.3.7). Yemens curves are skewed to the left, showing higher levels of undernutrition for all measures.
12
Findings
Findings
Percent
G
Percent
ab o
10
15
20
25
30
10
15
20
25
30
0
G
5 0 5
Sub-Saharan Africa
Figure 3.4 Percentage of children age 0-35 months who are moderately stunted and severely stunted, Demographic and Health Surveys, 1994-2001
Severe
Moderate
Jo rd an 1 Tu rk 997 ey Eg 199 yp 8 Ye t 2 0 0 m en 0 19 97 Ka za kh s U zb ta n ek 19 is Ky 9 rg tan 9 yz 19 Re 9 p. 6 19 97 Ca m bo d In ia 2 di 00 Ba a ng 19 0 98 la de -9 sh 9 2 N ep 000 al 19 96 n ha 2 0 n 00 G a1 ui ne 998 a To 19 go 99 1 C Ma te li 1 998 d 99 5Iv Bu Zim oire 96 ba rk 19 in a bw 94 Fa e so 19 19 99 Be 989 n Ce Ch in 9 nt 19 a ra l A Ca d 1 96 f r me 996 ic an roo -97 Re n 1 p. 9 1 9 98 94 Ke ny -95 a M Er oz it 199 am rea 8 19 bi q Co ue 95 m 1 or 99 os 7 1 U Nig 99 ga er 6 nd 19 a 20 9 8 M a l 000 a Et wi 1 hi 20 op 0 Za ia 0 m 20 Ta bia 00 n M z a 199 a d ni 6 ag a 1 as 9 ca 99 r1 99 7
om
Br az il 1 Re 996 Co p. 19 lo m bi 96 a 20 H ai 0 0 ti 2 Pe 000 ru 20 Bo G ua 0 te livia 0 m 19 al 9 a 19 8 98 -9 9
in ic
an
13
14
Percent
G
Percent
10
12
14
16
10
12
14
16
0 0 2 4 6 8
Jo rd an Tu 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 000 en 19 Ka 97 za kh Ky rg sta n yz 19 R U 99 zb ep. ek 19 is ta 97 n 19 96
Sub-Saharan Africa
Figure 3.5 Percentage of children age 0-35 months who are moderately wasted and severely wasted, Demographic and Health Surveys, 1994-2001
Severe
Ba Nep ng a la l 19 Ca des 96 m h2 bo 00 d 0 In ia 2 di 00 a 19 0 98 -9 9
Moderate
Pe C r om olo u 2 in mb 0 00 ic an ia 2 Re 00 p. 0 G ua Bol 199 iv 6 te m ia 1 al 9 a 1 9 98 98 Br az -99 il 19 H ai 96 ti 20 00
U ab ga on nd 20 a 2 00 Za 0 0 0 Ca mb -01 ia m e 1 Zi roo 996 m ba n 1 bw 998 M K e oz en 199 am y a 9 19 bi Ce Ta que 98 nt nz ra a n 199 lA 7 fr M ia 1 ic an a la 999 Re wi 20 p Co . 19 00 9 M mo 4-9 a d ro s 5 C aga 19 96 t e sc d ar 19 Iv oi r 97 G e1 ui ne 9 94 a To 19 9 Et go 9 hi 19 op 98 G ia 2 ha 0 na 00 Be 19 ni 98 Bu rk E n in rit 19 9 r a Fa ea 6 s o 19 Ch 19 9 95 a d 819 99 N 96ig 97 M er a l 19 i 1 98 99 596
Findings
Findings
Percent
Zi m G ab o
Percent
10
15
20
25
30
35
10
15
20
25
30
35
Sub-Saharan Africa
Figure 3.6 Percentage of children age 0-35 months who are moderately underweight and severely underweight, Demographic and Health Surveys, 1994-2001
Severe
Moderate
Eg yp Jo t 2 0 rd 0 an 0 19 Tu 97 rk e Ye y 1 m 998 en 19 97 Ka za kh Ky s rg ta n yz 19 R 99 U zb ep. ek 19 is ta 97 n 19 96 Ca m bo d In ia 2 di 00 a 19 0 98 Ba Nep -9 ng al 9 1 la de 99 sh 6 20 00
om
Br in ic az il an 19 R 96 Co ep lo . 19 m bi 96 a 2 Pe 00 0 ru Bo 2 liv 0 00 ia G 19 ua H 98 a te m iti 20 al a 1 9 00 98 -9 9
ba n 2 bw 00 e 0 M 1 oz Ken 99 am y a 9 1 b Ca iqu 99 m e 8 19 C er te oo 97 n d Iv 1 9 9 o Co ire 8 m 19 or os 94 To 1 9 U ga go 96 nd 19 a 20 98 Za 0 m 0-0 bi Ce 1 nt G a1 ha 99 ra lA 6 n fr G a1 u ic an in 998 e Re a 1 p. 9 1 99 M 99 a l 4aw 95 Bu rk Be i 20 in 00 n a Fa in 1 so 9 Ta 19 96 nz 98 an -9 9 M ia 1 al 99 i Ch 199 9 ad 51 9 96 M Erit 96a d re 97 ag a as 19 9 Et ca r 5 hi 1 op 99 ia 7 N 20 ig 0 er 0 19 98
15
In Central Asia (Figure 3.7), Kazakhstans curves are close to the normal curve. In the Kyrgyz Republic, the weight-for-height curve is skewed to the right, indicating that there are children who are overweight, whereas the height-for-age and weight-for-age curves are skewed to the left, indicating stunting and underweight. South/Southeast Asia curves are widely skewed to the left, indicating high rates of undernutrition in both India and Cambodia (Figure 3.7). Curves for India are more skewed to the left than those for Cambodia, indicating higher rates of undernutrition in India than in Cambodia.
Figure 3.7 Distribution of height-for-age, weight-for-height, and weight-for-age Z-scores among children age 3-35 months, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
Percent 15
Ethiopia
Percent 15
Ghana
10
10
0 -6 -5 -4 -3 -2 -1 0
Z- sc or e
0 1 2 3 4 5 6 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
reference po pulatio n weight-fo r-height
height-fo r-age weight-fo r-age
reference populatio n weight-fo r-height
Percent 15
Mali
Percent 15
Zimbabwe
10
10
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
16
Findings
Figure 3.7 (continued) Distribution of height-for-age, weight-for-height, and weight-for-age Z-scores among children age 3-35 months, Demographic and Health Surveys, 1994-2001 North Africa/West Asia/Europe
Percent 15
Egypt
Percent 15
Yemen
10
10
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
0 -6 -5 -4 -3 -2 -1 0
Z- s c or e
Central Asia
Percent 15
Kazakhstan
Percent 15
Kyrgyz Republic
10
10
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
South/Southeast Asia
Percent 15
Cambodia
Percent 15
India
10
10
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
reference po pulatio n weight-fo r-height height-fo r-age weight-fo r-age
Findings
17
Figure 3.7 (continued) Distribution of height-for-age, weight-for-height, and weight-for-age Z-scores among children age 3-35 months, Demographic and Health Surveys, 1994-2001 Latin America/Caribbean
Percent 15
Haiti
15
Percent
Peru
10
10
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
0 -6 -5 -4 -3 -2 -1 0 1 2 3 4 5 6
In Latin America and the Caribbean (Figure 3.7), Peru has a high percentage of well-nourished children, as evidenced by a right-skewed curve for weight-for-height. However, there are high rates of stunting, with the height-for-age curve having its center between -1 and -2 SD. Weight-for-age is only slightly skewed to the left. Haitis curve differs from Perus in that the weight-for-height curve is very close to the normal curve, with a slight skewing to the left. Left-skewed curves in weight-for-age and weight-for-height indicate considerable prevalence of wasting and underweight in Haiti, whereas in Peru, there is a higher prevalence of stunting. 3.3.5 Age Distribution of Undernutrition Levels of undernutrition are shown for children age 0 to 35 months, by age group in Table A.3.7. The age groups are based on WHO recommendations for appropriate child feeding (Pan American Health Organization, 2003). Infants from birth through six months are expected to be exclusively breastfed (breast milk only, no other fluids or foods). Infants are recommended to begin eating solids (complementary foods) at around six months of age through nine months, with continued breastfeeding through two years of age and beyond while eating a nutritionally adequate diet. The infant feeding patterns indicate that the lowest rates of stunting, wasting, and underweight are found among children less than six months of age (Figures 3.8 through 3.10, respectively). The highest rates of stunting are observed among children over one year of age (i.e., age 13-24 months and/or 25 months or more) in all regions (Figure 3.8). In sub-Saharan Africa, the lowest rates of wasting are among children under six months of age, followed by those age 25 months or more. Wasting increases from the period of the introduction of solid foods (age six months) through the second year of life (Figure 3.9). This is probably due to higher rates of illness among children during this period. In Latin America and the Caribbean, the data show less striking differences in wasting patterns across age groups, except in Haiti where the pattern is similar to that of sub-Saharan Africa. The pattern is less consistent in the Asian regions. In most countries, children age 10-24 months have higher rates of wasting than other children, with the exception of Uzbekistan, where the rates are highest for children under 10 months of age. This may be due to differences in infant feeding patterns; however,
18
Findings
the data on infant feeding in Uzbekistan could not be analyzed because the sample of children was not comparable to the samples in other countries. Countries in North Africa/West Asia/Europe have patterns similar to those in Latin America and the Caribbean, except in Yemen, where the patterns are more like those in the countries of South/Southeast Asia and sub-Saharan Africa. Underweight patterns, by age of child, are similar to stunting patterns in most cases (Figure 3.10). Mean Z-scores for the three nutritional status indexes for children age 0-35 months are shown in Table A.3.8. The graphs in Figure 3.11 show the mean Z-scores for 12 selected countries. Since the number of cases at each age is small, a three-point moving average was calculated. The graphs show that in most countries, the prevalence of low weight-for-height reaches its nadir between 12 and 18 months and then finds a plateau through 36 months of age. On the other hand, low height-for-age increases rapidly from birth to 18 to 24 months. It then decreases and begins to level off between 24 and 30 months and further declines again after that. The weight-for-age graph usually falls between the wasting and stunting lines. For most countries in this report, all of the curves fall below a mean Z-score of 0. However in Egypt, Peru, and the Kyrgyz Republic, the weight-for-height lines are around or above a mean Z-score of 0. In Egypt and Peru, children start out with weight-for-height Z-scores around 0 (a little chubby). The Zscores decline a little with age but through 36 months of age stay clearly above 0 (Figure 3.11). Also in the Kyrgyz Republic, children start out a little heavy but lose their baby fat around six months when their weight-for-height Z-scores stabilize at a mean of about 0. 3.3.6 Levels of Overnutrition While undernutrition is the major concern in developing countries, childhood obesity is increasing worldwide. The prevalence of overweight (defined as a weight-for-height Z-score above 2 SD from the mean of the reference population) in children less than three years of age is particularly noticeable in the Latin America and the Caribbean countries, followed by countries in Central Asia and North Africa/West Asia/Europe (Table A.3.9 and Figure 3.12). The proportion of overweight children in sub-Saharan Africa ranges from a low of less than 1 percent in Niger and Eritrea to a high of 9 percent in Zimbabwe. In 13 of 23 countries in sub-Saharan Africa, less than 3 percent of children are overweight, and in only two countries is the rate over 5 percent. The countries in South/Southeast Asia have the lowest rates: in all four countries, less than 3 percent of the children surveyed are overweight. In Latin America and the Caribbean, the proportion overweight ranges from a low of 2 percent in Haiti to a high of 8 percent in Bolivia and Peru. In Central Asia, the rate ranges from 3 percent in Kazakhstan to 14 percent in Uzbekistan. In North Africa/West Asia/Europe, it ranges from 2 percent in Yemen to 13 percent in Egypt.
Findings
19
20
Percent 10 20 30 40 50 60 70 Percent 0 10 20 30 40 50 60 70 0
Tu rk
ey
Ky rg
19 98 rd an 19 97 Eg yp t2 Ye 00 m 0 en 19 97
Jo
North Africa/ West Asia/ Europe
Figure 3.8 Levels of stunting by childs age group, Demographic and Health Surveys, 1994-2001
0-5 Months
Central Asia
6-9 Months
Sub-Saharan Africa
10-12 Months
yz Re Ka p za 19 kh 97 st an Uz be 19 ki 99 st an 19 96 Ba ng la de sh Ca 20 m 00 bo di a 20 00 Ne pa l1 In 99 di 6 a 19 98 -9 9
13-24 Months
25 Months or more
Br az il 19 96 Pe ru Co 20 lo 00 m bi a 20 00 Do Ha m iti in ic 20 an 00 Re p 19 Bo 96 Gu liv at ia em 19 98 al a 19 98 -9 9
Gh an a 1 To 998 go Ga 19 bo 98 n Bu 20 Er rk 00 itr in ea a Fa 19 so 9 19 5 98 M -9 al Ca i 1 9 9 m 95 Ce er oo 96 nt ra n Co lA 19 m fr 98 or ic os an 19 Re 96 p 19 94 Ch -9 ad C 5 te 19 96 d Iv -9 oi Zi re 7 m 19 ba bw 94 e 19 Ni 99 ge r1 Gu 99 in ea 8 19 Ke 9 Ug nya 9 an 19 da 9 20 8 00 Be -0 1 ni n Ta 19 nz 96 an ia 19 Za 99 m bi a Et 1 hi op 996 ia 20 M M al 00 aw oz am i2 00 bi q 0 M a d ue 19 ag 97 as ca r1 99 7
Findings
Findings
Percent
Ca m
Percent
10
15
20
25
30
35
10
15
20
25
30
35
Jo rd an 19 Tu 97 rk ey 19 98 Eg yp t2 Ye 00 0 m en 19 97
Figure 3.9 Levels of wasting by childs age group, Demographic and Health Surveys, 1994-2001
0-5 Months
Central Asia
6-9 Months
Sub-Saharan Africa
10-12 Months
Ka za kh st Ky an rg 19 yz 99 Re Uz p be 19 97 ki st an 19 96 Ba ng la de sh 20 00 Ne pa Ca l1 m 99 bo 6 di a In 20 di 00 a 19 98 -9 9
13-24 Months
Co lo m
bi
Do m
25 Months or more
a 20 00 Pe ru in 20 ic an 00 Gu Re at em p 1 99 al 6 a 19 98 -9 Ha 9 iti 20 Bo 00 liv ia 19 98 Br az il 19 96
er oo n Za 1 m 998 U g a b ia nd 19 96 a 20 00 G -0 a M ad bon 1 Ce ag 2 M nt as 00 o 0 ra c l A zam ar b i 199 fr ic an que 7 19 Re 97 p 19 94 G h a -9 5 Ta na 19 nz C 98 an te i d a 1 99 Iv oi 9 Et re 1 hi 99 op 4 C o ia 20 m 0 or os 0 Ke 19 n y 96 M a1 9 al aw 98 i2 To 00 go 0 B e 199 8 ni n 19 Er 96 it re a 19 N 9 ig er 5 G 19 ui 98 n Bu C h ea 19 rk ad 9 in 19 9 a 96 Fa s -9 7 Zi o 1 9 m b a 98 -9 bw 9 M e 19 al i 1 99 99 596
21
22
Percent Percent
Jo r
10 20 30 40 50 60 70 0 10 20 30 40 50 60 70
da n
Gh a
19 97
Ky rg
Eg yp t2 00 Tu 0 rk ey 19 Ye 98 m en 19 97
Figure 3.10 Levels of underweight by childs age group, Demographic and Health Surveys, 1994-2001
0-5 Months
Central Asia
6-9 Months
Sub-Saharan Africa
10-12 Months
yz Re Ka p za 19 kh 97 st an Uz be 19 ki 99 st an 19 96 Ca m bo di Ba a ng 20 la 00 de sh 20 00 Ne pa l1 In 99 di 6 a 19 98 -9 9
13-24 Months
Br
25 Months or more
az il 19 96 Pe ru Co 20 lo 00 Do m bi m a in 20 ic an 00 Re p 19 Bo 96 Gu liv at ia em 19 98 al a 19 98 -9 Ha 9 iti 20 00
Zi na m 19 ba bw 98 e Ga 1 9 bo 99 Ca n m 20 er 00 oo n 19 Ke 9 Ug nya 8 an 19 da 9 20 8 00 Ce -0 To nt 1 ra Ta go lA 19 nz fr 98 a ic an nia 19 Re 99 p 19 94 Bu Za -9 rk m 5 bi in a a 19 Fa so 96 1 Ch 9 98 -9 ad C te 19 9 96 d Iv -9 M oi oz re 7 am 19 bi 94 q M a d ue 19 ag 97 as c Co ar 19 m 9 or os 7 19 Gu 96 in ea 19 M al aw 99 i2 Er itr 000 ea Et 19 hi 95 op ia 20 Be 00 ni n 19 Ni 96 ge r1 M 99 al 8 i1 99 596
Findings
Figure 3.11 Distribution of mean Z-scores for height-for-age, weight-for-height, and weight-for-age among children age 3-35 months, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
Ethiopia
Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Ethiopia Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Zimbabwe
Zimbabwe
Ghana Ghana Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age
Mali Mali
18 wt/ht
24
30 wt/age
36
North African/West Asia/Europe

Egypt Egypt Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Yemen Yemen
Findings
23
Figure 3.11 (continued) Distribution of mean Z-scores for height-for-age, weight-for-height, and weight-for-age among children age 3-35 months, Demographic and Health Surveys, 1994-2001
Kazakhstan Kazakhstan Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36
Central Asia
Mean Z-score 2 1 0 -1 -2 -3 0 6
Kyrgyz Republic Kyrgyz Republic
12 ht/age
18 wt/ht
24
30 wt/age
36
Cambodia Cambodia Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 India India
Latin America/Carribean
Haiti Haiti Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Mean Z-score 2 1 0 -1 -2 -3 0 6 12 ht/age 18 wt/ht 24 30 wt/age 36 Peru Peru
24
Findings
Findings
Percent
Percent 10 12 14 16
Ye m
10 12 14 16 0 2 4 6 8
0 2 4 6 8
en
Figure 3.12 Percentage of overweight (weight-for-height) children age 035 months, Demographic and Health Surveys, 1994-2001
North Africa/ West Asia/ Europe Central Asia South/ Southeast Asia Latin America/ Caribbean
Sub-Saharn Africa
Tu 1 rk 99 7 ey Jo 1 rd 99 an 8 Eg 19 yp 97 t2 00 Ka 0 za kh Ky s rg ta n yz 1 Re 999 U zb p ek 19 is ta 97 n 19 Ba 96 ng la de sh 2 N ep 000 In al 19 di Ca a 1 96 9 m bo 98di 99 a 20 00 D om in Ha ic an iti R 20 Co ep 01 . l G ua om 199 6 bi te a m 20 al 0 a 19 0 98 Br az -99 Bo il 1 liv 996 ia 1 Pe 99 ru 8 20 00
N ig e Er r 1 Bu it 9 rk rea 9 8 in 19 a 9 M 199 5 al 8i 1 99 9 Be 95 ni -96 n Co 1 te Tog 99 -d o 6 Iv 1 o 9 Ch ire 98 ad 19 9 Et 1 9 4 M hio 96ad p 9 ag ia 7 as 200 Ce ca 0 nt G r1 ra ha 9 lA T n 9 f r an a 1 7 za ic an n 998 Re ia 1 9 p 1 9 G 99 9 ui 4 U g ne -9 M and a 1 5 oz a 9 am 20 99 bi 00q 0 Za ue 1 m 19 Co bia 97 m or 199 6 o G s1 ab 9 o 9 M n2 6 al Ca a 00 m wi 0 er oo 200 n 0 K 1 Zi en 99 m ya 8 ba bw 199 e 8 19 99
25
3.4 Influences on the Nutritional Status of Children Adapting the United Nations Childrens Fund (UNICEF) framework for nutrition (Figure 3.13), this report examines influences on child nutritional status (UNICEF, 1998). Immediate influences that lead to undernutrition include infectious diseases and inadequate food intake. These factors reflect other underlying biological and behavioral factors as well as socioeconomic conditions at the household, community, and national levels. Food availability, access to health services, health-related behaviors, and the environment are supported by the political, economic, and ideological structures in a country. This section discusses the relationships of these various factors and their influence on the nutritional status of children. Area of residence (urban or rural) is a basic influence on child nutritional status. Underlying social and economic influences are represented by mothers education, house construction (flooring), water sources, sanitation facilities, and mothers work status. Underlying biological and behavioral influences include immunization status, maternal and child characteristics, and feeding patterns that are more proximate influences on child nutrition. Immediate influences on nutrition are represented by micronutrient status/supplementation and reporting of recent bouts of acute respiratory infection and diarrhea. Although many factors, including poverty, affect the nutritional status of children, the variables included in this report are those that were collected by the majority of the surveys. 3.4.1 Basic Influences Whether a child is undernourished is as much a consequence of factors at the national, regional, and community levels as it is a consequence of individual household conditions. 3.4.1.1 Urban-Rural Residence The classification of urban and rural places of residence is based on the definitions used by the national statistical offices in each country. Therefore, the size of towns and cities defined as urban may differ from one country to another. There are consistent differences in undernutrition based on residence (Table A.3.10). Although the magnitude of the difference varies in almost all countries, stunting is considerably more common in rural areas than in urban areas (Figure 3.14). Uzbekistan is the only country surveyed where stunting prevalence is slightly greater in urban areas than in rural areas.
26
Findings
Figure 3.13 Conceptual framework for child nutritional status
Findings
27
28
Percent
G
Percent
10 0
20
30
40
50
60
10
20
30
40
50
60
Sub-Saharan Africa
Figure 3.14 Levels of stunting by urban-rural residence, Demographic and Health Surveys, 1994-2001
Urban
Rural
Jo rd an 1 Tu rk 997 ey Eg 199 8 yp Ye t 2 0 0 m en 0 19 97 Ka za kh st Ky rg a n 1 yz Re 999 U zb p 19 ek 97 is ta n 19 96 Ca m b Ba od ng ia 2 la de 00 0 sh In 20 di 0 a 19 0 98 N ep -99 al D 19 om 96 in ic an R Co ep 19 lo m 96 bi a 20 Br 00 az il 19 H ai 96 t Bo i 20 0 liv ia 0 19 G ua 98 Pe te m ru 2 al 00 a 19 0 98 -9 9 ha na To 199 8 g G o1 ui 99 ne 8 G a 19 ab on 99 Be 2 0 0 Zi m nin 0 ba 19 Co bw 96 te d' e 1 99 Iv 9 Bu Cam oir e1 rk er in oo 994 a Fa n 1 so 9 19 98 98 Ke ny -99 M a1 al 99 i Co 19 8 95 m o U ga ro 96 nd s 1 99 a Ce C 20 6 nt ha 00 d A 1 01 fr Re 996 M -9 oz p am 19 7 94 bi qu -95 e Er 19 it 9 Ta rea 7 nz 19 an 95 ia N 199 ig 9 Za er 1 m 99 b Et ia 8 1 hi op 99 ia 6 M 20 a M a d law 00 ag i 2 0 as ca 00 r1 99 7
Findings
Wasting is also more common in rural areas than in urban areas in most countries (Figure 3.15). In sub-Saharan Africa, two countries have a higher prevalence of wasting in urban areas than in rural areas: Mozambique (10 percent in urban areas and 7 percent in rural areas) and Comoros (10 percent in urban areas and 8 percent in rural areas) (Table A.3.10). In 5 of the 23 countries in sub-Saharan Africa, urbanrural differences are minimal or nonexistent. In Latin America and the Caribbean, the urban-rural difference in prevalence of wasting is generally small. In Haiti, which has the highest prevalence of wasting in the region (6 percent), wasting is higher in urban areas than in rural areas. In the other three regions, the prevalence of wasting is higher in rural areas than in urban areas of all countries except Kazakhstan and the Kyrgyz Republic. As with stunting, in most countries, the prevalence of underweight is higher in rural areas than in urban areas (Figure 3.16). In 14 of the 23 countries in sub-Saharan Africa, the urban-rural difference is over 10 percentage points, with Malawi and Niger having almost a 20 percentage point difference. Comoros is the only country in sub-Saharan Africa where the rates of underweight are about the same in urban and rural areas. Among other regions, the urban-rural differential in percent underweight is particularly noticeable for Nepal in South/Southeast Asia region and Guatemala and Peru in Latin America and the Caribbean. Kazakhstan is the only country where percent underweight is higher in urban areas than in rural areas. The reasons for the urban-rural differences in undernutrition may be due to differences in some of the more proximate influences. Improved accessibility to food (in and out of season) and health care in urban areas may explain some of these differences. In addition, differences in womens education, availability of water and sanitary facilities, socioeconomic status, womens decisionmaking power, access and utilization of antenatal and delivery care, as well as differences in quality of complementary feeding and immunization rates all contribute to improved nutritional status of urban children (Smith et al., 2004). 3.4.2 Underlying Social and Economic Influences The following variables are proxies for social and economic influences on child undernutrition: mothers education and work status, house flooring, sanitation facilities and source of drinking water. Mothers education may indicate the economic level, but it also demonstrates a mothers knowledge level and ability to adequately care for her child. A mothers work status may also indicate her economic level. House flooring, sanitation facilities, and source of drinking water reflect household living conditions and thus suggest economic influences beyond cash availability. In addition, these conditions reflect environmental conditions that may influence illness and undernutrition. A recently developed wealth index may better represent underlying social and economic influences on child nutrition in future comparative analyses (Rutstein and Johnson, 2004). In addition, multivariate analyses of the determinants of undernutrition would provide better insights into the relative importance of these influences.
Findings
29
30
Percent
U G
Percent
10
15
20
25
10
15
20
25
0 0 5
Sub-Saharan Africa
Figure 3.15 Levels of wasting by urban-rural residence, Demographic and Health Surveys, 1994-2001
Urban
Rural
Jo rd an 1 Tu rk 997 ey Eg 199 8 yp Ye t 2 0 0 m en 0 19 97 Ka za k Ky hst rg a n 1 yz Re 999 U zb p ek 19 is 97 ta n 19 96 Ba ng la de sh 2 N ep 000 al In 19 di 9 a Ca 19 6 98 m bo di 99 a 20 00 Co lo m bi a D 2 om Pe 00 0 in ru ic an 20 00 Re p 19 Bo liv 96 ia 1 G ua Bra 99 8 te zi l1 m al 99 a 19 6 98 H ai 99 ti 20 00 a ga bon nd 20 a 2 00 Za 00 m 0-0 Ca b 1 m ia er 19 oo 96 T n M anz 1 oz an 998 am ia bi 19 qu 99 e Ke 19 ny 97 Co a 1 m or 99 os 8 M 19 M a Ce a d law 96 ag i nt 2 A as c 00 fr ar 0 R Co ep 199 7 1 te d' 99 4 Iv -9 Zi oi 5 m r ba e 1 99 bw 4 G e1 ui 99 ne 9 a To 19 9 Et go 9 19 hi op 98 i G a2 ha 00 na 0 Be 19 ni 98 Bu n rk Er 19 in i a t re 96 a Fa so 19 19 95 Ch 9 ad 81 9 99 96 N ig -97 er M a l 19 i 1 98 99 596
Findings
Findings
Percent Percent 0 10 20 30 40 50 60
Zi m
10
20
30
40
50
60
Sub-Saharan Africa
Figure 3.16 Levels of underweight by urban-rural residence, Demographic and Health Surveys, 1994-2001
Urban
Rural
Eg yp t2 Jo rd 000 an 19 Tu 9 rk ey 7 Ye 19 m 9 en 8 19 97 Ka za k Ky hst rg a n 1 yz Re 999 U zb p ek 19 97 is ta n 19 96 Ca m b Ba od ia ng 2 la de 00 0 sh 2 N ep 000 al In 19 di 9 a 19 6 98 -9 9 Co D lo om m bi in ic an a 20 Re 0 0 p 19 Br 96 az il 1 Pe 996 ru 20 Bo 0 liv ia 0 19 G ua H 98 a te m iti 2 al 00 a 19 0 98 -9 9
ba bw G e1 ab 99 on 9 2 K Ca eny 000 m a 19 er U ga oon 98 nd 19 a 9 Co 20 8 m 00or 0 os 1 G 19 ui ne 96 G a 19 Co h te ana 99 d' Iv 199 oi re 8 M To 199 oz am go 4 bi 1 9 qu 98 Za e 1 9 m bi 97 Ce M a1 nt A a la 996 fr w Re i 2 0 p 19 01 94 Be -9 Ta nin 5 nz 19 96 Bu an rk ia 19 in a 9 Ch 199 9 ad 8M ad 1 99 ag 99 as 6-9 c 7 M ar 1 al 99 i Et 199 7 hi op 5-9 ia 6 Er 20 it re 00 a 1 N ig 9 95 er 19 98
31
3.4.2.1 Mothers Education Mothers education is defined as the highest level of schooling attended, but not necessarily completed. The three levels are no education, primary, and secondary or more (Table A.3.11). As expected, there is an inverse relationship between the mothers education and child undernutrition across all regions. The higher the level of education, the lower the prevalences of childhood stunting and underweight (Figures 3.17 and 3.19, respectively). Wasting does not have this universal response (Figure 3.18). For example, in Mozambique, children of mothers with secondary or higher levels of education are more likely to be wasted than children of less-educated mothers. The Central Asian countries are not included because there is no variability in mothers education: almost all of the mothers fall into the secondary and higher level of education.
Figure 3.17 Levels of stunting among children age 0-35 months by mothers education, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
60 50 40 Percent
G
30 20 10 0
n ha 2 00 na 0 G ui 19 ne 98 a To 199 go 9 Co Be 1 9 ni 98 Bu te n rk d'Iv 19 in a oire 96 Fa so 199 4 1 M 998 al -9 Zi i m 19 9 ba 95 -9 b Ce C we 6 n t ha 19 d A 1 99 fr Re 996 -9 p Co 19 7 94 m Ca oro -95 m s er 1 9 o U 9 ga on 6 19 M nd oz a 9 am 20 8 00 bi -0 q Ta ue 1 nz 1 an 997 ia 19 Er it re 99 a 1 N ig 9 95 er Ke 19 9 n Et y a 8 hi 19 op 98 Za ia 2 00 m M a d bi 0 ag a 1 99 as 6 ca r M a l 199 aw 7 i2 00 0 G
ab o

60 50 40 Percent 30 20 10 0
No Education
Primary
32
Br az il 19 96 Re p 19 96 H ai ti Co 20 lo 00 m bi a 20 00 Bo liv ia 19 98 Pe G ua ru te 20 m 00 al a 19 98 -9 9 om in ic an
19 97
20 00 Tu rk ey 19 98
bo di Ba a 20 ng 00 la de sh 20 00 N ep al 19 In 96 di a 19 98 -9 9
Jo rd an
Eg yp t
Ca m
Secondary or higher
Findings
Findings
Percent Percent 10 15 20 25 30 0 5
U
10
15
20
25
30
19 97 Tu rk ey 19 98
Jo rd an
Ba ng la
Figure 3.18 Levels of wasting among children age 0-35 months by mothers education, Demographic and Health Surveys, 1994-2001
No Education
Re p 19 96 19 98 20 00 liv ia Pe ru
ep al 19 96 de sh 20 In 00 di a 19 98 Ca -9 m 9 bo di a 20 00
om
Sub-Saharan Africa
Primary
in ic an
Bo
Co
Secondary or higher
bi ua a 20 te m 00 al a 19 98 -9 9 Br az il 19 96 H ai ti 20 00
lo m
G a ga bon nd 20 M a d a 2 00 00 M aga 0o 0 s Ce z am ca r 1 nt 19 bi qu 97 A fr Re e 1 Ca p 1 997 9 m er 9 4oo 95 Za n 1 m 99 C o b ia 8 19 m o 9 Ta ros 6 nz 19 an 96 i M a1 Co a 9 te law 99 i2 d' Iv oi 000 re Ke 19 Zi ny 94 m ba a 1 bw 99 8 G e1 ui 99 n 9 Et ea hi 1 op 99 ia 9 To 200 go 0 Be 1 9 ni 98 n G ha 199 na 6 Bu rk E 19 in rit re 98 a a Fa so 19 19 95 Ch 9 ad 8-9 19 9 96 N ig -97 er M a l 19 i 1 98 99 596
33
34
Percent
Co te bo n
Ga
Percent 10 20 30 40 50 60 0
10
20
30
40
50
60
Jo rd an 19 97 Tu rk ey 19 98
Zi
d'
Ivo
Ca m bo d ia
20 00 ep al Ba 19 ng 96 la de sh 20 In 00 di a 19 98 -9 9 N
Figure 3.19 Levels of underweight among children age 0-35 months by mothers education, Demographic and Health Surveys, 1994-2001
No Education
Sub-Saharan Africa
Primary
Co lo m bi a 20 00 19 96 99 6 in ic an Re p H Br az il 1
om
Secondary or higher
ai ti 20 00 Bo liv ia 19 98 Pe G ua ru te 20 m 00 al a 19 98 -9 9
20 ir 0 0 ba e 1 b w 99 4 Gu e 1 in 9 9 9 C o ea 1 m o r 99 os 9 To 1 9 g 96 G o1 M o z h a 998 am n a bi 199 qu 8 e B e 19 Ug n i 97 Ce n a nt nd 19 a 9 Af r R 20 0 6 ep 0- 0 1 1 M 99 a l 495 a Za wi 2 m 00 bi a 0 Ke 19 n y 96 Ta nz a 1 C a an 998 Bu m ia rk 1 er in o o 999 a Fa n 1 99 so 8 M 19 9 a l 8i 9 C h 199 9 M ad 5- 9 ad 1 6 ag 99 as 6- 9 ca 7 E r r 19 it r 9 E t ea 7 hi 19 op 9 ia 5 N i 20 g e 00 r1 99 8
Findings
3.4.2.2 Mothers Work Status In each survey, women were asked, Aside from your own housework, are you currently working? In 20 of the 23 countries surveyed in sub-Saharan Africa, 40 percent or more women of reproductive age (15-49 years) reported that they were currently working (Mukuria et al., 2005). This report finds that mothers work status has an impact on the nutritional status of children. For most countries, undernutrition is higher among children of working mothers than children whose mothers are not working (Table A.3.12). This may be due to the high poverty rates in these countries, which are reflected in womens need to work and its relationship to childrens nutritional status. However, if poverty is the major influencing factor, it may also affect the quality of alternative child care that a working mother is able to access. Other research has found that the characteristics of the caregiver have a stronger influence on child nutritional status when socioeconomic factors are controlled (Begin et al., 1998). When mothers work outside of the home, having inadequate alternative child care has a negative impact on child nutritional status (Lamontagne et al., 1998). In 15 of the 23 countries surveyed in sub-Saharan Africa, there were higher rates of stunting among children whose mothers worked than among those whose mothers did not work (Figure 3.20). This is consistent with previous research that found children of working mothers had a significantly lower height-for-age Z-score (stunting) than children of nonworking mothers (Toyama et al., 2001). However, the types of work in which mothers were engaged differentiated between the poverty avoiders, who worked in the informal sector, and the income enhancers, who worked in the formal sector. The real influence of mothers work on the nutritional status of her child was related to the type of work she did, which reflected her economic status.
Findings
35
36
Percent Percent 10 0 20 30 40 50 60 10 20 30 40 50 60 0
Sub-Saharan Africa
Figure 3.20 Levels of stunting among children age 0-35 months by mothers work status, Demographic and Health Surveys, 1994-2001
Not working
Jo rd an 1 Tu rk 997 ey Eg 199 yp 8 t2 Ye 00 m en 0 19 97 Ka za kh st Ky rg a n 19 yz 99 Re U zb p ek 19 is ta 97 n 19 96 Ca m bo di a N 200 ep Ba 0 a ng la l 19 de 9 sh 6 In 20 di 0 a 19 0 98 -9 9
Working
Co
Br az il om lom 199 6 bi in a ic an 20 Re 0 0 p 1 Pe 996 ru 20 H 00 ai t G Bo i 20 ua 0 te livia 0 m 19 al a 9 19 8 98 -9 9
Be ni n G ha 199 na 6 19 C Gu te ine 98 a d 1 Iv oi 999 re G ab 199 on 4 Ce nt T 2 ra Ca og 000 lA o m 1 fr ic ero 99 an on 8 Re 1 Zi p 1 998 m ba 994 -9 b Ta we 5 nz 19 an 9 Bu ia 9 rk Ma 19 in a li 1 99 Fa 99 so 519 96 M Ke 98 -9 oz n am y a 9 1 U biq 998 ga ue nd 19 a 9 Co 20 7 m 00or 0 Ch os 1 ad 1 9 1 96 Za 996 m bi 97 a Er 19 it re 96 a M Ni 19 9 a d ge 5 ag r 1 99 as ca 8 r M a l 199 a Et wi 7 hi 2 op 00 ia 0 20 00
Findings
There is no one discernible relationship between wasting and mothers work status in sub-Saharan countries. There were almost as many countries (9 of 23) with higher rates of wasting among children of women who worked as there were countries (10 of 23) with higher rates of wasting among children of women who did not work. Six countries had about equal rates of wasting among children of mothers who worked and mothers who did not work (Table A.3.12 and Figure 3.21). As with stunting, underweight rates were higher among children of working mothers in 14 of 23 countries (Table A.3.12 and Figure 3.22).
Figure 3.21 Levels of wasting among children age 0-35 months by mothers work status, Demographic and Health Surveys, 1994-2001
25
Sub-Saharan Africa
20
Percent
15 10
0
Ca n Ce m 2 er nt oo 000 U ra l A ga n 19 f r nd a ic 9 an 20 8 Re 00 -0 p 1 1 Za 994 m -9 Zi bi 5 m a ba 19 bw 96 e Ke 19 M 99 a d ny ag a 1 9 as ca 98 r1 M a C 9 te law 97 i2 d Iv 00 o Co ire 0 1 m M oz or 994 am os bi 1 99 q Ta ue 6 nz 1 an 997 ia G ui 199 n 9 Et ea 1 hi 99 op 9 ia G 20 ha 0 na 0 19 To 9 go 8 Bu 19 rk Be 98 in n a Fa in 1 99 so 19 6 98 Er -9 it 9 r Ch ea ad 19 1 9 95 96 N ig -97 er M a l 199 i1 8 99 596
ab o
25
Central Asia
20
Percent
15 10
0
Ka za kh st Ky an rg 19 yz 99 Re U zb p 19 ek 97 is ta n 19 96 Jo rd an 19 Tu 97 rk ey Eg 199 8 yp t2 Ye 00 m en 0 19 97 N ep Ba al ng 19 la 96 de sh Ca m 20 bo 00 di a In 20 di 0 a 19 0 98 -9 9 Co lo m bi a 20 00 Pe ru D 20 om Bo 00 liv in ia ic 19 an 98 Re p 19 G 96 ua Bra zi te l1 m 99 al a 19 6 98 -9 H 9 ai ti 20 00
Not working
Working
Findings
37
38
Percent Percent
G
10 10 20 30 40 50 60 0
20
30
40
50
60
Sub-Saharan Africa
Figure 3.22 Levels of underweight among children age 0-35 months by mothers work status, Demographic and Health Surveys, 1994-2001
Not working
Eg yp t2 Jo rd 000 an 19 Tu 9 rk ey 7 Ye 19 m 9 en 8 19 97 Ka za kh st Ky rg a n 19 yz 99 Re U zb p ek 19 is ta 97 n 19 96 Ca m bo di a 20 N 00 ep al In 19 d 96 Ba ia ng 19 98 la de -99 sh 20 00
Working
Br az il 1 Pe 996 Co ru D om lom 20 bi 00 in a ic an 20 Re 0 0 p Bo 19 liv 96 ia 19 G ua H ai 98 te ti m 20 al 0 a 19 0 98 -9 9
Zi abo m ba n 2 Ca bw 000 Ce e m nt 1 er ra U o 99 l A ga on 9 19 f r nd ic an a 2 98 00 Re 0p 1 9 01 9 M K oz en 4-9 am ya 5 19 C bi te qu 98 e d Iv 199 oi 7 Za re 1 m 99 bi 4 G a1 ha 99 6 n G a1 ui 99 ne 8 a Be 19 99 ni n To 199 6 g M o1 al 99 Ta aw 8 nz i 2 0 a Bu C nia 00 rk om 19 in or 99 a Fa os 1 so 99 M ad 6 1 ag 998 as -9 Ch ca r 9 ad 19 97 1 M 99 6al 9 i Et 199 7 hi 5op 9 ia 6 Er 20 it re 00 a 1 N ig 9 95 er 19 98
Findings
In six of seven countries surveyed in Latin America and the Caribbean, over 40 percent of women surveyed reported that they were working (Mukuria et al., 2005). Only two countries, Peru and Bolivia, have slightly higher rates of stunting (Figure 3.20) among children of working mothers than among children of nonworking mothers. In five of seven countries, wasting rates are about the same, regardless of whether the mother worked or not (Figure 3.21); and in five of seven countries, rates of underweight are slightly higher among children of mothers who do not work compared with children whose mothers do work (Figure 3.22). Other factors may be involved in the patterns observed in the Latin America and Caribbean countries. For example, poor women may not have the education or skills needed to obtain work outside of the home. In the Central Asia region, around 40 percent of women surveyed reported that they were working (Mukuria et al., 2005). In two of the three countries, the Kyrgyz Republic and Uzbekistan, higher rates of stunting exist among children of working mothers, compared with children of nonworking mothers (Figure 3.20). In the same two countries, however, children of nonworking mothers have a higher rate of wasting than children of working mothers (Figure 3.21). There are only slightly different rates of underweight among the children of working mothers and nonworking mothers (Figure 3.22). Kazakhstan rates contrast directly with those of the other two countries on all three measures of undernutrition, and the rates of undernutrition are much lower in Kazakhstan than in any of the other countries surveyed in Central Asia. In the South/Southeast Asia region, all indicators point to higher rates of undernutrition among children whose mothers work than among those whose mothers do not, except in Bangladesh, where wasting rates are about the same, regardless of the mothers work status (Figures 3.20 through 3.22). In this region, the proportion of women who reported themselves as working varies widely from 23 to 77 percent (Mukuria et al., 2005). In North Africa/West Asia/Europe, the rates of stunting, wasting, and underweight do not vary much by mothers work status in most cases, except in Turkey and Yemen, where wasting is more prevalent among children of nonworking mothers than children of working mothers. 3.4.2.3 House Flooring Status In this study, the type of flooring of the residence serves as a proxy for household economic level (Table A.3.13). To explore the relationship between this variable and child nutritional status, the study categorized flooring into two groups: finished flooring and unfinished flooring, the latter being rudimentary and natural flooring. The data on flooring status are not available for India, and Jordan has fewer than 25 cases of unfinished flooring, so the percentages are suppressed (Figures 3.23 through 3.25). As expected, stunting rates are higher among children who live in households with unfinished flooring than among those who live in households with finished flooring. Wasting rates present a less consistent pattern. In sub-Saharan Africa, 19 of the 23 countries have higher rates of wasting among children who live in households with unfinished flooring than among children who live in households with finished flooring.
Findings
39
40
Percent
Percent
10
20
30
40
50
60
10
20
30
40
50
60
Tu rk ey Eg 19 yp 98 Ye t 2 m 00 en 0 19 97
K Ky az rg ak yz hs Re ta n p 19 U ub zb lic 99 ek 19 is ta 97 n 19 96
Central Asia
Sub-Saharan Africa
Figure 3.23 Levels of stunting among children age 0-35 months by flooring status, Demographic and Health Surveys, 1994-2001
Finished
Ca m Ba bo ng dia la 2 de 00 sh 0 2 N ep 00 al 0 19 96
Unfinished
Br az il om 1 Pe 99 in ic ru 6 an 20 Co Rep 00 lo m 199 bi 6 a H 200 ai ti 0 G 2 ua B o liv 000 te m ia 19 al a 1 9 98 98 -9 9
G a G bo ha n 20 n Ta a 19 00 nz 98 an /9 ia 9 1 M 99 al 9 i1 To 99 g G o1 6 ui ne 998 a M Ke 19 oz ny 99 am Co b a 1 te iqu 998 d' e 1 Ca Ivo 99 m ire 7 er 1 oo 99 n 4 1 B Zi en 998 m in ba 1 bw 99 e 6 Bu Er 1 rk it re 999 in a a F 19 Co a so 95 m or 199 os 9 Ch 1 9 9 U ad 6 ga 1 n 99 Et da 7 hi 2 op 00 ia 0 2 CA 00 Za R 0 m 19 94 b M ia 1 al 99 aw 6 i M N 20 a d ig 0 ag er 0 as 19 ca 9 8 r1 99 7
Findings
In the Latin America and Caribbean region, which has some of the lowest wasting rates of all the regions, higher rates of wasting are also evidenced among children living in households with unfinished flooring in all countries except Haiti, where the rate of wasting is slightly higher among those who live in households with a finished floors. Most countries in the North Africa/West Asia/Europe region have the same pattern, except Turkey, where the wasting rate is higher among children living in households with finished flooring. Unexpectedly, Kazakhstan in Central Asia, and Cambodia in South/Southeast Asia have higher rates of wasting among children living in households with finished flooring than unfinished flooring (Table A.3.13). It should be noted that in this region a large percentage of households have flooring made of wood planks. For this analysis, wood planks are included in natural flooring.
Figure 3.24 Levels of wasting among children age 0-35 months by flooring status, Demographic and Health Surveys, 1994-2001 Sub-Saharan Sub-Saharan Africa
25 20
Africa
Percent
15 10
5 0
Percent
Re pu bl Ka ic za 19 kh 97 st U an zb 19 ek 99 is ta n 19 96
N ep Ba al ng 19 la 96 de sh Ca m 20 bo 00 di a 20 00
Ky rg yz
Finished
Unfinished
Findings
om
20 00 bi in a ic 20 an Re 0 0 p 19 Bo 96 liv ia 19 Br 98 a G ua z il 19 te 96 m al a 19 99 H ai ti 20 00 lo m
Tu rk ey 19 Eg 98 yp t2 Ye 00 m 0 en 19 97
Co
Pe ru
ga nd a 2 G ab 000 on Ca m 20 er oo 00 n 19 Za 98 m bi a 19 CA 96 R Ke 199 M 4 ny ad a ag 19 98 as c Co a r 1 99 m or 7 os 19 M al 96 aw Zi m i2 ba 0 bw 00 e Ta 19 nz 99 Co an te ia d' 19 Iv M 99 oi oz am re 1 9 bi qu 94 e Et 19 hi 97 op ia 20 Er 00 it re a 19 Ch 95 ad 19 G ui 97 ne a 19 Be 99 ni n 19 To 9 go 6 G ha 19 na 98 19 98 /9 N Bu 9 ig rk er in 19 a 98 Fa so 19 99 M al i1 99 6
North Africa/ North Africa/ West Asia/ West Asia/ Europe Europe
25 20 15
Central Central Asia Asia
South/ South/ Southeast Southeast Asia Asia
Latin America/ Latin America/ Caribbean

Caribbean
10 5 0
41
The pattern of underweight by household flooring status is similar to that of stunting, with higher rates of underweight among children who live in households with unfinished flooring than children who live in households with finished flooring, except in Turkey and Kazakhstan. In Turkey, there is small difference in rates of underweight by flooring status; whereas in Kazakhstan, the rate of underweight is slightly higher among children who live in households with finished flooring than among children who live in households with unfinished floors. The latter may be a reflection of the higher rates of underweight among children living in urban areas than in rural areas of this country (Figure 3.25).
Figure 3.25 Levels of underweight among children age 0-35 months by flooring status, Demographic and Health Surveys, 1994-2001
Sub-Saharan Africa Sub-Saharan Africa

60 50 40 Percent 30 20 10 0
Percent
Re pu bl Ka ic za 19 kh 97 st U an zb 19 ek 99 is ta n 19 96
ia 20 ep 0 0 Ba al ng 19 la 96 de sh 20 00
Ky rg yz
Finished
Unfinished
42
om
20 Br 00 az in il ic 19 an 96 Re p 19 Bo 96 li Co via 19 lo m 98 bi a 20 00 H ai G ti ua 20 te 00 m al a 19 99
bo d
Ca m
Pe ru
ab on Zi m ba 2 0 bw 00 e Ke 199 9 ny a 19 M al 9 aw 8 i2 U ga 00 Ca nda 0 m 20 er M oo 00 oz n am 19 bi qu 98 e 19 Za 97 m bi a Co 19 m 9 or os 6 19 C A 96 R Ta 19 nz 94 Co an ia te 19 d' Iv 99 oi re 19 G ui ne 94 G a ha 19 na 99 19 98 /9 To go 9 19 Be 98 ni n Et 19 hi 96 op ia 20 Er 00 it re a 19 Bu 95 M al rk i1 in a 99 Fa 6 so 19 Ch 9 M ad 9 ad 19 ag 97 as ca r1 99 N ig 7 er 19 98

60 50 40 30 20 10 0
Central Asia
Findings
3.4.2.4 Sanitation Facilities Diarrhea and parasitic infections, particularly intestinal helminthic infections (hookworms and roundworms), are extremely prevalent in children living in poor sanitary conditions. In undernourished children, deworming leads to improvements in growth. DHS surveys do not collect data on these parasitic conditions, but all surveys collect information on water and sanitation. There are plans to collect deworming information in future surveys. The type of sanitation facility a household has reflects its economic status, and poor households are less likely to have adequate toilet facilities. Inadequate sanitation facilities result in an increased risk of diarrheal disease, which contributes to undernutrition. According to the WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation, sanitation technologies consist of two categories: improved and unimproved. Improved sanitation facilities include connection to a public sewer system or septic system, simple and improved pit latrines, and pour-flush pit latrines. Unimproved facilities include latrines that are manually removed, public latrines and open latrines. In this report, no facility is included in the unimproved category (WHO and UNICEF, 2000). According to the DHS data, infants and young children from households with unimproved sanitation facilities are at greater risk of being undernourished than are children from households with improved facilities (Table A.3.14). Children age 0-35 months living in households with unimproved toilet facilities are more likely to be stunted in all the countries surveyed, except Madagascar, where the prevalence of stunting is higher among children living in households with improved sanitation facilities (Figure 3.26). The pattern is less consistent for wasting (Figure 3.27). In 17 of 22 sub-Saharan countriesComoros was not included because there were fewer than 25 cases in the unimproved categorythere are higher rates of wasting among those who live in households with unimproved facilities. However, in two countries (Mozambique and Zimbabwe) there is almost no difference, and in three countries (Ghana, Tanzania, and Gabon) there are slightly higher rates of wasting among children living in households with improved facilities. In most countries of North Africa/West Asia/Europe and South/Southeast Asia, there are higher rates of wasting among children in households with unimproved facilities (Figure 3.27). However, in Egypt and Bangladesh, there is almost no difference in wasting rates by type of sanitation facility. The Central Asian countries have very few children living in households with unimproved sanitation facilities and, therefore, were not included in this analysis. In Latin America and the Caribbean, four of the seven countries have higher rates of wasting among children who live in households with unimproved sanitation facilities (Figure 3.27). In the other three countries, Bolivia, Dominican Republic, and Haiti, the rates of wasting are about the same, regardless of the type of sanitation facility available to the household. The rates for underweight by type of sanitation facility are similar to the rates for stunting. There are higher rates of underweight among children who live in households with unimproved sanitation facilities, except in Gabon and Tanzania, where the rates are higher among children who live in households with improved sanitation facilities (Figure 3.28).
Findings
43
Figure 3.26 Percentage of children age 0-35 months who are stunted, by type of household sanitation facility, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
60 50 40 Percent 30 20 10 0
5 8 6 98 99 96 98 94 0 0 99 9 9 -99 98 98 -9 -9 7 -95 99 997 000 -01 996 999 000 997 0 1 1 2 1 1 19 19 19 19 19 20 19 a 1 98 19 a 19 995 96 9 4 r 1 i2 a e e e n 9 n a 9 9 0 0 bia nia n ia w ar go ne ni an oir bo bw it re o 1 oo eny li 1 d 1 . 1 ige iqu op a 2 la asc o i Be h Iv m za r K i a p N T a a u d Za n b e Er Fas G d' G ba M Cha Re G M dag m Eth an m m Ta g a za te an Zi na Ca U o M ic ki C M fr ur B lA ra nt Ce
60 50 40 Percent 30 20 10 0
44
20 00 ep Ba al ng 19 la 96 de sh 20 D 00 om in ic an Re p. 19 96 Br az il Co 19 lo 96 m bi a 20 00 H ai t2 00 Pe 0 ru 20 Bo 00 liv G ia ua 19 te 98 m al a 19 99 N
Tu rk ey 19 Eg 98 yp t2 00 Ye 0 m en 19 97
20 00 ia Ca m bo d In d
ia
Improved
Unimproved
Findings
Findings
Percent
U G
Percent 10 15 20
Figure 3.27
25
10
15
20
25
0
North Africa/ West Asia/ Europe South/ Southeast Asia
Tu rk ey 19 Eg 98 yp t2 00 Ye 0 m en 19 97
N ep Ba al ng 19 la 96 de sh 20 00 In di Ca a 20 m 00 bo di a 20 00
Sub-Saharan Africa
Improved
Unimproved
om
20 00 bi in a ic 20 an 00 Re p. 19 Bo 96 liv ia 19 98 Br az G il ua 19 te 96 m al a 19 99 H ai t2 00 0
Co
Pe ru
lo m
a ga bo nd n 2 00 Ca a m 200 0 er 0oo 0 Za n 1 1 M m a d b 998 ag ia 1 Zi as c 99 m ar 6 ba bw 199 Ce nt e 7 Ke 19 ra lA ny 99 T f r an a ic an z an 199 ia 8 C Re p 1 te . 1 999 d' 99 Iv oi 4-9 5 M M re 1 oz a l 99 am aw 4 bi i 20 qu 0 0 Et hi e 1 op 99 ia 7 To 20 g 00 G o1 ui ne 998 a Be 19 ni 99 n Er 19 it Bu re 96 rk G a in ha 19 a 9 Fa na 5 so 19 19 98 98 N ig -99 Ch er ad 19 9 M 1 99 8 al 6i 1 97 99 596
45
46
Percent
Zi m
Percent
10 10 20 30 40 50 60 0
20
30
40
50
60
Ca m
bo d
ia
In d
20 00
ia
20 00 ep Ba al ng 19 la 96 de sh 20 00
Sub-Saharan Africa
Figure 3.28 Percentage of children age 0-35 months who are underweight by type of household sanitation facility, Demographic and Health Surveys, 1994-2001
Improved
om
Unimproved
Br az in il ic 19 an 96 Re p. 19 96 Pe ru Co 20 lo 00 m bi a 20 Bo 00 liv ia 19 98 H ai G t2 ua 00 te m 0 al a 19 99
ba bw G e1 ab 9 on 99 To 2 0 g 00 C K o 1 en 99 te d' y a 8 1 Iv oi 99 re 8 G 1 Ca uin 99 m ea 4 er 1 oo 99 n 9 M oz Be 1 99 am nin 8 bi 19 qu 9 6 G e1 U ha 99 Ce ga n 7 nt nd a 1 ra 99 a lA Z 20 8 fr ic am 00an 0 b Re ia 1 1 9 p. 1 96 M 99 a l 4aw 95 Bu rk Er i 2 in i 0 a t re 00 Fa a so 19 Ta 19 95 nz 98 a -9 Ch nia 9 ad 19 9 Et 1 9 9 hi 96 op -9 ia 7 N 20 ig 0 M er 0 M a l 19 ad i 1 98 ag 99 as 5ca 96 r1 99 7
Findings
3.4.2.5 Source of Drinking Water The data collected on household source of drinking water were divided into improved and unimproved categories based on the guidelines of the WHO and UNICEF Joint Monitoring Programme for Water Supply and Sanitation (Table A.3.15 and Figures 3.29 through 3.31). Improved water sources include piped water, public taps, protected wells and springs, boreholes, and rainwater. Unimproved sources include surface water, unprotected wells and springs, bottled water, and tanker truck or vendor-supplied water. Although the quality of the water is not in question, bottled water is included in unimproved water sources because the reliability and quantity of bottled water are not ensured for adequate consumption. For the most part, improved water sources correlate with lower rates of undernutrition. In all but three countries (the Dominican Republic, Guatemala, and Egypt), children living in households with unimproved water sources have a higher prevalence of stunting than those living in households with improved water sources (Figure 3.29). The difference in stunting rates by water source is small in Chad, Burkina Faso, Guinea, Mali, and Togo in sub-Saharan Africa; in Uzbekistan in Central Asia; and in Bangladesh, Cambodia, and India in South/Southeast Asia. Wasting rates are less consistent by source of drinking water. In 14 of the 23 countries in sub-Saharan Africa, the rates of wasting are higher among children living in households with unimproved water sources. However, in six countries, there is little or no difference, and in three countries (Comoros, Chad, and Mozambique) the rates of wasting are higher among children who live in households with improved water sources. In North Africa/West Asia/Europe, there appears to be no distinction in wasting rates by water source, except in Yemen, where the rate is noticeably higher among children living in households with unimproved water sources. Children in Central Asian countries have higher wasting rates in households with unimproved water sources, except for Kazakhstan, where there is little difference in the wasting rate by water source (Figure 3.30). In two of the seven countries in Latin America and the Caribbean, there are higher rates of wasting among children who live in households with unimproved water sources. However, in Guatemala, the rates of wasting are higher among children who live in households with improved water sources. There is little difference in wasting by water source in the remaining countries (Figure 3.30). Underweight rates are mostly higher among children living in households with unimproved water sources than in households with improved water sources (Figure 3.31). In two countries in sub-Saharan Africa, Guinea and Chad, the rates of underweight are about the same for the two types of water sources.
Findings
47
48
Percent
Percent
G C G ab o
10
20
30
40
50
60
10
20
30
40
50
60
0
Sub-Saharan Africa
Figure 3.29 Percentage of children age 0-35 months who are stunted, by source of drinking water, Demographic and Health Surveys, 1994-2001
Improved
Unimproved
Jo rd a Tu n 1 rk 99 ey 7 Eg 19 yp 98 Ye t 2 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m Ba bod ng ia la 2 de 00 sh 0 In di 20 a 19 00 N 98 ep -9 al 9 19 96 D om in Bra ic an z il R 19 Co ep 96 lo . 1 m 9 bi 96 a 2 Pe 00 ru 0 H 20 0 ai 0 t G ua Bo i 20 liv 0 te m ia 0 al 19 a 1 9 98 98 -9 9
n 2 te han 00 d' a 0 Iv 19 oi re 98 To 19 g 9 G o1 4 ui ne 998 Be a 1 ni 999 Ke n 1 Zi 9 m ny 96 ba a 1 Ce Ca b 9 nt m w 98 ra Mo e e 1 ro 9 lA z f r am on 99 ic an biq 1 99 Re ue 8 p. 19 Bu 1 9 rk M 99 7 in a l 4i a 9 Fa 199 5 so 5 -9 Za 199 6 m 8bi 99 a U Erit 19 ga re 96 nd a a 1 Co 20 9 95 m 00 Ta oro -01 nz s 1 a 9 Ch nia 96 ad 19 1 9 99 N 96Et ige 97 hi r 1 op 99 i 8 M Ma a 2 a d la 00 ag wi 0 as 20 ca 00 r1 99 7
Findings
Findings
Percent
Percent
U
10 15 20 25 0 5
10
15
20
25
0
Sub-Saharan Africa
Figure 3.30 Percentage of children age 0-35 months who are wasted, by source of drinking water, Demographic and Health Surveys, 1994-2001
Improved
Jo rd a Tu n 1 rk 99 e 7 Eg y 19 yp 9 Ye t 2 8 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 1 U zb ep 999 ek . 1 9 is ta 97 n 19 96 N Ba ng epa la l 1 Ca de 99 m sh 6 bo 20 0 d In ia 0 di 20 a 19 0 0 98 -9 9
Unimproved
Co Per lo u 2 m D bi 0 00 om Bo a 2 in 0 ic livi 0 0 an a Re 1 99 p 8 G ua B . 19 ra te 9 m z il 6 al 19 a 1 9 96 9 H 8-9 ai ti 9 20 00
a ga bo nd n 2 a 00 Za 200 0 Ca mb 0-0 1 m i M er a 19 Ce a d oo 9 nt ag n 6 ra as 1 9 lA ca 98 fr ic Ke r 1 an n 99 Re ya 7 p 1 Ta . 1 998 nz 99 an 4-9 M ia 1 5 Zi a la 99 m w 9 C ba i 2 te bw 00 d' e 0 Iv 19 Co oire 99 M oz mo 19 am ro 94 bi s 1 9 qu 9 e 6 To 19 g 9 G o1 7 ha 9 n 9 G a1 8 ui 9 Et nea 98 hi op 199 9 Er ia 2 it Bu re 000 a rk in Be 19 a ni Fa n 95 so 19 19 96 N 98i Ch ger 99 ad 19 9 M 1 99 8 al 6i1 9 99 7 596
49
50
Percent Percent
G
0 10 20 30 40 50 60
10
20
30
40
50
60
Sub-Saharan Africa
Figure 3.31 Percentage of children age 0-35 months who are underweight, by source of drinking water, Demographic and Health Surveys, 1994-2001
Improved
Eg yp Jo t 2 rd 00 a 0 Tu n 1 rk 99 7 e Ye y 1 m 99 en 8 19 Ka 97 za Ky kh rg sta yz n R 1 U zb ep 999 ek . 1 9 is ta 97 n 19 Ca 96 m bo di a 20 N Ba e ng pa 0 0 la l 1 de 99 In s h 6 di 20 a 19 00 98 -9 9
Unimproved
om
Br az il in Pe 199 ic an r u 6 2 Co Rep 0 00 .1 lo m 9 bi 96 Bo a 2 liv 00 ia 0 G ua H 1 99 te m aiti 8 al a 200 19 0 98 -9 9
Zi ab m on ba bw 2 00 e 0 M oz Ke 19 ny 99 am bi a 19 q 9 Za ue 8 Ca mb 199 7 m i C e a 1 te roo 99 n 6 d U 'Ivo 1 9 Ce ga ir 98 nt nd e ra a 199 lA 2 4 fr ic Gh 000 an a -0 Re na 1 p. 19 1 9 98 To 94g 9 M o1 5 al 9 Co aw 98 m i2 or 00 G os 1 0 ui ne 99 6 Be a 1 Bu T ni 999 rk an n in z a 19 a ni 96 F a M a so 19 ad 19 99 ag 9 as 8-9 ca 9 Er r 1 it re 997 M a a l 19 Ch i 19 95 ad 95 Et 1 9 96 hi 96 op -9 ia 7 N 20 ig er 00 19 98
Findings
In North Africa/West Asia/Europe, there are small differences between rates of underweight by source of drinking water. Yemen is an exception, with a prevalence of underweight that is 10 percentage points higher among children living in households with unimproved water sources. On the other hand, in Egypt the difference is small, but the rate is higher among children living in households with improved water sources (Figure 3.31). Two of the three countries of Central Asia demonstrate a higher rate of underweight among children living in households with unimproved water sources. In Kazakhstan, however, children living in households with improved water sources are slightly more likely to be underweight (Figure 3.31). In South/Southeast Asia, although the rates of underweight are higher for children living in households with unimproved water sources, the differences are small (Figure 3.31). In Latin America and the Caribbean, five of the seven countries have higher rates of underweight among children in households with unimproved water sources. In the Dominican Republic, the rate is about the same for the two groups of children, and in Guatemala, the rate is higher among children living in households with improved water sources than among children in households with unimproved water sources (Figure 3.31).
3.4.3
3.4.3.1
Underlying Biological and Behavioral Influences

Characteristics of Mothers
Maternal Nutritional Status A mothers nutritional status has important implications for her own health status as well as the health status of her children. A woman who has poor nutritional status has a greater risk of giving birth to a low birth weight baby. Intrauterine growth retardation (IUGR) accounts for more than two-thirds of low birth weight babies in developing countries (Black, 1999). Infants born with IUGR have a greater chance of growth retardation in childhood and have an increased risk of illness, a major contributor to undernutrition. (Ramakrishnan et al., 1999). Maternal nutritional status is typically measured by the body mass index (BMI). The BMI is calculated 2 as a ratio of weight to height squared (kg/m ). Incorporating both height and weight, the BMI provides a better measure of nutritional status than height or weight alone. A BMI of less then 18.5 in women is considered undernutrition. In most of the countries included in this analysis, higher rates of stunting are found among children age 0-35 months whose mothers are undernourished (BMI <18.5) than among children whose mothers are adequately nourished (BMI 18.5 to 24.9) (Table A.3.16 and Figure 3.32) Infants of overweight mothers (BMI 25) have the lowest rates of stunting. An exception is Burkina Faso, where stunting rates are about the same for all levels of maternal nutritional status. In five countries (Benin, Ghana, Mozambique, Jordan, and Uzbekistan), rates of stunting are about the same for children of well-nourished mothers as for children of undernourished mothers. In Uzbekistan, stunting is highest among children of overweight women (Table A.3.16 and Figure 3.32).
Findings
51
52
Percent
Jo rd a n G ha na G
Percent
10
20
30
40
50
60
70
10
20
30
40
50
60
70
19 Tu 9 rk ey 7 Eg 199 8 yp t2 Ye 00 m en 0 19 97
Central Asia
Sub-Saharan Africa
Figure 3.32 Percentage of children age 0-35 months who are stunted, by mothers nutritional status, Demographic and Health Surveys, 1994-2001
<18.5
18.5-24.9
Ka za kh st U an zb 19 ek is Ky ta 99 rg n yz 1 Re 996 p. 19 97 Ca m b Ba od ia ng 20 la 0 de sh 0 20 In 00 di a 20 N 00 ep al 19 96 Br az
>=25.0
om
Co
il 19 lo m 96 bi in ic a an 20 00 Re p. 19 96 H ai ti 20 00 Pe ru 20 Bo G 00 ua liv te ia m 19 al 9 a 19 8 98 -9 9
1 ab 998 on B e 2 00 0 ni n 19 To C 9 go 6 te 19 d' Iv 98 oi Z r B u im b e 1 99 ab rk 4 in w a Fa e 19 so 9 19 9 98 G ui ne 99 a M 19 al 9 Ca i 19 9 95 m e M oz roo 96 am n 1 9 bi qu 98 e Ce Ke 199 nt 7 ny U ra ga a lA 19 nd fr 9 a ic an 20 8 00 Re -0 p. 1 1 C h 99 4ad 95 Co 1 99 6m 9 or os 7 19 N 96 ig er 19 Er 98 it re a Et 19 hi 95 op ia M 20 al aw 00 i2 Za 00 m M a d bia 0 19 ag 96 as ca r1 99 7
Findings
Wasting and underweight rates are also highest among children of mothers who are undernourished and lowest among children of mothers who are overweight (Figures 3.33 and 3.34). The exception is Uzbekistan, where the proportion underweight is highest among children of mothers with a normal BMI and lowest among children of undernourished mothers.
Figure 3.33 Percentage of children age 0-35 months who are wasted, by mothers nutritional status, Demographic and Health Surveys, 1994-2001
35 30 25 Percent 20 15 10 5 0
20 00 19 M al 9 aw 6 i Ke 200 ny 0 Zi a m Ce 19 ba nt bw 98 U ra e l A ga 19 nd fr 9 a ic an 20 9 00 R -0 C e p. 1 1 te d' 994 Iv -9 5 Ca oir e m 19 er M oo 94 oz am n 1 99 bi q 8 Co ue 19 m 97 o M a d ros 19 ag 96 as ca r1 G 9 ui ne 97 a Et 19 hi 99 op ia 2 G ha 00 na 0 Be 199 8 ni n 19 Er 96 it re a 19 To 95 g Ch o 1 99 ad 19 8 96 -9 N ig 7 er Bu M a l 199 rk i1 in 8 a 99 Fa 5so 9 19 6 98 -9 9 bi a
Sub-Saharan AfricaAfrica Sub-Saharan
ab o G
Za m
35 30 25 Percent 20 15 10 5 0
North Africa/ North Africa/ West Asia/ West Asia/ Europe Europe
Central Central Asia Asia
South/ South/ Southeast Southeast Asia Asia
Latin America/ Latin America/ Caribbean Caribbean
Ka za k Ky hst an rg yz 1 Re 999 U p. zb 19 ek 97 is ta n 19 96 Ba ng la de sh 20 N 00 ep al 19 96 In di Ca a m 20 bo 00 di a 20 00
Tu rk ey Eg 199 8 yp t2 Jo 00 rd 0 an 19 Ye 9 m en 7 19 97
<18.5
18.5-24.9
>=25.0
Findings
Bo liv in ia ic 19 an 98 R Co ep 19 lo 96 m bi a 20 00 Pe ru 20 Br az 00 il 19 G 96 H ua ai te ti m 20 al 0 a 19 0 98 -9 9 om
53
54
Percent Percent
G Zi m
10 20 30 40 50 60 70 0
ab o
10
20
30
40
50
60
70
Figure 3.34 Percentage of children age 0-35 months who are underweight, by mothers nutritional status, Demographic and Health Surveys, 1994-2001
<18.5
18.5-24.9
Eg yp t2 Jo 00 rd an 0 19 Tu 9 rk ey 7 19 Ye 9 m en 8 19 97 Ka za kh s U zb ta n ek 19 is 99 Ky rg tan yz 19 9 Re p. 6 19 97 Ca m bo di a 20 N ep 0 0 al 19 In 96 Ba di ng a 20 la 0 de sh 0 20 00
>=25.0
Br az il 19 om Bo 96 liv in ia ic 19 an 98 R Co ep 19 lo m 96 bi a 20 0 Pe ru 0 20 Gu H 00 at a em iti 20 al 0 a 19 0 98 -9 9
n 20 ba b w 00 Co e 1 m or 999 os 19 K M oz eny 96 a am 19 bi qu 98 e Ce 1 G ha 99 nt ra na 7 lA Za 19 fr m 98 ic bi an a Re 19 9 p. 19 6 94 To -9 U ga go 5 19 nd 9 a 20 8 00 M al aw 01 i2 G 0 ui n e 01 a 1 C Ben 999 te in d' 19 Iv 96 Ca oir e Bu m 19 er rk oo 94 in a n Fa 19 M so 1 98 ad 99 ag 899 as ca r1 Er 9 it re 97 a M a l 19 9 i1 5 9 Et hi 9596 op Ch ia 2 00 ad 19 0 96 -9 N ig 7 er 19 98
Findings
Antenatal Care Regular antenatal care is needed to help detect and manage pregnancy-related complications and improve delivery outcomes. Since most pregnancy-related complications cannot be anticipated, women need access to appropriate care if complications arise. WHO defines antenatal care as having one or more visits with a skilled medical attendant during pregnancy (WHO and UNICEF, 2003). Adequate, timely, and regular use of antenatal care contributes to improved birth outcomes and higher birth weight. The analysis of undernutrition by number of antenatal care visits looked at children of mothers who had one or more antenatal visits and children of mothers who had no visits (Table A.3.17). In most cases, children whose mothers had one or more antenatal care visits were less likely to be stunted and underweight than children whose mothers had no antenatal visits (Figures 3.35 and 3.37, respectively). Wasting rates were not as clearly related to antenatal care visits (Figure 3.36). In most countries, the rate of wasting was about the same for children of mothers who had one or more antenatal visits and those whose mothers had no visits. (This is not surprising since wasting measures acute undernutrition, which may be more influenced by a recent illness.) Use of antenatal care may be indicative of improved availability and/or access to health services as well as a willingness or ability to practice effective health behaviors. A multivariate analysis would better determine the impact of these factors on the nutritional status of children. Mothers Age at Delivery Mothers age at delivery is related to maternal nutritional status. There are higher rates of undernutrition among younger mothers, and undernourished mothers have higher rates of low birth weight babies. Younger women usually have lower BMIs than older women, and younger mothers and older mothers tend to have higher risk of low birth weight infants (Karim and Mascie-Taylor, 1997). In the DHS surveys, mothers age at delivery is calculated from the mothers date of birth and the childs date of birth. In this analysis, three categories were used: under 20 years, 20 to 34 years, and 35 years or older. Some interesting region-specific patterns of undernutrition emerge by mothers age at the time of the childs birth (Table A.3.18). In sub-Saharan Africa, 17 of the 23 countries have the highest rates of stunting among children of mothers under age 20 (Figure 3.38). However wasting has a different pattern. In half of the 23 countries, wasting is most common among children of older mothers (35 years or older). In three countries (Comoros, Kenya, and Central African Republic), wasting is most common among children of younger mothers (under 20 years). Although the differences are small for Brazil, Colombia, and Haiti, in Latin America and the Caribbean, stunting is most common among children of older mothers (35 years or older). Wasting rates are quite low in this region, yet there are some noticeable differences by mothers age at delivery. Wasting is highest among children of younger mothers (under 20 years) in the Dominican Republic. It is highest among children of older mothers (35 years or older) in Guatemala (Figure 3.39).
Findings
55
56
Percent
G ab o
Percent
10 0
G
20
30
40
50
60
10
20
30
40
50
60
Ka za
Jo rd an 19 Tu 97 rk ey 19 Eg 98 yp t2 Ye 00 m en 0 19 97
Central Asia
Sub-Saharan Africa
Figure 3.35 Percentage of children age 0-35 months who are stunted, by antenatal care visits, Demographic and Health Surveys, 1994-2001
One or more visits
k Ky hst a rg yz n 1 Re 999 U p. zb 19 ek 97 is ta n 19 96 Ca m b Ba o d ia ng 20 la 00 de sh In 20 di 0 a 19 0 98 N ep -99 al 19 96 Br az i
D an
None/missing
om
in ic
l1 Re 996 p. Co 19 lo 96 m bi a 20 00 H ai ti 20 00 Pe ru 20 Bo G 00 ua liv te ia m 19 al 9 a 19 8 98 -9 9
n 2 ha 00 na 0 To 199 go 8 G 19 C ui 9 te nea 8 d 19 Iv 9 oi re 9 19 B Zi eni 94 n m 1 ba bw 996 M e1 a 9 Ca li 1 99 99 m 5 er oo -96 Bu n C rk had 1 9 9 in 19 8 a Ce Fa 96 nt so -9 ra 19 7 lA 98 fr ic Ken -9 an ya 9 Re 19 p. 9 Co 1 99 8 4 m or -95 os 1 E M oz rit r 996 am ea 19 bi 9 U q ga ue 5 nd 19 a 9 20 7 00 N -0 i Ta ger 1 nz 19 an 98 i Za a 1 99 m 9 b Et ia 1 hi 99 op 6 i M a2 00 al M a d aw 0 i2 ag 00 as 0 ca r1 99 7
Findings
Findings
Percent Percent
G
10 15 20 25 30 0 5
10
15
20
25
30
Jo rd an 19 Tu 97 rk ey Eg 199 8 yp t2 Ye 00 m en 0 19 97
Central Asia
Ka za k Ky hst a rg yz n 1 Re 999 U p. zb 19 ek 97 is ta n 19 96
Sub-Saharan Africa
Figure 3.36 Percentage of children age 0-35 months who are wasted, by antenatal care visits, Demographic and Health Surveys, 1994-2001
One or more visits
N ep Ba al ng 19 la 96 de Ca sh m 20 bo 00 di a In 20 di 0 a 19 0 98 -9 9 Co Pe ru
None/missing
lo m
bi a
Latin America/ Carribean
20 00 D 20 Bo om liv 0 0 in i ic an a 1 Re 998 p. 19 G Br 96 ua az te il m 19 al 9 a 19 6 98 -9 H 9 ai ti 20 00
a Ca bo n m 2 er oo 000 U ga n 19 nd 9 a 20 8 00 Za -0 m 1 Ta bia Ce 19 nz nt 9 an ra ia 6 lA fr Ke 19 ic an ny 99 Re a 1 99 p. 8 Zi m 1 99 ba 49 b M a d we 5 ag 19 as 99 ca r1 M 99 C a 7 te law i2 d Iv 00 o 0 Co ire 19 m M 94 oz or am os 19 bi qu 96 G e1 9 ui ne 97 a 1 To 99 go 9 Et 19 hi 98 op ia 20 G ha 0 na 0 19 Be 98 n Ch in 1 99 ad 19 6 Bu Er 96rk it 97 in re a a Fa so 19 9 5 19 98 -9 N ig 9 er M a l 199 i1 8 99 596
57
58
Percent
Percent
10
20
30
40
50
60
10
20
30
40
50
60
Figure 3.37 Percentage of children age 0-35 months who are underweight, by antenatal care visits, Demographic and Health Surveys, 1994-2001
One or more visits
None/missing
Eg yp t2 Jo 00 rd an 0 19 Tu 97 rk ey 19 Ye 9 m en 8 19 97 Ka za k Ky hst an rg 1 yz Re 999 U p. zb 19 ek 97 is ta n 19 96 Ba ng la de sh 20 N ep 00 Ca al m 19 bo 96 di a In 20 di 0 a 19 0 98 -9 9 Co lo m bi a Bo 200 liv 0 ia D 19 om 98 H ai in ic ti an 20 00 Re p. 19 G 96 ua Pe ru te m 20 al 0 a 19 0 98 -9 Br 9 az il 19 96
G ha Zi m na 19 ba Ca bw 98 e m 1 er M oo 999 ad n ag 19 as 98 ca r1 Er 9 it re 97 a 19 C T te ogo 95 d Iv 1 99 oi 8 r G e1 ui 99 ne 4 a Ke 19 ny 99 Ce Za a 1 nt 99 m ra U l A ga bia 8 nd fr 19 ic an a 2 96 00 Re 0p. 0 19 1 94 N ig -95 er M a l 199 i1 8 9 Be 9596 n Ch in ad 199 19 6 C M om 9697 or o Bu z am os rk bi 1 9 qu 96 in a Fa e 1 99 so 7 Et 199 hi 8op 99 i M a2 0 al aw 00 i2 G 00 ab Ta on 0 20 nz 0 an ia 0 19 99
Findings
Findings
Percent
G
Percent 10 20 30 40 50 60 0
10
20
30
40
50
60
Sub-Saharan Africa
Figure 3.38 Levels of stunting among children age 0-35 months by mothers age at delivery, Demographic and Health Surveys, 1994-2001
< 20
South/ Southeast Asia Latin America/ Carribean
Eg yp Ye t 2 m 00 en 0 19 Ka 97 za kh U zb sta n e Ky ki s 1 9 rg tan 99 yz 1 Re 99 p. 6 19 97 Ca m Ba bo ng dia la 2 de 00 sh 0 2 N ep 00 al 0 In 19 di a 9 19 6 98 -9 9
20-34
35+
B C ra om olo z il 1 in mb 99 ic ia 6 an 2 Re 00 p. 0 19 H ai 96 ti Bo 2 liv 000 ia G 19 ua te Per 98 m u 20 al a 1 9 00 98 -9 9
ha n G a1 ab 9 o 9 G n2 8 ui 0 Zi m nea 00 ba bw 199 e 9 To 19 g 9 M o 9 al 19 i 1 98 C B 995 en -9 te d in 6 1 Ce Ca Ivo 99 nt m ire 6 er ra 1 oo 99 lA n 4 fr 1 ic K Bu an eny 998 Re a rk in p 1 a . 1 998 Fa 99 so 4Ch 19 95 ad 98 Co 1 9 -99 m 96 or - 9 o 7 Er s 1 U 99 it g r 6 M and ea 1 oz a 99 am 20 5 b 00 Ta iqu -01 nz e 1 an 99 Za ia 7 m 19 bi 99 a N 19 ig 9 Et er 6 hi 19 op 9 M ia 8 M a l 20 a d aw 00 ag i as 20 ca 00 r1 99 7
59
60
Percent 10 15 20 25 30 0 5 Percent 10 15 20 25 0
Sub-Saharan Africa
Figure 3.39 Levels of wasting among children age 0-35 months by mothers age at delivery, Demographic and Health Surveys, 1994-2001
< 20
20-34
35+
Jo rd an Eg 19 yp 97 Tu t 2 rk 00 0 e Ye y 1 m 99 en 8 19 Ka 97 za kh Ky rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 Ba 96 ng la de sh 2 N Ca ep 000 m al bo 19 9 d In ia 6 20 di a 0 19 0 98 -9 Co 9 lo m bi a 2 Pe 00 ru 0 G 20 u a Bo te livi 00 a m 19 al a D 1 9 98 om 9 in Bra 8-9 ic an z il 9 Re 199 p. 6 19 H ai 96 ti 20 00
G U ab ga o nd n 2 a 00 Za 200 0 0Ca mb 0 m ia 1 er 19 Ta oon 96 n 1 Zi z an 99 m M b ia 1 8 oz ab 9 am w 99 e bi 19 Ce qu 9 nt M e1 9 ra M al lA a a 99 f r dag wi 7 ic an as c 200 Re a r 0 p. 19 1 9 G 99 7 ui ne 4-9 5 C K a 1 te en 99 d y a 9 Iv o 19 Et ire 98 hi o 19 Co pia 94 m or 200 o 0 G s1 ha 9 Bu 96 na rk in To 19 9 a Fa go 8 so 1 9 19 98 Be 98 ni -99 Er n 1 9 it Ch rea 96 ad 19 1 9 95 N 96ig 9 M er 7 a l 19 i1 9 99 8 596
Findings
Findings
Percent
Zi m
Percent
10 10 20 30 40 50 60 0
20
30
40
50
60
70
Sub-Saharan Africa
Figure 3.40 Levels of underweight among children age 0-35 months by mothers age at delivery, Demographic and Health Surveys, 1994-2001
< 20
20-34
35+
Eg yp Jo t 2 rd 00 0 a Tu n 1 rk 99 7 e Ye y 1 m 99 en 8 19 Ka 97 za kh Ky rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m bo di a 20 N Ba e 00 ng pa la l 1 de 99 In s h 6 20 di a 19 00 98 -9 Co 9 lo m bi a Br 20 az 0 0 B o il 1 liv 996 D ia om 1 Pe 99 in ic an r u 8 2 Re 0 0 p. 0 G 19 ua H ai 96 te t m al i 20 a 1 9 00 98 -9 9
ba bw G e1 ab 9 Ce o 9 nt G n2 9 ra ui lA ne 00 0 fr ic Ke a 1 an n 99 R ya 9 U e p. 19 ga 1 9 n 99 8 Ca da 4-9 m 20 5 er 00 oo -0 1 C G n 1 te han 99 d a 8 Iv 19 o 9 Za ire 8 m 19 bi 94 a To 19 go 96 M M oz a l 1 9 am aw 98 bi i 2 qu 00 0 Be e 19 ni 97 Co m n1 Ta oro 996 nz s 1 an 99 Bu rk Ch ia 1 6 in ad 99 a Fa 1 99 9 so 69 M 199 7 al 8 -9 i1 9 M Eri 995 a d t r -9 ag ea 6 as 19 Et ca r 95 hi op 199 ia 7 N 20 ig er 00 19 98
61
In Central Asia, there is no discernible maternal age pattern in regard to stunting. However, wasting and underweight are higher among children of older mothers (35 years or older). In South/Southeast Asia stunting, wasting, and underweight rates are higher among children of older mothers (35 years or older). Stunting is slightly higher among children of younger mothers in the North Africa/West Asia/Europe region. However, wasting and underweight rates are almost the same in all maternal age groups in this region (Figures 3.39 and 3.40, respectively). 3.4.3.2 Child Characteristics
Size at Birth The birth weight of an infant is a determinant of child health and nutrition. Low birth weight babies face higher risks of illness and death than do babies of normal birth weight. With only about 40 to 60 percent of women delivering in health facilities in most of the countries surveyed, actual birth weight is not available for most infants. As a proxy, a mothers assessed size of her infant at birth is used. Mothers were asked, When (NAME) was born, was he/she very large, larger than average, average, smaller than average, or very small. The childs nutritional status is assessed based on the mothers report of the childs size at birth (Table A.3.19). In this analysis, there are three categories of birth size: very small, smaller than average, and average or larger. In most countries in sub-Saharan Africa, the lowest rates of stunting, wasting, and underweight were recorded among children reported to be average or larger than average at birth (Figures 3.41 through 3.43). On the other hand, children whom the mothers perceived as very small at birth had the highest rates of undernutrition. Ghana, Mozambique, and Tanzania had fewer than 50 cases of very small infants; hence their results in this category should be interpreted with caution. Countries in North Africa/West Asia/Europe, South/Southeast Asia, and Latin America and the Caribbean have a pattern of birth size similar to that of sub-Saharan Africa, with low rates of undernutrition among children reported as average and above average at birth and the highest rates among children reported as very small at birth. The question of child size at birth was not asked in the Colombia and Peru surveys. The Central Asia region has very small numbers of children reported to be very small at birth. This category is therefore not included in the discussion. In most cases, the children who were reported to be average to above average at birth had lower rates of stunting, wasting, and underweight than those reported to be smaller than average.
62
Findings
Figure 3.41 Levels of stunting among children age 0-35 months by mothers perceived size of child at birth, Demographic and Health Surveys, 1994-2001
70 60 50 Percent 40 30 20 10 0
bi qu G e1 ui ne 997 G a1 ha 9 Bu na 99 rk in To 199 a g Fa o 8 so 19 1 98 Ga 998 bo -9 9 C K n 2 te eny 000 d a 1 I Ca voi 99 m re 8 er 1 o 99 Ch on 4 19 Zi ad m 19 98 ba 96 bw -9 M e 7 a l 19 i 1 99 9 Be 95 U ga ni -96 nd n 1 9 a Ce 2 96 nt Er 000 ra itr lA ea 01 fr 19 ic an Nig 9 Re er 5 p. 19 Et 19 98 hi 9 4 op -9 M ia 5 al 20 Co aw 00 m i 20 o Ta ro 00 nz s 1 M ad an 996 ag i a as 199 c Za ar 9 m 19 bi 97 a 19 96
North Africa/ West Asia/ Europe Central Asia South/ Southeast Asia Latin America/ Carribean
Sub-Saharan Africa
M oz
am
70 60 50 Percent 40 30 20 10 0
00 000 -99 996 97 998 000 997 96 97 999 1 19 2 1 19 . 19 20 1 98 l1 t2 y a n n h n n 19 di pa es ta Rep sta k e gy p m e da r a r is h bo lad E Ne di Tu Jo Ye ek yz m g ak In zb yrg az Ca Ban U K K 9 6 8 0 6 -9 00 199 199 199 98 l . a p zi 19 vi a Re Bra oli Ha al n B a m ic te in ua m G o D 2 iti
Very small
Smaller than average
Average or larger
Findings
63
64
Percent Percent 10 15 20 25 30 35 40 45 0 5
pt
Eg y
10
15
20
25
30
0
Figure 3.42 Levels of wasting among children age 0-35 months by mothers perceived size of child at birth, Demographic and Health Surveys, 1994-2001
Very small
Central Asia South/ Southeast Asia Latin America/ Carribean
20 Tu 0 rk ey 0 1 Jo rd 998 an 19 Ye 9 m en 7 19 97 Ka za k Ky hsta rg n 19 yz 99 Re U p. zb 1 ek ist 997 an 19 96
Sub-Saharan Africa
Average or larger
Ne pa Ca l1 m 99 bo 6 Ba di a ng 20 la 00 de sh In 20 di 0 a 19 0 98 D om -9 9 in ic an Gu Re at em p. 19 al 9 a 19 6 Bo 9899 liv ia 19 98 H ai ti 20 Br az 00 il 19 96
Ta nz an i Ke a 1 ny 999 G a1 Zi ab 99 Ce m on 8 nt ba ra bw 200 lA fr M e1 0 ic an ala 99 Re wi 9 U p. 200 ga 1 0 nd 99 Ca a 2 4-9 m 0 5 M er 00oo 0 ad ag n 1 as 199 c Za ar 8 m 19 bi 97 C Gh a 1 te an 996 d a 1 Iv o 9 Co i re 9 8 m 19 o 9 Et ros 4 hi 19 op 9 ia 6 To 20 g 00 Er o 1 i tr 9 9 e 8 G a1 ui 99 ne a 5 Be 1 9 ni 9 9 Ch n ad 19 Bu 19 96 rk N 96in a ige 97 Fa r so 19 9 M 199 8 M oz ali 8-9 am 19 9 bi 95 qu - 9 e 6 19 97
Findings
Percent
Percent
Findings
G ab o
10 20 30 40 50 60 70 80 0 60 70 80
Eg yp t
10 20 30 40 50 0
20 00
Jo rd an 19 Tu 97 rk ey 19 Ye 98 m en 19 97
Central Asia
Figure 3.43 Levels of underweight among children age 0-35 months by mothers perceived size of child at birth, Demographic and Health Surveys, 1994-2001
Very small
Sub-Saharan Africa
Ka za kh st Ky an rg 19 yz 99 Re p. U zb 19 ek 97 is ta n 19 96 Ca m bo di a 20 In 00 di a 19 98 -9 N 9 ep Ba al ng 19 la 96 de sh 20 00 Bo liv ia
Average or larger
Latin America/ Carribean
19 98 Br az il 19 D 96 om H ai in ti ic 20 an 00 Re G ua p. te 19 m 96 al a 19 98 -9 9
n Ke 2 00 ny 0 Zi a m 19 ba 98 bw e Co 19 m 9 or U os 9 ga Ce 19 nd nt 9 a ra 20 6 lA 00 G fr u -0 ic 1 an ine Re a 19 p. 9 19 9 94 M -9 al C 5 aw te i2 d 00 Iv oi re 0 19 To 9 Ca go 4 m er 1 99 oo 8 n 19 Za M m 98 oz b am ia 19 bi qu 96 e Et 19 hi 97 op Ch ia 2 Bu 00 rk ad in 0 1 a Fa 996 -9 so 19 7 98 G -9 ha M na 9 ad ag 19 as 98 ca r1 Er 99 it 7 re a 19 Be 95 ni Ta n 19 nz 96 an ia 19 N 99 ig er M a l 199 i1 8 99 596
65
Sex In most of the regions, there are gender differentials in stunting based on sex (Figure 3.44). Typically, males have a slightly higher rate of stunting than females (Table A.3.20). However, in South/Southeast Asia, there is a higher rate of stunting among females than males. Of the sub-Saharan countries included here, Eritrea is the only one in which females have a slightly higher rate of stunting (41 percent) than males (36 percent). In Tanzania and Mozambique, the stunting rates are about equal between males and females.
Figure 3.44 Levels of stunting among children age 0-35 months by sex of a child, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
60 50 40 Percent 30 20 10 0
Percent
Ka za k Ky hst a rg yz n 1 Re 999 U p. zb 19 ek 97 is ta n 19 96 Ca m b Ba od ia ng 20 la 00 de sh In 20 di 0 a 19 0 98 N ep -99 al 19 96
Jo rd an 19 Tu 97 rk ey 19 Eg 98 yp t2 Ye 00 m en 0 19 97
Male
Female
66
om
Br in az ic an il 1 Re 996 p. Co 19 lo 96 m bi a 20 00 H ai ti 20 0 Pe ru 0 20 Bo G 00 ua liv te ia m 19 al 9 a 19 8 98 -9 9
G ab on G 2 ha 00 na 0 1 To 99 go 8 G ui 1 99 ne 8 a C Be 199 ni 9 te d n 1 Iv 99 o Zi m ire 6 ba 19 Ca bw 94 e m 19 er oo 99 Bu n rk Ke 1 9 in ny 98 a Fa a 1 so 99 8 1 Ce M 998 nt al ra i 1 -99 lA C 9 f r om 95ic an oro 96 Re s 1 99 p U ga . 1 9 6 nd 94 -9 a 5 Ch 200 M ad 0-0 oz am 1 99 1 6bi 9 q Ta ue 7 19 nz 97 an i Za a 1 9 m bi 99 a 19 N 96 ig e Er r 19 it re 9 8 M a1 al 99 a 5 Et wi 2 hi M op 000 ad ag ia 2 0 as ca 00 r1 99 7
60 50 40 30 20 10 0
Central Asia
Findings
In Latin America and the Caribbean, males have a higher rate of stunting, except in Peru, where the rate of stunting between males and females is about the same. Among all regions, the North Africa/West Asia/Europe region shows the smallest differences between males and females (Figure 3.44). Again, females seem to have a slight advantage when it comes to wasting, with slightly higher rates of wasting among males than among females across all regions (Figure 3.45). However, there are a few exceptions. In sub-Saharan Africa, eight countries have about equal rates of wasting for males and females. And in Togo and Malawi, the rates of wasting are higher among females. Jordan, in the North
Figure 3.45 Levels of wasting among children age 0-35 months by sex of child, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
25 20 15 10 5 0
Percent
Percent
Ka za kh st Ky an rg 19 yz 99 Re U p. zb 19 ek 97 is ta n 19 96
Jo rd an 19 Tu 97 rk ey 19 Eg 98 yp t2 Ye 00 0 m en 19 97
Findings
N ep Ba al ng 19 la 96 de sh In 20 di 00 a 19 Ca 98 m -9 bo 9 di a 20 D om 00 in ic an Re p. Co 19 lo 96 m bi a 20 00 Pe ru 20 Bo G 00 ua liv ia te m 19 al 98 a 19 98 -9 Br 9 az il 19 96 H ai ti 20 00
Male Female
G ab U ga on 20 nd 0 a 20 0 00 Za -0 m 1 bi Ca a m Ce er 199 nt M oo 6 ra n l A a da ga 1 99 fr ic 8 an s ca Re r 1 99 p. 7 Ta 1 99 nz 4C 95 an te ia d 19 Iv 99 oi re Ke 199 ny 4 Zi a m 19 ba bw 98 e Co 19 m M oz oro 99 am s1 9 bi qu 96 e M 19 al aw 97 Et i2 hi op 000 ia 2 G ha 000 na G 19 ui ne 98 a Be 199 9 ni n 19 To 96 g Ch o 1 Bu 99 ad rk 8 in 1 a Fa 996 -9 so 19 7 98 Er -9 it 9 re a 19 N 9 ig er 5 M 19 al i 1 98 99 596

25 20
Central Asia
15 10 5
67
Africa/West Asia/Europe region, shows no gender differences for wasting, and this is also the case in Colombia, Peru, and Brazil in Latin America and the Caribbean. In South/Southeast Asia, where rates of stunting are higher among females than males, rates of wasting are higher among males than females. Underweight has a different distribution by sex, although females continue to have a small advantage over males (Figure 3.46). In sub-Saharan Africa, there are a few countries (namely, Burkina Faso, Ghana, Tanzania, Malawi, and Mali) where the prevalence of underweight is about the same for males and females. In Eritrea and Niger, females have a higher rate of underweight than males.
Figure 3.46 Levels of underweight among children age 0-35 months by sex of child, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
60 50 40 Percent 30 20 10 0
G ab Zi m on 20 ba bw 00 e Ke 199 9 Ca ny a m 19 er C oo 98 te n d 19 Iv 98 oi U re ga 19 nd 9 a 20 4 00 Za -0 m 1 b Co ia 1 99 m M 6 oz oro am s1 9 bi qu 96 e Ce 19 To nt 9 ra go 7 lA 19 G fr h 9 ic an ana 8 19 Re 9 p. 19 8 94 Be ni 95 n G ui 199 ne 6 a M 19 al aw 99 i Bu Tan z a 200 rk 0 in ni a a Fa 19 so 99 1 Ch 998 -9 M ad 19 9 ad 96 ag -9 as 7 ca r1 M 99 al i1 7 9 Et hi 9596 op ia 20 Er 00 it re a 19 N 9 ig er 5 19 98
60 50 40 Percent 30 20 10 0
Central Asia
Ka za kh st Ky an rg 19 yz 99 Re U p. zb 19 ek 97 is ta n 19 96 Ca m bo d Ba ng ia 2 00 la de 0 sh 20 N 00 ep al In 19 di 96 a 19 98 -9 9
20 Jo 00 rd an 19 Tu 97 rk ey 19 Ye 98 m en 19 97
Male
Female
68
om
Br az il 19 96 Re p. Co 19 lo 96 m bi a 20 00 Pe ru 20 Bo 00 liv ia 19 G 98 H ua ai te ti m 20 al 00 a 19 98 -9 9 in ic an
Eg
yp t
Findings
In North Africa/West Asia/Europe, underweight rates are higher for males than females, except in Jordan, where females are at a slight disadvantage to males. In Central Asia, males also have a higher rate of underweight than females. South/Southeast Asia has the opposite pattern, with higher rates of underweight among females, except in Cambodia where the rates are about the same for males and females. In Latin America and the Caribbean, four of the seven countries have almost the same rates of underweight for males and females (Figure 3.46). Birth Order A childs birth order is taken from the birth history given by the mother at the time of the interview. Birth orders were recoded into four categories (first, second or third, fourth or fifth, and sixth or higher). Data on undernutrition and birth order are presented in Table A.3.21 and Figures 3.47 to 3.49. Figures 3.47 through 3.49 show the patterns of undernutrition by birth order for the five regions. With the exception of sub-Saharan Africa, all of the regions have a pattern of stunting that increases as birth order increases (Figure 3.47). This pattern may be partly a reflection of poverty because larger families are usually poorer than smaller families and therefore less likely to have adequate food resources available. Yemen, in North Africa/West Asia/Europe, has a pattern that is almost flat, with high levels of stunting among children of all birth orders. In Kazakhstan, in Central Asia, the highest levels of stunting are among children of fourth or fifth birth order: this is not surprising because Kazakhstan has a small number of births overall and therefore only a small number of higher order births in the sample. The sub-Saharan region shows four patterns of undernutrition by birth order, not all of which can be fully explained by poverty. The data suggest that the largest group (10 countries) has a pattern of stunting that increases with birth order, as seen in the other regions. Mothers of children of higher birth order tend to be older and less educated than younger mothers. A second group, made up of six countries (Cameroon, Central African Republic, Chad, Guinea, Niger, and Togo), has a flatter distribution of stunting, indicating that undernutrition as measured by stunting is not influenced by birth order (Figure 3.47). This may be due to the overall high levels of poverty in these countries. A third group, made up of five countries (Burkina Faso, Cte dIvoire, Tanzania, Zambia, and Madagascar), shows a U-shaped distribution of stunting, with levels of stunting being higher for the first and sixth or higher order births than the middle order births. This may be related to the mothers increased experience with child feeding practices as well as the application of improved health behaviors with subsequent children. However, at higher birth orders, poverty may negate the improvements gained from knowledge and experience. In Benin, Burkina Faso, and Uganda, the prevalence of stunting is highest for first births and levels off for second and higher order births. Mozambique has a unique pattern of undernutrition that shows decreasing stunting with increasing birth order.
Findings
69
70
Percent
G
Percent
10 10 20 30 40 50 60 0
20
30
40
50
60
Figure 3.47 Levels of stunting among children age 0-35 months by birth order, Demographic and Health Surveys, 1994-2001
1st birth
Sub-Saharan Africa
Birth 2-3
Birth 4-5
Birth 6+
Jo rd a Tu n 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m bo d In ia Ba dia 200 ng 19 0 9 la de 8-9 sh 9 2 N ep 00 al 0 19 96 D om in Bra ic an z il R 19 Co ep 96 lo . 1 9 m bi 96 a H 200 ai ti 0 Pe 200 ru 0 G 20 u a Bo 0 te liv m ia 0 al 19 a 1 9 98 98 -9 9 ha na ab 19 on 98 To 2 0 g 0 G o 0 Zi uin 1 99 m ea 8 ba bw 199 9 Be e 1 99 n C K in 1 9 te en 99 d y a 6 Iv o 199 M ire 8 a 1 Ce Co li 1 994 nt 99 m ra l A Ca or 5-9 f r me os 6 ic an roo 1 99 Re n 1 6 p 9 Ch . 1 9 98 ad 94 Bu 1 9 -95 rk in Erit 96a Fa rea 97 U so 19 g 9 M an 199 5 oz da 8am 20 99 b 00 Ta iqu -01 nz e 1 an 99 ia 7 N 19 ig 9 Za er 9 m 19 Et bia 9 8 hi op 199 M ia 6 M 2 a d a la 00 ag wi 0 as 20 ca 00 r1 99 7
Findings
Wasting increases with increasing birth order in most countries. In 11 of 23 countries in sub-Saharan Africa, children that are of sixth or higher order have the highest rates of wasting. In three countries, wasting shows a generally flat pattern across all birth orders. Three countries have a U-shaped pattern, which may be a reflection of mothers experience and improved health and nutrition practices. Four countries in this region have wasting levels that are highest for fourth and fifth order children. Two countries (Kenya and the Central African Republic) show unique patterns of low rates of wasting for first births and birth order six or higher (Figure 3.48). Countries in Latin America and the Caribbean have very low rates of wasting to start with, and these rates are about equal across birth orders, with the exception of Colombia and Brazil, where wasting rates increase with increasing birth order. All countries in South/Southeast Asia have high rates of wasting (over 10 percent for all births of second or higher order), and their rates increase with increasing birth order in most cases. In Central Asia, the Kyrgyz Republic and Kazakhstan have low rates of wasting, but the rates in Uzbekistan are much higher. In Uzbekistan, wasting increases with increasing birth order; in Kazakhstan and the Kyrgyz Republic, first births have the highest prevalence of wasting. North Africa/West Asia/Europe has low rates of wasting in three of the four countries. Birth order has little effect on wasting rates in this region (Figure 3.48). Underweight patterns by birth order are similar to stunting patterns in most regions, the prevalence of underweight increases with increasing birth order (Figure 3.49). However, sub-Saharan Africa again offers a more challenging picture with four distinct patterns of underweight. Like the other regions, the first group, including Kenya, Uganda, Guinea, and others, has an increasing relationship of birth order to underweight. A second group, including Cameroon, Ghana, Mali, and others, shows a J-shaped pattern between birth order and underweight. A third group has a U-shaped pattern. In a fourth group of countries, including Comoros, Togo, Cte dIvoire, and others, the prevalence of underweight does not vary much by birth order.
Findings
71
72
Percent
U G
Percent
10
15
20
25
30
10
15
20
25
0
Figure 3.48 Levels of wasting among children age 0-35 months by birth order, Demographic and Health Surveys, 1994-2001
1st birth
Sub-Saharan Africa
Birth 2-3
Birth 4-5
Birth 6+
Tu rk e Jo y 1 rd 99 an 8 Eg 19 yp 97 Ye t 2 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 N Ba e n g pa la l 19 de 9 In s h 6 di 20 Ca a 1 00 9 m bo 98di 99 a 20 00 Co lo m bi D a om 2 Pe 00 in ic ru 0 an 2 Re 0 0 p. 0 Bo 1 liv 996 ia G ua Br 1 9 9 a te m z il 8 19 al a 1 9 96 9 H 8-9 ai ti 9 20 00 a g a bo nd n 2 Ca a 0 m 200 00 er 0o 0 Za on 1 m 19 Ce bi 98 nt ra K a Zi en 199 lA f r mb y a 6 ic an abw 199 e 8 R M e p 19 ad . 1 9 M ag 99 9 oz a 4 am s ca -95 r1 b Ta iqu 997 nz e 1 an 99 M ia 1 7 al 9 E aw 99 C th i2 te iop 00 d ia 0 Iv 20 Co oire 00 m or 199 G os 4 ui 1 9 ne 9 a 6 To 19 g 9 G o1 9 ha 9 Bu na 98 rk in Be 19 9 a n Fa in 8 so 19 1 96 Er 998 it Ch rea 99 ad 1 1 9 9 95 N 96ig 9 M er 7 a l 19 i1 9 99 8 596
Findings
Findings
Percent
Zi m
Percent
10
20
30
40
50
60
70
10
20
30
40
50
60
70
Figure 3.49 Levels of underweight among children age 0-35 months by birth order, Demographic and Health Surveys, 1994-2001
1st birth
Central Asia South/ Southeast Asia Latin America/ Caribbean
Sub-Saharan Africa
Birth 2-3
Birth 4-5
Birth 6+
Eg yp Jo t 2 rd 00 0 a Tu n 1 99 rk 7 e Ye y 1 m 99 en 8 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m bo di a 2 N ep 00 In al 0 Ba dia 199 ng 19 6 9 la de 8-9 sh 9 20 00 D om Br in ic az an il Re 199 p. 6 1 Pe 996 Co ru lo m 20 bi 00 Bo a 2 liv 00 0 ia G 19 ua te Hai 98 m t al i 20 a 1 9 00 98 -9 9
ba bw G e1 ab 9 o 99 Ke n 2 U ga ny 00 a 0 n Ce Ca da 199 nt m 20 8 ra er 00 lA oo - 0 fr G n 1 ic ui 1 9 an n 9 Re ea 8 p. 19 Co 1 99 m 994 or -9 os 5 To 1 9 go 96 C G 1 te han 99 M dI a 1 8 oz vo 9 am ire 98 bi 1 q 99 Za ue 4 m 19 b 9 M ia 7 a l 19 aw 96 Be i 2 Ta ni 000 nz n 1 9 a Ch nia 96 M ad 1 99 ad ag 1 99 9 as 6ca 97 Er r 1 it Bu r 99 rk Eth ea 7 in io 19 a Fa pia 95 so 20 0 M 199 0 al 8 -9 i1 9 9 N 95ig er 96 19 98
73
Preceding Birth Interval The length of the birth interval provides not only a descriptive variable for undernutrition (Mozumder et al., 2000; Rafalimanana and Westoff, 2000; Sharmanov et al., 1997; Boerma and Bicego, 1992), but it also explains how other relationships operate. Short birth intervals have been found to be associated with low birth weight and with intrauterine growth retardation, both of which have major implications for child undernutrition. (Fikree and Berendes, 1994). In other studies, children of women who live in urban areas or have secondary or more education are less likely to be born after a short interval than children of women who live in rural areas or have lower levels of education (Rutstein, 2002). Both place of residence and level of education were reported earlier to be related to child undernutrition. The length of the interval preceding each childs birth is derived from the birth history provided by the mother. Birth interval length is divided into four categories: first birth, less than 24 months, 24 to 47 months, and 48 months or longer (Table A.3.22 and Figures 3.50 through 3.52). The pattern that emerges for all regions is that the highest rates of stunting are among children with birth intervals of less than 24 months, followed by intervals of 24 to 47 months. Four countries (Kenya, Uzbekistan, the Kyrgyz Republic, and Bolivia) are exceptions. In Kenya, the Kyrgyz Republic, and Bolivia the highest rate of stunting is among children with a birth interval of 24 to 47 months, and in Uzbekistan, the highest rate is among children with an interval of 48 months or longer. In Zambia, first births have the highest rate of stunting (Figure 3.50). In sub-Saharan Africa, the lowest rate of stunting is typically among children born after an interval of 48 months or longer. Again, Kenya is the exception with a rate for the 48-month interval almost the same as that for first births; in Comoros and Zimbabwe, stunting is the lowest for first births. In the Latin America and Caribbean region, first births and children born after an interval of 48 months or longer have almost the same rate of stunting, except for Guatemala, where the rate of stunting is higher for first births. In the South/Southeast Asia region, Cambodia and Bangladesh have the lowest rates of stunting following an interval of 48 months. In Nepal and India, stunting rates are higher for children born after an interval of 49 months or longer than for first births. The North Africa/West Asia/Europe region has the lowest rates of stunting for children with intervals of 48 months or longer, except in Egypt, where the rate is almost the same in three of the four birth interval categories (Figure 3.50). There are no discernible patterns in the level of wasting by the length of the preceding birth interval (Figure 3.51). The patterns for underweight by preceding birth interval are similar to those for stunting. In 17 of the 23 countries of sub-Saharan Africa, underweight is highest among children with the shortest birth interval (less than 24 months). Cameroon, Cte dIvoire, Guinea, Malawi, Tanzania, and Zambia are the exceptions (Figure 3.52).
74
Findings
In most countries in the other four regions, the highest rates of underweight are among children with birth intervals of less than 24 months. There are a few exceptions. Bolivia and Guatemala in Latin America and the Caribbean, the Kyrgyz Republic in Central Asia, and Nepal in South/Southeast Asia all have rates of underweight that are higher among children with a birth interval of 24 to 47 months than among those with an interval of less than 24 months. The countries in South/Southeast Asia and Yemen in North Africa/West Asia/Europe all have high levels of underweight; the patterns of underweight by birth interval are similar to those of countries in sub-Saharan Africa that have high levels of underweight (Figure 3.52).
Figure 3.50 Levels of stunting among children age 0-35 months by length of preceding birth interval, Demographic and Health Surveys, 1994-2001 Sub-Saharan Africa
60 50 40 Percent 30 20 10 0
20 00 o 19 G ui 98 ne Zi a m 19 ba bw 99 e 19 Be 99 ni n 19 Ke 96 C ny te a 19 d Iv 98 oi re 19 M al 94 i1 Ca 99 m 5Ce er oo 96 nt ra n Co lA 19 m 98 fr or ic os an 19 Re 96 p. 19 Ch 94 -9 ad 19 5 96 Bu Er -9 rk it 7 re in a a 19 Fa so 95 U ga 199 8nd 99 M oz a 2 am 00 0bi qu 01 e Ta 19 nz 97 an ia 19 99 N ig er 19 Za 98 m bi a Et 19 hi 96 op ia 20 M 0 al M aw 0 ad ag i 20 00 as ca r1 99 7 To g 19 98 ha na G G ab o

60 50 40 Percent 30 20 10 0
Central Asia
Ka za kh st Ky an rg 19 yz 99 Re p. U zb 19 ek 97 is ta n 19 96 Ca m bo di a 20 In 00 di a Ba 19 98 ng -9 la 9 de sh 20 00 N ep al 19 96
Jo rd an 19 Tu 97 rk ey 19 98 Eg yp t2 00 Ye 0 m en 19 97
First birth
< 24 Months
24-47 Months
Findings
om
Br az in il ic 19 an 96 Re p. Co 19 lo 96 m bi a 20 00 H ai ti 20 00 Pe ru 20 Bo 00 G liv ua ia te 19 m al 98 a 19 98 -9 9
48 Months or more
75
76
Percent Percent 10 15 20 25 0 5
10
15
20
25
Tu rk ey 19 Jo 98 rd an 19 97 Eg yp t2 00 Ye 0 m en 19 97
Central Asia
Ka za kh st Ky an rg 19 yz 99 Re p. U zb 19 ek 97 is ta n 19 96
Figure 3.51 Levels of wasting among children age 0-35 months by length of preceding birth interval, Demographic and Health Surveys, 1994-2001
First birth
Sub-Saharan Africa
< 24 Months
N ep Ba al ng 19 la 96 de sh 20 In 00 di a 19 Ca 98 m -9 bo 9 di a 20 00
24-47 Months
Co
lo m
bi a
om
48 Months or more
in ic an
Pe ru
20 00
Re p.
20 00
Bo
liv ia
19 96
19 98 Br az ua il te 19 m 96 al a 19 98 -9 9 H ai ti 20 00
G ab on ga 20 nd 00 a 20 00 Za -0 m 1 bi Ca a 19 m er 96 oo n 19 Ce Ke 98 nt ny Zi ra a m lA 19 ba fr bw 98 ic an e 19 Re 99 p. M oz 19 am 94 -9 bi 5 qu M ad e 19 ag 97 as ca r1 Ta nz 99 an 7 ia 19 M 9 al aw 9 i2 Et 00 hi op 0 C ia te 20 d 00 Iv oi Co re 1 99 m or 4 os 19 G ui 96 ne a 19 9 To go 9 19 G 98 ha na 19 Bu Be 98 rk ni in n a 19 Fa 96 so 19 98 Er -9 it 9 re a Ch 19 ad 95 19 96 -9 N 7 ig er 19 M al 98 i1 99 596
Findings
Findings
Percent
Zi m
Percent
10
20
30
40
50
60
10
20
30
40
50
60
Figure 3.52 Levels of underweight among children age 0-35 months by length of preceding birth interval, Demographic and Health Surveys, 1994-2001
First birth
Eg yp t2 00 Jo rd 0 an 19 Tu 97 rk ey 19 Ye 98 m en 19 97 Ka za k Ky hsta rg n 1 yz Re 999 U p. zb 19 ek 97 is ta n 19 96
< 24 Months
Sub-Saharan Africa
N ep al Ca 19 m bo 96 di a In 20 d 00 Ba ia 1 99 ng 8 la de -99 sh 20 00
24-47 Months
om
48 Months or more
Br az in ic an il 19 96 Re p. Co 19 lo 96 m bi a 20 00 Pe ru 20 Bo 00 liv ia 19 G 98 H ua ai te ti m 20 al 0 a 19 0 98 -9 9
ba bw e 1 G ab 99 on 9 Ke 2 00 U ga ny a 0 nd 19 a 9 Ca 20 8 Ce m 00 er nt oo -01 ra lA n 19 G fr ui ic ne 98 an Re a 1 99 p. 9 Co 1 99 4m 9 or os 5 19 To 9 go 6 19 G C h 9 te ana 8 d 19 M I 98 oz voi am re 19 bi qu 94 Za e 19 m 97 bi M a 19 al aw 96 i Be 200 0 ni Ta n 19 nz 96 an Ch ia 1 99 M ad 19 9 ad 9 ag as 6-9 7 ca r1 Bu Er 99 rk it in 7 re a a Fa 19 so 95 19 Et 98 hi op -99 i M a2 0 al i 1 00 99 5 N ig -96 er 19 98
77
Vaccination History Universal immunization of children less than one year of age against the six vaccine-preventable childhood diseases (tuberculosis, diphtheria, pertussis, tetanus, poliomyelitis, and measles) is one of the most cost-effective approaches to reducing child morbidity and mortality. To be fully immunized, a child should receive one dose of BCG (vaccination against tuberculosis) at birth, three doses each of DPT (diphtheria, pertussis, tetanus) and polio, and one dose of measles vaccine, although this vaccination schedule has been modified recently. Some countries recommend a second dose of measles vaccine after the first year. Nevertheless, for countries included in this study, a child who received one dose of measles vaccine is considered fully immunized for measles. Because it is recommended that children receive the complete schedule of vaccinations before 12 months of age, this report analyzes the vaccination status of children age 12-23 months. Measles Measles is a severe disease with high case fatality rates in developing countries. The primary reason for the difference in clinical severity and case fatality between developed and developing countries is the poor nutritional status of children in developing countries. Undernutrition reduces the bodys resistance to infections and adversely affects the immune system. Therefore, immunization against measles has proven to be very effective in reducing the incidence in many countries. In sub-Saharan Africa, the prevalence of measles vaccination (Table A.3.23) runs from a low of 23 percent (Chad) to 87 percent (Zambia). Latin America and the Caribbean region has a spread ranging from 51 percent (Bolivia) to 89 percent (Brazil). Much higher rates are seen in Central Asia, with a high of 92 percent (Uzbekistan). South/Southeast Asia has lower rates, ranging from 54 percent (India) to 70 percent (Bangladesh). Yemen in the North Africa/West Asia/Europe region has the lowest rate of measles vaccination (47 percent), while in the same region, Egypt has the highest (97 percent) (Figure 3.53). Figure 3.54 shows that in most countries, the rates of stunting are higher among children age 12-23 months who did not receive a measles vaccination than among those who did. In a few countries (Benin, Burkina Faso, Ethiopia, Togo, Uganda, and Jordan), there is little difference in stunting rates between children who were vaccinated and those who were not. Contrary to expectation, in Madagascar and Egypt, children with measles vaccinations have higher rates of stunting.
78
Findings
Findings
Percent
Ch
Percent
Ye m
en
20
40
60
80
100
100
20 0
40
60
80
Sub-Saharan Africa
Figure 3.53 Percentage of children age 12-23 months with a measles vaccination, Demographic and Health Surveys, 1994-2001
Tu 1 rk 99 ey 7 Jo 1 rd 99 an 8 Eg 19 yp 97 t2 00 Ka 0 za Ky khs rg ta yz n 1 9 R U zb ep 99 ek . 1 9 is ta 97 n 19 96 In di Ca a 1 9 m bo 98di 99 a 20 B a Ne 00 ng pa la l 19 de 9 sh 6 20 00 Bo liv ia 19 H Co ait 98 lo i 2 m 0 bi 00 D a om 2 Pe 00 in ic an r u 0 G 2 ua Re 0 0 te m p. 1 0 al 99 a 19 6 Br 98az 99 il 19 96
ad Et 1 9 hi 96 op -9 ia 7 N 20 ig 00 e M To r 19 Ce B a nt ur da go 9 8 ra kin ga 1 l A a s c 99 f r Fa a r 8 ic an so 199 Re 199 7 p. 8-9 1 9 Er 994 it -9 re 5 C Ma a 1 li 99 te d 199 5 Ca Ivo 5-9 m ire 6 er oo 199 G n1 4 ab 9 o 9 G n2 8 U uin 0 ga 0 nd ea 1 0 a 9 C 2 9 M om 00 9 oz o 0am ro 01 bi s 1 9 qu 9 e 6 Be 19 ni 97 G n1 h Ta an 996 nz a 1 an 99 ia 8 Ke 1 Zi ny 999 m ba a 1 bw 99 M e1 8 al a 99 Za wi 9 m 20 bi 00 a 19 96
79
80
Percent
G G ab o
Percent
100
20
40
60
80
100
C
20
40
60
80
Figure 3.54 Levels of stunting among children age 0-35 months by measles vaccination status, Demographic and Health Surveys, 1994-2001
Measles vaccination
Sub-Saharan Africa
No measles vaccination
Jo rd a Tu n 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m Ba bo ng dia la 2 de 00 In s h 0 di 20 a 19 00 N 98ep 9 D al 9 om 19 in 96 ic an Re p. Br 19 Co az 96 lo il 1 m 9 bi 96 a H 200 ai ti 0 2 Pe 00 ru 0 G 20 ua Bo te livi 00 a m 19 al a 1 9 98 98 -9 9 n 2 te han 00 d a 0 Iv 19 oi 9 G re 8 ui 19 ne 9 4 Be a 1 ni 999 n Ce Zi Tog 199 m nt ba o 1 6 ra bw 99 lA 8 fr ic Ke e 19 an n 9 Re y a 9 p. 19 1 9 M Ma 99 8 oz 4 l am i 19 -95 95 bi q Ch ue 96 ad 19 Ca m 1 9 97 er 96 oo -9 Bu 7 rk Er n 1 in a it re 998 Fa a U so 19 ga 1 9 nd 99 5 a 8-9 Co 20 9 m 00 or -0 Za os 1 m 1 Ta bi 996 nz a 1 an 99 ia 6 N 19 ig 9 M er 9 a l 19 Et aw 9 8 M hio i 20 ad p 0 ag ia 0 as 20 ca 00 r1 99 7
Findings
Findings
Percent Percent 10 15 20 25 30 35 0 5 10 15 20 25 30 35 0
Figure 3.55 Levels of wasting among children age 0-35 months by measles vaccination status, Demographic and Health Surveys, 1994-2001
Measles vaccination
Sub-Saharan Africa
Jo rd a Tu n 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 00 en 0 19 Ka 97 za Ky kh rg sta yz n R 19 U zb ep 99 ek . 1 9 is ta 97 n 19 96 B a Ne ng pa la l 1 de 99 In s h 6 d 2 Ca ia 1 000 99 m bo 8di 99 D a om 20 in 00 ic an Re p. 1 Pe 99 ru 6 Bo 20 Co livi 00 a lo m 19 bi 98 a G 20 ua B te raz 0 0 m i al l 19 a 1 9 96 9 H 8-9 ai ti 9 20 00
G Ca ab m on U ero 2 0 ga o 00 nd n 1 a Ta 20 998 nz 00 an -0 1 i Ke a 1 Ce ny 99 nt Za a 9 ra l A Zi mb 199 f r mb ia 8 ic an ab 199 w Re e 6 p. 19 1 9 99 M Ma 94 a d la -9 ag wi 5 a 20 0 C sc M om a r 0 oz o 19 ro 9 a C mb s 1 7 iq 99 te d ue 6 Iv 19 oi 9 G re 7 ui 19 ne 9 4 G a1 ha 9 Et na 99 hi op 199 8 i Be a 2 ni 000 n To 19 Bu go 96 rk in Erit 1 9 a 9 Fa rea 8 so 19 Ch 19 95 ad 981 9 99 N 96ig 9 M er 7 a l 19 i1 9 99 8 596
81
Similar to stunting, the rates of wasting are generally higher among children age 12-23 months who did not receive a measles vaccination than among those who did. However, particularly puzzling are the higher wasting rates among vaccinated children in Mozambique and Cte dIvoire in sub-Saharan Africa, Guatemala in Latin America and the Caribbean, Uzbekistan in Central Asia, and Cambodia in South/Southeast Asia (Figure 3.55). In most cases, underweight rates are higher among children age 12-23 months who have not been vaccinated against measles than among those who have (Figure 3.56).
Figure 3.56 Levels of underweight among children age 0-35 months by measles vaccination status, Demographic and Health Surveys, 1994-2001
100
Sub-Saharan Africa
80 60
Percent
40 20 0
100 80 60
Percent
40 20 0
Ka za kh st Ky an rg 19 yz 99 Re p. U zb 19 ek 97 is ta n 19 96
Jo rd an 19 Tu 97 rk ey 19 Ye 98 m en 19 97
Measles vaccination
82
D om
Br az in il ic 19 an 96 Re p. 19 96 Pe ru Co 20 lo 00 m bi a 20 Bo 00 liv ia 19 98 G H ua ai ti te 20 m al 00 a 19 98 -9 9
19 98 -9 N 9 ep Ba al ng 19 la 96 de sh 20 00
20 00
Eg yp t
bo d
ia
Ca m
In d
ia
20 00
20 ba bw 00 e 19 Ke 99 ny Ca a m 19 er C oo 98 te n 19 d 98 Iv oi re Co 19 Ce m 94 or nt U os ra ga lA 19 nd fr 96 a ic 20 an 00 Re -0 p. M 1 oz 1 am 994 -9 bi 5 qu e 19 G ui 97 ne a 19 Za 99 m bi a 19 M 9 al aw 6 i2 G ha 000 na 19 98 To go Ta 19 nz 98 an ia 19 Be 99 ni n Ch 19 Bu 96 ad rk in 19 a 96 Fa -9 so 7 19 98 -9 Er 9 it re a 19 M al 95 i1 99 Et 5hi 96 op M ia ad 20 ag 00 as ca r1 99 N 7 ig er 19 98
Zi m
ab o
Central Asia
Findings
Other Vaccinations Exploring vaccination status further to see whether other vaccinations and no vaccinations make a difference in undernutrition rates, the analysis shows that the lowest rates of undernutrition are still among children who have had a measles vaccination (Table A.3.24). The highest rates are generally among those who have had no vaccinations. In the sub-Saharan region, rates of undernutrition among children with only other vaccinations tend to be lower than or equal to rates among children with no vaccinations (Figures 3.57 through 3.59). Sample size must be scrutinized closely when analyzing vaccination data. In sub-Saharan Africa, there are six countries with less than 50 cases with no vaccinations. In North Africa/West Asia/Europe, three of the four countries have less than 50 cases of no vaccinations; hence the results of only one country (Yemen) can be discussed. In Yemen, children with a measles vaccination still have the lowest rates of stunting and underweight, but those with no vaccinations have the lowest rates of wasting. In Central Asia, two of the three countries have no cases in which children received no vaccinations; the remaining country (Kazakhstan) has less than 10 cases. Therefore, most children in Central Asia have completed vaccinations (Table A.3.24). Five of the seven countries in the Latin America and Caribbean region have less than 50 cases with no vaccinations; therefore, only other vaccinations can be compared with measles vaccinations in these countries. In most cases, stunting and underweight rates are higher among children with only other vaccinations than among those with measles vaccinations (Figures 3.57 and 3.59, respectively). Wasting rates are generally low in this region; only Haiti has a high enough level to determine that there is no relationship between vaccination status and wasting rates in that country (Figure 3.58). In Guatemala, wasting rates are higher among children with a measles vaccination than among those with only other vaccinations. Uzbekistan in Central Asia and Cambodia in South/Southeast Asia stand out as having the highest rates of wasting among children with a measles vaccination (Figure 3.58).
Findings
83
84
Percent
G ab o
Percent
100
G
100
20 20 40 60 80 0
40
60
80
Figure 3.57 Levels of stunting among children age 0-35 months by vaccination status, Demographic and Health Surveys, 1994-2001
Measles
Other vaccinations only
Sub-Saharan Africa
No vaccinations/missing
Jo rd a Tu n 1 rk 997 ey Eg 19 yp 98 Ye t 2 m 00 en 0 19 Ka 97 za kh Ky rg sta yz n 1 9 R U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m bo Ba ng dia la 2 de 00 In s h 0 di 20 a 19 00 N 98ep 9 D al 9 om 19 in 96 ic an Re p. Br 199 6 Co az lo il 1 m 9 bi 96 a 20 H ai 0 0 ti Pe 200 ru 0 G 20 ua Bo te livi 00 a m 19 al a 1 9 98 98 -9 9 n 2 te han 00 d a 0 Iv 19 oi 9 G re 8 ui 19 ne 9 4 Be a 1 ni 999 n Ce Zi To 199 m go 6 nt ba ra bw 1 99 lA 8 fr ic Ke e 19 an n 99 Re y a p. 19 9 M 1 99 8 M oz a l 4am i 19 95 bi 95 q Ch ue 96 ad 19 Ca 9 m 1 99 7 er 6oo 9 Bu 7 rk Er n 1 in it 99 a r Fa ea 8 U so 19 ga 1 9 nd 99 5 8a Co 20 99 m 00 or -0 Za os 1 m 1 Ta bi 996 nz a 1 an 99 ia 6 N 19 ig 9 M er 9 a l 19 Et aw 9 8 M hio i 20 ad p 0 ag ia 0 as 20 ca 00 r1 99 7
Findings
Percent
G
Findings
Percent 10 20 30 40 10 20 30 40 0 0
North Africa/ West Asia/ Europe Central Asia South/ Southeast Asia
Eg yp Ye t 2 0 0 m en 0 19 97 Ka za k Ky hs rg ta n yz 1 Re 99 U 9 p zb ek . 19 is 97 ta n 19 96
Figure 3.58 Levels of wasting among children age 0-35 months by vaccination status, Demographic and Health Surveys, 1994-2001
Measles
Sub-Saharan Africa
N e Ba ng pal 1 la de 996 sh In 20 di 00 Ca a 1 99 m bo 8-9 di 9 a D om 20 00 in ic an Re p. 19 96 Pe ru 20 Bo 0 liv Co ia 0 lo 19 m bi 98 a 20 G u a Br az 0 0 te il m 19 al 9 a 19 6 98 H ai 99 ti 20 00
Ca ab m on U ero 2 0 ga o 00 nd n 1 Ta a 2 998 nz 00 an 0-0 i 1 Ke a 1 Ce ny 99 nt Za a 9 ra l A Zi mb 199 f r mb ia 8 ic an ab 199 w Re e 6 p 19 .1 99 9 M Ma 94 a d la -9 ag wi 5 a 2 Co s ca 000 M m r1 oz o ro 99 a C mb s 1 7 te iqu 99 d e 6 Iv 19 o 9 G ire 7 ui 19 ne 9 G a1 4 ha 9 Et na 99 hi op 199 8 i Be a 2 00 ni n 0 To 19 Bu go 96 rk in Erit 1 9 9 a Fa rea 8 so 19 Ch 19 95 ad 98 1 9 -99 N 96ig 9 M er 7 a l 19 i1 9 99 8 596
85
86
Percent 10 10 20 30 40 50 60 70 80 0
Zi m
Percent
20
30
40
50
60
70
80
Figure 3.59 Levels of underweight among children age 0-35 months by vaccination status, Demographic and Health Surveys, 1994-2001
Measles
Sub-Saharan Africa
Eg yp Jo t 2 rd 00 0 a Tu n 1 99 rk 7 e Ye y 1 m 99 en 8 19 Ka 97 za Ky khs rg ta yz n 1 9 R U zb ep 99 ek . 1 9 is ta 97 n 19 96 Ca m bo d In ia 20 di a 0 19 0 N 98Ba e ng pa 99 la l 19 de 9 sh 6 20 00 D om Br in ic az i an l Re 199 6 p .1 99 P Co er 6 lo u 2 m 00 bi 0 Bo a 2 00 liv ia 0 G 19 ua H ai 98 te t m al i 20 a 1 9 00 98 -9 9
ba bw Ke e 1 Ca n 99 9 m y C e a 1 ro 99 te o d n 8 Iv 1 9 Ce Co oire 98 nt m 1 ra l A Ug oro 99 an fr s1 4 ic 9 an da 2 96 M Re 000 oz p. am 1 9 01 bi 94qu 9 G e1 5 ui n 99 Za ea 7 m 19 99 b M ia 1 al 9 aw 96 i2 G ha 0 na 00 To 19 Ta go 98 nz 1 an 99 ia 8 Be 19 9 n Bu Ch in 9 rk 19 in ad 9 a Fa 1 99 6 so 619 97 Er 98 -9 it r M ea 9 a l 19 i Et 19 95 M hio 95ad p 9 ag ia 2 6 as 00 ca 0 r N 19 ig er 97 19 98
Findings
Feeding Practices Infant feeding practices are important to the nutritional status of children. It is recommended that infants age 0-6 months are breastfed exclusively, followed by the timely introduction of complementary foods 2 between the ages of 6 and 9 months. The use of bottles for feeding infants is not recommended because poor hygienic practices can lead to the introduction of pathogens. Breastfeeding should continue into the second year of life (WHO, 2003). This report does not analyze child nutritional status by infant feeding practices. Data on infant feeding practices are based on the past 24 hours while nutritional status is based on a childs experience over time. A comparison of the two would be better served by using longitudinal data. Nevertheless, an examination of infant feeding practices in the countries included in this report provides useful information for analysis of the nutritional status of children. There are substantial variations in infant feeding practices across countries and regions, and discussion of these variations is important. Exclusive breastfeeding in this report is measured based on the percentage of youngest children (under 6 months of age) who have been fed only breast milk in the 24 hours preceding the survey. Breastfeeding status of children under six months of age is shown in Table A.3.25. Rates of exclusive breastfeeding in sub-Saharan Africa range from less than 1 percent in Niger to over 63 percent in Uganda (Figure 3.60). Countries in Latin America and the Caribbean have higher rates of exclusive breastfeeding, ranging from 18 percent in the Dominican Republic to 67 percent in Peru. In South/Southeast Asia, the proportion of exclusively breastfed children ranges from 11 percent in Cambodia to 75 percent in Nepal. Exclusive breastfeeding data are available for only one country in Central Asia, Kazakhstan, where the figure is 36 percent. In North Africa/West Asia/Europe, Yemen has no data on exclusive breastfeeding, and Egypt has the highest rate for the region, 64 percent (Figure 3.60). Bottle-feeding of children less than six months of age varies across countries and regions. In subSaharan Africa, six countries have bottle-feeding rates of more than 10 percent, with a high of 37 percent in Gabon. In Latin America and the Caribbean, rates of bottle-feeding reach almost 60 percent for breastfed infants in the Dominican Republic and 87 percent among nonbreastfed infants in Brazil (Table A.3.25). Table A.3.26 shows current breastfeeding status for infants age 6-9 months. At this age, children are expected to begin eating solid (complementary) foods in addition to breast milk. In sub-Saharan Africa (Figure 3.61), timely complementary feeding of infants ranges from 28 percent in Guinea to more than 90 percent in the Central African Republic, Malawi, Zambia, and Zimbabwe. (In many of these countries, rates of complementary feeding are already high among children under six months of age.) In Latin America and the Caribbean, timely complementary feeding ranges from 31 percent in Brazil to 76 percent in Peru. North Africa/West Asia/Europe has moderate rates of complementary feeding of children age 6-9 months, ranging from 55 to 64 percent. In South/Southeast Asia, India has a low rate of 34 percent, but in the three other countries, it ranges from 59 percent in Bangladesh to 72 percent in Cambodia. Table A.3.26 shows that there are significant proportions of children still being exclusively breastfed or receiving breast milk and plain water only at age 6-9 months, when complementary feeding is considered essential to provide adequate nutrition.
Since the initial preparation of this report, recommendations for complementary feeding have been greatly expanded (PAHO, 2003, WHO, 2005). Comparative DHS data on the new complementary feeding indicators can be found in the Infant and Young Child Feeding Update (Mukuria et al., 2006).
Findings
87
88
Percent
Ce nt ra lA
60 70 80 10 20 30 40 50 60 70 80 0
Percent
10
20
30
40
50
0
Ka za kh st an
Central Asia
Tu rk ey 19 Jo 9 rd an 8 Eg 199 7 yp t2 00 0
Ca m
19 99
Sub-Saharan Africa
Figure 3.60 Exclusive Breastfeeding status of children under 6 months, Demographic and Health Surveys, 19942001
b Ba od ia ng 2 la de 00 0 sh In 20 di 0 a 19 0 98 N ep -99 al D 19 om 96 in ic an Re p. 19 96 H ai ti 2 G ua Bra 000 te zi l1 m al 99 a 19 6 Bo 9899 l Co ivia 19 lo m bi 98 a 20 00 Pe ru 20 00
N ig f r Ch er ic an ad 199 1 8 C Re p 996 te . 1 -9 d 99 7 Iv 4 Co oir -95 m e1 or 99 Bu o rk G s1 4 in ab 9 a 9 Fa on 6 so 2 0 0 M 199 0 a l 8i 1 99 Be 995 ni -96 n To 19 g 9 G o 6 ui 1 9 Ca n m ea 98 er 1 oo 99 n 9 Ke 1 n 99 M Za y a 8 oz m 19 am bia 98 bi 19 qu 9 6 G e1 ha 9 Zi 97 m na ba 19 Ta bw 98 e nz an 199 M ia 1 9 M a d a la 99 ag wi 9 as 20 Et ca r 00 hi op 199 7 Er ia 2 U it 00 ga re nd a 1 0 a 9 20 95 00 -0 1
Findings
Findings
Percent
Percent
100
100
20
20 40 60 80 0
40
60
80
0
Ka za kh st an
Central Asia
Tu rk ey 19 Jo 9 rd an 8 19 Eg 97 yp t2 00 0
19 99
In d Ba ia ng 199 8 la de -99 sh 20 N 00 ep Ca al m 19 bo 96 di a 20 00
Sub-Saharan Africa
Co
Figure 3.61 Complementary feeding status of children age 6-9 months, Demographic and Health Surveys, 19942001
Br az il D 19 lo om m 96 bi in ic an a 20 G 00 ua Re te p. m 19 al 9 a 19 6 98 Bo -9 liv 9 ia 19 98 H ai ti 20 00 Pe ru 20 00
G ui n M ea a l 19 Et i 19 99 hi 95 op - 9 Bu 6 i rk Er a 2 in a it re 000 Fa a s 1 Ta o 1 9 9 nz 99 5 an 8-9 9 i G a1 ab 9 99 o C Gh n 2 te an 00 d a 0 Iv 19 o Ch ire 98 ad 19 1 9 94 N 96Ca ig m er 97 U ero 19 g o 9 M and n 1 8 oz a 9 am 20 98 bi 00 qu -0 1 Be e 19 ni 97 Co n M mo 19 ad r 9 ag os 6 as 1 9 ca 96 r To 19 Ce go 97 nt ra K l A Zim en 1 99 y 8 fr ic bab a 1 an w 998 Re e p. 199 M 1 99 9 al 4 a -9 Za wi 5 m 20 bi 00 a 19 96
89
WHO recommends that breastfeeding should continue through the second year of life. Table A.3.27 shows the median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey. DHS calculates the median duration of breastfeeding from current breastfeeding status data. For each month of age, the percentage of children who are breastfeeding is derived by dividing the number of children breastfeeding by the total number of children born the same number of months ago. The median is derived (usually through interpolation) by identifying the age at which 50 percent of the sample children are no longer breastfeeding. This method is preferred over mothers reports of breastfeeding duration among fully weaned children because of biases in recall (Haggerty and Rutstein, 1999). In sub-Saharan Africa, the median duration of any breastfeeding ranges from 12 months in Gabon to 26 months in Burkina Faso and Ethiopia. In North Africa/West Asia/Europe, it ranges from 12 months in Jordan and Turkey to 18 months in Yemen and Egypt. Among all the countries surveyed, Brazil (7 months) and the Dominican Republic (8 months) in Latin America and the Caribbean have the shortest median duration of any breastfeeding. Central Asia has a median duration of about 16 months. In South/Southeast Asia, the median duration of breastfeeding ranges from 21 months in Cambodia to 31 months in Bangladesh and Nepal (Figure 3.62 and Table A.3.27). The median duration of predominant breastfeeding (breast milk and other nonmilk liquids) is longer than that of exclusive breastfeeding in most countries. In three countries (Yemen, the Kyrgyz Republic, and Uzbekistan), the median durations of predominant and exclusive breastfeeding are the same (0.4 month). The longest median duration of exclusive breastfeeding is found in Nepal (4.7 months). Short median durations of exclusive breastfeeding (less than 1 month) are reported for 16 of 23 countries in sub-Saharan Africa, 3 of 4 countries in North Africa/West Asia/Europe, 2 of 3 countries in Central Asia, 1 of 4 countries in South/Southeast Asia, and 3 of 7 countries in Latin America and the Caribbean (Figure 3.62 and Table A.3.27).
90
Findings
Months Months
G Ce nt ra lA
Findings
10 15 20 25 30 35 10 15 20 25 30 35 0 0 5
Figure 3.62 Median duration of exclusive breastfeeding, predominant breastfeeding, and any breastfeeding, Demographic and Health Surveys, 1994-2001
Exclusive
Sub-Saharan Africa
Predominant
Any breastfeeding
Jo rd an Eg 199 yp 7 t2 00 Ky 0 rg yz R U zb ep. ek 19 Ka i sta 97 za n 19 kh 9 st an 6 19 99 Ca m b Ba od ia ng 2 la de 00 0 sh In 20 di 0 a 19 0 98 N ep -99 al D om 19 96 in ic an Re p. 19 G ua 96 H ai te ti m 20 al 0 a 19 0 98 Br az 99 il 19 Bo 9 l Co ivia 6 lo 19 m bi 98 a 2 Pe 00 0 ru 20 00 ab f r Co m on ic an or 2 00 Re os 0 p. 1 9 1 96 C B 99 en 4te 9 d in 5 Iv 19 o Ch ire 96 ad 19 Bu 1 9 94 rk in N 96a ig Fa er 97 so 19 1 9 G 99 8 ui 8 ne -99 a Ke 1 ny 99 a 9 To 19 g 9 Za o 8 m 19 Ca m bia 98 er 1 o 99 M on 6 al 19 i1 9 M G 9 8 oz ha 95am na 96 19 b Ta iqu 98 e n Zi z an 199 m ba ia 1 7 bw 99 e 9 M Ma 1 a d la 99 ag wi 9 a 20 Et s ca 00 hi r 1 op 99 7 i Er a 2 U ga it re 000 nd a a 19 20 95 00 -0 1
91
3.4.3.3 Immediate Influences Recent Illnesses The interaction of undernutrition and infection is the leading cause of morbidity and mortality in most developing countries. In a vicious cycle, infections make undernutrition worse and poor nutrition increases the susceptibility to and severity of infectious diseases. Acute respiratory infection (ARI) and diarrhea are the most prevalent infections in the developing world. Acute Respiratory Infection ARI is one of the leading causes of childhood morbidity and mortality in the developing world. Acute lower respiratory infections (primarily pneumonia) are the cause of a significant proportion (19 percent) of infant and childhood deaths (WHO, 2005). Programs for the early identification and antibiotic treatment of pneumonia are being implemented in many countries. To estimate the proportion of children who show symptoms consistent with ARI, DHS surveys asked mothers the following questions: Has (NAME) had an illness with a cough at any time in the last two weeks? When (NAME) had an illness with a cough, did he/she breathe faster than usual with short, rapid breaths? Table A.3.28 shows the prevalence of ARI in the two weeks preceding the survey among children age 423 months by nutritional status. In sub-Saharan Africa, the prevalence of ARI ranges from 6 percent in Niger to 21 percent in the Central African Republic. In North Africa/West Asia/Europe, the range is relatively smallfrom 7 percent in Jordan to 12 percent in Yemen. Countries in Central Asia have a very low prevalence of ARI, from 1 percent in Uzbekistan to 4 percent in the Kyrgyz Republic. In South/Southeast Asia, the prevalence ranges from 13 percent (Cambodia) to 20 percent (Nepal). In Latin America and the Caribbean, the lowest rate of ARI reported is in Peru (15 percent), and the highest rate is in Haiti (25 percent). Figures 3.63 through 3.65 show the prevalence of ARI by nutritional status. There is not as much elevation in ARI rates due to undernutrition as might be expected. In most countries, ARI rates for children that are stunted and those that are not are about the same or slightly higher or lower. There are no clear regional differences. The illness actually consists of lower respiratory infection, which includes pneumonia and poses a serious public health risk, and upper respiratory infection, which is common and poses less of a risk to children (Mishra et al., 2005). It has been suggested that the way ARI is assessed in DHS surveys may not be sensitive enough to distinguish between upper and lower respiratory infections, and this may account for the lack of a clear relationship between nutritional status and ARI.
92
Findings
Findings
Percent
M
19 Eg 97 yp t2 Ye 00 m en 0 19 97
Jo rd an
Percent 10 15 20 25 30 0 5
10
15
20
25
30
0 North Africa/ West Asia/ Europe Central Asia
Figure 3.63 Prevalence of ARI among children age 4-23 months by stunting, Demographic and Health Surveys, 1994-2001
Stunted South/ Southeast Asia Latin America/ Caribbean
Sub-Saharan Africa
Not stunted
U zb ek Ky ista n rg 19 yz 9 R Ka ep 6 za 19 kh 9 st an 7 19 99 C am bo di a 20 00 In di a 20 Ne 01 Ba pa ng l1 la de 996 sh 20 00 G ua te m al a 19 99 Pe ru Do Bo 200 m liv 0 in ia ic 19 an 9 R ep 8 19 Br 96 az il 1 99 Ha 6 iti 20 01
oz Nig am er bi 19 q 9 C ue 8 ha 19 d 1 9 Za 99 7 m 6-9 b 7 M ia 1 C 99 t ali Bu e 1 6 rk dI 995 in vo -9 a Fa ire 6 so 19 19 94 98 Zi Tog -99 m ba o 1 bw 99 8 G e1 ab 99 Co on 9 m 20 o Ta ros 00 nz 1 an 9 9 ia 6 G h a 199 na 9 M Be 19 ad 9 n ag in 8 as 19 ca 96 Ke r 1 9 C am nya 97 e r 19 o 9 Et on 8 19 hi op 98 i Er a 2 00 i tr e 0 M a1 al 99 aw C 5 en G i2 tra U u in 0 0 l A ga ea 1 fri nd ca a 199 2 n 9 R 00 ep 001 19 94 -9 5
93
94
Percent
M oz am bi qu
10 15 20 25 0 5 Percent
10
15
20
25
0
Sub-Saharan Africa
Figure 3.64 Prevalence of ARI among children age 4-23 months by wasting, Demographic and Health Surveys, 1994-2001
Wasted
Not wasted
Eg yp t2 Jo rd 000 an Ye 1 m 997 en 19 97 Ka za k Ky hst a rg yz n 1 Re 999 U p zb ek . 19 is ta 97 n 19 96 Ba ng la d Ca es h m bo 200 0 d In ia 2 di 00 a 19 0 98 N ep -99 al 19 96 Bo liv ia D 19 om Br in az 98 ic an il 1 G ua Re 996 te p. m 19 al 9 a 19 6 98 H ai 99 ti 2 Pe 000 ru 20 00 e 1 ig 997 Za er m 19 bi 9 a 8 Be 19 ni 96 Ch n ad 19 9 M 1 99 6 al 6i1 9 G 99 7 ui 5 ne -9 a 6 To 19 go 99 Ke 1 ny 998 G a1 ab 9 Bu o 9 rk Eth n 2 8 in io a p 00 C Fa s ia 2 0 te o 1 00 d 99 0 Ca Ivo 8-9 m ire 9 er 1 oo 99 G n1 4 M a d han 99 ag a 8 as 199 ca 8 r E U rit 19 ga re 97 nd a 1 a 99 M 200 5 a l 0Ce Co aw 01 nt m i2 ra or 0 lA f r Tan os 00 ic an zan 1 99 Re ia 6 Zi p. 199 m 19 9 ba 9 bw 4-9 e 5 19 99
Findings
Findings
Percent
Percent 10 15 20 25 30 0 5
Eg y
10
15
20
25
30
0 North Africa/ West Asia/ Europe Central Asia
Figure 3.65 Prevalence of ARI among children age 4-23 months by underweight, Demographic and Health Surveys, 1994-2001
Underweight South/ Southeasst Asia Latin America/ Caribbean
p Y e t 20 0 m en 0 19 Jo rd 9 an 7 19 97 U zb ek Ky ista n rg 19 yz Ka Re 9 6 p za 19 kh 9 st an 7 19 99 Ca m bo di a 20 In di 00 a 2 N ep 001 Ba al ng 1 la de 996 sh 20 00
Sub-Saharan Africa
Not underweight
Gu Per u at em 200 0 al a Br 1 9 9 az 9 i Bo l 19 96 liv ia Do 19 H m a i 98 in t ic an i 20 Re 01 p 19 96
N ig e Ga r 1 bo 99 Ch n 8 ad 20 1 0 M Za 99 0 oz m 6 am bia 97 bi 19 q 9 M ue 6 al 19 i1 9 7 C B 995 en -9 te d i n 6 Iv 1 9 oi 9 Gu re 1 6 in 9 9 Bu ea 4 rk To 19 in 9 a Fa go 9 so 19 Ta 19 98 nz 98 an -9 9 i G a1 ha 9 99 Et na hi op 199 8 i K a2 Ca en 00 m ya 0 M er 19 a d oo 9 ag n 8 a 19 Co sca 98 m r1 or 9 9 o 7 Er s 1 Zi itr 99 m ea 6 ba bw 199 Ce nt M e 5 1 ra a l A Ug law 999 f r a nd i 2 ic an a 2 00 Re 00 1 p 0-0 19 1 94 -9 5
95
Diarrhea Diarrhea is an important contributor to child morbidity and mortality. Mothers were asked to report the occurrence of diarrhea in their children. The following question was asked in DHS surveys: Has (name) had diarrhea in the last two weeks? Table A.3.29 shows the overall prevalence of diarrhea in the two weeks preceding the survey among children age 4-23 months and the prevalence of diarrhea by nutritional status of children. Overall, diarrhea rates in sub-Saharan Africa range from 23 percent in Kenya and Tanzania to 44 percent in Niger. In North Africa/West Asia/Europe, the range is broader, from 12 percent in Egypt to 44 percent in Turkey. In Central Asia, Uzbekistan has the lowest prevalence (7 percent) and the Kyrgyz Republic has the highest prevalence (24 percent). In South/Southeast Asia, the prevalence ranges from 11 percent in Bangladesh to 34 percent in Nepal. In Latin America and the Caribbean, the lowest rate reported is in Brazil (20 percent), and the highest is in Haiti (43 percent). Figures 3.66 through 3.68 show the prevalence of diarrhea by nutritional status. Unlike ARI rates, diarrhea rates in most countries are higher among children who are stunted, wasted, or underweight. There are a few exceptions, particularly among stunted children in sub-Saharan Africa, where the rates of diarrhea are not affected by nutritional status. Wasting and underweight are better covariates of increased levels of diarrhea than stunting. As a measure of acute and generalized undernutrition, wasting could be the result of diarrhea or another recent childhood illness, whereas stunting is a long-term adaptation, less affected by acute illness in the past two weeks.
96
Findings
Findings
Percent Percent 10 20 30 40 50 60 70 0 10
20
30
40
50
60
70
Sub-Saharan Africa
Figure 3.66 Prevalence of diarrhea among children age 4-23 months by stunting, Demographic and Health Surveys, 1994-2001
Stunted
Not stunted
Eg yp Jo t 2 rd 00 0 a Ye n 1 m 99 e 7 Tu n 1 99 rk ey 7 19 Ka 98 za kh U zb sta n e Ky ki s 1 9 rg tan 99 yz Re 199 p. 6 19 Ba 97 ng la de In s h 2 d Ca ia 1 000 99 m bo 8di 99 a 2 N ep 00 al 0 19 96 Br az C G olo il 1 ua m 9 D tem bia 96 om 20 a in la 00 ic an 1 99 Re 8-9 p. 9 1 Pe 996 ru Bo 2 liv 0 0 ia 0 19 H ai 98 ti 20 00
M K oz en Ce am y a nt 19 bi ra 9 l A Zim que 8 fr ba 19 ic an bw 97 Re e 1 9 p. 1 9 99 Be 949 n C o in 5 19 m or 9 os 6 19 Er it 9 C Bu am rea 6 19 rk er in oo 95 a Fa n 1 99 so 19 8 9 G ha 8-9 na 9 G ab 199 8 o G n2 ui 00 ne 0 M a1 99 al U ga aw 9 i2 n 00 M da ad 20 0 ag 0 as 0-0 1 ca r M a l 199 i1 7 Za 995 m -9 b 6 Et ia 19 hi op 9 ia 6 20 To go 00 N 1 99 ig er 8 19 98
97
98
Percent 10 10 20 30 40 50 60 0
Percent
20
30
40
50
60
Sub-Saharan Africa
Figure 3.67 Prevalence of diarrhea among children age 4-23 months by wasting, Demographic and Health Surveys, 1994-2001
Wasted
Eg yp Jo t 2 rd 00 0 a Ye n 1 99 m en 7 Tu 1 rk 99 ey 7 19 U 98 zb e Ky ki s rg ta yz n 1 Ka Re 99 z a p. 6 kh 19 9 st an 7 19 Ba 99 ng la de In s h 2 d Ca ia 1 000 9 m bo 98di 99 a 2 N ep 00 al 0 19 96
Not wasted
Pe ru Br 20 az 00 i G ua Bo l 19 96 te liv D om ma ia 1 9 in la 1 9 ic an 99 8 Re 8-9 p. 9 19 H Co ait 96 lo i 2 m 0 bi 00 a 20 00
Ta n Zi z an m ba ia 1 bw 99 9 Ke e 1 ny 99 G a1 9 ha 9 n 98 Er a 1 99 it r C 8 C om ea 1 Ce te or 9 9 nt 5 d o s ra l A Ug Ivo 1 99 ire 6 f r an ic an da 199 Re 200 4 0p Ch . 1 9 01 ad 94 Bu 1 9 -95 rk Be 96 in a ni -97 F n M a so 1 99 ad ag 199 6 as 89 c M ar 9 a l 19 a 9 M wi 7 Ca a li 200 m 19 0 er 95 oo -9 n 6 To 1 9 9 Za go 8 m 19 b 9 G ia 8 ui 19 ne 9 a 6 M oz Gab 19 am o 99 n bi 2 q 0 Et ue 00 hi op 199 ia 7 N 20 ig 0 er 0 19 98
Findings
Findings
Percent 0 10
Percent 10 20 30 40 50 60
20
30
40
50
60
Figure 3.68 Prevalence of diarrhea among children age 4-23 months by underweight, Demographic and Health Surveys, 1994-2001
Underweight
Sub-Saharan Africa
Not underweight
ua B te raz m i al l 19 a 1 9 96 D om 9 in Pe 8-9 ic ru 9 an R 20 Co ep 00 lo . 1 m 9 bi 96 a Bo 20 liv 0 0 ia H 1 99 ai ti 8 20 00
Eg yp Jo t 2 rd 00 0 a Ye n 1 m 99 e 7 Tu n 1 99 rk ey 7 19 U 98 zb ek Ky i rg sta yz n 1 Ka Re 99 z a p. 6 kh 19 9 st an 7 19 Ba 99 ng la de In s h 2 d Ca ia 1 000 9 m bo 98di 99 a 2 N ep 00 al 0 19 96
T C anz te an d ia Iv 19 Co oire 99 m o 19 Ch ros 94 ad 1 9 1 96 Ke 996 ny - 9 7 Be a 1 ni 998 G n1 ha 9 n 96 E a Ce Ca rit 199 nt 8 m re ra Mo e a 1 l A z ro 99 f r am on 5 ic an biq 1 99 Re ue 8 1 Bu Zim p. 1 99 rk b 99 7 in ab 4a 9 Fa we 5 so 19 1 9 G 998 9 ab -9 M on 9 M a 2 a d li 1 00 ag 99 0 5 a U ga s ca -96 nd r 1 a 99 M 200 7 a l 0a 0 G wi 1 ui 2 ne 00 a 0 To 19 go 99 Et hi op 1 99 Za ia 8 m 20 bi 00 a N 19 ig er 96 19 98
99
4
Summary and Conclusions
ndernutrition remains high in most developing countries. Underweight rates for children are 25 percent or more in most of sub-Saharan Africa and over 40 percent in South/Southeast Asia and in Yemen in North Africa/West Asia/Europe. Underweight rates are less than 10 percent in most countries in Latin America and the Caribbean (except Guatemala and Haiti), in most of North Africa/West Asia/Europe, and in Kazakhstan in Central Asia. Overweight rates, although generally low in most countries, should be monitored in Latin America and the Caribbean and in Central Asia, where rates are higher. Monitoring the nutritional status of children worldwide should continue to identify populations and subpopulations where malnutrition is increasing. Undernutrition is age dependent and related to place of residence; the highest rates are found among children age 6-23 months and among children who live in rural areas. Underlying influences that measure social and economic pressures on families and communities are more closely associated with stunting and underweight than with wasting. Biological and behavioral influences related to maternal and child demographic characteristics and utilization of health services produce differentials in child undernutrition; however, all indicators of undernutrition in children are higher for children whose mothers are undernourished. Mothers age at delivery is an important variable that operates differently in different regions. Higher rates of undernutrition are observed for children of younger mothers (under 20 years) and/or older mothers (35 years or more). Use of antenatal services is negatively related to undernutrition in children. Certain characteristics of children, such as size at birth, sex, birth order, and preceding birth interval, are related to stunting and underweight but less so to wasting. All indicators of undernutrition are higher for children who were perceived to be very small at birth. Males have slightly higher rates of undernutrition than females in all regions except South/Southeast Asia. However, even in South/Southeast Asia, wasting is higher among males than females. In general, the higher the birth order and the smaller the birth interval, the higher the rates of stunting and underweight. Infant feeding practices vary by region and country along with levels of undernutrition. While breastfeeding duration is longest in South/Southeast Asia and sub-Saharan Africa, these regions also have the highest rates of undernutrition. On the other hand, these rates would probably be even higher if the children were not able to benefit from the protective effects and additional nutrients provided by breastfeeding and the nonuse of bottles. Immediate influences, such as recent episodes of diarrhea, are better predictors of wasting than any of the other factors and are less likely to be associated with stunting and underweight. ARI was not clearly related to undernutrition. Therefore, this report concludes that improved health services, water sources, and sanitation facilities, as well as immunizations, are important for the prevention and treatment of childhood illness and the improvement of the nutritional status of children. Although developing regions of the world share similar problems related to poverty and illiteracy, there are significant regional differences in the prevalence of
101
undernutrition and the factors that influence child nutritional status. Of course, to gain a better understanding of how these factors interact and operate to cause undernutrition, multivariate analyses of the individual country data sets and/or smaller groups of countries in selected regions should be carried out. This report provides comparative data that can be used for policymaking, program planning, and monitoring the nutritional status of children.
102
References
Begin, F., E.A. Frongillo, Jr., and H. Delisle. 1999. Caregiver behaviors and resources influence child height-for-age in rural Chad. Journal of Nutrition 129(3): 680-686. Black, R. 1999. Reducing perinatal and neonatal mortality. Report of a meeting, Baltimore, Maryland, May 10-12, 1999. Child Health Research Project Special Report, Vol. 3, No. 1. Baltimore, Maryland: Johns Hopkins University. Available at http://www.reproline.jhu.edu/english/2mnh/perinatal.pdf. Boerma, J.T., and G.T. Bicego. 1992. Preceding birth intervals and child survival: searching for pathways of influence. Studies in Family Planning 23(4): 243-256. Brown, K., K. Dewey, and L. Allen. 1998. Complementary feeding of young children in developing countries: a review of current scientific knowledge. Geneva: World Health Organization. Fikree, F.F., and H.W. Berendes. 1994. Risk factors for term intrauterine growth retardation: a community-based study in Karachi. Bulletin of the World Health Organization 72(4): 581-587. Haggerty, P.A., and S.O. Rutstein. 1999. Breastfeeding and complementary infant feeding, and the postpartum effects of breastfeeding. DHS Comparative Studies, No. 3. Calverton, Maryland: Macro International Inc. p. 39. Karim, E., and C.G. Mascie-Taylor. 1997. The association between birthweight, sociodemographic variables and maternal anthropometry in an urban sample from Dhaka, Bangladesh. Annals of Human Biology 24(5): 387-401. Lamontagne, J.F., P.L. Engle, and M.F. Zeitlin. 1998. Maternal employment, child care, and nutritional status of 12-18-month-old children in Managua, Nicaragua. Social Science and Medicine 46(3): 403-414. Mahy, M. 2003. Child mortality in the developing world: a review of evidence from the Demographic and Health Surveys. DHS Comparative Reports, No. 4. Calverton, Maryland: Macro International Inc. p. 4. Mishra, V., K.R. Smith, and R.D. Retherford. 2005. Effects of cooking smoke and environmental tobacco smoke on acute respiratory infections in young Indian children. Population and Environment 26(5). Mozumder, A.B., Barkat-E-Khuda, T.T. Kane, A. Levin, and S. Ahmed. 2000. The effect of birth interval on malnutrition in Bangladeshi infants and young children. Journal of Biological Science 32(3): 289-300. Mukuria, A., M. Kothari, and N. Abderrahim. 2006. Infant and young child feeding update. Calverton, Maryland, USA: ORC Macro. Mukuria, A., C. Aboulafia, and A. Themme. 2005. The context of womens health: Results from the Demographic and Health Surveys 1994-2001. DHS Comparative Studies, No. 11. Calverton, Maryland: ORC Macro.
References
103
Pan American Health Organization (PAHO). 2003. Guiding principles for complementary feeding of the breastfed child. Washington, D.C.: PAHO/World Health Organization, Division of Health Promotions and Protection, Food and Nutrition Program. Pelletier, D.L., E.A. Frongillo, and J.P. Habicht. 1993. Epidemiological evidence for a potentiating effect of malnutrition on child mortality. American Journal of Public Health 83: 1130-1133. Pelletier, D.L., E.A. Frongillo, Jr., D.G. Shroeder, and J.P. Habicht. 1994. A methodology for estimating the contribution of malnutrition to child mortality in developing countries. Journal of Nutrition 124(10 Suppl.): 2106S-2122S. Rafalimanana, H., and C.F. Westoff. 2000. Potential effects on fertility and child health and survival of birth-spacing preferences in sub-Saharan Africa. Studies in Family Planning 31(2): 99-110. Ramakrishnan, U., R. Martorell, D. Schroeder, and R. Flores. 1999. Role of intergenerational effects on linear growth. Journal of Nutrition 129(2S Suppl.): 544S-549S. Rice, A.L., L. Sacco, A. Hyder, and R.E. Black. 2000. Malnutrition as an underlying cause of childhood deaths associated with infectious diseases in developing countries. Bulletin of the World Health Organization 78(10): 1207-1221. Rutstein, S.O. 2000. Factors associated with trends in infant and child mortality in developing countries during the 1990s. Bulletin of the World Health Organization 78(10): 1256-1270. Rutstein, S.O. 2002. Fertility levels, trends, and differentials 1995-1999. DHS Comparative Reports, No. 3. Calverton, Maryland: Macro International Inc. Rutstein, S.O., and K. Johnson. 2004. The DHS Wealth Index. DHS Comparative Reports, No. 6. Calverton, Maryland: Macro International Inc. Scrimshaw, N.S., C.E. Taylor, and J.E. Gordon. 1968. Interaction of nutrition and infection. World Health Organization Monograph Series, No. 57. Geneva: World Health Organization. Sharmanov, T.S., N.M. Karsybekova, T.T. Bekbocynov, A.P. Sarsembaeva, and Z.K. Kudalbergeno. 1997. Nutritional status of early age children in Kazakhstan [in Russian] Voprosy Pitaniia (4)23-25. Smith, L.C., M.T. Ruel, and A. Ndiaye. 2004. Why is child malnutrition lower in urban than rural areas? Evidence from 36 developing countries. Discussion Paper No. 176. Washington, DC: International Food Policy Research Institute. Stephensen, C.B. 1999. Burden of infection on growth failure, Symposium: Causes and Etiology of Stunting, April, 1998, San Francisco, California. Journal of Nutrition 129 (2S Suppl.) 534S-538S. Tomkins, A. and F. Watson. 1993. Malnutrition and infection: a review. United Nations Administrative Committee on Coordination/Subcommittee on Nutrition State-of-the-Art Series, Nutrition Policy Discussion Paper, No. 5. Geneva: ACC/SCN.
104
References
Toyama, N., S. Wakai, Y. Nakamura, and A. Arifin. 2001. Mothers working status and nutritional status of children under the age of 5 in urban low-income community, Surabaya, Indonesia. Journal of Tropical Pediatrics 47: 179-181. United Nations Childrens Fund (UNICEF). 1998. The state of the worlds children 1998. New York: Oxford University Press. World Health Organization (WHO). 2003. Global strategy for infant young child feeding. Geneva: WHO. World Health Organization (WHO). 2005. Guiding principles for feeding non-brestfed children 6-24 months of age. Geneva: WHO. World Health Organization (WHO). 2005. Proportional mortality among under fives worldwide, 2001. Available at http://www.who.int/child-adolescent-health/OVERVIEW/CHILD_HEALTH/map_01_ world.jpg. World Health Organization (WHO) and United Nations Childrens Fund (UNICEF). 2000. Global water supply and sanitation assessment 2000 report. Geneva: WHO and UNICEF. World Health Organization (WHO) and United Nations Childrens Fund (UNICEF). 2003. Antenatal care in developing countries: promises, achievements and missed opportunities: an analysis of trends, levels and differentials, 1990-2001. Geneva: WHO.
References
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Appendix A
Table A.3.1 Infant and under-five mortality rates, Demographic and Health Surveys, 1994-2001
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 Infant mortality rate 94 105 77 97 103 77 89 97 66 57 57 98 74 96 104 123 135 123 99 80 88 109 65 54 29 43 75 62 61 49 66 95 68 79 67 39 21 47 45 80 33 Under-five mortality rate 167 219 151 157 194 104 150 166 136 89 108 177 112 159 189 238 201 274 147 146 146 197 102 44 34 52 105 71 72 59 94 124 95 118 92 49 25 57 59 119 47
Appendix A
107
Table A.3.2 Contribution of undernutrition to under-five mortality

Percentage of deaths among children age 059 months due to moderate or severe undernutrition, Demographic and Health Surveys, 1994-2001 Percentage of deaths due to moderate or severe undernutrition Percentage of Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 deaths due to total undernutrition 46 37 a 30 a 38 52 42 a 40 a 61 57 25 39 37 a 32 a 54 37 a 57 a 44 57 40 a 38 34 38 28 9 11 17 56 10 18 32 55 56 72 57 16 11 12 16 37 30 15
a
Moderate undernutrition 38 28 25 26 38 29 34 46 43 21 33 30 27 42 31 42 33 41 34 32 29 35 27 8 10 15 43 9 17 23 47 43 51 44 14 10 11 14 32 26 14
Severe undernutrition 8 9 5 12 14 13 6 15 14 4 6 7 5 12 6 15 11 16 6 6 5 3 <1 1 <1 2 13 1 1 9 8 13 21 13 2 1 1 2 5 4 1
Note: calculations are based on a formula developed by Pelletier et al. to quantify the contribution of moderate and severe undernutrition to under-five mortality (Pelletier et al.,1994). a Data where collected only on children age 0-35 months.
108
Appendix A
Table A.3.3 Undernutrition among young children

Percentage of children age 0-35 months who are stunted, wasted or underweight, Demographic and Health Surveys, 1994-2001 Number of Country children Stunted Wasted Underweight Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 25.0 30.9 29.3 33.6 34.9 33.8 24.4 38.4 44.9 20.5 20.0 23.2 30.9 48.3 44.0 30.1 35.9 41.1 37.9 21.7 35.5 38.9 26.4 19.3 7.2 12.0 45.7 9.5 24.8 31.3 40.2 37.3 44.9 48.4 24.2 10.3 12.8 11.0 41.9 18.9 21.7 14.3 17.7 5.9 7.1 17.9 8.3 8.3 16.4 12.9 3.1 12.9 11.7 6.9 7.4 7.5 23.3 7.9 20.7 6.5 12.3 5.3 5.4 7.2 3.2 2.1 2.5 15.0 1.9 3.4 11.6 11.4 16.3 15.7 11.2 1.9 2.9 1.0 1.6 3.2 5.7 1.1 29.2 36.3 22.2 27.3 39.1 25.8 23.8 43.7 45.3 12.9 24.9 25.4 21.5 40.0 27.8 40.0 26.1 49.6 30.3 25.1 24.7 25.3 13.7 4.5 4.9 7.6 43.7 4.6 11.0 18.8 45.7 40.1 46.7 46.9 9.0 5.5 7.2 6.3 23.9 16.3 7.7 2,273 2,530 1,923 2,310 3,541 921 3,341 2,269 5,905 2,013 1,638 2,067 2,821 3,080 6,073 4,678 2,837 4,022 1,674 3,260 3,584 3,588 1,587 6,235 3,266 1,610 4,966 354 1,015 989 3,306 1,842 24,143 3,705 3,451 2,306 2,498 2,131 2,149 3,389 6,070
Appendix A
109
Table A.3.4 Height-for-age Z-scores among young children

Percent distribution of height-for-age Z-scores among children age 035 months based on the standard deviation (SD) categories of the International Reference Population, Demographic and Health Surveys, 1994-2001 Height for age Z scores Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 Below -3.00 to -2.00 to -1.00 to 0.00 to -3.00 SD -2.01 SD -1.01 SD -0.01 SD 1.00 SD 7.8 13.9 10.7 14.3 16.7 13.4 8.4 18.3 22.0 6.5 5.9 8.9 11.4 21.6 21.8 14.5 15.7 19.5 13.9 7.0 13.6 15.8 10.0 17.2 17.0 18.6 19.4 18.2 20.4 16.1 20.1 22.9 14.0 14.1 14.3 19.5 26.7 22.2 15.6 20.2 21.6 24.0 14.8 22.0 23.1 16.4 12.4 5.5 8.0 22.5 6.7 18.8 17.3 25.1 22.1 22.4 28.2 15.9 7.8 10.1 8.4 24.7 12.3 15.4 27.2 25.2 25.8 26.4 21.2 24.5 27.8 27.5 27.5 24.9 28.5 24.6 26.1 24.8 23.7 23.8 25.5 25.6 31.3 27.6 29.4 28.1 25.2 26.8 22.7 22.3 23.7 25.4 31.5 22.1 30.5 25.1 25.1 29.7 27.0 19.7 27.1 21.7 29.4 25.8 29.1 25.7 23.5 22.8 22.3 20.9 26.1 27.5 18.8 16.1 29.0 25.9 25.0 21.9 17.5 17.1 22.3 20.5 19.2 21.0 29.0 22.7 20.3 23.1 30.8 36.7 30.8 17.0 33.4 24.7 21.7 19.3 19.8 17.5 15.6 26.2 32.3 36.7 32.8 19.1 31.6 28.9 14.6 12.3 14.1 12.2 12.8 11.6 13.0 11.0 7.7 15.8 16.7 16.5 12.7 6.9 9.4 14.9 12.7 9.8 7.6 14.3 8.8 8.7 13.1 14.0 24.1 23.0 8.8 21.4 14.2 10.4 7.6 10.6 8.2 4.9 15.4 24.3 19.1 23.9 7.4 16.1 14.7 1.01 to 2.00 SD 5.7 5.2 5.2 4.0 6.5 2.6 5.7 2.9 2.5 6.1 7.1 6.4 4.5 1.6 3.3 6.3 3.3 2.9 1.7 5.1 2.3 2.6 6.9 5.2 7.1 9.2 2.8 7.5 3.6 7.2 1.7 4.4 2.7 1.1 4.7 8.9 3.7 8.2 1.8 5.4 3.9 Above 2.00 SD 1.9 2.9 2.9 1.4 3.7 1.4 1.6 1.4 1.4 3.8 1.8 4.2 3.7 0.9 2.5 2.6 2.2 1.4 0.5 2.2 1.3 1.3 5.2 3.8 2.2 2.6 2.0 2.8 1.2 7.4 0.7 2.8 1.6 0.3 2.4 4.6 0.5 2.4 0.5 2.1 1.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,273 2,530 1,923 2,310 3,541 921 3,341 2,269 5,905 2,013 1,638 2,067 2,821 3,080 6,073 4,678 2,837 4,022 1,674 3,260 3,584 3,588 1,587 6,235 3,266 1,610 4,966 354 1,015 989 3,306 1,842 24,143 3,705 3,451 2,306 2,498 2,131 2,149 3,389 6,070
North Africa/West Asia/Europe Egypt 2000 6.9 Jordan 1997 1.8 Turkey 1998 4.0 Yemen 1997 23.2 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 2.7 6.0 14.0 15.1 15.2 22.6 20.2 8.3 2.5 2.7 2.6 17.2 6.5 6.3
110
Appendix A
Table A.3.5 Weight-for-height Z-scores among young children

Percent distribution of weight-for-height Z-scores among children age 0-35 months based on the standard deviation (SD) categories of the international Reference Population, Demographic and Health Surveys, 1994-2001 Weight-for-height Z scores Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 Below -3.00 SD 2.7 3.5 0.8 1.1 3.3 2.0 1.2 3.1 1.8 0.4 1.8 2.7 1.5 0.9 1.5 6.2 2.1 3.7 0.6 2.1 0.7 0.8 1.9 -3.00 to -2.00 to -1.00 to 0.00 to -2.01 SD -1.01 SD -0.01 SD 1.00 SD 11.6 14.2 5.2 6.1 14.6 6.3 7.1 13.3 11.1 2.7 11.1 9.0 5.5 6.5 5.9 17.1 5.8 17.0 5.9 10.1 4.6 4.6 5.3 28.8 31.9 20.9 23.0 29.7 22.7 26.3 33.3 30.5 16.0 29.6 24.2 21.0 26.4 17.0 32.1 21.7 33.8 22.8 28.1 19.5 18.9 17.0 32.7 29.1 28.7 35.3 29.7 28.7 34.6 30.8 34.0 33.3 32.5 30.5 31.5 35.7 28.4 26.1 31.1 29.2 34.1 33.9 33.7 34.9 26.1 18.3 16.9 27.3 25.1 17.4 27.7 23.1 14.8 16.7 31.3 18.4 21.8 25.4 21.8 29.8 13.6 26.6 12.9 25.5 19.1 29.1 27.9 29.0 1.01 to 2.00 SD 4.6 3.3 12.2 7.1 3.7 8.9 6.2 3.8 4.0 12.1 4.4 8.7 10.1 6.7 12.6 3.6 9.3 2.6 9.0 5.1 9.0 9.3 12.3 Above 2.00 SD 1.3 1.1 5.0 2.3 1.6 3.8 1.5 0.9 1.9 4.3 2.1 3.0 5.1 2.0 4.7 1.3 3.4 0.8 2.1 1.5 3.4 3.7 8.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,273 2,530 1,923 2,310 3,541 921 3,341 2,269 5,905 2,013 1,638 2,067 2,821 3,080 6,073 4,678 2,837 4,022 1,674 3,260 3,584 3,588 1,587
0.6 0.1 0.5 3.2 0.3 0.7 2.8 1.2 3.7 2.8 1.7 0.5 0.6 0.1 0.1 1.4 0.6 0.3
2.6 1.9 2.0 11.8 1.5 2.8 8.8 10.2 12.7 12.9 9.6 1.5 2.2 1.0 1.5 1.7 5.1 0.9
6.6 13.4 14.3 28.3 11.6 11.4 13.7 37.1 32.4 32.8 33.2 7.6 10.5 9.5 12.4 11.5 20.4 6.1
22.4 35.7 34.2 31.9 33.7 23.8 24.7 33.7 28.9 30.6 35.2 26.6 31.0 31.6 32.3 33.4 33.5 23.7
33.3 34.6 35.8 17.6 36.5 38.6 23.1 14.5 15.2 14.8 16.9 39.0 35.4 38.7 34.9 33.1 29.6 40.6
21.3 10.6 10.5 4.8 13.4 16.4 12.5 2.8 4.6 3.9 3.0 17.3 14.8 14.9 14.0 13.6 8.5 20.3
13.2 3.6 2.8 2.3 3.0 6.3 14.4 0.5 2.6 2.2 0.5 7.5 5.4 4.3 4.7 5.3 2.3 8.1
100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
6,235 3,266 1,610 4,966 354 1,015 989 3,306 1,842 24,143 3,705 3,451 2,306 2,498 2,131 2,149 3,389 6,070
Appendix A
111
Table A.3.6 Weight-for-age Z-scores among young children

Percent distribution of weight-for-age Z-scores among children age 0-35 months based on the standard deviation (SD) categories of the International Reference Population, Demographic and Health Surveys, 1994-2001 Weight-for-age Z scores Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 Below -3.00 to -2.00 to -1.00 to 0.00 to -3.00 SD -2.01 SD -1.01 SD -0.01 SD 1.00 SD 7.4 13.6 4.8 7.5 15.4 7.9 6.3 17.0 16.5 2.4 5.7 6.2 5.4 12.8 7.2 16.5 9.1 20.2 7.3 6.7 5.8 6.4 2.0 21.8 22.8 17.4 19.8 23.7 17.9 17.5 26.8 28.8 10.5 19.2 19.3 16.1 27.2 20.6 23.5 17.1 29.4 23.1 18.4 18.9 18.9 11.7 3.8 4.3 6.0 28.2 3.9 9.4 13.8 32.3 28.3 29.0 30.8 7.4 4.6 6.1 5.1 17.9 12.7 6.6 31.6 29.5 26.1 29.7 25.2 29.9 30.4 28.3 28.5 25.3 32.9 26.1 30.1 29.4 29.6 26.9 30.2 25.8 32.9 31.1 30.8 32.9 29.5 17.8 21.8 21.6 30.6 21.4 26.5 26.1 30.1 29.6 28.7 31.4 22.4 17.6 21.3 20.6 29.2 28.3 21.0 23.9 19.7 24.0 24.9 18.9 24.5 27.4 16.9 16.5 29.6 23.4 24.2 25.5 18.6 24.1 19.8 26.0 15.4 21.3 26.1 26.1 23.2 26.4 35.3 36.3 32.3 17.3 36.4 30.6 24.7 16.7 20.3 16.1 15.9 31.6 32.9 34.1 30.3 26.6 29.2 30.4 11.2 9.9 16.0 13.3 10.9 13.5 13.1 7.5 6.5 21.1 13.2 15.1 14.0 8.5 12.6 9.4 12.3 6.8 10.9 13.0 13.2 13.6 18.4 25.8 26.4 25.6 6.0 25.7 20.0 15.5 6.2 6.5 6.1 4.9 23.9 28.5 26.3 27.8 15.1 17.9 25.5 1.01 to 2.00 SD 3.4 3.4 8.4 3.4 4.1 4.6 3.9 2.7 2.1 7.2 4.4 5.0 6.1 2.4 4.1 2.6 4.2 1.6 3.6 3.4 4.1 3.8 8.0 11.5 8.1 9.6 1.7 8.5 8.2 8.1 1.2 2.3 1.5 0.7 9.0 10.9 8.2 10.4 3.5 5.9 11.3 Above 2.00 SD 0.7 1.1 3.3 1.4 1.8 1.7 1.3 0.9 1.2 3.8 1.3 4.1 2.8 1.1 1.8 1.2 1.2 0.8 0.9 1.2 1.1 1.2 4.0 5.1 2.4 3.3 0.7 3.5 3.6 6.8 0.2 1.1 0.8 0.2 4.1 4.7 2.8 4.5 1.7 2.4 4.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,273 2,530 1,923 2,310 3,541 921 3,341 2,269 5,905 2,013 1,638 2,067 2,821 3,080 6,073 4,678 2,837 4,022 1,674 3,260 3,584 3,588 1,587 6,235 3,266 1,610 4,966 354 1,015 989 3,306 1,842 2,4143 3,705 3,451 2,306 2,498 2,131 2,149 3,389 6,070
112
Appendix A
Table A.3.7 Undernutrition by child's age group

Percentage of children age 0 to 35 months who are stunted, wasted, or underweight by age group in months, Demographic and Health Surveys. 1994-2000
Percent stunted Country 0-5 6-9 10-12 13-24 25+ 16.9 19.8 31.2 30.1 28.0 33.7 17.0 39.7 26.2 16.3 18.7 23.3 30.3 47.3 34.6 19.6 26.0 39.5 28.9 17.1 33.4 29.9 19.8 22.9 6.7 10.1 35.8 8.9 30.8 29.1 36.6 28.6 39.1 38.3 21.5 9.9 8.2 13.7 31.4 20.7 14.4 31.6 39.0 48.7 45.7 43.6 34.2 45.3 48.6 49.8 32.1 58.4 51.0 31.2 26.6 34.6 42.1 65.2 59.5 43.8 45.6 58.0 52.9 33.9 47.3 50.6 39.1 0-5 Percent wasted 6-9 10-12 13-24 26.0 31.1 9.6 10.3 27.8 7.4 12.3 17.3 22.3 4.0 24.1 20.5 10.1 8.9 11.5 35.8 12.1 33.6 4.8 20.5 8.9 7.3 11.6 5.0 1.7 7.1 22.5 0.0 6.1 8.0 17.9 24.8 18.3 10.2 2.3 5.5 0.0 1.0 2.1 6.3 1.6 17.8 24.2 7.5 10.4 24.8 12.7 12.5 18.3 24.2 2.9 19.6 17.5 9.3 12.0 9.5 31.7 13.2 30.5 9.6 18.4 7.6 8.8 9.3 3.0 2.8 2.7 17.6 2.3 5.7 11.8 18.3 21.4 22.2 21.3 1.9 2.3 1.9 2.2 5.1 9.3 1.5 25+ 10.1 12.4 4.0 4.4 13.8 5.6 4.9 9.7 14.4 2.3 6.6 5.9 4.4 4.7 4.3 17.9 3.6 14.7 5.4 7.5 2.3 2.2 4.4 0-5 Percent underweight 6-9 10-12 39.8 48.6 33.0 34.8 49.2 29.5 33.1 52.6 55.1 19.6 37.4 41.8 24.3 49.3 33.7 47.7 32.3 66.2 35.6 33.2 34.8 31.0 17.3 7.1 7.7 12.8 48.2 4.3 17.6 24.4 60.5 47.9 50.7 48.5 10.8 6.1 3.2 9.3 23.1 17.8 9.6 13-24 37.3 51.2 31.3 35.9 53.8 34.3 30.3 55.8 55.4 19.0 36.6 37.0 27.1 54.6 35.5 54.1 35.8 66.4 39.8 36.3 32.7 34.7 18.0 5.6 6.3 10.6 54.8 5.9 19.4 25.0 58.6 51.4 58.6 61.4 12.6 6.3 11.1 8.1 34.3 21.6 10.1 25+ 35.6 45.0 25.0 0-5 448 544 365 Number of children 6-9 297 339 242 274 491 114 418 698 284 243 233 298 350 393 739 624 403 512 206 446 436 379 158 747 396 207 733 39 111 115 10-12 13-24 213 255 156 222 309 95 269 525 191 158 109 143 243 292 591 434 230 393 133 303 331 364 132 756 766 652 742 1,107 315 1,087 2,031 687 686 592 636 990 1,065 1,976 1,348 947 1,310 569 999 1,331 1,236 563 25+ 559 626 508 658 896 234 953 1,770 704 567 445 503 810 757 1,762 1,308 678 1,016 465 903 948 1,012 463
Sub-Saharan Africa
Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 8.5 12.5 5.0 13.5 5.5 14.9 5.6 5.7 5.5 6.0 10.8 4.4 3.8 2.9 7.0 7.1 14.0 11.4 5.3 13.6 6.8 9.4 3.6 7.9 10.4 6.0 16.9 15.8 20.2 12.0 25.1 17.3 14.1 7.7 10.8 14.1 31.1 26.4 11.3 24.8 22.3 21.0 7.9 22.9 20.5 14.3 6.2 17.1 6.9 20.2 1.9 9.7 6.5 23.0 4.1 29.3 1.9 15.4 3.6 4.3 5.5 4.6 6.2 6.2 1.9 0.5 5.9 2.3 4.8 5.9 9.7 4.7 6.7 3.3 3.3 2.8 3.7 1.9 18.0 26.1 20.2 18.9 32.1 26.4 11.8 14.5 18.8 11.3 29.5 23.9 28.1 21.2 38.5 18.6 16.6 22.0 17.6 7.8
46.3 2.8 8.8 54.9 6.9 20.2 38.5 4.3 7.9 35.2 3.5 9.3 55.7 3.9 13.5 57.3 6.5 12.5 22.0 2.5 5.7 28.0 3.3 13.8 32.0 6.8 13.2 37.3 5.2 6.2 59.9 2.7 5.7 55.8 5.8 8.9 46.8 12.3 25.2 51.4 2.8 7.6 56.0 6.7 18.8 48.1 3.4 6.3 28.8 6.0 11.1 41.1 2.5 5.2 51.6 2.3 6.3 29.1 7.2 4.2
33.7 415 53.3 738 29.9 163 28.4 615 55.7 882 57.7 403 11.3 360 25.7 259 29.1 487 28.1 427 47.8 573 31.3 1,005 51.0 964 31.7 578 60.6 792 39.8 301 29.0 610 23.6 538 27.4 597 16.6 272 3.7 1,007 4.8 420 7.8 285 54.0 944 3.4 8.7 17.2 48 174 123
North Africa/West Asia/Europe

10.7 17.6 3.3 5.8 2.0 2.7 16.4 32.4 5.5 2.8 5.4 12.4 8.4 26.9 13.9 14.1 15.2 14.9 6.2 3.4 4.1 5.0 15.3 4.4 3.9 21.4 24.4 27.7 24.8 12.0 11.0 7.9 3.3 23.6 7.5 10.1 23.4 19.2 5.3 3.4 10.5 5.9 1.0 1.8 17.9 16.5 2.1 1.3 63.2 58.3 10.9 18.2 15.7 7.0 1.7 3.5 33.5 29.3 1.9 3.8 41.8 31.3 17.1 14.9 53.3 45.9 57.8 61.8 33.9 14.9 20.3 15.5 54.0 25.4 29.2 49.5 49.9 55.8 64.3 28.6 8.9 12.7 10.8 50.2 23.2 27.1 3.1 5.7 8.7 8.5 9.6 11.6 3.8 5.7 2.5 3.0 0.8 1.4 1.5 1.5 1.0 2.8 3.8 0.5 2.4 4.6 6.0 1.2 1.7 1.4 6.2 1.9 0.8 3.4 1.5 1.7 3.8 10.0 12.9 39.3 1.4 1.1 9.3 4.0 4.5 0.3 4.7 6.0 13.4 487 2,044 1,951 303 1,133 1,014 146 534 437 504 1,521 1,265 32 84 107 119 330 335 116 315 310
Central Asia
Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996
Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 8.6 8.1 32.1 16.6 6.7 21.2 12.9 11.9 32.4 6.0 8.8 31.2 1.1 2.1 0.8 1.1 1.5 3.2 0.7 1.6 6.5 0.4 7.1 1.1 2.9 1.2 1.6 3.3 17.7 4.1 7.7 1.0 3.5 55.2 627 320 286 1,137 937 54.2 331 232 150 572 556 57.9 4,104 2,875 1,850 8,037 7,276 56.9 594 431 367 1,270 1,043 9.3 6.5 9.2 7.6 24.3 19.6 8.9 524 380 400 310 314 499 854 440 256 319 236 248 451 626 311 1,155 1,023 243 752 675 220 817 742 211 725 649 168 754 665 284 1,141 1,015 545 2,113 1,932
Latin America/Caribbean
Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000
Appendix A
113
Table A.3.8 Nutritional status of young children

Mean Z-scores and standard deviations for height-for-age, weight-for-height, and weight-for-age among children age 035 months, Demographic and Health Surveys, 1994-2001 Height-for-age Z-score Weight-for-height Z-score Weight-for-age Z-score Number Country Sub-Saharan Africa Benin 1996 Burkina 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 Mean -1.1 -1.4 -1.3 -1.5 -1.4 -1.5 -1.2 -1.7 -2.0 -0.9 -1.0 -1.0 -1.3 -2.0 -1.8 -1.3 -1.5 -1.8 -1.8 -1.1 -1.6 -1.7 -1.1 -0.9 -0.5 -0.6 -1.9 -0.6 -1.2 -1.1 -1.8 -1.6 -1.9 -2.0 -1.1 -0.4 -0.8 -0.5 -1.8 -0.9 -1.1 Standard deviation 1.4 1.6 1.6 1.5 1.8 1.5 1.4 1.5 1.5 1.5 1.4 1.6 1.6 1.4 1.7 1.7 1.6 1.5 1.3 1.4 1.4 1.4 1.7 1.5 1.2 1.3 1.6 1.2 1.3 2.0 1.3 1.6 1.6 1.3 1.5 1.4 1.1 1.3 1.4 1.4 1.3 Mean -0.8 -1.1 -0.2 -0.5 -1.0 -0.4 -0.6 -1.0 -0.9 -0.1 -0.8 -0.7 -0.3 -0.6 -0.2 -1.2 -0.5 -1.2 -0.4 -0.8 -0.3 -0.3 0.0 0.6 0.0 -0.1 -0.8 0.0 0.2 0.1 -1.0 -0.9 -0.9 -0.9 0.3 0.1 0.2 0.1 0.0 -0.3 0.5 Standard deviation 1.2 1.2 1.3 1.1 1.2 1.3 1.1 1.1 1.1 1.1 1.2 1.3 1.3 1.1 1.3 1.3 1.3 1.1 1.1 1.1 1.1 1.2 1.4 1.3 1.0 1.0 1.3 1.0 1.2 1.8 1.0 1.3 1.2 1.0 1.1 1.2 1.0 1.1 1.2 1.1 1.1 Mean -1.4 -1.7 -1.0 -1.3 -1.6 -1.3 -1.2 -1.9 -1.9 -0.6 -1.2 -1.1 -1.0 -1.7 -1.3 -1.7 -1.3 -2.1 -1.4 -1.3 -1.2 -1.3 -0.7 -0.2 -0.4 -0.4 -1.9 -0.4 -0.6 -0.7 -1.9 -1.7 -1.9 -2.0 -0.5 -0.2 -0.4 -0.3 -1.1 -0.9 -0.3 Standard deviation 1.2 1.3 1.4 1.3 1.5 1.3 1.3 1.3 1.2 1.3 1.3 1.4 1.4 1.2 1.3 1.4 1.3 1.2 1.2 1.2 1.2 1.3 1.3 1.2 1.1 1.2 1.2 1.1 1.2 1.7 1.1 1.2 1.3 1.1 1.3 1.2 1.2 1.3 1.3 1.3 1.3 of children 2,088 2,315 1,759 2,122 3,227 844 3,069 2,080 5,532 1,861 1,530 1,847 2,649 2,839 5,665 4,258 2,577 3,679 1,536 3,012 3,380 3,331 1,460 5,759 3,095 1,488 4,571 331 938 937 3,027 1,695 22,723 3,472 3,244 2,146 2,333 1,992 2,033 3,189 5,716
114
Appendix A
Table A.3.9 Overweight children

Percentage of overweight (weight-for-height) children age 035 months, Demographic and Health Surveys, 1994-2001 Overweight Number of Country (above 2 SD) children Sub-Sahara Africa Benin 1996 Burkina 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 1.3 1.1 5.1 2.4 1.6 3.9 1.5 0.9 1.9 4.3 2.1 3.1 5.3 2.0 4.8 1.3 3.6 0.8 2.1 1.5 3.5 3.7 8.5 13.4 3.6 2.9 2.4 3.0 6.3 14.4 0.5 2.6 2.2 0.5 7.7 5.5 4.3 4.7 5.4 2.3 8.3 2,273 2,530 1,923 2,310 3,541 921 3,341 2,269 5,905 2,013 1,638 2,067 2,821 3,080 6,073 4,678 2,837 4,022 1,674 3,260 3,584 3,588 1,587 6,235 3,266 1,610 4,966 354 1,015 989 3,306 1,842 24,143 3,705 3,451 2,306 2,498 2,131 2,149 3,389 6,070
Appendix A
115
Table A.3.10 Undernutrition by urban-rural residence

Percentage of children age 035 months who are stunted, wasted, or underweight by urban-rural residence, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country Urban 21.4 20.4 22.3 28.6 27.6 29.9 15.3 32.8 28.7 18.1 11.4 17.3 22.7 44.6 29.2 21.8 27.3 31.2 19.7 14.8 26.9 30.1 22.1 14.6 5.9 9.2 34.3 6.8 14.8 32.6 33.2 35.1 35.2 35.4 17.4 7.4 10.2 7.5 31.2 11.2 11.1 Rural 26.6 32.4 31.8 37.2 36.8 35.0 29.2 46.2 40.9 26.4 22.9 25.7 32.7 49.2 46.3 33.1 38.9 43.0 42.0 23.9 36.5 44.5 28.5 22.4 12.9 16.8 49.6 11.1 27.7 30.7 41.6 37.6 48.0 49.3 33.6 19.2 18.5 15.6 48.2 22.5 34.5 Urban 12.1 13.0 4.9 5.8 15.8 10.3 7.9 8.0 12.8 3.1 8.9 11.3 5.0 5.3 6.2 23.3 10.4 13.3 6.0 9.1 3.7 4.4 3.8 2.9 2.0 2.2 11.5 1.9 4.3 10.2 10.7 12.3 13.3 5.8 1.5 2.8 0.9 1.7 2.2 6.8 0.9 Rural 15.3 18.4 6.3 8.1 18.5 7.6 8.4 13.5 17.4 3.1 14.3 11.9 7.4 7.9 7.7 23.3 7.1 22.1 6.6 13.3 5.4 6.1 8.8 3.4 2.4 2.9 16.2 1.8 3.2 12.2 11.5 17.0 16.5 11.6 2.4 3.0 1.3 1.5 3.7 5.2 1.4 Urban 24.4 24.6 14.3 22.2 32.9 25.0 16.2 31.8 31.0 10.9 16.9 21.7 11.5 35.6 12.0 31.7 20.0 35.3 18.7 16.1 13.7 17.9 7.8 3.2 4.3 5.8 32.7 6.0 5.9 16.6 38.6 32.3 38.2 29.8 5.9 4.1 6.3 4.1 14.5 13.1 3.4 Rural 31.3 38.0 25.0 30.8 40.8 26.1 27.7 46.8 47.1 18.1 27.6 27.0 23.6 41.0 30.2 43.0 28.2 52.4 32.9 27.9 25.9 29.9 16.5 5.4 7.8 10.6 47.4 3.7 12.5 19.7 47.0 41.4 49.3 48.1 13.3 9.7 9.1 9.3 29.4 17.7 12.8 Urban 709 306 508 949 747 224 1,134 585 473 1,431 418 613 500 600 800 1,235 713 656 308 770 354 1,382 505 2,454 2,659 1,010 1,260 136 228 285 540 260 5,689 237 2,004 1,750 1,703 1,204 797 1,074 3,319 Rural 1,564 2,224 1,415 1,361 2,794 697 2,206 5,320 1,796 582 1,220 1,454 2,321 2,481 5,274 3,443 2,124 3,366 1,366 2,490 3,230 2,206 1,082 3,782 607 600 3,706 219 787 704 2,767 1,582 18,454 3,468 1,448 556 795 927 1,352 2,315 2,751
Sub-Saharan Africa
Benin 1996 Burkina 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
North Africa/West Africa/Europe

Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997
Central Asia
Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996
116
Appendix A
Table A.3.11 Undernutrition by mother's education

Percentage of children age 035 months who are stunted, wasted, or underweight by mother's education, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children No 1 education Primary
26.1 31.4 38.2 37.2 37.1 38.2 26.7 41.8 46.5 21.8 23.7 24.8 42.9 48.5 49.5 31.7 40.8 42.3 41.3 25.5 39.6 47.4 32.7 23.6 33.9 27.0 32.4 28.5 27.4 22.3 29.2 43.2 24.9 22.3 17.3 34.0 51.3 43.5 24.3 34.8 35.5 37.9 17.6 35.4 40.5 30.9
Country
Secondary
13.3 12.4 21.6 24.1 19.7 25.0 13.0 22.9 25.7 16.4 15.8 13.0 18.3 40.5 26.3 14.7 9.1 23.6 15.7 12.0 27.4 28.9 21.7
No 1 education
14.5 18.2 8.0 7.7 19.3 8.4 9.2 17.3 13.6 4.5 15.7 12.1 9.7 7.5 9.2 24.0 7.5 21.2 8.8 14.2 7.3 8.1 11.7
Primary
13.2 15.7 5.8 7.0 13.4 8.7 6.9 14.6 10.2 3.3 11.9 12.3 7.7 8.1 6.7 19.3 7.7 20.0 5.7 9.6 4.8 5.5 8.2
No Secon1 dary education

15.3 8.6 3.5 5.2 12.2 7.1 4.9 11.7 9.0 2.7 11.2 7.3 3.9 5.3 7.0 20.5 14.6 8.9 4.4 9.5 3.6 3.6 5.8 30.6 37.3 35.1 30.9 42.2 28.4 25.9 47.2 47.8 17.4 30.2 26.8 34.4 42.3 31.6 41.9 30.4 50.7 34.9 30.1 30.7 33.9 26.4
Primary
25.5 34.6 18.2 25.4 29.6 25.0 22.6 36.3 38.3 16.5 24.8 20.7 23.7 43.0 27.9 32.0 24.1 46.6 29.5 19.1 23.8 26.8 17.3
No Secon1 dary education

20.3 14.0 12.0 19.1 23.4 16.4 11.6 24.3 26.3 9.2 20.5 16.4 10.7 29.9 11.2 24.5 17.3 28.7 11.9 14.2 17.3 15.6 9.0 1,762 2,269 644 1,138 2,727 573 2,228 1,735 4,790 139 584 1,720 303 632 1,859 3,944 1,040 3,536 463 1,915 854 503 110
Primary
391 178 773 867 702 208 825 364 774 875 344 192 1,786 1,764 3,761 516 1,678 354 1,143 1,047 2,321 2,292 682
Secondary
120 83 507 305 112 140 288 170 341 999 709 155 732 684 454 218 119 132 67 299 410 793 796
Sub-Saharan Africa
Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central Afr. Rep. 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2001 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
North Africa/West Africa/Europe

Egypt 2000 Jordan 1997 Turkey 1998 23.2 22.7 27.4 48.1 42 54.5 52.4 41.4 20.8 26.0 22.3 58.9 24.6 48.5 21.2 11.3 9.8 41.1 37 44.3 40.1 30.3 14.8 17.8 13.2 40.4 18.3 31.8 15.6 5.6 3.8 25.3 27.4 30.2 24.7 13.1 5.9 8.6 5.1 11.3 7.1 10.8 3.2 4.1 4.3 13.3 18.9 17.6 12.2 2.7 4.6 3.2 1.5 3.6 5.8 2.9 2.9 1.8 2.1 11.1 16.3 15.9 8.4 2.2 3.1 0.8 1.7 3.3 4.9 1.5 3.2 1.9 1.6 8.4 10.5 12.7 6.9 1.4 2.5 1.1 1.6 1.6 7.6 0.6 6.1 13.2 18.7 53.7 47 55.1 51.1 18.9 9.0 14.2 15.3 35.0 18.8 20.0 4.4 7.8 5.5 46.6 38.3 48.6 36.2 10.8 8.3 9.4 7.1 22.4 15.1 11.6 3.3 4.0 2.7 30.4 31.1 32.6 25.0 4.5 3.0 5.3 3.0 5.5 13.7 3.2 2,355 178 325 1,508 597 12,300 2,924 353 145 80 192 696 1,239 431 925 375 943 947 983 3,995 441 1,653 899 1,002 1,159 1,122 1,621 2,372 2,955 2,713 342 851 261 7,847 340 1,445 1,263 1,417 780 331 528 3,267
Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Rep 1996 Guatemala 1999 Haiti 2000 Peru 2000
1
Includes missing cases
Appendix A
117
Table A.3.12 Undernutrition by mother's work status

Percentage of children age 0 to 35 months who are stunted, wasted, or underweight by mother's work status, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country
Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000
1
Mother working
25.7 31.2 30.7 35.2 33.7 32.9 25.8 38.6 46.0 20.7 20.2 24.1 30.3 50.0 44.7 30.0 38.9 42.7 40.6 21.6 36.4 40.9 24.6 18.9 6.2 11.2 48.7 4.7 26.5 36.6 42.0 38.6 51.8 51.5 25.1 8.6 12.8 6.1 38.5 18.7 25.0
Not 1 working
18.8 30.5 24.9 27.2 35.8 34.4 20.3 38.3 43.5 20.4 19.2 19.4 31.6 41.8 43.1 30.3 31.7 39.3 29.1 22.5 32.3 37.1 28.1 19.4 7.3 12.3 44.7 10.4 24.4 29.2 39.9 34.3 42.1 39.0 23.5 11.2 12.8 13.1 42.9 19.1 18.3
Mother working
14.4 18.8 6.1 7.4 17.3 7.7 8.2 15.4 13.8 3.0 13.0 11.8 7.2 7.6 7.2 22.6 6.6 22.1 5.5 12.0 5.2 4.8 8.1 3.5 1.9 1.6 13.4 2.1 3.2 9.0 11.2 18.1 19.2 12.0 2.1 2.7 1.3 0.8 2.4 5.8 1.0
Not 1 working
13.8 15.3 5.4 5.9 18.3 8.6 8.4 16.8 11.9 3.2 12.7 11.5 6.6 6.6 7.9 24.2 9.7 19.1 10.0 13.6 5.5 6.0 6.3 3.1 2.1 2.8 15.5 1.8 3.5 12.6 11.4 12.3 14.3 8.8 1.7 2.9 0.9 2.0 3.4 5.6 1.3
Mother working
29.6 38.3 23.4 29.0 38.8 25.2 24.4 41.5 46.1 11.7 25.0 25.7 21.5 41.0 29.5 39.7 29.1 52.1 31.6 25.1 26.3 27.2 13.1 3.8 5.9 6.8 46.0 2.4 11.8 20.4 48.6 44.2 55.6 50.1 8.5 4.1 7.1 3.5 21.1 15.5 8.6
Not 1 working
25.2 32.1 18.6 20.3 39.4 26.3 22.1 44.5 44.2 13.7 24.1 24.2 21.4 35.7 25.5 40.4 21.8 46.8 25.9 25.4 19.1 23.6 14.3 4.6 4.8 7.8 42.9 5.0 10.8 18.2 45.1 31.0 43.0 37.3 9.4 6.2 7.3 7.5 24.7 17.0 6.7
Mother working
2,045 1,718 1,451 1,852 1,513 389 2,497 579 3,294 717 1,332 1,680 1,533 2,464 3,513 2,489 1,666 2,100 1,283 2,730 2,789 1,726 763 817 346 397 1,239 58 224 272 508 1,272 7,123 2,786 1,614 819 922 626 488 1,655 3,077
Not 1 working
228 811 472 457 2,028 532 844 1,690 2,610 1,296 306 387 1,288 616 2,561 2,189 1,171 1,922 391 530 796 1,863 825 5,419 2,920 1,213 3,728 296 791 717 2,798 570 17,020 919 1,838 1,487 1,576 1,505 1,661 1,734 2,993
118
Appendix A
Table A.3.13 Undernutrition by flooring status

Percentage of children age 0 to 35 months who are stunted, wasted, or underweight by flooring in residence, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Rep. 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Rep. 1996 Guatemala 1998-99 Haiti 2001 Peru 2000 Finished flooring 22.6 25.5 22.3 27.0 26.0 25.8 21.7 25.0 26.9 16.9 18.5 20.2 20.7 41.4 29.4 19.6 20.7 30.0 18.9 19.8 26.6 29.1 22.7 17.1 7.1 11.9 41.3 3.3 10.2 23.6 22.7 14.0 23.6 16.4 8.1 10.7 9.2 28.4 13.5 8.4 Unfinished 1 flooring 27.2 32.8 33.5 35.1 35.3 40.1 32.1 40.5 45.6 28.2 27.1 25.8 35.0 49.4 46.9 32.9 40.8 42.8 41.1 26.2 37.0 45.8 32.3 25.3 * 12.6 50.4 10.7 26.0 31.7 42.9 38.5 49.5 31.9 22.1 22.5 24.0 55.5 23.6 30.1 Finished flooring 11.8 14.2 4.0 4.9 11.4 6.4 7.6 9.4 9.3 3.1 12.2 11.5 5.1 5.6 6.4 21.6 8.6 12.7 6.8 12.0 2.6 4.4 6.6 3.1 2.0 2.8 12.2 3.5 0.8 9.2 7.2 17.8 4.4 1.5 2.7 0.9 1.3 2.8 6.1 0.5 Unfinished 1 flooring 16.6 18.9 7.1 7.6 18.2 9.7 10.1 17.5 13.1 3.1 16.4 11.9 7.7 7.6 7.7 23.8 7.7 21.9 6.5 13.0 5.7 6.1 8.1 3.5 * 1.4 17.9 1.5 3.6 11.8 12.1 16.2 11.6 2.3 3.9 1.4 3.6 3.5 5.3 1.5 Finished flooring 23.9 28.2 14.6 20.4 30.3 19.7 21.5 25.2 24.1 10.8 23.1 22.1 11.8 33.2 12.7 27.8 15.9 33.8 21.0 23.6 12.8 17.1 10.8 3.6 4.8 7.1 38.2 5.9 3.2 11.1 26.3 20.2 23.8 5.4 4.2 6.0 4.8 15.5 12.0 2.3 Unfinished 1 flooring 34.0 39.1 26.8 28.8 39.5 30.7 30.2 46.7 46.1 17.6 33.2 28.3 25.3 41.0 30.7 43.2 29.3 52.1 31.8 28.5 26.7 31.0 18.4 7.1 * 9.0 49.4 4.3 11.6 19.2 48.5 41.2 48.0 12.5 12.1 12.7 17.2 32.3 20.0 11.1 Finished flooring 1,090 636 727 406 158 407 2,460 315 222 1,371 1,354 950 801 397 998 964 682 555 238 2,257 521 1,471 972 4,565 3,251 1,202 2,541 59 74 55 436 94 165 1,712 1,942 2,042 1,868 1,081 1,583 2,359 Unfinished 1 flooring 1,184 1,894 1,196 1,904 3,384 514 881 1,955 5,683 642 284 1,117 2,020 2,683 5,075 3,715 2,155 3,467 1,436 1,003 3,064 2,117 615 1,670 15 408 2,425 295 941 934 2,871 1,748 3,540 1,740 364 456 263 1,069 1,806 3,712
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Rudimentary and natural flooring
Appendix A
119
Table A.3.14 Undernutrition by type of sanitation facility

Percentage of children age 035 months who are stunted, wasted, or underweight by type of household sanitation facilities, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children
Country Improved
1
Unimproved Improved Unimproved Improved
Unimproved
Improved
Unimproved
Sub-Saharan Africa
Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
18.5 25.6 27.9 31.0 29.5 34.0 19.7 25.3 34.5 20.2 19.3 16.0 28.3 52.0 42.5 28.8 32.0 31.6 37.5 14.4 34.9 36.8 24.7 18.5
26.2 32.9 38.0 41.9 36.9 * 29.7 40.3 46.8 22.6 21.3 25.0 42.9 46.3 50.8 33.7 39.7 43.1 40.2 24.2 38.6 44.0 31.4 26.2 30.1 * 21.4 50.1 * * * 46.6 39.1 50.6 50.6 30.6 22.1 23.9 18.6 53.7 23.2 34.9
11.3 13.7 5.2 6.8 15.9 8.4 6.8 11.9 8.5 3.3 13.3 11.0 6.7 6.0 7.0 22.6 8.0 13.7 6.7 10.2 4.8 5.3 6.1 11.3 3.2 2.0 2.2 12.4 1.7 3.5 11.6 11.1 11.7 11.6 8.3 1.9 2.6 0.9 1.7 2.7 5.6 0.8
14.9 18.9 8.4 7.9 18.7 * 10.0 17.1 13.8 1.4 12.2 11.8 8.1 8.1 9.6 24.7 7.9 22.3 5.5 12.8 5.9 5.7 10.2 14.9 3.3 * 3.9 18.5 * * * 11.7 17.0 17.4 11.7 1.9 3.8 2.0 1.5 5.4 5.8 1.9
20.6 29.5 20.3 24.8 32.9 26.0 19.9 26.3 36.3 13.3 23.4 20.2 18.2 38.8 25.8 37.7 21.1 36.3 30.9 17.4 23.6 23.6 11.6 20.6 4.4 4.9 6.1 40.0 4.5 11.1 18.8 40.7 25.7 32.5 36.0 6.5 4.3 6.3 4.5 21.5 14.5 5.3
30.6 38.5 37.8 34.8 41.6 * 28.1 46.3 47.0 10.2 28.1 26.7 35.7 40.6 36.1 46.5 30.6 52.6 27.9 27.9 28.3 29.3 19.1 30.6 11.1 * 15.1 48.8 * * * 51.8 42.5 52.6 48.7 11.2 11.1 13.6 10.2 35.4 18.6 12.8
345 508 1,607 1,733 1,001 909 1,767 291 812 1,808 1,135 418 2,276 1,088 4,804 3,399 1,332 735 1,303 797 2,812 2,587 1,042 345 5,819 3,251 1,321 2,879 331 1,011 988 1,831 267 7,192 507 1,587 1,883 2,190 1,437 1,768 1,826 3,988
1,904 1,930 198 570 2,528 4 1,559 1,973 4,892 194 501 1,607 522 1,990 1,094 1,249 1,469 3,272 270 2,375 584 970 472 1,904 167 14 271 2,083 23 2 1 1,466 1,561 17,195 3,191 1,854 411 307 679 374 1,525 1,917
North Africa/West Asia/Europe 19.0 Egypt 2000 7.1 Jordan 1997 10.3 Turkey 1998 42.6 Yemen 1997 Central Asia
10.1 24.9 31.3 35.2 27.1 31.5 34.4 16.9 7.7 11.3 7.5 39.5 15.4 15.5
Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Rep 1996 Guatemala 1998-99 Haiti 2001 Peru 2000
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Flush toilet, pit latrine, VIP latrine 2 No facility, open pit, service or bucket latrine, public latrine
120
Appendix A
Table A.3.15 Undernutrition by source of drinking water

Percentage of children age 0-35 months who are stunted, wasted, or underweight, by source of drinking water, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 Improved Unimproved 22.0 30.2 26.9 27.4 34.7 32.9 19.3 31.6 39.1 17.9 17.9 20.5 24.3 41.5 40.7 28.2 27.1 38.0 33.3 20.1 31.6 30.7 25.2 29.4 32.3 30.3 37.1 35.0 (36.7) 27.9 40.0 46.7 26.7 22.4 23.9 33.9 49.5 49.9 30.9 39.3 42.9 45.5 23.4 39.6 45.7 32.6 14.0 12.2 17.7 49.2 12.1 33.4 32.6 43.2 37.7 46.2 52.9 33.7 16.9 19.2 9.7 26.1 21.2 31.9
1 2
Improved 13.8 17.8 5.4 6.2 19.3 8.3 8.2 12.8 11.5 3.1 10.9 11.0 5.8 5.7 7.1 23.0 9.0 18.6 6.7 10.7 4.7 5.0 7.1 3.2 2.0 2.5 13.0 1.7 2.8 9.3 11.6 14.0 15.1 11.0 1.8 2.3 1.1 1.8 3.5 5.5 0.7
Unimproved 15.3 17.8 5.7 7.7 17.4 (4.1) 8.3 17.3 13.5 3.0 15.2 12.1 7.3 7.7 8.1 23.4 7.6 21.9 6.2 14.0 5.7 5.6 8.1 3.4 2.6 2.4 16.5 2.0 4.9 16.6 7.1 17.1 18.0 11.6 2.2 3.4 0.9 1.4 1.7 6.1 2.0
Improved Unimproved 26.9 34.0 19.4 22.1 38.6 25.1 20.0 34.4 39.8 11.6 21.7 25.3 15.1 34.0 24.4 36.8 17.2 45.4 28.9 22.7 21.4 19.0 13.4 4.7 4.8 7.2 38.0 5.4 9.3 17.6 45.6 37.8 45.9 45.5 6.9 3.8 6.6 6.5 25.8 14.5 5.3 32.4 38.9 24.1 30.5 39.4 (28.6) 26.3 45.9 47.0 16.0 28.5 25.5 24.3 41.0 33.4 41.4 29.5 52.1 32.7 27.5 27.9 30.4 15.7 3.1 5.7 8.5 48.0 3.9 14.8 21.4 47.5 40.8 49.5 49.1 13.7 9.1 10.2 5.6 14.4 19.0 12.7
Improved 1,363 1,177 754 837 1,007 853 1,363 433 1,189 1,432 882 487 782 453 3,745 1,402 763 1,353 973 1,575 1,717 1,598 1,196 5,782 3,086 1,153 2,167 172 698 678 3,183 533 19,054 2,352 2,364 1,594 2,111 1,374 1,773 1,968 3,853
Unimproved 900 1,271 1,050 1,454 2,522 49 1,965 1,832 4,513 574 753 1,559 1,986 2,626 2,158 3,255 2,046 2,620 600 1,656 1,699 1,954 318 204 176 436 2,793 176 315 311 118 1,228 5,254 1,285 1,023 602 375 729 370 1,385 1,931
Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Piped water into residence, piped public tap, protected well water, rainwater 2 Unprotected well or spring, surface water, vendor, bottled water, tanker truck
Appendix A
121
Table A.3.16 Undernutrition by mothers nutritional status

Percentage of children age 035 months who are stunted, wasted, or underweight by mother's nutritional status (eligible women BMI <=60.0), Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country Sub-Saharan Africa Benin 1996 Burkina 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 <18.5 26.1 32.1 37.5 39.4 42.1 42.7 30.5 43.9 46.4 25.4 21.6 32.7 37.8 53.6 48.3 36.4 37.7 43.7 26.4 39.0 49.1 31.2 18.5-24.9 25.8 30.2 31.4 32.4 33.5 34.3 25.2 34.4 44.8 22.6 21.5 24.2 31.8 48.1 44.5 29.4 37.4 41.7 22.0 34.8 38.3 29.3 14.1 8.9 12.8 45.0 13.1 24.6 30.3 38.3 35.6 42.3 46.4 24.9 9.8 13.3 11.7 45.2 19.2 24.6 25.0 15.3 31.2 20.8 25.8 25.3 24.8 16.9 24.3 38.5 13.4 13.0 17.2 17.2 29.5 37.3 18.3 18.9 22.2 14.0 25.3 31.6 18.6 18.7 6.4 9.9 35.4 4.2 20.1 35.7 19.6 31.9 23.9 31.0 22.5 7.8 10.1 6.5 32.4 11.6 17.0 <18.5 21.8 31.3 14.1 11.5 28.1 14.7 13.6 22.0 18.0 3.4 20.3 16.3 10.0 14.9 9.8 31.2 14.4 31.2 22.5 10.9 6.9 10.2 2.7 3.1 (1.4) 24.0 (4.9) 12.6 13.1 14.9 21.4 19.8 16.4 (0.0) 5.1 3.1 1.9 (10.6) 9.6 (4.6) 18.5-24.9 14.4 17.1 5.5 6.7 16.9 8.1 9.0 13.7 12.0 3.3 13.3 12.5 7.1 6.0 8.0 23.1 8.7 19.9 12.5 5.4 5.7 6.9 1.7 3.0 3.3 13.9 2.0 3.6 11.6 9.0 14.5 12.9 9.8 2.0 3.3 1.2 1.8 3.6 5.4 1.5 25.0 8.5 13.4 4.1 4.1 14.6 8.1 5.0 7.4 9.2 2.5 6.3 10.2 4.1 3.6 4.5 22.4 4.2 11.0 7.0 3.2 2.6 6.0 2.9 1.2 1.8 8.9 0.0 0.9 6.2 5.7 7.0 8.5 7.3 1.6 1.8 0.8 0.5 2.6 4.6 0.5 <18.5 40.9 49.5 44.0 37.5 54.4 30.7 43.4 52.5 53.9 23.6 34.5 40.4 34.0 51.6 40.3 52.9 34.2 59.3 38.0 40.3 36.4 24.0 4.7 7.1 (11.1) 53.4 (4.9) 29.2 13.6 57.4 51.6 57.3 56.6 (11.2) 10.4 16.7 15.6 (49.3) 25.9 (22.8) 18.5-24.9 30.2 35.8 24.2 26.0 37.1 27.5 24.9 39.4 44.3 14.6 26.5 26.5 20.8 38.5 28.5 39.8 28.2 49.7 25.6 25.2 26.7 14.1 3.5 6.5 8.7 41.9 5.3 11.4 20.3 37.8 36.6 40.5 43.7 9.4 5.3 8.0 5.7 28.8 16.4 9.5 25.0 17.5 28.1 10.2 14.4 24.9 18.8 12.0 22.8 21.8 8.7 15.3 16.6 10.8 15.3 15.9 27.8 8.5 28.4 13.7 12.7 10.7 8.1 4.9 3.9 5.9 31.8 0.0 6.0 16.4 18.9 28.2 21.4 21.9 7.8 3.1 4.5 3.4 16.3 10.5 4.5 <18.5 268 260 121 299 594 75 222 745 1,217 121 173 187 298 496 317 592 233 656 306 263 259 68 958 68 36 947 28 63 116 1,376 324 8,821 891 25 132 72 130 41 257 47 18.5-24.9 1,470 1,831 1,130 1,448 2,193 530 2,209 1,049 3,691 1,116 1,026 1,377 1,822 1,949 4,279 2,881 1,945 2,359 2,208 2,265 2,390 1,008 311 1,018 629 2,347 231 658 631 1,443 1,122 11,037 2,278 1,666 1,209 1,290 1,052 1,031 1,975 3,000 25.0 191 111 326 134 139 149 382 75 86 478 232 203 310 91 546 330 242 255 322 308 343 315 1,917 1,506 726 577 66 161 125 101 77 949 52 1,279 636 830 606 755 663 2,413
North Africa/West Africa/Europe Egypt 2000 21.7 Jordan 1997 8.7 Turkey 1998 (14.1) Yemen 1997 48.8 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 (0.0) 32.4 31.0 45.6 43.7 50.2 51.1 (34.0) 15.2 17.9 18.6 (61.0) 23.9 (28.0)
Note: Figures in parentheses are based on 25-49 unweighted cases.
122
Appendix A
Table A.3.17 Undernutrition by antenatal care visits

Percentage of children age 0-35 months who are stunted, wasted, or underweight by whether the mother had one or more antenatal visits, Demographic and Health Surveys, 1994-2001 Percent stunted One or more antenatal visits 24.4 29.6 26.7 31.3 29.2 32.7 23.2 33.3 39.7 19.5 19.7 22.9 30.7 49.1 42.2 25.2 33.8 35.5 35.9 20.7 34.5 38.6 25.0 Percent wasted One or more antenatal visits 13.5 17.2 5.4 6.9 14.3 8.0 7.9 15.7 12.2 2.7 12.3 11.4 6.9 7.3 7.7 21.8 8.3 17.6 6.3 11.9 5.5 5.5 7.1 3.3 2.0 2.1 12.9 1.6 3.8 11.2 11.2 14.8 15.4 10.9 1.5 2.9 1.1 1.6 3.1 5.4 1.0 Percent underweight One or more antenatal visits 27.9 34.8 18.8 25.0 32.2 24.1 22.4 40.2 39.9 12.2 24.5 24.5 21.0 40.1 26.7 34.2 25.5 44.1 29.1 23.9 25.0 24.9 12.9 4.0 4.7 4.9 36.0 4.6 11.4 18.4 39.2 33.9 42.8 43.8 6.6 4.3 5.9 6.1 23.7 13.4 6.0 Number of children One or more antenatal visits 1,904 1,665 1,498 1,751 1,339 790 2,837 1,142 1,435 1,666 1,458 1,670 2,616 2,613 5,210 2,211 2,021 1,661 1,458 2,688 2,830 3,388 1,218 3,316 3,148 1,141 1,913 294 908 863 1,201 763 17,013 1,580 2,455 2,013 2,022 2,091 1,913 2,343 4,776
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
None 27.8 33.6 38.4 40.9 38.3 40.5 31.5 43.6 46.5 25.1 22.2 24.6 33.2 44.3 55.2 34.6 41.3 45.0 51.3 26.3 39.5 44.6 31.0 21.1 16.9 22.7 49.5 10.0 28.7 31.6 44.7 41.1 57.4 52.1 35.5 26.5 21.1 23.1 47.2 27.1 36.5
None 18.3 18.7 7.7 7.8 20.1 9.9 10.4 17.2 13.2 5.0 18.3 13.0 7.3 8.1 6.2 24.7 6.8 22.8 8.1 13.9 4.2 5.0 7.4 3.1 2.4 3.5 16.3 3.2 0.0 14.8 11.5 17.4 16.4 11.5 3.0 2.5 0.9 3.4 3.5 6.2 1.7
None 35.9 39.2 34.3 34.6 43.4 36.6 31.9 47.3 47.0 16.4 27.6 29.3 27.2 39.1 34.2 45.2 27.6 53.4 38.1 30.9 23.7 31.6 16.4 5.1 10.8 14.0 48.5 4.5 8.3 21.3 49.3 44.5 56.1 49.2 14.8 13.5 12.6 18.1 24.9 22.6 13.8
None
370 865 425 559 2,202 131 504 1,127 4,469 347 180 397 205 467 863 2,467 816 2,361 216 572 754 200 369 2,920 118 469 3,053 60 107 125 2,105 1,079 7,130 2,125 997 293 476 40 236 1,046 1,294
North Africa/West Asia/Europe Egypt 2000 17.7 Jordan 1997 6.9 Turkey 1998 7.7 Yemen 1997 39.7 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000
1
9.3 24.4 31.2 32.4 31.8 39.7 43.4 19.7 7.9 10.9 10.8 41.2 15.2 17.7
Appendix A
123
Table A.3.18 Undernutrition by mother's age at delivery

Percentage of children 0-35 months who are stunted, wasted, or underweight by mother's age at delivery, Demographic and Health Surveys, 1994-2001 Percent stunted < 20 20-34 35+ 30.9 36.7 32.9 33.4 36.8 37.6 31.2 40.6 45.6 22.4 21.5 24.6 33.2 49.8 46.0 28.5 42.6 43.5 43.6 27.5 42.5 43.5 26.1 22.5 9.3 15.2 49.9 (12.7) 27.9 27.8 46.2 38.6 50.0 45.5 20.0 10.9 13.5 13.8 43.5 19.1 22.8 24.2 30.6 28.5 34.0 34.4 33.9 22.6 35.4 45.0 19.8 19.9 22.8 30.2 47.1 42.8 30.6 35.1 40.0 36.3 21.0 34.1 37.3 25.8 18.6 6.8 11.3 45.4 23.8 27.7 27.2 31.8 34.1 30.5 24.3 45.3 43.8 20.5 19.4 23.0 32.1 52.4 47.5 29.8 29.5 41.9 40.4 21.0 33.9 40.5 30.3 21.7 8.6 14.0 43.1 Percent wasted < 20 20-34 35+ 14.7 13.9 6.4 9.0 17.4 10.9 9.4 15.8 10.5 2.6 12.3 9.0 9.1 8.2 8.1 21.2 8.1 19.8 7.2 13.9 3.7 6.0 7.7 3.0 2.8 3.8 13.1 (1.0) 2.0 10.1 10.0 15.4 16.2 10.8 1.8 3.1 0.7 3.2 2.4 4.5 1.3 14.0 17.6 5.7 6.5 17.4 8.4 7.8 16.9 13.3 2.9 12.6 12.7 6.4 7.0 7.0 23.6 7.1 20.1 5.6 11.6 5.0 5.1 6.8 3.2 2.0 2.3 15.2 2.2 3.1 11.3 11.9 15.6 15.5 11.2 1.9 2.6 1.1 1.2 2.8 5.9 1.1 15.2 20.9 6.7 7.6 22.1 5.8 9.0 15.3 13.5 5.2 14.7 11.3 7.5 8.0 9.2 24.5 11.7 24.4 10.5 14.0 8.9 6.5 8.4 3.1 1.7 1.6 15.9 (0.0) 9.1 20.8 13.6 19.1 16.5 12.3 2.1 3.8 1.3 1.0 5.9 5.8 1.3 Percent underweight < 20 20-34 35+ 33.5 38.2 26.9 25.1 36.6 34.7 28.5 40.9 42.7 15.5 28.1 23.4 23.5 41.1 30.3 39.9 32.1 50.8 35.2 29.0 25.7 29.0 12.6 5.3 6.5 9.4 44.9 (1.8) 10.3 10.8 49.1 40.1 50.7 45.1 7.2 5.8 5.0 10.4 21.1 14.3 9.3 28.3 35.5 20.2 27.3 39.5 25.7 22.3 43.0 44.9 12.1 23.9 26.4 20.3 38.5 26.4 39.7 25.0 48.4 28.8 24.5 23.7 23.9 13.8 4.3 4.8 7.4 43.3 4.8 10.2 19.3 43.0 39.1 45.2 46.6 8.9 5.3 7.7 4.7 22.3 16.1 6.8 29.4 37.8 25.0 30.7 42.2 20.8 24.9 48.0 49.0 12.1 26.5 24.1 26.2 45.6 31.4 41.4 22.0 53.1 32.7 25.3 29.0 27.2 15.0 5.3 4.8 5.9 44.2 (5.9) 20.1 28.4 57.6 43.4 52.4 52.9 10.9 5.9 8.0 12.6 34.8 18.2 10.1 Number of children < 20 20-34 35+ 297 355 406 456 771 101 646 370 812 504 195 423 460 637 1,153 760 600 870 260 354 620 703 318 661 260 229 713 39 123 114 1,021 167 5,532 654 475 450 508 441 344 467 892 1,584 1,712 1,279 1,593 2,387 666 2,287 1,413 4,121 1,302 1,160 1,365 2,041 2,038 4,128 3,166 1,871 2,560 1,202 2,370 2,505 2,451 1,074 4,935 2,578 1,255 3,458 284 810 824 2,102 1,279 17,710 2,695 2,396 1,627 1,736 1,578 1,510 2,264 4,218 392 462 238 261 384 154 408 486 972 207 283 279 320 405 793 752 366 592 212 537 459 434 196 640 427 126 795 31 82 51 183 396 901 355 580 229 253 112 295 658 960
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Rep. 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Rep. 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Rep. 1996 Guatemala 1998-99 Haiti 2000 Peru 2000
8.2 (17.0) 24.0 28.7 31.0 43.2 36.3 36.2 43.2 48.3 23.6 10.1 12.4 9.9 40.1 18.5 20.1 52.2 40.3 47.6 54.2 30.0 10.5 14.3 15.3 49.1 20.2 27.6
Note: Figures in parentheses are based on 25-49 unweighted cases.
124
Appendix A
Table A.3.19 Undernutrition by mother's perceived size of child at birth

Percentage of children age 035 months who are stunted, wasted, or underweight by mother's perceived size of child at birth, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Smaller Smaller Smaller Smaller than Average Very than Average Very than Average Very than Average Very Small average or larger Small average or larger Small average or larger Small average or larger 43.2 36.1 40.6 50.4 40.7 54.3 40.0 47.3 51.2 36.7 (32.7) 29.2 38.0 59.8 52.8 41.3 (14.6) 49.4 (55.0) 34.7 44.9 63.1 40.9 32.9 37.5 33.3 44.0 38.6 38.5 30.4 39.3 50.6 28.3 31.0 24.2 39.0 53.3 55.7 36.0 44.0 42.5 43.6 28.4 43.9 47.9 29.2 24.8 13.4 16.1 49.9 11.9 45.7 37.4 48.2 43.6 50.0 57.3 23.1 29.9 28.1 31.2 32.6 30.5 22.5 36.4 41.5 18.6 18.3 22.8 29.4 45.5 42.0 29.0 34.5 38.6 36.9 19.6 33.5 37.2 25.5 18.4 5.7 9.7 43.5 7.8 22.5 30.7 37.7 35.9 42.9 44.8 23.7 27.6 10.0 9.1 26.2 14.9 14.7 22.6 17.6 7.4 (14.6) 22.8 5.8 10.7 8.1 35.2 (42.1) 27.4 (5.6) 19.9 9.8 12.7 8.1 3.2 5.8 4.3 18.5 * * * 16.3 16.2 21.0 15.5 14.4 18.2 5.8 11.0 22.5 8.5 11.1 22.2 12.5 2.8 18.8 13.8 7.1 10.3 11.0 27.8 6.6 23.4 15.3 18.1 7.2 9.4 5.5 3.8 1.6 2.0 17.7 8.2 3.4 17.6 14.5 24.0 20.5 16.5 13.9 16.9 5.8 6.5 14.8 7.3 7.4 14.0 12.7 2.9 12.1 11.0 7.0 6.4 7.0 22.3 7.7 18.2 5.7 10.7 4.5 4.8 7.4 3.1 1.9 2.3 13.7 0.8 3.4 10.4 10.5 15.3 14.2 9.5 55.7 53.7 45.2 43.7 52.9 39.4 43.7 55.1 52.7 26.4 (53.9) 43.4 33.2 54.2 43.7 58.4 (51.6) 57.4 (55.9) 44.1 40.2 51.4 36.1 11.4 16.3 17.5 54.1 * * * 68.2 47.2 61.9 62.6 39.0 44.8 25.5 35.5 45.8 32.3 32.8 51.8 51.4 20.8 39.6 32.0 27.9 48.9 39.7 48.4 31.5 57.0 36.0 38.5 33.8 39.9 15.8 6.4 10.0 6.9 49.4 13.1 20.4 29.2 55.3 52.7 54.5 60.7 26.7 34.2 20.5 25.3 34.3 23.1 21.2 40.0 41.6 11.1 22.3 23.7 19.9 36.0 25.4 38.1 24.5 45.3 29.0 21.5 21.9 22.9 12.4 4.0 3.6 6.3 40.5 2.5 9.8 17.1 42.4 38.2 43.8 42.1 83 158 81 91 520 94 194 371 371 80 27 80 130 372 223 179 39 621 47 242 250 99 70 197 174 174 487 12 20 5 175 76 1,101 188 266 245 215 285 653 130 378 238 1,804 168 189 183 306 394 719 475 466 831 137 368 452 343 181 700 329 260 1,032 53 100 108 491 191 4,642 757 1,919 2,119 1,622 1,887 2,355 685 2,767 1,622 3,721 1,728 1,418 1,782 2,375 2,297 5,110 3,975 2,298 2,556 1,490 2,647 2,837 3,145 1,326 5,318 2,762 1,169 3,441 289 887 865 2,638 1,559 18,360 2,759
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
North Africa/West Asia/Europe Egypt 2000 26.3 Jordan 1997 19.5 Turkey 1998 22.6 Yemen 1997 53.1 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 * * * 56.9 51.0 57.1 64.4
Latin America/Caribbean Bolivia 1998 37.6 33.9 21.5 3.5 2.6 1.6 16.0 16.1 7.3 269 401 2,773 Brazil 1996 31.0 18.0 7.1 6.8 4.5 2.2 20.3 8.2 3.9 93 460 1,744 Dominican Republic 1996 29.8 19.0 8.3 2.0 1.3 1.7 27.1 12.1 3.9 96 355 1,675 Guatemala 1998-99 52.5 49.7 38.0 2.6 3.4 2.9 30.0 30.1 20.8 204 426 1,501 Haiti 2000 26.4 16.9 16.6 6.0 8.0 5.1 25.0 21.4 12.2 775 428 2,186 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Appendix A
125
Table A.3.20 Undernutrition by sex of child

Percentage of children age 035 months who are stunted, wasted, or underweight by sex of child, Demographic and Health Surveys, 1994-2001 Percent Percent Percent Number of stunted wasted underweight children Country Male Female Male Female Male Female Male Female Sub-Saharan Africa
Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 27.2 32.8 31.5 35.5 35.7 35.7 25.2 36.4 46.5 22.7 21.1 24.9 33.8 51.8 46.1 31.0 36.1 42.5 38.4 23.4 37.3 40.4 27.4 20.5 8.0 12.6 46.4 7.8 28.0 33.9 39.4 36.2 43.6 46.6 25.5 11.2 13.6 12.5 45.1 20.4 21.4 22.7 29.1 27.0 31.8 34.1 31.7 23.6 40.5 43.2 18.2 19.0 21.4 27.9 44.8 41.9 29.2 35.8 39.5 37.4 20.1 33.7 37.5 25.3 18.0 6.4 11.4 45.1 10.9 21.5 28.5 41.0 38.4 46.4 50.2 22.9 9.4 12.1 9.4 38.6 17.3 22.0 16.0 19.3 7.0 7.6 19.8 9.4 9.7 16.2 14.6 3.2 14.5 12.0 7.1 8.2 6.9 24.5 8.0 20.6 6.4 11.4 6.6 6.5 7.5 3.7 2.1 2.8 15.9 3.3 4.2 12.6 11.6 17.1 16.0 12.3 2.2 2.8 0.8 2.1 3.6 4.8 1.1 12.6 16.1 4.9 6.6 16.0 7.0 6.7 16.7 11.2 3.0 11.4 11.4 6.8 6.5 8.1 22.2 7.7 20.7 6.6 13.1 3.9 4.4 6.9 2.6 2.0 2.0 14.1 0.6 2.6 10.6 11.2 15.5 15.4 10.2 1.6 2.9 1.2 1.1 2.8 6.6 1.2 32.1 35.9 24.0 29.1 40.6 27.6 26.4 42.3 47.2 14.0 24.4 24.6 22.9 42.2 27.9 39.7 28.2 48.9 29.8 25.8 26.3 27.1 14.6 5.2 4.6 8.3 44.0 5.2 13.4 20.7 44.4 39.8 45.0 45.8 9.4 6.4 7.0 7.0 27.6 16.1 7.9 26.2 36.8 20.4 25.4 37.7 24.0 21.1 45.2 43.3 11.9 25.3 26.3 20.0 37.7 27.6 40.3 24.0 50.3 30.8 24.5 23.1 23.6 12.8 3.8 5.2 6.7 43.4 4.0 8.6 16.8 47.0 40.4 48.5 48.0 8.6 4.5 7.4 5.6 20.0 16.4 7.5 1,145 1,272 962 1,171 1,760 479 1,705 1,162 2,991 1,010 807 1,075 1,440 1,553 3,032 2,288 1,450 2,108 863 1,603 1,783 1,767 821 3,209 1,668 866 2,526 166 519 509 1,684 949 12,574 1,887 1,742 1,144 1,285 1,099 1,093 1,726 3,075 1,128 1,258 961 1,139 1,781 442 1,636 1,107 2,914 1,003 830 992 1,380 1,528 3,042 2,390 1,387 1,914 811 1,657 1,802 1,822 767 3,027 1,598 744 2,440 188 496 480 1,623 893 11,569 1,817 1,709 1,162 1,214 1,031 1,057 1,663 2,995
North Africa/West Asia/Europe
Central Asia
126
Appendix A
Table A.3.21 Undernutrition by birth order

Percentage of children age 035 months who are stunted, wasted, or underweight by birth order, Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 1st Birth 26.8 35.8 30.8 31.5 33.4 29.8 27.6 35.2 42.1 19.5 18.4 21.6 27.2 49.1 43.8 29.3 40.1 40.6 40.5 21.0 37.0 41.7 23.4 Birth 2-3 24.8 28.9 27.5 35.2 34.0 33.9 23.7 33.8 43.8 20.7 19.8 24.0 29.5 44.3 43.1 26.3 38.6 40.2 32.2 20.6 35.5 37.2 26.3 17.9 6.3 10.5 42.6 7.9 23.9 30.7 36.6 35.3 43.8 48.4 21.3 8.5 12.1 9.8 36.1 15.6 18.3 Birth 4-5 24.6 30.3 29.7 33.2 36.3 33.2 22.0 40.9 45.6 17.9 17.9 22.9 34.3 46.8 42.8 30.4 33.4 42.5 39.0 22.5 36.6 37.3 29.5 20.1 7.4 13.3 47.1 18.6 25.9 37.4 44.8 37.5 52.1 49.9 30.0 14.8 17.0 17.7 47.8 20.2 28.3 Birth 6+ 24.2 30.9 29.9 33.8 35.6 36.5 25.4 44.5 47.3 23.9 24.5 23.8 34.4 54.2 47.0 33.4 29.2 41.1 43.3 22.9 33.8 40.6 30.3 25.2 9.7 27.4 47.5 * 40.2 40.7 46.4 41.8 55.9 56.4 35.4 27.6 29.9 19.8 53.6 27.2 41.0 1st Birth 13.9 15.2 5.0 6.0 17.4 8.9 8.7 16.5 8.2 3.5 13.4 9.5 5.5 6.3 7.4 20.3 6.3 19.4 7.1 12.4 4.2 5.1 6.0 3.4 2.8 2.3 14.7 3.6 4.4 9.0 9.4 16.8 14.6 8.3 2.0 2.5 0.6 1.9 2.9 3.9 0.8 Birth 2-3 14.6 17.2 5.6 8.8 15.4 6.3 7.2 15.8 13.2 2.5 11.9 10.7 7.6 7.1 7.3 21.2 8.1 18.4 6.4 11.7 4.2 5.9 7.1 2.8 2.3 2.4 14.9 1.1 2.5 11.6 10.7 13.2 15.2 10.2 2.0 2.6 0.9 1.0 3.0 6.2 1.2 Birth 4-5 12.7 17.7 6.0 6.2 18.2 8.9 8.7 17.6 14.8 3.4 13.1 14.5 7.8 8.6 7.8 23.6 6.6 20.6 5.1 10.7 5.5 4.7 8.3 3.8 2.0 3.2 15.2 1.0 3.8 13.0 15.9 16.4 17.2 13.5 1.2 3.8 2.1 3.1 2.8 6.5 1.4 Birth 6+ 15.6 19.9 7.3 6.6 20.9 9.4 8.9 16.1 14.1 3.3 14.1 11.9 6.8 7.7 7.6 26.3 11.0 23.0 7.4 14.6 6.9 5.8 8.8 3.1 1.1 2.3 15.0 * 4.8 22.8 12.5 20.6 18.8 14.8 2.3 4.4 2.8 1.2 4.1 6.0 1.5 1st Birth 30.8 37.7 21.7 23.6 36.1 23.8 25.0 37.5 37.5 12.7 24.7 22.1 16.8 36.6 29.7 37.9 25.6 48.1 32.3 24.3 21.4 26.4 11.8 4.4 4.9 6.6 40.6 5.3 9.8 11.8 45.8 39.5 40.7 39.5 5.3 3.9 4.9 4.6 16.1 13.0 4.8 Birth 2-3 27.6 34.3 19.2 28.6 35.3 25.9 22.5 41.0 43.1 14.4 22.9 24.9 20.6 37.6 26.0 35.7 27.9 45.9 29.2 24.8 22.7 24.2 13.7 3.2 3.5 6.4 40.7 3.6 10.2 20.0 41.8 35.4 45.9 45.4 7.8 3.4 7.0 4.9 19.6 13.4 6.1 Birth 4-5 31.0 34.2 23.4 27.6 42.5 25.3 23.9 46.7 49.1 10.6 24.4 26.5 23.6 41.0 27.2 39.0 26.1 49.7 27.8 25.0 26.6 24.7 14.4 5.5 5.8 9.6 45.2 7.5 9.9 23.4 50.6 42.3 52.9 51.3 10.4 11.0 9.8 11.2 26.0 16.0 10.2 Birth 6+ 28.4 39.6 25.6 28.3 42.6 27.4 24.6 49.9 49.5 13.3 29.2 27.5 26.3 45.2 29.4 45.2 23.1 53.1 32.5 26.4 27.3 26.5 17.7 8.0 6.3 14.7 46.4 * 23.4 35.1 53.0 45.8 58.3 54.7 14.2 14.6 19.3 12.5 37.0 23.5 16.2 1st Birth 442 435 419 466 652 168 630 499 1,056 508 390 386 685 678 1,327 690 577 670 367 622 555 723 507 1,693 608 582 843 118 287 313 Birth Birth 2-3 4-5 725 799 617 500 595 435 Birth 6+ 606 701 452 541 939 277 811 570 1,716 411 324 510 593 756 1,295 1,595 520 1,396 369 788 999 866 221 737 711 136 1,832 16 76 56 358 411 2,154 594 681 192 130 164 460 827 816
775 527 1,081 869 286 190 1,072 828 703 496 1,847 1,286 683 411 592 332 652 519 998 545 996 650 2,177 1,275 1,313 1,080 1,067 673 1,073 883 577 361 1,031 820 1,171 860 1,195 805 618 243 2,654 1,152 1,181 766 698 194 1,317 974 170 468 465 51 184 154
936 1,439 574 336 649 445 7,092 10,769 4,127 819 1,469 823 834 819 931 665 502 798 1,866 1,246 1,007 1,118 975 730 1,109 2,426 690 289 319 327 458 655 961
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Appendix A
127
Table A.3.22 Undernutrition by length of preceding birth interval

Percentage of children age 035 months who are stunted, wasted, or underweight by length of preceding birth interval in months, Demographic and Health Surveys, 1994-2001 Percent stunted Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Eritrea 1995 Ethiopia 2000 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 First 1 birth 26.9 36.0 30.8 31.4 33.3 30.8 27.6 35.1 42.3 19.7 18.3 21.9 27.0 49.2 44.2 29.4 40.0 40.5 40.5 20.8 36.9 41.6 23.5 < 24 33.6 35.8 35.6 40.8 46.0 38.8 27.7 46.6 52.7 26.8 26.3 29.1 31.0 49.9 48.9 38.3 40.5 50.2 42.0 26.8 39.9 39.9 29.2 23.3 8.6 19.8 50.9 12.0 28.4 33.6 48.9 50.2 50.3 51.2 29.8 19.6 20.1 18.1 50.1 26.4 34.1 24-47 23.6 29.4 28.3 34.2 33.6 32.7 24.9 40.0 45.8 22.0 22.5 24.2 35.1 49.0 43.0 30.1 36.7 39.7 36.2 22.9 34.8 38.5 27.3 18.7 8.1 14.0 45.2 13.2 29.2 31.5 42.8 38.2 48.3 50.8 30.7 12.4 16.4 12.5 46.6 20.6 29.8 48+ 23.2 28.8 24.7 27.4 28.9 33.3 17.9 28.4 37.7 13.3 15.3 19.4 27.2 42.7 43.1 22.4 28.1 35.0 37.0 17.8 28.6 35.6 28.1 18.2 2.8 8.8 38.1 7.6 18.7 36.7 32.2 29.8 41.7 48.9 18.3 6.6 9.3 5.4 26.8 12.9 15.8 First 1 birth 14.1 15.2 5.2 5.9 17.6 8.7 8.6 16.4 8.2 3.4 13.4 9.9 5.7 6.3 7.5 20.3 6.3 19.3 7.1 12.4 4.1 5.1 5.9 3.4 2.7 2.5 14.7 3.6 4.4 9.0 9.7 16.8 14.6 8.3 2.0 2.5 0.6 1.9 2.9 4.2 0.8 Percent wasted < 24 20.0 21.0 7.4 10.2 18.3 8.5 5.3 18.3 12.2 4.3 15.1 9.4 10.4 8.8 8.1 24.2 5.3 23.5 1.5 12.8 5.3 4.7 4.7 4.1 2.6 4.1 14.3 0.0 2.4 13.9 11.0 11.0 16.1 13.2 1.0 3.1 1.8 1.5 3.2 5.2 1.0 24-47 14.4 17.5 6.0 5.9 17.7 8.9 8.8 15.7 14.5 2.3 12.0 12.2 7.2 7.6 6.7 23.4 8.2 20.1 7.6 12.4 5.4 5.5 7.8 3.1 1.5 2.1 15.6 2.6 3.0 13.8 12.3 17.5 15.9 11.2 2.1 4.5 1.1 1.3 3.8 6.0 1.4 48+ 11.2 19.1 5.5 9.6 18.5 4.9 8.1 16.9 13.7 3.1 13.4 13.4 5.1 6.6 9.0 25.4 9.8 21.1 5.9 11.6 6.1 6.5 8.6 2.2 1.0 1.8 15.0 0.5 3.8 8.7 12.4 16.8 16.7 13.5 2.4 1.6 1.1 1.9 1.9 7.6 1.3 Percent underweight First 1 birth 30.9 37.6 22.3 23.5 36.2 24.4 24.9 37.3 37.8 12.7 24.6 22.7 16.7 36.8 30.0 38.2 25.4 48.1 32.3 24.5 21.2 26.3 12.0 4.4 4.8 6.8 40.7 5.3 9.7 11.8 46.1 39.5 40.9 39.4 5.3 3.9 4.8 4.5 16.1 13.3 4.9 < 24 38.0 46.4 22.6 34.9 46.9 34.3 24.4 50.8 51.1 16.5 32.7 26.6 28.1 43.4 30.5 48.0 32.3 59.0 32.5 30.3 26.9 24.9 16.7 6.8 6.0 12.7 47.7 9.1 12.8 28.0 53.1 47.9 52.0 49.0 9.8 10.7 12.7 9.5 27.4 20.6 13.5 24-47 27.9 35.3 24.1 25.8 38.0 22.6 25.2 46.4 46.3 13.8 26.3 25.4 22.8 41.0 25.4 39.1 28.4 48.5 31.2 26.3 25.7 25.0 15.1 4.3 5.0 8.4 44.3 4.9 13.4 20.9 46.8 41.1 49.7 49.2 12.2 8.1 10.5 6.6 29.2 17.4 10.5 48+ 27.2 33.8 15.5 29.4 38.5 25.2 18.4 36.5 45.2 8.5 20.1 27.5 19.2 37.1 29.3 36.9 18.5 43.3 24.0 20.9 20.7 25.4 13.2 3.3 2.0 4.9 37.7 0.0 7.4 16.4 40.4 34.5 44.8 48.8 6.8 1.5 4.3 4.9 15.1 12.5 5.3 Number of children First 1 birth 445 436 423 467 654 172 633 501 1,064 514 392 390 691 681 1,340 695 580 673 367 627 558 725 511 1,713 617 590 845 118 288 314 942 336 7,124 823 838 820 937 668 502 802 1,873 < 24 176 218 257 353 559 201 353 347 831 331 135 194 458 524 782 709 246 672 185 252 775 539 112 1,011 1,143 233 1,374 72 192 196 379 255 3,805 604 704 405 407 475 500 651 717 24-47 1,322 1,406 948 48+ 331 470 295
1,155 335 1,855 473 425 123 1,742 613 1,116 304 3,078 931 769 399 706 405 1,036 447 1,118 554 1,442 433 2,837 1,115 2,582 693 1,433 578 2,232 444 819 303 1,702 679 1,835 417 1,845 478 576 389 2,231 1,280 1,087 419 395 393 2,047 700 68 333 348 96 202 131
North Africa/West Asia/Europe Egypt 2000 18.6 Jordan 1997 6.1 Turkey 1998 9.8 Yemen 1997 45.0 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000
1
7.3 21.7 27.4 40.9 35.3 39.3 40.9 14.6 6.9 10.0 7.4 34.2 13.8 14.4
1,129 856 792 458 9,513 3,701 1,737 541 1,249 514 542 660 567 613
647 340 862 286 1,398 539 1,807 1,673
Includes all children from multiple first births
128
Appendix A
Table A.3.23 Undernutrition by measles vaccination status

Percentage of children age 12-23 months who are stunted, wasted, or underweight by measles vaccination status, Demographic and Health Surveys, 1994-2001 Percentage of children age 12-23 months Percent stunted Percent wasted Percent underweight Number of children with a measles Measles No measles Measles No measles Measles No measles Measles No measles Country vaccination vaccination vaccination vaccination vaccination vaccination vaccination vaccination vaccination Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 67.5 50.6 54.4 51.6 22.7 65.1 53.5 27.1 51.6 55.5 74.4 56.3 78.2 46.8 83.5 51.7 66.4 35.5 78.0 44.1 57.9 86.5 81.4 30.2 44.1 40.5 38.1 40.4 46.4 28.7 57.5 40.7 25.2 25.6 29.9 37.3 66.8 56.8 38.3 40.3 48.9 47.4 32.0 46.0 47.3 33.7 23.6 10.5 14.4 55.5 15.9 32.5 42.2 48.1 40.2 48.3 53.3 31.0 13.6 17.5 13.6 50.4 20.9 27.4 31.6 46.0 48.8 51.9 47.6 51.4 33.4 57.6 59.8 34.2 31.1 37.1 58.3 62.6 62.8 42.8 46.4 59.4 63.8 33.4 46.7 50.2 50.9 20.2 11.3 24.8 65.4 * 45.0 (60.0) 62.3 48.8 66.7 67.4 34.0 27.0 25.6 19.2 65.2 32.7 30.5 19.1 23.3 4.6 9.5 23.5 9.7 13.8 17.9 22.4 1.9 17.8 16.2 8.2 9.7 9.7 31.7 13.0 27.1 6.9 19.5 6.3 8.7 9.4 3.1 2.8 2.9 17.9 3.0 5.9 13.8 19.4 26.2 20.2 17.4 1.8 2.6 1.8 1.4 6.1 8.8 1.6 19.0 27.5 11.9 11.6 26.9 18.0 12.5 20.2 28.4 3.3 27.0 20.5 12.7 14.4 10.7 34.5 12.0 33.3 19.4 19.7 8.5 9.6 11.3 2.5 2.1 2.9 20.3 * 6.8 (5.4) 22.2 19.3 24.3 24.6 2.1 5.0 1.2 4.8 3.4 8.9 1.3 37.8 45.7 24.0 29.9 42.6 28.5 28.2 53.6 48.1 15.9 35.8 32.7 22.5 55.0 34.7 51.7 32.5 57.3 37.3 37.3 29.5 33.4 16.5 5.6 6.4 7.9 49.1 4.2 19.1 25.3 54.7 49.4 50.7 52.4 10.8 5.4 8.5 8.1 30.7 17.2 10.0 40.2 58.2 42.3 42.5 56.6 43.2 34.4 57.5 64.0 22.1 44.5 41.7 42.7 55.9 46.1 55.7 36.3 70.6 56.5 36.6 35.6 43.2 25.4 8.2 7.8 19.7 59.8 * 20.6 (18.8) 72.0 51.0 66.7 68.5 14.0 13.9 13.5 10.8 42.5 26.8 12.4 515 407 355 384 254 207 577 551 357 381 439 360 766 505 1,688 719 636 472 435 442 769 1,087 458 1,992 1,016 430 726 94 292 309 804 310 4,403 736 588 681 584 576 598 624 1,556 248 397 297 360 866 111 502 1,479 335 306 151 279 213 574 334 672 322 859 122 559 558 170 105 60 116 116 827 24 51 25 341 244 3,726 554 567 88 239 157 132 519 595
North Africa/West Asia/Europe Egypt 2000 97.1 Jordan 1997 89.7 Turkey 1998 78.7 Yemen 1997 46.8 Central Asia Kazakhstan 1999 Kyrgyz Rep 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2000 Peru 2000 79.4 85.1 92.4 70.2 56.0 54.2 57.0 50.9 88.6 71.0 78.5 82.0 54.6 72.3
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Appendix A
129
Table A.3.24 Undernutrition by vaccination status

Among all children age 1223 months, the percentage who are stunted, wasted, or underweight by vaccination status (according to vaccination card or mother's report), Demographic and Health Surveys, 1994-2001 Percent stunted Percent wasted Percent underweight Number of children Other Other Other Other vaccina- No vacvaccina- No vacvaccina- No vacvaccina- No vaccinacinacinacinations tions tions tions 1 1 1 1 tions tions tions tions only only only only Measles Measles Measles Measles 30.2 44.1 40.5 38.1 40.4 46.4 28.7 57.5 40.7 25.2 25.6 29.9 37.3 66.8 56.8 38.3 40.3 48.9 47.4 32.0 46.0 47.3 33.7 33.1 47.0 48.0 51.5 48.1 49.5 32.7 58.6 64.3 33.0 29.0 37.4 59.7 61.9 59.1 42.5 46.0 57.6 64.4 31.8 46.7 48.6 (41.5) 19.2 11.3 20.7 65.8 * 44.7 (60.0) 60.4 49.2 64.3 69.0 31.3 20.7 19.8 19.9 65.4 30.1 29.3 28.2 41.9 51.0 52.5 47.2 * 34.7 54.2 58.4 (45.7) (37.7) 36.5 (48.3) 64.0 82.7 43.1 47.1 60.5 (61.7) 37.7 46.7 * 58.9 * * * 63.3 * * * 67.2 48.3 73.5 65.6 48.3 * * * * 37.3 (53.0) 19.1 23.3 4.6 9.5 23.5 9.7 13.8 17.9 22.4 1.9 17.8 16.2 8.2 9.7 9.7 31.7 13.0 27.1 6.9 19.5 6.3 8.7 9.4 3.1 2.8 2.9 17.9 3.0 5.9 13.8 19.4 26.2 20.2 17.4 1.8 2.6 2.0 1.4 6.1 8.8 1.6 14.0 26.9 11.8 8.7 22.4 15.1 11.3 20.5 27.8 3.6 24.9 21.1 14.1 14.8 11.4 36.1 9.5 29.6 16.5 19.9 8.0 10.3 (10.6) 2.7 2.1 2.8 21.3 * 6.9 (5.4) 21.5 22.2 24.0 23.8 2.2 6.0 1.5 4.7 1.4 8.3 1.4 29.6 29.8 12.2 16.3 30.1 * 14.7 19.4 28.6 (0.0) (33.6) 19.4 (2.6) 13.4 7.4 32.6 15.9 35.8 (28.6) 19.4 9.7 * 11.9 * * * 15.4 * * * 24.1 16.4 25.3 25.6 1.7 * * * * 9.8 (0.0) 37.8 45.7 24.0 29.9 42.6 28.5 28.2 53.6 48.1 15.9 35.8 32.7 22.5 55.0 34.7 51.7 32.5 57.3 37.3 37.3 29.5 33.4 16.5 5.6 6.4 7.9 49.1 4.2 19.1 25.3 54.7 49.4 50.7 52.4 10.8 5.4 10.7 8.1 30.7 17.2 10.0 36.4 58.4 42.6 39.5 52.2 39.8 31.7 57.4 64.2 21.5 41.9 42.5 43.1 54.4 45.0 56.7 36.8 65.4 65.2 34.0 33.1 42.2 (26.7) 8.7 7.8 17.6 59.8 * 20.2 (18.8) 69.6 50.0 64.6 70.8 11.6 13.9 9.6 10.5 39.7 27.8 12.0 48.3 57.6 41.5 47.5 59.7 * 39.1 57.9 64.0 (28.1) (52.5) 40.2 (40.0) 58.8 52.1 54.5 35.6 73.9 (28.9) 44.0 41.8 * 24.3 * * * 59.4 * * * 78.5 52.2 72.8 65.9 27.0 * * * * 25.1 (19.1) 515 407 355 384 254 207 577 551 357 381 439 360 766 505 1,688 719 636 472 435 442 769 1,087 458 1,992 1,016 430 726 94 292 309 804 310 4,403 736 588 681 210 576 598 624 1,556 168 319 217 225 365 93 319 1,142 78 278 114 185 186 375 282 359 196 334 93 412 398 147 48 56 116 99 683 18 51 25 249 124 2,774 298 477 74 604 146 108 330 565 79 78 80 135 501 18 183 337 257 28 37 95 27 198 52 313 127 524 29 148 161 23 57 4 0 18 144 6 0 0 92 120 952 257 90 14 10 11 24 189 30
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes missing cases
130
Appendix A
Table A.3.25 Breastfeeding status of children under 6 months

Percent distribution of youngest children under 6 months living with the mother by breastfeeding status and percentage of children under 6 months using a bottle with a nipple according to age in months, Demographic and Health Surveys, 1994-2001 PredominReceived BreastNot comple- Breastfed Exclusive milk and Predomin- antly or breastfed Number breastantly fully Fully Received mentary and used plain and used of Not 1 2 3 4 5 6 feeding water breastfed breastfed breastfed milk foods Country bottle breastfed bottle children Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 10.1 5.5 12.2 3.0 1.9 3.2 3.0 54.3 58.9 5.4 31.5 11.2 12.6 47.9 44.0 8.4 30.3 0.8 34.2 10.5 63.2 18.8 31.9 14.8 29.2 32.4 40.8 51.7 21.5 60.4 15.2 17.0 22.5 33.9 53.7 9.5 9.4 12.0 66.9 34.1 51.1 21.4 27.8 3.8 34.2 22.3 0.3 10.2 24.8 18.9 9.9 64.6 24.5 3.4 3.2 4.4 7.5 4.4 4.6 16.0 3.9 25.0 34.6 44.6 43.8 53.6 24.7 63.4 69.5 76.0 27.9 65.4 64.9 22.1 57.3 56.1 75.3 64.5 51.9 55.6 38.4 67.0 53.0 54.2 64.3 21.2 31.9 54.7 56.4 76.0 71.3 78.1 53.8 33.8 59.2 22.5 43.8 39.7 71.0 35.7 53.5 16.2 6.6 23.1 14.0 11.8 8.0 13.7 1.5 11.4 16.8 15.1 14.1 0.6 13.0 3.1 28.5 14.7 14.1 3.9 3.1 0.4 14.2 21.3 14.9 11.0 9.8 3.2 2.6 0.5 9.7 9.3 3.0 9.9 21.3 9.2 5.8 60.7 88.2 60.8 50.4 76.8 38.7 75.2 77.5 89.7 29.4 76.8 81.7 37.2 71.4 56.7 88.3 67.6 80.3 70.3 52.4 70.9 56.1 54.6 78.5 42.5 46.8 65.7 66.2 79.2 73.9 78.7 63.5 43.1 62.2 32.4 65.1 48.8 76.8
4 5
2.0 2.3 7.9 0.5 8.3 23.1 2.2 16.9 6.8 41.7 6.8 7.2 20.0 2.9 1.0 6.5 2.3 6.9 21.4 2.0 17.1 3.0 2.0 3.8 19.6 20.0 11.1 13.9 3.6 18.2 10.7 20.1 15.6 20.0 32.4 16.2 15.6 13.4
37.0 9.4 30.1 49.0 14.2 37.1 21.7 4.7 3.2 15.1 16.3 10.0 42.2 25.1 42.3 4.9 26.7 12.1 5.9 44.6 11.3 40.3 43.3 14.1 30.2 23.6 17.6 19.5 16.1 5.9 10.3 13.7 17.2 8.6 17.4 15.4 34.5 7.4
5.8 1.0 19.3 2.0 3.6 22.6 4.6 14.6 3.1 37.0 23.1 7.8 24.7 2.8 2.3 3.2 u 3.9 9.1 6.9 4.7 3.2 4.6 16.4 35.1 35.8 26.0 19.8 11.1 11.6 2.7 29.4 37.2 52.7 58.6 36.0 33.3 21.3
0.3 0.1 1.3 0.2 0.7 1.1 0.9 0.9 0.3 13.8 u 1.1 0.6 0.7 u 0.4 3.4 0.6 2.5 0.9 0.6 0.7 u 3.7 7.7 9.6 5.6 0.4 1.0 1.9 0.3 2.7 24.1 9.3 17.8 3.2 1.1 2.4
u u 4.0 u 1.1 1.0 4.3 4.7 1.5 34.8 u 0.0 0.9 1.3 0.3 1.3 u u u u 1.1 1.7 u 36.8 35.0 29.9 6.4 0.9 4.4 80.1 1.5 15.8 87.0 0.0 68.6 13.7 6.0 24.0
505 639 422 456 808 186 663 1,070 448 401 291 662 517 663 1,257 1,039 757 856 326 657 705 655 342 1,191 490 357 113 765 800 5,495 678 600 433 427 384 462 531 1,025
North Africa/West Asia/Europe Egypt 2000 64.0 Jordan 1997 11.0 Turkey 1998 7.1 Central Asia Kazakhstan 1999 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 35.8 46.5 11.4 46.8 74.8
Latin America and the Caribbean Bolivia 1998 50.6 Brazil 1996 29.4 Colombia 2000 51.7 Dominican Republic 1996 18.0 Guatemala 1998-99 39.2 Haiti 2001 23.7 Peru 2000 67.2
u = Unknown (not available) 1 Breast milk only 2 Exclusive breastfeeding or breast milk and plain water 3 Breast milk predominantly, with other non-milk liquids
Combines full and predominant breastfeeding Receive breast milk plus other milks or formula 6 Breast milk plus solid or semisolid foods
Appendix A
131
Table A.3.26 Breastfeeding status of children age 69 months

Percent distribution of youngest children age 69 months living with the mother by breastfeeding status and percentage of children age 6 to 9 months using a bottle with a nipple, according to age in months, Demographic and Health Surveys, 1994-2001 Predomin- PredominReceived BreastNot antly antly or compleExclusive milk and breastfed Number Breastfed breastbreastfully Fully Received mentary plain and used Not breast- and used of chil1 2 3 4 5 6 feeding fed breastfed milk foods Country water breastfed bottle fed bottle dren Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Rep. 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 0.0 1.7 1.2 0.0 0.4 0.0 0.6 12.8 15.6 0.3 4.8 7.5 0.9 2.8 2.6 3.1 2.2 0.2 2.2 0.3 6.8 0.7 0.5 2.7 20.5 11.3 5.1 16.9 1.6 25.7 14.7 17.9 3.3 12.0 36.4 1.2 3.1 3.1 46.4 9.3 9.2 5.8 5.3 2.1 2.8 4.0 0.4 3.3 5.0 2.1 11.2 19.4 23.5 7.1 0.7 2.1 1.2 1.6 2.2 7.4 1.1 2.7 22.2 12.5 5.1 17.3 1.6 26.4 27.5 33.5 3.6 16.8 43.9 2.1 5.9 5.6 49.5 11.5 9.4 8.0 5.6 8.9 3.5 4.5 16.8 3.5 5.0 4.4 18.8 21.2 36.2 28.5 10.4 10.8 32.7 3.3 12.9 10.7 10.5 10.0 26.6 7.5 0.8 6.4 0.8 5.6 8.1 13.0 0.7 10.4 21.4 1.4 4.3 0.6 9.1 1.3 15.5 11.3 4.0 6.5 1.0 2.6 4.6 3.0 3.7 3.1 7.2 0.7 4.1 0.6 3.7 4.1 0.7 1.7 11.7 2.5 3.4
4 5
12.8 48.8 20.0 5.9 23.7 2.5 32.0 35.6 46.5 4.3 27.2 65.3 3.5 10.3 6.2 58.5 12.8 24.9 19.3 9.6 15.4 4.5 7.1 21.3 6.5 8.7 7.5 25.9 21.9 40.3 29.1 14.1 14.9 33.5 5.1 24.6 13.2 13.9
1.8 1.3 5.0 0.3 3.9 5.7 1.3 21.0 7.9 13.5 7.3 5.3 3.3 0.5 0.2 8.1 0.8 3.4 14.0 1.2 8.7 0.8 0.0 4.4 2.6 2.8 3.1 11.9 0.1 21.8 7.5 6.0 5.2 2.8 7.3 3.4 7.2 3.1
84.8 49.8 73.0 93.4 71.2 86.9 66.2 42.4 44.9 63.9 64.5 27.9 89.6 88.4 93.4 33.0 84.5 71.5 63.8 88.6 74.6 93.6 90.6 64.4 63.7 54.5 72.7 59.4 71.9 33.6 62.5 70.3 31.0 33.3 38.5 61.2 74.1 75.6
3.1 0.6 17.8 0.0 2.1 18.9 0.8 13.5 4.4 25.8 22.6 7.9 23.0 3.0 2.3 2.4 0.0 3.8 10.0 4.2 5.4 3.6 13.1 14.5 15.5 30.3 37.0 20.4 13.4 15.2 5.2 32.8 29.0 48.6 43.9 34.5 25.1 27.8
0.7 0.2 2.0 0.3 1.1 4.9 0.6 1.0 0.6 18.3 1.0 1.5 3.6 0.8 0.1 0.4 1.9 0.2 2.8 0.6 1.2 1.2 2.4 9.8 27.2 34.0 16.7 2.8 6.2 4.3 0.8 9.7 48.9 30.4 49.1 10.8 5.5 7.4
0.0 0.0 1.8 0.0 1.2 2.0 2.0 4.9 1.3 28.4 0.0 0.9 7.6 3.4 0.7 0.2 0.0 0.0 0.1 1.2 1.3 2.8 2.9 57.1 103.8 76.1 12.3 8.9 24.7 116.9 1.5 43.3 120.7 0.0 124.9 31.4 21.4 47.8
325 366 263 289 506 122 425 724 290 259 232 328 378 412 799 659 458 536 205 468 488 392 209 800 439 245 88 352 527 3,484 437 469 290 334 255 292 458 681
North Africa/West Asia/Europe Egypt 2000 16.4 Jordan 1997 0.3 Turkey 1998 0.0 Central Asia Kazakhstan 1999 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 2.3 7.6 1.8 12.7 21.4
Latin America and the Caribbean Bolivia 1998 9.7 Brazil 1996 8.6 Colombia 2000 31.5 Dominican Rep. 1996 1.8 Guatemala 1998-99 10.6 Haiti 2001 3.2 Peru 2000 9.4
1 2
Breast milk only Exclusive breastfeeding or breast milk and plain water 3 Breast milk predominantly, with other non-milk liquids
Combines full and predominant breastfeeding Resceive breast milk plus other milks or formula 6 Breast milk plus solid or semisolid foods
132
Appendix A
Table A.3.27 Median duration and frequency of breastfeeding

Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, Demographic and Health Surveys, 1994-2001 Exclusive Predominant Number of Any breast1 2 breastfeeding breastdfeeding Country feeding children Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Rep 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Republic 1996 Guatemala 1998-99 Haiti 2001 Peru 2000
1 2
22.8 25.8 18.1 20.6 21.4 20.1 20.3 25.5 22.0 12.1 21.5 22.4 20.9 20.7 23.3 21.6 22.0 20.6 20.9 24.4 19.9 20.0 19.6 18.4 11.9 12.0 17.8 14.7 16.9 17.3 30.5 21.2 25.4 31.0 17.5 7.0 12.8 7.6 19.9 17.3 20.6
0.4 0.4 0.5 0.4 0.4 0.4 0.4 2.5 3.3 0.4 0.7 0.4 0.5 2.2 2.0 0.5 0.8 0.4 1.3 0.5 3.4 0.5 1.3 3.7 0.5 0.4 0.4 1.7 0.4 0.4 1.8 0.4 1.9 4.7 2.3 1.1 2.6 0.6 0.9 0.7 4.0
3.2 7.0 3.3 2.4 5.0 1.7 4.9 5.3 7.1 0.6 4.8 8.7 1.9 4.1 2.7 7.8 3.9 5.3 4.1 2.5 4.2 2.6 2.6 4.8 1.9 2.2 0.4 3.7 0.4 0.4 4.4 4.9 5.8 5.4 3.7 2.0 4.4 0.9 4.8 2.2 4.8
2,939 3,622 2,469 2,836 4,450 1,145 3,989 7,165 2,580 2,482 1,927 3,427 3,464 3,893 7,758 6,019 4,207 5,007 2,029 3,978 4,681 4,449 2,191 7,026 3,817 2,108 7,706 827 1,172 1,392 4,214 4,657 32,393 4,375 4,106 2,865 2,775 2,654 2,751 3,985 7,013
Breast milk only Breast milk predominantly, with other non-milk liquids
Appendix A
133
Table A.3.28 Undernutrition by ARI status

Prevalence of ARI (cough with rapid breathing) with no diarrhea in malnourished children age 423 months, Demographic and Health Surveys, 1994-2001
Percentage Percentage with ARI Total number of children of children age 4-23 Not Not months Not Not Under- underNot Not Under- underwith ARI Stunted stunted Wasted wasted weight weight Stunted stunted Wasted wasted weight weight 10.7 9.7 16.1 21.0 8.1 13.9 10.2 14.1 14.4 11.9 12.3 13.3 15.1 14.6 18.7 9.8 8.4 5.7 12.0 12.8 17.0 7.9 13.9 12.5 10.3 14.0 22.7 7.8 11.3 10.1 14.8 15.5 11.2 12.0 16.2 13.9 13.5 15.9 8.5 7.7 5.3 11.5 10.7 18.0 8.1 11.0 10.2 9.4 17.0 20.1 8.2 15.4 10.3 13.6 13.7 12.1 12.4 12.4 15.6 15.7 20.8 10.3 8.7 5.9 12.4 13.3 16.4 7.8 15.1 6.5 12.5 14.1 21.7 7.9 18.6 13.6 12.3 15.9 (12.3) 14.2 9.6 10.6 14.4 17.3 8.2 4.2 4.7 19.7 10.5 16.7 5.9 22.2 11.6 8.8 16.2 20.9 8.1 13.4 9.8 14.5 14.0 11.8 11.9 13.9 15.5 14.7 18.8 10.5 8.9 6.0 11.4 13.2 17.0 8.0 13.1 9.9 12.1 14.4 21.3 8.2 14.7 11.5 13.7 14.7 8.0 13.5 11.7 14.0 14.6 17.2 9.0 8.6 4.7 12.8 12.0 18.8 8.2 15.8 11.1 8.0 16.6 20.9 7.9 13.6 9.8 14.5 14.1 12.6 11.8 13.9 15.4 14.7 19.3 10.4 8.3 6.7 11.7 13.1 16.3 7.7 13.6 313 449 358 431 654 203 433 1,528 433 257 186 281 509 937 1,550 712 576 976 376 405 815 783 260 1,061 1,058 763 882 1,411 350 1,484 1,895 804 918 793 924 1,132 934 2,004 1,944 1,156 1,377 585 1,481 1,411 1,312 626 244 344 86 124 467 59 210 563 249 39 170 186 137 179 328 765 173 619 72 299 152 160 76 1,130 1,163 1,035 1,189 1,598 494 1,707 2,860 988 1,136 809 1,019 1,503 1,692 3,227 1,891 1,559 1,734 889 1,587 2,074 1,934 811 434 598 282 380 830 156 484 1,573 544 181 281 341 342 811 1,060 1,098 477 1,260 300 515 625 592 127 940 909 838 933 1,235 397 1,433 1,850 694 994 698 864 1,298 1,060 2,494 1,559 1,255 1,093 660 1,371 1,601 1,502 760
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Republic 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2000 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Republic 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 1998-99 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Dominican Republic 1996 Guatemala 1998-99 Haiti 2001 Peru 2000
All children 1,374 1,507 1,121 1,312 2,065 553 1,917 3,423 1,238 1,175 979 1,205 1,641 1,871 3,555 2,656 1,732 2,353 960 1,886 2,226 2,094 886
8.2 7.4 12.3 1.3 3.5 1.2 19.0 12.8 14.0 20.2 17.3 19.2 18.2 15.3 25.1 15.2
10.0 8.0 12.2 * 3.6 0.7 21.2 10.2 13.8 17.3 17.5 20.1 19.6 12.2 22.9 13.7
7.7 7.4 12.4 0.7 3.5 1.5 17.5 14.1 14.1 22.6 17.3 19.0 18.0 17.6 25.7 15.7
9.1 (16.4) 11.0 * 3.8 4.6 17.7 8.0 14.4 19.2 (23.2) (13.8) (20.1) 20.7 22.6 (15.2)
8.2 7.2 12.6 1.3 3.5 0.8 19.2 13.8 13.9 20.4 17.2 19.3 18.2 15.1 25.3 15.2
11.7 12.9 12.5 * 1.3 0.4 20.3 10.5 14.4 18.7 21.8 17.8 25.7 14.6 25.4 14.4
8.0 7.1 12.2 1.4 3.9 1.5 17.7 14.2 13.7 21.6 16.9 19.2 17.7 15.6 25.1 15.3
733 156 1,348 24 150 205 758 344 6,176 997 493 160 141 510 376 725
2,730 1,746 1,598 175 417 372 1,079 680 7,637 1,198 1,547 1,175 1,074 714 1,597 2,717
114 44 546 4 30 71 272 179 2,512 320 43 45 26 55 140 48
3,349 195 1,858 104 2,401 1,354 195 537 506 12 83 122
3,268 1,797 1,593 187 484 454 938 643 7,306 1,155 1,841 1,260 1,131 904 1,654 3,166
3,463 1,902 2,946 199 567 576 1,837 1,024 13,812 2,195 2,040 1,335 1,215 1,224 1,973 3,442
1,565 899 844 381 11,300 6,507 1,875 1,040 1,997 1,290 1,189 1,170 1,833 3,394 199 75 84 320 319 276
134
Appendix A
Table A.3.29 Undernutrition by diarrhea status

Prevalence of diarrhea in malnourished children age 4-23 months, Demographic and Health Survey 1994-2001
Percentage Percentage with diarrhea of children age 4-23 months with Not Not Underdiarrhea Stunted stunted Wasted wasted weight 30.6 29.4 24.9 27.8 28.4 27.7 25.2 36.7 28.2 27.8 25.7 30.1 22.8 32.8 32.5 28.9 26.4 44.1 23.4 35.8 32.5 39.2 25.6 27.0 31.5 31.2 27.0 26.1 27.6 26.1 38.3 28.6 32.6 31.7 33.9 26.3 35.8 34.3 36.3 26.3 45.7 24.4 44.2 34.9 38.2 26.9 31.7 28.6 21.9 28.2 29.5 27.7 25.0 35.4 27.9 26.4 24.3 28.9 21.3 29.9 31.1 26.2 26.5 43.0 22.8 33.5 31.1 39.7 25.1 34.9 35.1 37.6 33.9 34.2 28.8 32.5 48.0 28.2 (44.0) 27.1 43.0 26.7 35.4 35.9 37.4 44.6 52.9 18.4 39.2 33.6 42.9 21.9 29.7 27.8 23.8 27.2 26.7 27.5 24.4 34.5 28.1 27.2 25.4 27.7 22.5 32.6 32.1 25.5 24.4 41.0 23.8 35.1 32.4 38.8 26.0 31.7 33.9 33.1 33.5 30.4 28.8 28.1 43.0 32.0 35.4 32.0 40.1 31.1 36.8 37.6 36.1 33.2 48.6 27.2 42.6 37.1 43.6 33.8 Total number of children
Country Sub-Saharan Africa Benin 1996 Burkina Faso 1998-99 Cameroon 1998 Central African Rep 1994-95 Chad 1996-97 Comoros 1996 Cte dIvoire 1994 Ethiopia 2000 Eritrea 1995 Gabon 2000 Ghana 1998 Guinea 1999 Kenya 1998 Madagascar 1997 Malawi 2001 Mali 1995-96 Mozambique 1997 Niger 1998 Tanzania 1999 Togo 1998 Uganda 2000-01 Zambia 1996 Zimbabwe 1999 North Africa/West Asia/Europe Egypt 2000 Jordan 1997 Turkey 1998 Yemen 1997 Central Asia Kazakhstan 1999 Kyrgyz Rep 1997 Uzbekistan 1996 South/Southeast Asia Bangladesh 2000 Cambodia 2000 India 2001 Nepal 1996 Latin America/Caribbean Bolivia 1998 Brazil 1996 Colombia 2000 Dominican Rep 1996 Guatemala 1999 Haiti 2001 Peru 2000
Not underweight 30.1 26.5 22.1 25.4 27.1 27.2 24.3 31.4 25.1 26.4 23.2 26.1 20.6 29.8 30.3 23.9 23.9 38.9 21.7 33.2 30.7 37.4 24.3
Not All Not Not Under- underStunted stunted Wasted wasted weight weight Children 313 449 358 431 654 203 433 1,528 433 257 186 281 509 937 1,550 712 576 976 376 405 815 783 260 1,061 1,058 763 882 1,411 350 1,484 1,895 804 918 793 924 1,132 934 2,004 1,944 1,156 1,377 585 1,481 1,411 1,312 626 244 344 86 124 467 59 210 563 249 39 170 186 137 179 328 765 173 619 72 299 152 160 76 1,130 1,163 1,035 1,189 1,598 494 1,707 2,860 988 1,136 809 1,019 1,503 1,692 3,227 1,891 1,559 1,734 889 1,587 2,074 1,934 811 434 598 282 380 830 156 484 1,573 544 181 281 341 342 811 1,060 1,098 477 1,260 300 515 625 592 127 940 909 838 933 1,235 397 1,433 1,850 694 994 698 864 1,298 1,060 2,494 1,559 1,255 1,093 660 1,371 1,601 1,502 760 1,374 1,507 1,121 1,312 2,065 553 1,917 3,423 1,238 1,175 979 1,205 1,641 1,871 3,555 2,656 1,732 2,353 960 1,886 2,226 2,094 886
11.6 32.0 43.6 37.7 22.1 23.7 7.2 10.7 29.3 23.0 34.4 29.4 19.6 21.2 25.6 23.8 42.5 24.2
11.5 34.3 61.1 39.9 * 28.5 6.3 11.5 33.6 24.1 37.4 34.3 21.2 24.7 29.3 26.6 49.0 30.0
11.6 31.8 41.4 35.9 20.8 22.0 7.7 10.2 27.1 22.1 31.9 27.8 19.4 20.6 25.1 21.8 41.0 22.6
11.0 (27.6) (45.5) 44.4 * (16.2) 7.9 13.6 32.0 26.3 43.2 (26.3) (24.4) * (34.6) 29.1 48.5 (23.6)
11.6 32.1 43.6 36.2 21.2 24.1 7.1 10.2 28.7 22.2 32.9 29.5 19.4 21.1 25.4 23.6 42.0 24.2
14.0 35.8 56.5 41.7 * 28.5 6.0 11.9 34.6 25.6 38.6 38.3 26.3 35.9 32.3 26.5 47.3 32.3
11.5 31.8 42.4 34.4 19.9 22.9 7.5 9.6 26.2 20.7 30.6 28.4 19.2 20.1 25.1 22.8 41.6 23.5
733 156 108 1,348 24 150 205 758 344 6,176 997 493 160 209 141 510 376 725
2,730 1,746 835 1,598 175 417 372 1,079 680 7,637 1,198 1,547 1,175 1,233 1,074 714 1,597 2,717
114 44 29 546 4 30 71 272 179 2,512 320 43 45 15 26 55 140 48
3,349 1,858 914 2,401 195 537 506 1,565 844 11,300 1,875 1,997 1,290 1,427 1,189 1,170 1,833 3,394
195 104 82 1,354 12 83 122 899 381 6,507 1,040 199 75 100 84 320 319 276
3,268 1,797 861 1,593 187 484 454
3,463 1,902 943 2,946 199 567 576
938 1,837 643 1,024 7,306 13,812 1,155 2,195 1,841 1,260 1,342 1,131 904 1,654 3,166 2,040 1,335 1,442 1,215 1,224 1,973 3,442
Appendix A
135
DHS Comparative Reports Series

1. Westoff, Charles F. 2001. Unmet Need at the End of the Century. 2. Westoff, Charles F. and Akinrinola Bankole. 2002. Reproductive Preferences in Developing Countries at the Turn of the Century. 3. Rutstein, Shea O. 2002. Fertility Levels, Trends, and Differentials 1995-1999. 4. Mahy, Mary. 2003. Childhood Mortality in the Developing World: A Review of Evidence from the Demographic and Health Surveys. 5. Westoff, Charles F. 2003. Trends in Marriage and Early Childbearing in Developing Countries. 6. Rutstein, Shea O. and Kiersten Johnson. 2004. The DHS Wealth Index. 7. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting in the Demographic and Health Surveys: A Critical and Comparative Analysis. 8. Stallings, Rebecca. 2004. Child Morbidity and Treatment Patterns. 9. Rutstein, Shea O. and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in Developing Countries. 10. Mukuria, Altrena, Jeanne Cushing, and Jasbir Sangha. 2005. Nutritional Status of Children: Results from the Demographic and Health Surveys, 19942001. 11. Mukuria, Altrena, Casey Aboulafia, and Albert Themme. 2005. The Context of Womens Health: Results from the Demographic and Health Surveys, 1994-2001.

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MEASURE DHS assists countries worldwide in the collection and use of data to monitor and evaluate population, health,

DHS Comparative Reports No. 10

Altrena Mukuria Jeanne Cushing Jasbir Sangha

ORC Macro Calverton, Maryland, USA

Tables and Figures

Tables and Figures

Tables and Figures

Tables and Figures

Tables and Figures

Martin Vaessen Project Director

Data and Methods

Data and Methods

Data and Methods

Infant and Under-Five Mortality

Tables mentioned in Chapters 3 and 4 are located in Appendix A.

North Africa/West Asia/ Europe Central Asia

Contribution of Undernutrition to Mortality

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North Africa/ West Asia Europe

South/ Southeast Asia

Latin America/ Caribbean

South/ Southeast Asia Latin America/ Caribbean

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North Africa/ West Asia/ Europe Central Asia

South/ Southeast Asia

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Latin America/ Caribbean

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference populatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

reference po pulatio n weight-fo r-height

height-fo r-age weight-fo r-age

North Africa/ West Asia/ Europe

South/ Southeast Asia

Latin America/ Caribbean

North Africa/ West Asia/ Europe

South/ Southeast Asia

Latin America/ Caribbean

North Africa/ West Asia/ Europe

South/ Southeast Asia

Latin America/ Caribbean

North African/West Asia/Europe