à In 1995 stunting affected 53.5% of preschool children in South Asia, 39.4% in Sub-Saharan Africa, 38.3% in South East Asia, 27.8% in Middle America and the Caribbean, 22.2% in Near East/North Africa, and 12.9% in South America. About 34.1% of preschool children in China were stunted in 1992.
à These prevalences translate into very large numbers of stunted children: by far the worst affected region is South Asia, where 89.9 million children were stunted in 1995, followed by 42.6 million in Sub-Saharan Africa. About 30.2 million children were stunted in South East Asia in 1995. In comparison, numbers are much lower in the three remaining regions: 10.9 million in Near East/North Africa, 5.6 million in Middle America/Caribbean and 4.6 million in South America.
à The prevalence of stunting has declined globally from 48.8% in 1980 to 39.9% in 1995. However, numbers (excluding China) have increased over this period from about 175.8 to 183.9 million.
à The average rate of decline in the 61 countries for which trend data are available is about 0.54 percentage points per year. Rates of progress differed across regions. South East Asia experienced the most rapid rate of progress, at -0.90 percentage points per year, followed by South Asia at -0.84 percentage points per year, and South America at -0.81 percentage points per year. Rates of progress in reducing stunting were -0.64 percentage points per year in Near East/North Africa and -0.26 in Middle America/Caribbean.
à Sub-Saharan Africa as a whole saw no progress in reducing stunting during the period 1980 to 1995, in fact the trend was positive, at +0.13 percentage points per year. The numbers of children in Sub-Saharan Africa affected by stunting increased by an alarming 62% during this period.
à There are important differences amongst Sub-Saharan African countries. Of the 25 countries in this region with more than one survey, 13 countries made important progress at an average rate of - 0.44 percentage points per year. Stunting increased in the remaining 12 countries at an average rate of +0.84 percentage points per year.
à Except for the Near East/North Africa region, there is no evidence for a slowdown in the rate of progress over the two successive five-year periods examined, 1985-90 and 1990-95. There is no information on trends in Central Asia and the Caucasus. However, recent surveys show high rates of stunting in several countries of this region, as well as wide disparities within countries.
à The prevalence of low-birth-weight is very high in countries with prevalent stunting. Low-birth-weight is especially high in South Asia, which also has both the highest rates and numbers of stunted children.
à Rates of salt iodization in all regions have increased significantly, especially over the past five years. This has resulted in a dramatic reduction in the percentage of populations at risk of iodine deficiency disorders. This figure has declined from 28.9% to 13.7% globally during the period 1994 to 1997.
à Progress has been most dramatic in Central and South America, which have historically had very high prevalence rates of iodine deficiency disorders. In about 20 countries in this region more than 90% of salt is iodized and in an additional 14 countries the rate is between 75 and 90%. There are some countries in other regions, in particular in the former Soviet Union where special efforts need to be made to get programmes back on track.
à Progress has been impressive in Sub-Saharan Africa where all but four countries have implemented salt iodization programmes. While iodization rates tend to be lower in Sub-Saharan Africa, with only 11 of the 40 countries in this region reporting more than 75% of salt adequately iodized, progress continues to be made and momentum is high.
à Impacts on goitre prevalence have been documented for those countries with data on both iodization and goitre prevalence. Elimination of iodine deficiency disorders could, in due course, be recognised as the most spectacular public health success of this century. However, it bears repeating that the management systems put in place so far are fragile. Monitoring is all important and community-based monitoring of salt iodization will play an essential role.
à Prevalence rates of clinical vitamin A deficiency decreased in all regions during the period 1985 to 1995. Rates of progress were highest in South Asia, at about -0.84 percentage points per ten years, followed by Eastern and Southern Africa at about -0.74 percentage points per ten years. This translates into a reduction in numbers affected globally from about 5 million 1985 to 3.3 million in 1995. Although these trends are encouraging, progress will have to accelerate if elimination targets are to be met in all regions by the year 2000. Presumably global progress in reducing clinical vitamin A deficiency is reflected by progress in reducing subclinical deficiency, but it is not possible to substantiate this until sufficient data from repeat surveys are available.
à Iron deficiency anaemia affects about 43% of women and 34% of men in developing countries. Countries of South and South East Asia have the highest prevalence of anaemia, about 80% of pregnant women are affected. In all regions, the prevalence of anaemia is higher in pregnant women than in non-pregnant women. Preschool children in all regions are affected by anaemia; average prevalence rates range up to about 64% in South and South East Asia.
à The past few years have seen increased interest and policy attention on programmes to address iron deficiency anaemia, especially through preventive supplementation and fortification of staple cereals. Concerted and sustained efforts are needed to increase this momentum, and to keep iron on the policy agenda.
à The extent of folic acid deficiency in developing countries is generally unknown. Folic acid deficiency may be a contributing cause to much of the anaemia of pregnancy seen amongst African women. The prevalence of zinc deficiency is also unknown. Mild and moderate forms are likely to be widespread and until recently largely overlooked. Zinc deficiency may contribute significantly to growth stunting in young children. Zinc deficiency may be particularly widespread among African women. A high proportion of pregnant women in developing countries are also likely to be at risk because of chronically low zinc intakes.
REFUGEES AND DISPLACED PERSONS
à When continual access to populations of refugees and internally displaced persons is possible, levels of wasting are generally low. Two exceptions to this are for the Somali refugees in Kenya and Ethiopia where levels of wasting over 20% are seen.
à Cases of micronutrient malnutrition, specifically beri-beri, pellagra, scurvy and vitamin A deficiency, continue to be reported. Efforts to prevent this include the provision of a micronutrient-fortified blended food to populations wholly dependent on food aid. At the same time, questions on the reliability of methods used to diagnose micronutrient malnutrition are being raised.