STATE OF NUTRITION OF ZAMBIAN CHILDREN

1. STATE OF NUTRITION OF ZAMBIAN CHILDREN Presenter: Dr. B. Nduna-Chansa

2. Introduction • Good nutrition is essential for healthy and active lives and has direct bearing on intellectual capacity • This impacts positively on social and economic development of a country. • Malnutrition is a serious public health problem in Zambia • Both acute and chronic Protein Energy Malnutrition exists in high proportions in both rural and urban areas

3. Causes of Malnutrition • There are three main levels of malnutrition causality: • Immediate causes such as low food intake and the high disease burden • Underlying causes of inadequate food security, insufficient maternal and child care and poor health, environmental and sanitary conditions • Socio-economic and cultural factors in society

4. Nutritional status assessment • The nutritional status of children is calculated using new growth standards published by WHO in 2006. • These were generated using data collected in the WHO Multicentre Growth Reference Study (WHO, 2006). • They use three anthropometric indices to assess nutritional status: height-for-age, weight-for-height, and weight-for-age • Each of these indices provides different information about growth and body composition

5. Height for Age index • An indicator of linear growth retardation and cumulative growth deficits. • Children whose height-for-age Z-score is <-2 SD are considered short for their age (stunted) and are chronically malnourished. • Children who are <-3 SD are considered severely stunted.

6. Height for Age continued • 45% of children under five (18% less than 6 months) are stunted and 21% are severely stunted. • Male children (48%) are more likely to be stunted than female children (42%). • 44% of children who are average or larger at birth are stunted compared with 63% of children who are very small at birth. • Stunting is slightly higher among children who are less than 24 months apart than among first born children or those with a larger birth interval.

7. Height for Age continued • More rural children are stunted (48%) than urban children (39%). • At the provincial level, stunting is highest in Luapula province (56%) and lowest in Western and Southern provinces (36% each). • Education and wealth are both inversely related to stunting levels. • Stunting decreases with increasing levels of mother’s education.

8. Weight for Height Index • Measures body mass in relation to body height or length and describes current nutritional status. • Children whose Z-scores are <-2 SD are considered thin (wasted) and are acutely malnourished. • Children whose weight-for-height is <-3 SD are considered severely wasted

9. Weight for Height continued • 5% of children under five are wasted. • Wasting varies greatly by age and peaks among children aged 9-11 months (12%). • Boys (6%) are slightly more likely to be wasted than girls (5%). • Children reported to be very small at birth are more likely to be wasted (9%) than those reported to be of average size or larger (5%).

10. Weight for Height Continued • Wasting among children born to thin mothers (BMI <18.5) is higher than for children born to normal mothers (BMI 18.5-24.9) and overweight/obese mothers (BMI ≥25). • There is slight difference in wasting between urban (4%) and rural children (6%). • Education is inversely related to wasting.

11. Weight for Height continued • Western, North-Western, Northern, Luapula, and Central provinces reported wasting levels that are above the national average (5%). • Children born to mothers in highest wealth quintile are less likely to be wasted (4%) than those in the lowest wealth quintile (6%). • It must be noted that 8% of children in Zambia are overweight, with the Z-scores >+2 SD.

12. Weight for age Index • A composite index of height-for-age and weight-for-height. • It takes into account both acute and chronic malnutrition. • Children whose weight-for-age is <-2 SD are classified as underweight. • Children whose weight-for-age is <-3 SD are considered severely underweight.

13. Weight for Age continued • The prevalence of underweight children nationally is 15%, and the prevalence of severely underweight children is 3%. • The percentage of children underweight doubles from 7% among children under age 6 months to 15% among children aged 9-11 months.

14. Weight for Age continued • As with the other two nutritional indicators, male children are more likely to be underweight (17%) than female children (13%), and smaller size at birth is associated with lower weight-for-age. • Children born to thin or underweight mothers (BMI <18.5) are more likely to be underweight than those born to normal mothers with a BMI 18.5-24.9 (23% versus 15%)

15. Weight for Age continued • The proportion of underweight children is higher in rural areas than in urban areas. • Children in Lusaka are less likely to be underweight (10%), than in the North-Western province (20%). • The proportion of underweight children decreases with increases in mother’s level of education. • Similarly under nutrition is higher among children in the lowest three wealth quintiles

16. Nutritional status of children by age

17. Trends in nutritional status of children under five years

18. WHO Malnutrition Severity Index for Zambia

19. References • ZDHS 2007 • NFNP