The Prevalence and Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries: A Systematic Scoping Review

Abstract

Objective: To explore the prevalence and determinants of undernutrition among infants and children aged 6 months to 5 years in sub-Saharan African countries.

Background: Despite substantial progress over the past 20 years, undernutrition has remained an alarming global challenge. Sub-Saharan Africa is the only region where the prevalence of stunting in children younger than 5 years has significantly increased. This study seeks to update the evidence on the prevalence and determinants of childhood undernutrition in this vulnerable region.

Methods: This systematic scoping review was conducted following the 2018 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched on December 14, 2022, with no date or language restrictions. Primary studies presenting evidence on the prevalence and determinants of childhood undernutrition among infants and children aged 6 months to 5 years were included. Data on the prevalence of stunting, wasting, and underweight, and on determinants of undernutrition were extracted, described, and compared with national survey data.

Results: A total of 59 publications from 11 countries were included, with most studies conducted in Ethiopia (n = 38) and Tanzania (n = 7). Stunting prevalence ranged from 8% to 64%, wasting prevalence ranged from 1% to 58%, and the prevalence of underweight ranged from 2% to 63%. The most frequently reported determinants of undernutrition were the child's age (>24 months), male sex, maternal illiteracy, diarrhea or illness in the past 2 weeks, low household socioeconomic status, or living in a larger household (n > 4 members). Overall, 56% of the included studies reported higher stunting prevalence, 60% reported higher wasting prevalence, and 57% reported a higher prevalence of underweight than reported by relevant national surveys.

Conclusion: The prevalence of childhood undernutrition reported by primary studies is often higher than that reported by national surveys. Several immediate and underlying determinants influence childhood undernutrition. Future research should incorporate the findings from primary research to develop holistic, multistrategy approaches to address childhood undernutrition in sub-Saharan African countries.

Keywords: stunting; sub-Saharan Africa; under-fives; underweight; wasting.

Figure 1.

PRISMA Flow Diagram

Figure 2.

The Prevalence of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries. Underweight is a composite index of height-for-age (stunting) and weight-for-height (wasting) measures. As such, World Health Organization–United Nation Children’s Fund (WHO and UNICEF) do not provide prevalence thresholds for underweight. Prevalence distribution of stunting, wasting and underweight across 11 Sub-Saharan African countries. Maps of prevalence of the following in sub-Saharan African countries: stunting (A), wasting (B), and underweight (C). Prevalence thresholds of stunting and wasting were based on the WHO–UNICEF prevalence thresholds, with “very high” indicating a critical need for interventions.

Figure 3.

Determinants of Undernutrition Among Infants and Children Aged 6 Months to 5 Years in Sub-Saharan African Countries. The determinants were classified according to the United Nation Children’s Fund conceptual framework of maternal and child nutrition. Child-related factors were classified as immediate determinants, and household- and maternal-related factors were classified as underlying determinants