Title: GCRF-Measuring and Mapping the Prevalence and Patterning of Multiple Malnutrition in Young Children in West and Central Africa
Funder: Economic and Social Research Council

Abstract: Between 1990 and 2014, sub-Saharan Africa saw a 23% increase in the number of children experiencing stunting, with around 58 million children under 5 affected. Many of these children also experienced wasting, and the co-occurrence of these anthropometric deficits ("multiple malnutrition", MM) entail heightened morbidity risks. At household and community level, MM can refer to the co-existence of under- and over-nutrition, a pattern observed across many low and middle income countries (LMICs), and which the 2015 and 2016 Global Nutrition Reports have noted to be "the new normal". This project focuses on MM in young children in one of the world's poorest regions, the countries of West and Central Africa (WCA). Utilising data from existing household surveys from the 24 countries of WCA, the project will conduct quantitative analyses on anthropometric and demographic data and variables to explore the prevalence and patterning of MM. It will bring together individual and household level data from the surveys (DHS, MICS), and combine this information with macro-level indicators, of national governance, of public expenditure on health and nutrition, and of food prices, to examine the underlying, intermediate and basic causes of MM, as set out in UNICEF's conceptual framework on (mal)nutrition. Malnutrition is associated with raised mortality risks, particularly in children; analysis of longitudinal survey data has shown that children experiencing multiple anthropometric deficits are 12.3 times more likely to die. Such children are likely to benefit most from nutrition and other child survival interventions (McDonald et al., 2013), as long as they can be indentified - which is not currently happening. Despite this, and the efforts and resources (national and international) which go to early child development programs in LMICs, a UNICEF/WHO/World Bank review of child malnutrition revealed that data on the prevalence and patterning of MM in young children are severely lacking, with no regional or global estimates of the number of children concurrently stunted and wasted. This knowledge gap is a real and ongoing problem for national governments and international agencies like UNICEF and the FAO. The analysis of existing household surveys, using advanced quantitative methods, will provide policy-relevant evidence on the determinants of MM for policy makers. We will also show how patterns of MM have changed over time, and identify key geographic and socio-demographic factors associated with MM. The project focuses on children under 5 years of age, since this is a crucial period of physical development, and also because anthropometric data (heights, weights) on this age group are most reliable and routinely collected in national surveys. The WCA region has some of the world's poorest countries, many with high rates of child malnutrition. These countries also face on-going challenges of food security not least with respect to unstable food production in the context of increasing desertification, political and economic instability, and violent conflict (e.g. in northern Nigeria, Niger and Mali). WCA has excellent coverage in terms of the number of countries with existing survey data, all of which contain detailed, comparable data with which to investigate drivers of disparities in MM. Importatnly, the evidence generated by this project will aid assessment of progress towards the first three Sustainable Development Goals (SDG) - of ending poverty, hunger and reducing child mortality.


Research activity codes: 2.4 SURVEILLANCE AND DISTRIBUTION
Health categories: CANCER AND NEOPLASMS;CARDIOVASCULAR;METABOLIC AND ENDOCRINE;ORAL AND GASTROINTESTINAL;STROKE