The global hidden hunger indices and maps: an advocacy tool for action

Abstract

The unified global efforts to mitigate the high burden of vitamin and mineral deficiency, known as hidden hunger, in populations around the world are crucial to the achievement of most of the Millennium Development Goals (MDGs). We developed indices and maps of global hidden hunger to help prioritize program assistance, and to serve as an evidence-based global advocacy tool. Two types of hidden hunger indices and maps were created based on i) national prevalence data on stunting, anemia due to iron deficiency, and low serum retinol levels among preschool-aged children in 149 countries; and ii) estimates of Disability Adjusted Life Years (DALYs) attributed to micronutrient deficiencies in 136 countries. A number of countries in sub-Saharan Africa, as well as India and Afghanistan, had an alarmingly high level of hidden hunger, with stunting, iron deficiency anemia, and vitamin A deficiency all being highly prevalent. The total DALY rates per 100,000 population, attributed to micronutrient deficiencies, were generally the highest in sub-Saharan African countries. In 36 countries, home to 90% of the world's stunted children, deficiencies of micronutrients were responsible for 1.5-12% of the total DALYs. The pattern and magnitude of iodine deficiency did not conform to that of other micronutrients. The greatest proportions of children with iodine deficiency were in the Eastern Mediterranean (46.6%), European (44.2%), and African (40.4%) regions. The current indices and maps provide crucial data to optimize the prioritization of program assistance addressing global multiple micronutrient deficiencies. Moreover, the indices and maps serve as a useful advocacy tool in the call for increased commitments to scale up effective nutrition interventions.

Figure 1. Prevalence of stunting, iron deficiency anemia, and low serum retinol in the countries with the 20 highest and lowest hidden hunger index based on the prevalence estimates (HHI-PD).

The hidden hunger index (HHI-PD) was estimated based on national estimates of the prevalence of stunting, anemia due to iron deficiency, and low serum retinol concentration.

Figure 2. Global map presenting hidden hunger index based on the prevalence estimates (HHI-PD) in 149 countries and prevalence of low urinary iodine concentration in 90 countries with 2007 Human Development Index <0.9.

The hidden hunger index HHI-PD was estimated based on national estimates of the prevalence of stunting, anemia due to iron deficiency, and low serum retinol concentration.

Figure 3. The association between hidden hunger index based on the prevalence estimates (HHI-PD) and 2007 Human Development Index (HDI).

The alphabet characters symbolize the first initial of each country; the font sizes are proportional to the population size. Font color represents different regions, such that black represents Africa; red, East Asia; yellow, West Central Asia; green, Central and South America; turquoise, the Pacific Islands, and the Caribbean; purple, South Asia; and blue, Europe, North America, Australia, and New Zealand.

Figure 4. The association between hidden hunger index based on the prevalence estimates (HHI-PD) and the proportion of the population with inadequate dietary energy.

The alphabet characters symbolize the first initial of each country; the font sizes are proportional to the population size. Font color represents different regions, such that black represents Africa; red, East Asia; yellow, West Central Asia; green, Central and South America; turquoise, the Pacific Islands, and the Caribbean; purple, South Asia; and blue, Europe, North America, Australia, and New Zealand.

Figure 5. Global map presenting the population-adjusted hidden hunger associated Disability Adjusted Life Years (DALY) (HHI-DBa) in 136 countries.

The hidden hunger index HHI-DBa was estimated based on estimates of the DALYs per 100,000 population, attributable to iron, vitamin A, and zinc deficiencies.

Figure 6. The association between hidden hunger index based on the prevalence estimates (HHI-PD) and hidden hunger associated Disability Adjusted Life Years (DALY) (HHI-DBa) in 133 countries.

Prevalence-based HHI-PD estimates were not available for three of the 136 countries with HHI-DBa estimates (the Bahamas, Bahrain, and Somalia).

Figure 7. Total population-unadjusted Disability Adjusted Life Years (DALYs) attributed to micronutrient deficiencies in 136 countries.

This includes iron, vitamin A, and zinc micronutrient deficiencies.