FUTURE SCENARIOS

Goals have been put forward for reducing malnutrition, by half (in prevalence terms) between 1990 and 2000 at the World Summit for Children (1990) and the International Conference on Nutrition (1992). The World Food Summit is expected to propose reducing the numbers of malnourished people by half by 2010 or if possible 2015. Such goals of reducing the problem by half can be seen in the light of present trends, at its simplest by examining how prevalences would change if the highest and the lowest rates of change in recent years continued, for example to 2010. Results of such calculations are shown in Table 2.

In Near East and North Africa, South East Asia, China, Middle America and Caribbean, and (nearly) South America, re-establishing the 1985-90 trends would meet such goals by 2010 - the “optimistic scenario” in Table 2. On the other hand, in the regions with the most malnutrition - Sub-Saharan Africa and South Asia - much faster progress is needed than has been seen in the last ten years (or indeed since trend measurements began 20 years ago).

Progress in many of the countries showing rapid improvement has come from a number of factors that can be affected by policy. Economic growth that generates employment, reduces inequality, and brings down poverty is essential; investment in agricultural and rural development, health and education, can be shown to have an important impact on malnutrition, especially when supportive of women. In most countries with rapid progress, local programmes specifically designed to reduce malnutrition have been widely and vigorously carried out. Future progress to sharply lower malnutrition prevalence and numbers of undernourished will require such intensified and broad based efforts, in overall development and community-based action. There is ample experience of how nutrition improves - this needs to be applied with determination to meet future goals.

Table 2 - Scenarios for 2010: Projections of underweight prevalences by region

Region	1995	2010: “Optimistic”	2010: “Pessimistic”
Sub-Saharan Africa	27	25	34
Near East and North Africa	10	0	9
South Asia	49	33	45
Southeast Asia	32	16	27
China	15	0	7
Middle America and Caribbean	15	7	15
South America	8	6	7

Note: Scenarios projected on basis of applying best and worst rates of prevalence change observed 1985-90 and 1990-95 to the 1995 prevalence estimates.

¹ This report updates a preliminary document available at the ACC/SCN meeting in February 1996, the results of which were also included in UNICEF's Progress of Nations, 1996.

² The modeling methods used for these estimates, described in other publications, involve using correlations of nutritional survey data (174 national results were available for the present study) with other data available for each country and year, to interpolate estimates by country for the standard years (1985, 1990, 1993, 1995 here) when nutritional data were not available for that year, and to estimate the likely prevalence for those countries lacking data.

³ Panels can be compared directly between regions; note that for GNP only the scales differ between certain regions.

⁴ Estimates of poverty are compiled by ILO, and those quoted here stem from World Bank calculations. It is important to stress that the poverty figures are both derived from household surveys different to those providing the nutritional data, and moreover independent variables used for interpolating nutritional data are also not related. These two estimates are thus independent of each other, and their consistency provides useful corroboration of the plausibility of each.

⁵ All GNP estimates referred to here are World Bank Atlas methodology data, taken from STARS 1996, the World Bank data base.

⁶ Chen Chunming. Country Report of China. Paper presented at ADB-UNICEF meeting, Manila, May 1996.

⁷ The important relation between GNP and underweight prevalence on a cross-country basis is shown in the ACC/SCN Second Report on the World Nutrition Situation, Volume 1, page 9, (1992).

Country	Year, Prevalence				Trend	Rate (pp/yr) (rate for goals)
	Earlier		Later
Sub-Saharan Africa							(-1.5)
Cameroon	1978	17.3	1991	13.6	Falling	-0.28
Ethiopia	1983	37.3	1992	46.9	Rising	+1.07
Ghana	1988	27.1	1994	27.4	Static	+0.05
Kenya	1982	22.0	1987	17.5	Palling	-0.80
Kenya	1987	18.0	1993	22.3	Rising	+0.72
Kenya	1993	22.3	1994	22.5	Static	+0.20
Lesotho	1976	17.3	1981	13.3	Falling	-0.80
Lesotho	1981	13.3	1992	15.8	Rising	+0.23
Lesotho	1992	15.8	1993	21.4	Rising	+5.60
Madagascar	1984	33.0	1992	39.0	Rising	+0.75
Madagascar	1992	39.0	1994	32.1	Falling	-3.45
Malawi	1981	24.0	1992	27.0	Rising	+0.27
Rwanda	1976	27.8	1985	27.5	Static	-0.03
Rwanda	1985	27.5	1992	29.2	Static	+0.24
Senegal	1986	17.5	1992	20.1	Rising	+0.43
Tanzania	1987	33.0	1992	28.0	Falling	-1.00
Togo	1977	20.5	1988	24.4	Rising	+0.35
Zambia	1985	26.5	1991	26.8	Static	+0.05
Zambia1	1990	27.8	1992	29.0	Static	+0.60
Zimbabwe	1984	14.0	1988	10.0	Falling	-1.00
Zimbabwe	1988	10.0	1994	15.5	Rising	+0.92
Near East and N. Africa							(-0.6)
Algeria	1987	8.6	1990	9.2	Static	+0.20
Algeria	1990	9.2	1992	9.2	Static	0.00
Egypt	1978	16.6	1988	10.0	Falling	-0.66
Egypt	1990	10.4	1992	9.4	Static	-0.50
Jordan	1990	6.4	1991	9.7	Rising	+3.30
Morocco	1987	12.0	1992	9.0	Falling	-0.60
Tunisia	1975	20.2	1988	7.8	Falling	-0.95
Tunisia	1988	7.8	1994	8.7	Static	+0.15
South Asia							(-2.9)
Bangladesh2	1975	84.4	1981	70.1	Palling	-2.38
Bangladesh	1981	70.1	1989	66.5	Falling	-0.45
Bangladesh3	1990	71.0	1993	67.0	Falling	-1.33
India	1977	71.0	1988/90	63.0	Falling	-0.67
India4	1988/90	63.0	1991/92	66.0	Rising	+1.00
Pakistan	1977	54.7	1990	40.4	Falling	-1.10
Sri Lanka	1980	47.5	1987	36.6	Falling	-1.56
Sri Lanka	1987	36.6	1993	37.6	Static	+0.17
South East Asia							(-1.6)
Indonesia	1978	43.6	1987	41.4	Falling	-0.24
Indonesia	1987	41.4	1989	38.7	Falling	-1.35
Lao, PDR	1984	36.5	1994	40.0	Rising	+0.35
Malaysia2	1983	26.6	1990	25.0	Falling	-0.23
Malaysia2	1990	25	1993	23.3	Static	-0.57
Myanmar5	1982	42.1	1990/91	34.6	Falling	-0.83
Myanmar	1990/91	34.6	1994	31.2	Falling	-1.13
Philippines	1978	33.3	1982	33.2	Static	-0.03
Philippines	1982	33.2	1990	33.5	Static	+0.04
Philippines	1990	33.5	1993	29.6	Falling	-1.30
Thailand	1982	36.0	1987	22.2	Falling	-2.76
Thailand	1987	22.2	1990	13.0	Falling	-3.07
Vietnam	1987	51.5	1994	44.9	Falling	-0.94
China6	1987	21.7	1990	17.5	Falling	-1.40	(-1.1)
	1990	17.5	1995	15.8	Falling	-0.34
Middle America/Caribbean							(-0.8)
Costa Rica	1978	16.0	1982	6.0	Falling	-2.50
Costa Rica	1982	6.0	1992	2.3	Falling	-0.37
Dominican Republic	1986	12.5	1991	10.4	Falling	-0.42
El Salvador	1975	21.6	1988	15.5	Falling	-0.47
El Salvador	1988	15.5	1993	11.2	Falling	-0.86
Guatemala	1980	43.6	1987	28.5	Falling	-2.16
Haiti	1978	37.4	1990	26.8	Falling	-0.88
Honduras	1987	20.6	1992	18	Static	-0.26
Jamaica	1978	15.0	1985	14.9	Static	-0.01
Jamaica	1985	14.9	1989	7.2	Falling	-1.93
Jamaica	1989	7.2	1993	9.9	Rising	+0.66
Nicaragua	1982	10.5	1993	11.9	Static	+0.13
Panama	1980	16.0	1992	7.0	Falling	-0.75
Trinidad/Tobago	1976	16.3	1987	5.9	Falling	-0.95
South America							(-0.4)
Bolivia	1981	14.5	1989	11.4	Falling	-0.39
Bolivia	1989	11.4	1994	13.4	Rising	+0.40
Brazil	1975	18.4	1989	7.1	Falling	-0.81
Brazil (NE)	1989	12.7	1992	9.2	Falling	-1.17
Chile	1978	2.1	1986	2.5	Static	+0.01
Chile	1986	2.5	1994	0.9	Static	-0.18
Colombia	1980	16.7	1989	10.1	Falling	-0.73
Guyana	1981	22.1	1991	26.6	Rising	+0.45
Guyana	1991	26.6	1993	18.3	Falling	-4.15
Peru	1975	16.1	1984	13.4	Falling	-0.30
Peru	1984	13.4	1992	10.8	Falling	-0.33
Venezuela	1982	10.2	1987	5.9	Falling	-0.85

¹ Zambia 1990-1992, rural.

² Surveillance data.

³ Bangladesh data for 1981/1989 from surveys, 1990/1993 from surveillance, thus levels not comparable but trends should be reliable.

⁴ Data from: Karnataka, Maharashtra, Gujarat, Kerala, Tamil Nadu, Andhra Pradesh, and Orissa.

⁵ These data are for 0-36 months. The 190/1991 figure is an average for the two years.

⁶ 1987, nine provinces; 1990, seven provinces. Five provinces have data for both years; in these, the prevalences trend (weight of average by sample size) was -1.1 pp/yr.

Recent trends with later data in 1990's are bold italicized.

The purpose of this table is more to give prevalence trends than levels comparable across countries. Most prevalences given are of children 0-59 months, <-2 SDs by NCHS standards. In some of the recent cases, however, this indicator was not available and could not be estimated (e.g. 0-36 month age range, <80% w/a cut-off), in which case priority was given to deriving identically-defined prevalences comparable within country across time. This has minor effects on the estimated rates, in percentage-points per year (pp/yr), which are considered generally comparable across countries.

Trend is described as static if there is less than a two percentage point difference between the earlier and later prevalence. This cut off was chosen as it represents a significant difference given a sample size of 2000.