Revisiting maternal and child undernutrition in low-income and middle-income countries: variable progress towards an unfinished agenda

Abstract

13 years after the first Lancet Series on maternal and child undernutrition, we reviewed the progress achieved on the basis of global estimates and new analyses of 50 low-income and middle-income countries with national surveys from around 2000 and 2015. The prevalence of childhood stunting has fallen, and linear growth faltering in early life has become less pronounced over time, markedly in middle-income countries but less so in low-income countries. Stunting and wasting remain public health problems in low-income countries, where 4·7% of children are simultaneously affected by both, a condition associated with a 4·8-times increase in mortality. New evidence shows that stunting and wasting might already be present at birth, and that the incidence of both conditions peaks in the first 6 months of life. Global low birthweight prevalence declined slowly at about 1·0% a year. Knowledge has accumulated on the short-term and long-term consequences of child undernutrition and on its adverse effect on adult human capital. Existing data on vitamin A deficiency among children suggest persisting high prevalence in Africa and south Asia. Zinc deficiency affects close to half of all children in the few countries with data. New evidence on the causes of poor growth points towards subclinical inflammation and environmental enteric dysfunction. Among women of reproductive age, the prevalence of low body-mass index has been reduced by half in middle-income countries, but trends in short stature prevalence are less evident. Both conditions are associated with poor outcomes for mothers and their children, whereas data on gestational weight gain are scarce. Data on the micronutrient status of women are conspicuously scarce, which constitutes an unacceptable data gap. Prevalence of anaemia in women remains high and unabated in many countries. Social inequalities are evident for many forms of undernutrition in women and children, suggesting a key role for poverty and low education, and reinforcing the need for multisectoral actions to accelerate progress. Despite little progress in some areas, maternal and child undernutrition remains a major global health concern, particularly as improvements since 2000 might be offset by the COVID-19 pandemic.

Figure 1. Prevalence of wasting and stunting in children younger than 5 years

Data are for 31 low-income countries and 19 middle-income countries, taken from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (appendix pp 1-5). We refer to data collected from 1996 to 2005 as 2000 data, and data collected from 2010 to 2018 as 2015 data.

Figure 2. Height-for-age and weight-for-height distributions of children younger than 5 years, from 2000 and 2015

The green curves show the WHO child growth standards. The black vertical lines correspond to the traditional cutoff Z scores of −2. Data are for 31 low-income countries and 19 middle-income countries, taken from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (appendix pp 1-5). We refer to data collected from 1996 to 2005 as 2000 data, and data collected from 2010 to 2018 as 2015 data.

Figure 3. Mean height-for-age and weight-for-height Z scores by age of children younger than 5 years, from 2000 and 2015

The dashed horizontal lines at 0 represent the WHO child growth standards. The black horizontal lines correspond to the traditional cutoff Z scores of −2. Data are for 31 low-income countries and 19 middle-income countries, taken from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (appendix pp 1-5). We refer to data collected from 1996 to 2005 as 2000 data, and data collected from 2010 to 2018 as 2015 data.

Figure 4. Mean height-for-age and weight-for-height Z scores by age of children younger than 5 years in the poorest and wealthiest quintiles in 2015

The dashed horizontal lines at 0 represents the WHO child growth standards. The black horizontal lines corre-spond to the traditional cutoff Z scores of −2. Data are for 31 low-income countries and 19 middle-income countries, taken from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (appendix pp 1-5). We refer to data collected from 1996 to 2005 as 2000 data, and data collected from 2010 to 2018 as 2015 data. Q1=quintile 1. Q5=quintile 5.

Figure 5. Map of low BMI (2) prevalence in women aged 15−49 years by subnational regions in African and Asian countries with available data from 2010 or later

Data are taken from Demographic and Health Surveys and Multiple Indicator Cluster Surveys (appendix pp 1-5). BMI=body-mass index.