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Update on Nutritional Status of
Women and Children
Monica T. Kothari March 9, 2015
Overview
• Introduction to the Demographic and
Health Surveys (DHS) Program
• DHS Nutrition Indicators
• Key findings from the Nutritional Status
comparative report
• Take home messages
A project funded by the United States Agency for International
Development and implemented by ICF International
The DHS Program:
Demographic and Health Surveys
Since 1984, DHS has provided technical assistance in 90+
countries for the implementation of more than 300 surveys
© 2007 Amio James Ascension,
Courtesy of Photoshare.
©2008 Erberto Zani,
Courtesy of Photoshare.
What is The DHS Program?
A project that provides, at the global
level, assistance to developing
countries in the areas of
Collection and use of data
to monitor and evaluate population,
health, and nutrition programs
Overview
• Introduction to the Demographic and
Health Surveys (DHS) Program
• DHS Nutrition Indicators
• Key findings from the Nutritional Status
comparative report
• Take home messages
Nutrition Related Information
• Nutritional status assessment
– Anthropometry (Height/Weight)
– Anemia (Hemoglobin)
– Other nutritional biomarkers
• Infant and young child (IYCF) feeding
practices
– Breastfeeding
– Complementary feeding
– Dietary diversity
• Micronutrient coverage
– Iron supplementation
– Vitamin A supplementation
– Iodine fortification
– Others (zinc supplementation, RUTFs)
© 2005 Peter Verbiscar-Brown, Courtesy of Photoshare.
History of Nutritional Biomarkers
7
Anthropometry (more than 6 million measurements since
1985)
Iodine testing in salt (1.4 million tests since 1994)
Anemia (1.6 million tests since 1996)
Plus MUAC, hip and waist circumference, urinary iodine,
Vitamin A, and iron tests/measurements in selected countries
• Height and weight first biomarkers to be collected in
DHS
• To date, DHS has collected height and weight data in 238
surveys in 77 countries among children and adults
Overview
• Introduction to the Demographic and
Health Surveys (DHS) Program
• DHS Nutrition Indicators
• Key findings from the Nutritional Status
comparative report
• Take home messages
About Comparative Report
• 2014 update on nutritional status by
sociodemographic and water, sanitation, and
hygiene (WASH) indicators
• Indicators include: – Nutritional status (stunting, wasting, underweight,
overweight, BMI),
– breastfeeding
– complementary feeding
– anemia
– dietary diversity
– micronutrient supplementation
– diarrhea
• Indicators divided into four sections (Appendix –
WASH data from JMP)
About Comparative Report contd …
Section 1: Nutritional status of children and
women (17 tables)
Section 2: Infant and young child feeding (IYCF)
and women’s dietary diversity (30 tables)
Section 3: Anemia, iron supplementation,
deworming, and use of iodized salt (13 tables)
Section 4: Diarrhea in children (14 tables)
Appendix: WASH data from JMP 2014 report
About Comparative Report contd …
37 countries, 2005-2013
USAID FtF, MCH, and WASH priority countries
Procedures of Height/Length Measurements
12
Children under
five years of age
Adult
(adolescents)
women and men
24
27
28
29
32
33
33
35
35
37
38
39
39
42
43
44
44
44
45
46
47
50
58
Congo Brazzaville 2022-12
Senegal 2010-11
Ghana 2008
Sao Tome and Principe 2008-09
Zimbabwe 2010-11
Cameroon 2011
Uganda 2011
Burkina Faso 2010
Kenya 2008-09
Nigeria 2013
Mali 2006
Lesotho 2009
Liberia 2007
Tanzania 2010
Mozambique 2011
Niger 2012
Rwanda 2010
Ethiopia 2011
Zambia 2007
Congo (DRC) 2007
Malawi 2010
Madagascar 2008-09
Burundi 2010
Stunting in
Children under
5: Africa
Stunting in Children under 5: Asia and LAC
27
23
22
19
26
40
41
41
45
48
58
Bolivia 2008
Honduras 2011-12
Haiti 2012
Armenia 2010
Tajikistan 2012
Cambodia 2010
Nepal 2011
Bangladesh 2011
Pakistan 2012-13
India 2005-06
Timor Leste 2009-10
Stunting by Background Characteristics
• Stunting is:
– Higher in rural areas (33/35 countries)
– Higher among male children (30/35 countries)
– Higher among children of thin mothers (13/14
countries)
– Lowest among children whose mothers have
attended secondary or higher education (35/35
countries)
– Lowest among children from wealthiest households
(13 countries > 25% in the wealthiest households)
Stunting by WASH indicators
• Stunting is:
– Highest in households with unimproved
sanitation facilities or no facilities
– Lowest among children whose households
• Have an improved source
of drinking water
• Have water on premises
• Have soap or detergent
for hand washing
Magnitude of difference in stunting – Sanitation Facility
0
5
10
15
20
25
30
Bu
rkin
a F
aso
201
0
D.R
. C
on
go
20
07
Eth
iopia
2011
Gh
ana
200
8
Ke
nya
20
09
Lib
eria
20
07
Ma
da
ga
sca
r 2
00
8-0
9
Ma
law
i 2
01
0
Ma
li 2
00
6
Mozam
biq
ue 2
011
Nig
er
20
12
Nig
eria
20
13
Rw
an
da
20
10
-11
Se
neg
al 20
10
-11
Ta
nza
nia
20
10
Za
mb
ia 2
00
7
Ba
ngla
de
sh
201
1
Ca
mb
od
ia 2
01
0
Ind
ia 2
00
6
Ne
pa
l 2
01
1
Pa
kis
tan 2
01
2-1
3
Ha
iti 2
011
Ho
nd
ura
s 2
01
1-1
2
Unimproved - Improved SF No access - Improved SF
Sub-Saharan Africa LAC
Women’s Nutritional Status: Africa
7
9
9
16
10
19
10
12
14
27
27
11
16
11
12
9
22
76
75
74
73
71
70
69
69
69
67
67
67
66
63
62
61
56
14
12
13
8
14
9
15
15
12
5
5
15
14
17
18
21
15
3
5
5
4
6
3
6
5
6
1
1
7
5
8
8
10
7
Rwanda 2010
Mozambique 2011
Malawi 2010
Burkina Faso 2010
Zambia 2007
Congo (DRC) 2007
Liberia 2007
Uganda 2011
Mali 2006
Ethiopia 2011
Madagascar 2008-09
Tanzania 2010
Niger 2012
Nigeria 2013
Kenya 2008-09
Ghana 2008
Senegal 2010-11
Thin Normal Overweight Obese
Women’s Nutritional Status: Asia and LAC
5
13
11
14
18
36
19
24
43
62
59
45
68
52
70
59
29
17
20
25
11
10
10
14
23
8
10
16
3
3
2
3
Honduras 2011-12
Haiti 2012
Tajikistan 2012
Pakistan 2012-13
Nepal 2011
India 2005-06
Cambodia 2010
Bangladesh 2011
Thin Normal Overweight Obese
Anemia Results: Hemoglobin Measurement
Photos courtesy of Monica Kothari.and Alfredo Fort Image from http://hometestingblog.testcountry.com/?p=728
Anemia Among Children and Women
38 44
49 50
59 63
69 71 73 76 78 82
88
46 51
55
70
29
65
17 17 23
35 40
29
54 53 46
54 59 61
49
35 42 44
55
15
49
Rw
an
da
20
11
Eth
iop
ia 2
01
1
Ug
an
da
20
11
Ma
da
ga
sca
r 2
00
8-0
9
Ta
nza
nia
20
10
Ma
law
i 2
01
0
Mo
za
mb
iqu
e 2
01
1
D.R
. C
ongo 2
007
Nig
er
20
11
Se
neg
al 20
10
-11
Gh
ana
200
8
Ma
li 2
00
6
Bu
rkin
a F
aso
201
0
Nepal 2011
Ba
ngla
de
sh
201
1
Ca
mb
od
ia 2
01
0
Ind
ia 2
00
5-0
6
Ho
nd
ura
s 2
01
1-1
2
Ha
iti 2
012
Children Women
Sub-Saharan Africa Asia LAC
Any anemia: Children (6-59 months) and pregnant women < 11.0 g/dl
Not pregnant women < 12.0 g/dl
Childhood Anemia by Background Characteristics
• Anemia in children…
– Is more common in rural areas (17/19 countries)
– Peaks at 9-23 months of age
– Decreases with household wealth but still very
common in even the wealthiest households: In
11/19 countries, more than HALF of children in the
wealthiest households are anemic
– Is lower among children living in households with
improved sanitation facilities
– Is lowest among children with an improved source
of drinking water (13/18 countries)
Women’s Anemia by Background Characteristics
• Anemia in women…
– Is higher in rural areas (15/19 countries)
– Is most common among thin women, least
common among obese women
– Is more common among pregnant women
– Decreases with household wealth
– Is less affected by WASH indicators
Infant and Young Child Feeding Results
>90% of children ever-breastfed in
every country considered
Early breastfeeding is not
universal: • Highest in Malawi (91 percent) and
lowest in Pakistan (17 percent)
Continued breastfeeding until 2
years of age ranges from 35
percent (Nigeria and Haiti) to 90
percent (Bangladesh)
© 2005 Peter Verbiscar-Brown, Courtesy of Photoshare.
Exclusive Breastfeeding by Age: Africa
10
13
13
19
13
17
24
19
27
23
30
32
35
40
49
41
76
17
23
25
29
32
36
38
39
43
50
51
52
61
62
63
71
85
Nigeria 2013
Niger 2012
Burkina Faso 2010
Liberia 2007
Kenya 2008-09
Congo (DR) 2007
Mali 2006
Senegal 2010-11
Mozambique 2011
Tanzania 2010
Madagascar 2008-09
Ethiopia 2011
Zambia 2007
Uganda 2011
Ghana 2008
Malawi 2010
Rwanda 2010
<6 months
4-5 months
Exclusive breastfeeding by age: Asia and LAC
19
24
21
24
27
28
36
53
60
31
40
34
38
42
46
64
70
74
Honduras 2011-12
Haiti 2012
Tajikistan 2012
Pakistan 2012-13
Indonesia 2012
India 2005-06
Bangladesh 2011
Nepal 2011
Cambodia 2010
<6 months
4-5 months
Dietary Diversity Among Young Children:
Children 6-23 months consuming 4 or more food groups
29 68
15 25
29 37
58
4 5 6
13 13
16 19
23 24
26 27 29
30 31 31
47
Haiti 2012Honduras 2011-12
India 2005-06Bangladesh 2011
Nepal 2011Cambodia 2010Indonesia 2012
Mali 2006Ethiopia 2011
Burkina Faso 2010Tanzania 2010
Uganda 2011D.R. Congo 2007
Nigeria 2013Liberia 2007
Madagascar 2008-09Rwanda 2011
Senegal 2010-11Malawi 2010
Mozambique 2011Kenya 2008-09
Zambia 2007Ghana 2008
Sub-Saharan Africa
LAC
Iron Supplementation and Deworming
Children:
• Weekly iron supplementation among children is rare
(ranging from 1% in Tanzania to 28% in Ghana)
• In 11 out of 21 countries, at least half of children had
received deworming medication in the 6 months
before the survey. Rwanda (86%) and Nepal (75%)
the highest.
Women:
• In only 4 of 21 countries did pregnant women receive
the recommended iron supplementation
• Nepal is the only country in which at least half of
women received deworming medication during
pregnancy
Overview
• Introduction to the Demographic and
Health Surveys (DHS) Program
• Nutrition Indicators
• Key findings from the Nutritional Status
comparative report
• Take Home messages
Take home messages
• Stunting remains at critical levels in most of the
countries. It is prevalent even in the wealthiest
households.
• Selected WASH indicators show association with
stunting in children.
• Dual burden of malnutrition is on the rise among
women.
• Anemia prevalence seem to be associated with
selected WASH indicators in children but not so
much in women.
• Breastfeeding and complementary feeding vary
considerably across and within regions.
Use of DHS nutrition data
Use of Nutrition Data
Advocacy for
Policy Makers
Programmatic Support
for Managers
In-depth Analyses
for Researchers
©2006 African Children, Courtesy of Photoshare.
• Effective actions to improve
nutritional status of children
• Management of dual burden
of malnutrition in adults
Questions?
Useful links
Nutrition Status of Women and Children 2014:
http://dhsprogram.com/pubs/pdf/NUT6/NUT6.pdf
DHS Program Website:
www.DHSprogram.com
Email: [email protected] OR [email protected]
Acknowledgments
USAID & – Noureddine Abderrahim/Amanda Coile/Yuan Cheng
– Fred Arnold
– Sally Zweimueller
– Erica Nybro
– Sunita Kishor
To all those who make a DHS survey happen
