Nutrition Landscape Information System (NLiS)


Global Nutrition Monitoring Framework Country Profile: Afghanistan

Global Targets: To improve maternal, infant and young child nutrition

WHO Member States have endorsed the Global Nutrition Targets for improving maternal, infant and young child nutrition. The Global Nutrition Monitoring Framework helps countries monitor progress towards the Global Targets, measuring outcomes, processes and policies.
Below are the most recent data available for the indicators Afghanistan
  • anaemia circle logo 40% reduction in the number of children under-5 who are stunted
  • low birth weight circle logo 50% reduction of anaemia in women of reproductive age
  • low birth weight circle logo 30% reduction in low birth weight
  • overweight circle logo no increase in childhood overweight
  • breastfeeding circle logo increase the rate of exclusive breastfeeding in the first 6 months up to at least 50%
  • wasting circle logo reduce and maintain childhood wasting to less than 5%
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Primary outcome indicators for the Six Global Nutrition Targets

Indicator Year Value Source
Stunting (HAZ <-2 SD) in children 0-59 months (%) help
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Malnutrition in children

Underweight, stunting, wasting and overweight

 

What do these indicators tell us?

These indicators are used to measure nutritional imbalance resulting in undernutrition (assessed from underweight, wasting and stunting) and overweight. Child growth is internationally recognized as an important indicator of nutritional status and health in populations.

The percentage of children with a low height for age (stunting) reflects the cumulative effects of undernutrition and infections since and even before birth. This measure can therefore be interpreted as an indication of poor environmental conditions or long-term restriction of a child's growth potential. The percentage of children who have low weight for age (underweight) can reflect 'wasting' (i.e. low weight for height), indicating acute weight loss, 'stunting', or both. Thus, 'underweight' is a composite indicator and may therefore be difficult to interpret.

Stunting, wasting and overweight in children under five years of age are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Targets 1, 4 and 6. These three indicators are also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How are they defined?

·   Underweight: weight for age < -2 standard deviations (SD) of the WHO Child Growth Standards median

·   Stunting: height for age < -2 SD of the WHO Child Growth Standards median

·   Wasting: weight for height < -2 SD of the WHO Child Growth Standards median

·   Overweight: weight for height > +2 SD of the WHO Child Growth Standards median

 

What are the consequences and implications?

Underweight: As weight is easy to measure, this is the indicator for which most data have been collected in the past. Evidence has shown that the mortality risk of children who are even mildly underweight is increased, and severely underweight children are at even greater risk.

Stunting: Children who suffer from growth retardation as a result of poor diets or recurrent infections tend to be at greater risk for illness and death. Stunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual capacity. This in turn affects economic productivity at national level. Women of short stature are at greater risk for obstetric complications because of a smaller pelvis. Small women are at greater risk of delivering an infant with low birth weight, contributing to the intergenerational cycle of malnutrition, as infants of low birth weight or retarded intrauterine growth tend be smaller as adults.

Wasting: Wasting in children is a symptom of acute undernutrition, usually as a consequence of insufficient food intake or a high incidence of infectious diseases, especially diarrhoea. Wasting in turn impairs the functioning of the immune system and can lead to increased severity and duration of and susceptibility to infectious diseases and an increased risk for death.

Overweight: Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. The risks for most noncommunicable diseases resulting from obesity depend partly on the age at onset and the duration of obesity. Obese children and adolescents are likely to suffer from both short-term and long-term health consequences, the most significant being:

·   cardiovascular diseases, mainly heart disease and stroke;

·   diabetes;

·   musculoskeletal disorders, especially osteoarthritis; and

·   cancers of the endometrium, breast and colon.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

 

Underweight

< 10%:   Low prevalence

10-19%: Medium prevalence

20-29%: High prevalence

 30%:   Very high prevalence

 

Stunting

< 20%:   Low prevalence

20-29%: Medium prevalence

30-39%: High prevalence

 40%:   Very high prevalence

 

Wasting

< 5%:     Acceptable

5-9%:     Poor

10-14%: Serious

 15%:   Critical

 

Reference: WHO, 1995.

 

Applying similar methodology used to calculate the cut-off values for public health significance for underweight, stunting and wasting, levels of public health significance for overweight (> +2 SD weight-for-height) for children under 5 years of age based on the WHO child growth standards have also been calculated using the data from the WHO Global Database on Child Growth and Malnutrition. However, they are not yet included here as they are currently being evaluated.

 

Source of data

WHO. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD), Geneva, Switzerlandhttp://www.who.int/nutgrowthdb/en/.

 

Further reading

WHO. Child Growth Standards, publications and peer-reviewed articles. http://www.who.int/childgrowth/publications/en/.

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Series No. 854. Geneva, World Health Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.

UNICEF-WHO-The World Bank. Joint child malnutrition estimates - Levels and trends. http://www.who.int/nutgrowthdb/estimates/en/

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO. Global Nutrition Targets 2025: Stunting policy brief. Geneva, World Health Organization, 2014. http://who.int/nutrition/publications/globaltargets2025_policybrief_stunting/en/

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en

Target 1: 40% reduction in the number of children under-5 who are stunted. http://www.who.int/elena/global-targets/en/#stunting

Target 4: No increase in childhood overweight. http://www.who.int/elena/global-targets/en/#childhoodoverweight  

Target 6: Reduce and maintain childhood wasting to less than 5%. http://www.who.int/elena/global-targets/en/#wasting  

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2004 59.3 View
Anaemia in pregnant women (Hb <110 g/L) (%) help
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Anaemia

What does this indicator tell us?

Anaemia has a wide variety of causes. Although iron deficiency is considered to be the most common  cause of anaemia, other causes include acute and chronic infections that result in inflammation and blod loss; deficiencies of other vitamins and minerals, especially folate, vitamin B12 and vitamin A; and genetically inherited traits, such as thalassaemia. Other conditions (malaria and other infections, genetic disorders, cancer) also play a role. The terms ‘iron-deficiency anaemia’ and ‘anaemia’ are often used synonymously, and the prevalence of anaemia has often been used as a proxy for iron-deficiency anaemia, although the degree of overlap between the two varies considerably from one population to another according to gender and age.

Anaemia prevalence among pregnant and non-pregnant women are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Target 2,  a 50% reduction in anaemia among women of reproductive age by 2025. Anaemia in women of reproductive age and in children are also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How is it defined?

Anaemia is defined as a haemoglobin concentration below a specified cut-off point, which can change according to the age, gender, physiological status, smoking habits and altitude at which the population being assessed lives. WHO defines anaemia in children under 5 years of age and pregnant women as a haemoglobin concentration <110 g/L at sea level and anaemia in non-pregnant women as a haemoglobin concentration <120 g/L.

Tests to measure haemoglobin levels are easy to administer. A few drops of blood obtained by a finger-stick  can be used to assess haemoglobin concentrations in the field using a portable haemoglobinometer.  The test could be easily integrated into regular health or prenatal visits or household surveys to capture women of reproductive age, though one needs to consider the cost of the equipment and regular calibration.

 

What are the consequences and implications?

Anaemia is associated with increased risks for maternal and child mortality. Iron-deficiency anaemia reduces the work capacity of individuals and entire populations, with serious consequences for the economy and national development. In addition, the negative consequences of iron-deficiency anaemia on the cognitive and physical development of children and on physical performance - particularly the work productivity of adults - are major concerns. Anaemia is a global problem affecting all countries. Resource-poor areas are often more heavily impacted due to the prevalence of infectious diseases. Malaria, HIV/AIDS, hookworm infestation, schistosomiasis and other infections such as tuberculosis contribute to the high prevalence of anaemia in some areas.

The main risk factors for iron-deficiency anaemia include a low dietary intake of iron or poor absorption of iron from diets rich in phytates or phenolic compounds. Population groups with greater iron requirements, such as growing children and pregnant women, are particularly at risk. Overall, the most vulnerable, poorest and least educated groups are disproportionately affected by iron-deficiency anaemia.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

Anaemia

< 5%:

5-19%:

20-39%:

≥ 40%:

No public health problem

Mild public health problem

Moderate public health problem

Severe public health problem

 

Reference: WHO, 2008.

 

Source of data

Stevens GA et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Global Health; 2013; 1:e16-25.

Data about haemoglobin and anaemia for women of childbearing age (15–49 years) were estimated for each country and for each year between 1995 and 2016 using survey data obtained from 257 population-representative data sources from 107 countries worldwide. A Bayesian hierarchical mixture model was used to estimate haemoglobin distributions and systematically addressed missing data, non-linear time trends, and representativeness of data sources. More information on the methodology can be found in: Stevens GA et al. 2013.

 

Further reading

WHO. Global Nutrition Targets 2025: Anaemia policy brief. Geneva, World Health Organization, 2014. http://who.int/nutrition/publications/globaltargets2025_policybrief_anaemia/en/

WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1).  http://www.who.int/vmnis/indicators/haemoglobin.pdf.  

WHO. Vitamin and Mineral Nutrition Information System (VMNIS). Department of Nutrition for Health and Development (NHD), Geneva, Switzerland. http://www.who.int/vmnis/en/.

WHO. Anaemia/iron deficiency list of publications. http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/en/index.html.

WHO. Global Health Observatory. Indicator Metadata Registry. Prevalence of anaemia among women aged 15-49 years (%). http://apps.who.int/gho/data/node.wrapper.imr?x-id=4552

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). http://www.who.int/elena/health_condition/en/#anaemia  

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en  

Target 2: 50% reduction of anaemia in women of reproductive age. http://www.who.int/elena/global-targets/en/#anaemia  

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2016 38.2 View
Anaemia in non-pregnant women (Hb <120 g/L) (%) help
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Anaemia

What does this indicator tell us?

Anaemia has a wide variety of causes. Although iron deficiency is considered to be the most common  cause of anaemia, other causes include acute and chronic infections that result in inflammation and blod loss; deficiencies of other vitamins and minerals, especially folate, vitamin B12 and vitamin A; and genetically inherited traits, such as thalassaemia. Other conditions (malaria and other infections, genetic disorders, cancer) also play a role. The terms ‘iron-deficiency anaemia’ and ‘anaemia’ are often used synonymously, and the prevalence of anaemia has often been used as a proxy for iron-deficiency anaemia, although the degree of overlap between the two varies considerably from one population to another according to gender and age.

Anaemia prevalence among pregnant and non-pregnant women are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Target 2,  a 50% reduction in anaemia among women of reproductive age by 2025. Anaemia in women of reproductive age and in children are also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How is it defined?

Anaemia is defined as a haemoglobin concentration below a specified cut-off point, which can change according to the age, gender, physiological status, smoking habits and altitude at which the population being assessed lives. WHO defines anaemia in children under 5 years of age and pregnant women as a haemoglobin concentration <110 g/L at sea level and anaemia in non-pregnant women as a haemoglobin concentration <120 g/L.

Tests to measure haemoglobin levels are easy to administer. A few drops of blood obtained by a finger-stick  can be used to assess haemoglobin concentrations in the field using a portable haemoglobinometer.  The test could be easily integrated into regular health or prenatal visits or household surveys to capture women of reproductive age, though one needs to consider the cost of the equipment and regular calibration.

 

What are the consequences and implications?

Anaemia is associated with increased risks for maternal and child mortality. Iron-deficiency anaemia reduces the work capacity of individuals and entire populations, with serious consequences for the economy and national development. In addition, the negative consequences of iron-deficiency anaemia on the cognitive and physical development of children and on physical performance - particularly the work productivity of adults - are major concerns. Anaemia is a global problem affecting all countries. Resource-poor areas are often more heavily impacted due to the prevalence of infectious diseases. Malaria, HIV/AIDS, hookworm infestation, schistosomiasis and other infections such as tuberculosis contribute to the high prevalence of anaemia in some areas.

The main risk factors for iron-deficiency anaemia include a low dietary intake of iron or poor absorption of iron from diets rich in phytates or phenolic compounds. Population groups with greater iron requirements, such as growing children and pregnant women, are particularly at risk. Overall, the most vulnerable, poorest and least educated groups are disproportionately affected by iron-deficiency anaemia.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

Anaemia

< 5%:

5-19%:

20-39%:

≥ 40%:

No public health problem

Mild public health problem

Moderate public health problem

Severe public health problem

 

Reference: WHO, 2008.

 

Source of data

Stevens GA et al. Global, regional, and national trends in haemoglobin concentration and prevalence of total and severe anaemia in children and pregnant and non-pregnant women for 1995-2011: a systematic analysis of population-representative data. Lancet Global Health; 2013; 1:e16-25.

Data about haemoglobin and anaemia for women of childbearing age (15–49 years) were estimated for each country and for each year between 1995 and 2016 using survey data obtained from 257 population-representative data sources from 107 countries worldwide. A Bayesian hierarchical mixture model was used to estimate haemoglobin distributions and systematically addressed missing data, non-linear time trends, and representativeness of data sources. More information on the methodology can be found in: Stevens GA et al. 2013.

 

Further reading

WHO. Global Nutrition Targets 2025: Anaemia policy brief. Geneva, World Health Organization, 2014. http://who.int/nutrition/publications/globaltargets2025_policybrief_anaemia/en/

WHO. Haemoglobin concentrations for the diagnosis of anaemia and assessment of severity. Vitamin and Mineral Nutrition Information System. Geneva, World Health Organization, 2011 (WHO/NMH/NHD/MNM/11.1).  http://www.who.int/vmnis/indicators/haemoglobin.pdf.  

WHO. Vitamin and Mineral Nutrition Information System (VMNIS). Department of Nutrition for Health and Development (NHD), Geneva, Switzerland. http://www.who.int/vmnis/en/.

WHO. Anaemia/iron deficiency list of publications. http://www.who.int/nutrition/publications/micronutrients/anaemia_iron_deficiency/en/index.html.

WHO. Global Health Observatory. Indicator Metadata Registry. Prevalence of anaemia among women aged 15-49 years (%). http://apps.who.int/gho/data/node.wrapper.imr?x-id=4552

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). http://www.who.int/elena/health_condition/en/#anaemia  

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en  

Target 2: 50% reduction of anaemia in women of reproductive age. http://www.who.int/elena/global-targets/en/#anaemia  

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2016 42.4 View
Low birth weight (<2500 g) (%) help
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Low birth weight

What does this indicator tell us?

At population level, the proportion of infants with a low birth weight is an indicator of a multifaceted public health problem that includes long-term maternal malnutrition, ill health and poor health care in pregnancy. Low birth weight is more common in developing than developed countries.

Low birth weight is included as a primary outcome indicator in the core set of indicators for the Global Nutrition Monitoring Framework.  It is also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How is it defined?

Low birth weight has been defined by WHO as weight at birth of < 2500 grams (5.5 pounds).

 

What are the consequences and implications?

Low birth weight is caused by intrauterine growth restriction, prematurity or both. It contributes to a range of poor health outcomes: it is closely associated with fetal and neonatal mortality and morbidity, inhibited growth and cognitive development and noncommunicable diseases later in life. Low-birth-weight infants are approximately 20 times more likely to die than heavier infants.

Low birth weight is more common in developing than developed countries. However, data on low birth weight in developing countries is often limited because a significant portion of deliveries are done in homes or small health facilities where cases of infants with low birth weight often go unreported. These cases are not reflected in official figures and may lead to a significant underestimation of low birth weight prevalence. 

 

Source of data

UNICEF. Childinfo Database. http://data.unicef.org/topic/nutrition/low-birthweight

 

Further reading

WHO. Feto-maternal nutrition and low birth weight. http://www.who.int/nutrition/topics/feto_maternal/en/index.html.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/  

WHO. Global Nutrition Targets 2025: Low birth weight policy brief.  Geneva, World Health Organization, 2014. http://who.int/nutrition/publications/globaltargets2025_policybrief_lbw/en/  

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en

Target 3: 30% reduction in low birth weight. http://www.who.int/elena/global-targets/en/#lowbirthweight

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Overweight (WHZ >+2 SD) in children 0-59 months (%) help
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Malnutrition in Children

Underweight, stunting, wasting and overweight

 

What do these indicators tell us?

These indicators are used to measure nutritional imbalance resulting in undernutrition (assessed from underweight, wasting and stunting) and overweight. Child growth is internationally recognized as an important indicator of nutritional status and health in populations.

The percentage of children with a low height for age (stunting) reflects the cumulative effects of undernutrition and infections since and even before birth. This measure can therefore be interpreted as an indication of poor environmental conditions or long-term restriction of a child's growth potential. The percentage of children who have low weight for age (underweight) can reflect 'wasting' (i.e. low weight for height), indicating acute weight loss, 'stunting', or both. Thus, 'underweight' is a composite indicator and may therefore be difficult to interpret.

Stunting, wasting and overweight in children under five years of age are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Targets 1, 4 and 6. These three indicators are also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How are they defined?

·   Underweight: weight for age < -2 standard deviations (SD) of the WHO Child Growth Standards median

·   Stunting: height for age < -2 SD of the WHO Child Growth Standards median

·   Wasting: weight for height < -2 SD of the WHO Child Growth Standards median

·   Overweight: weight for height > +2 SD of the WHO Child Growth Standards median

 

What are the consequences and implications?

Underweight: As weight is easy to measure, this is the indicator for which most data have been collected in the past. Evidence has shown that the mortality risk of children who are even mildly underweight is increased, and severely underweight children are at even greater risk.

Stunting: Children who suffer from growth retardation as a result of poor diets or recurrent infections tend to be at greater risk for illness and death. Stunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual capacity. This in turn affects economic productivity at national level. Women of short stature are at greater risk for obstetric complications because of a smaller pelvis. Small women are at greater risk of delivering an infant with low birth weight, contributing to the intergenerational cycle of malnutrition, as infants of low birth weight or retarded intrauterine growth tend be smaller as adults.

Wasting: Wasting in children is a symptom of acute undernutrition, usually as a consequence of insufficient food intake or a high incidence of infectious diseases, especially diarrhoea. Wasting in turn impairs the functioning of the immune system and can lead to increased severity and duration of and susceptibility to infectious diseases and an increased risk for death.

Overweight: Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. The risks for most noncommunicable diseases resulting from obesity depend partly on the age at onset and the duration of obesity. Obese children and adolescents are likely to suffer from both short-term and long-term health consequences, the most significant being:

·   cardiovascular diseases, mainly heart disease and stroke;

·   diabetes;

·   musculoskeletal disorders, especially osteoarthritis; and

·   cancers of the endometrium, breast and colon.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

 

Underweight

< 10%:   Low prevalence

10-19%: Medium prevalence

20-29%: High prevalence

 30%:   Very high prevalence

 

Stunting

< 20%:   Low prevalence

20-29%: Medium prevalence

30-39%: High prevalence

 40%:   Very high prevalence

 

Wasting

< 5%:     Acceptable

5-9%:     Poor

10-14%: Serious

 15%:   Critical

 

Reference: WHO, 1995.

 

Applying similar methodology used to calculate the cut-off values for public health significance for underweight, stunting and wasting, levels of public health significance for overweight (> +2 SD weight-for-height) for children under 5 years of age based on the WHO child growth standards have also been calculated using the data from the WHO Global Database on Child Growth and Malnutrition. However, they are not yet included here as they are currently being evaluated.

 

Source of data

WHO. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD), Geneva, Switzerlandhttp://www.who.int/nutgrowthdb/en/.

 

Further reading

WHO. Child Growth Standards, publications and peer-reviewed articles. http://www.who.int/childgrowth/publications/en/.

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Series No. 854. Geneva, World Health Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.

UNICEF-WHO-The World Bank. Joint child malnutrition estimates - Levels and trends. http://www.who.int/nutgrowthdb/estimates/en/

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO. Global Nutrition Targets 2025: Stunting policy brief. Geneva, World Health Organization, 2014. http://who.int/nutrition/publications/globaltargets2025_policybrief_stunting/en/

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en

Target 1: 40% reduction in the number of children under-5 who are stunted. http://www.who.int/elena/global-targets/en/#stunting

Target 4: No increase in childhood overweight. http://www.who.int/elena/global-targets/en/#childhoodoverweight  

Target 6: Reduce and maintain childhood wasting to less than 5%. http://www.who.int/elena/global-targets/en/#wasting  

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2004 4.6 View
Exclusive breastfeeding under 6 months (%) help
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Children exclusively breastfed under 6 months

Infant and young child feeding

The recommendations for feeding infants and young children (6-23 months) include:

·   continuing breastfeeding;

·   introduction of solid, semisolid or soft foods at 6 months;

·   appropriate food diversity (at least four food groups per day);

·   appropriate frequency of meals: two to three times a day between 6 and 8 months, increasing to three to four times a day between 9 and 23 months with nutritious snacks offered once or twice a day, as desired;

·   safe preparation of foods; and

·   feeding infants in response to their cues.

The caring practice indicators for infant and young child feeding available on the NLIS country profiles include:

  • proportion of children aged 0-23 months who were put to the breast within 1 hour of birth
  • proportion of infants under 6 months who are exclusively breastfed
  • proportion of infants aged 6-8 months who receive solid, semisolid or soft foods; and
  • proportion of children aged 6-23 months who receive a minimum acceptable diet.

Early initiation of breastfeeding

What does this indicator tell us?

This indicator is the percentage of infants who are put to the breast within 1 hour of birth.

How is it defined?

Early initiation of breastfeeding is defined as the proportion of children born in the past 24 months who were put to the breast within 1 hour of birth.

What are the consequences and implications?

Breastfeeding contributes to saving children's lives, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality.

Infants under 6 months who are exclusively breastfed

What does this indicator tell us?

This indicator is the percentage of infants aged 0-5 months who are exclusively breastfed.

How is it defined?

It is the proportion of infants aged 0-5 months who are fed exclusively on breast milk.

What are the consequences and implications?

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important implications for the health of mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants. Thereafter, infants should receive complementary foods with continued breastfeeding up to 2 years of age or beyond.

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and UNICEF recommend:

·   initiation of breastfeeding within the first hour of life;

·   exclusive breastfeeding, i.e. only breast milk with no additional food or drink, not even water;

·   breastfeeding on demand, as often the child wants, day and night; and

·   no use of bottles, teats or pacifiers.

Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life. It continues to provide up to one half or more of a child's nutritional needs during the second half of the first year and up to one third during the second year of life.

Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness.

Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources. It is a secure way of feeding and is safe for the environment.

Infants aged 6-8 months who receive solid, semisolid or soft foods

What does this indicator tell us?

The indicator is the percentage of infants who start solid, semisolid or soft foods at between 6 and 8 months of age. WHO recommends starting complementary feeding at 6 months of age.

How is it defined?

It is defined as the proportion of infants aged 6-8 months who receive solid, semisolid or soft foods.

What are the consequences and implications?

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. The transition from exclusive breastfeeding to family foods, referred to as 'complementary feeding', typically occurs between 6 and 18-24 months of age. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.

Children aged 6-23 months who receive a minimum acceptable diet

What does this indicator tell us?

This indicator is the percentage of children aged 6-23 months who receive a minimum acceptable diet

How is it defined?

The composite indicator of a minimum acceptable diet is calculated from:

·         the proportion of breastfed children aged 6-23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day and

  • the proportion of non-breastfed children aged 6-23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day.

Dietary diversity is present when the diet contained four or more of the following food groups:

·         grains, roots and tubers;

·         legumes and nuts;

·         dairy products (milk, yogurt, cheese);

·         flesh foods (meat, fish, poultry, liver or other organs);

·         eggs;

·         vitamin A-rich fruits and vegetables; and

·         other fruits and vegetables.

The minimum daily meal frequency is defined as:

·         twice for breastfed infants aged 6-8 months,

·         three times for breastfed children aged 9-23 months and

·         four times for non-breastfed children aged 6-23 months.

What are the consequences and implications?

A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6-23 months. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality.

Source of all infant and young child feeding indicators

WHO. Global Data Bank on Infant and Young Child Feeding. http://www.who.int/nutrition/databases/infantfeeding/en/index.html.

Further reading

WHO. Infant and young child feeding list of publications. http://www.who.int/nutrition/publications/infantfeeding/en/index.html.

WHO. The optimal duration of exclusive breastfeeding: a systematic review. Geneva, World Health Organization, 2001.

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2015 43.3 View
Wasting (WHZ <-2 SD) in children 0-59 months (%) help
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Wasting

Underweight, stunting, wasting and overweight

 

What do these indicators tell us?

These indicators are used to measure nutritional imbalance resulting in undernutrition (assessed from underweight, wasting and stunting) and overweight. Child growth is internationally recognized as an important indicator of nutritional status and health in populations.

The percentage of children with a low height for age (stunting) reflects the cumulative effects of undernutrition and infections since and even before birth. This measure can therefore be interpreted as an indication of poor environmental conditions or long-term restriction of a child's growth potential. The percentage of children who have low weight for age (underweight) can reflect 'wasting' (i.e. low weight for height), indicating acute weight loss, 'stunting', or both. Thus, 'underweight' is a composite indicator and may therefore be difficult to interpret.

Stunting, wasting and overweight in children under five years of age are included as primary outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework to monitor progress towards reaching Global Nutrition Targets 1, 4 and 6. These three indicators are also included in the WHO Global Reference List of 100 Core Health Indicators.

 

How are they defined?

·   Underweight: weight for age < -2 standard deviations (SD) of the WHO Child Growth Standards median

·   Stunting: height for age < -2 SD of the WHO Child Growth Standards median

·   Wasting: weight for height < -2 SD of the WHO Child Growth Standards median

·   Overweight: weight for height > +2 SD of the WHO Child Growth Standards median

 

What are the consequences and implications?

Underweight: As weight is easy to measure, this is the indicator for which most data have been collected in the past. Evidence has shown that the mortality risk of children who are even mildly underweight is increased, and severely underweight children are at even greater risk.

Stunting: Children who suffer from growth retardation as a result of poor diets or recurrent infections tend to be at greater risk for illness and death. Stunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual capacity. This in turn affects economic productivity at national level. Women of short stature are at greater risk for obstetric complications because of a smaller pelvis. Small women are at greater risk of delivering an infant with low birth weight, contributing to the intergenerational cycle of malnutrition, as infants of low birth weight or retarded intrauterine growth tend be smaller as adults.

Wasting: Wasting in children is a symptom of acute undernutrition, usually as a consequence of insufficient food intake or a high incidence of infectious diseases, especially diarrhoea. Wasting in turn impairs the functioning of the immune system and can lead to increased severity and duration of and susceptibility to infectious diseases and an increased risk for death.

Overweight: Childhood obesity is associated with a higher probability of obesity in adulthood, which can lead to a variety of disabilities and diseases, such as diabetes and cardiovascular diseases. The risks for most noncommunicable diseases resulting from obesity depend partly on the age at onset and the duration of obesity. Obese children and adolescents are likely to suffer from both short-term and long-term health consequences, the most significant being:

·   cardiovascular diseases, mainly heart disease and stroke;

·   diabetes;

·   musculoskeletal disorders, especially osteoarthritis; and

·   cancers of the endometrium, breast and colon.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

 

Underweight

< 10%:   Low prevalence

10-19%: Medium prevalence

20-29%: High prevalence

 30%:   Very high prevalence

 

Stunting

< 20%:   Low prevalence

20-29%: Medium prevalence

30-39%: High prevalence

 40%:   Very high prevalence

 

Wasting

< 5%:     Acceptable

5-9%:     Poor

10-14%: Serious

 15%:   Critical

 

Reference: WHO, 1995.

 

Applying similar methodology used to calculate the cut-off values for public health significance for underweight, stunting and wasting, levels of public health significance for overweight (> +2 SD weight-for-height) for children under 5 years of age based on the WHO child growth standards have also been calculated using the data from the WHO Global Database on Child Growth and Malnutrition. However, they are not yet included here as they are currently being evaluated.

 

Source of data

WHO. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD), GenevaSwitzerlandhttp://www.who.int/nutgrowthdb/en/.

 

Further reading

WHO. Child Growth Standards, publications and peer-reviewed articles. http://www.who.int/childgrowth/publications/en/.

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert CommitteeTechnical Report Series No. 854. Geneva, World Health Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.

UNICEF-WHO-The World Bank. Joint child malnutrition estimates - Levels and trends. http://www.who.int/nutgrowthdb/estimates/en/

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO. Global Nutrition Targets 2025: Stunting policy brief. Geneva, World Health Organization, 2014.http://who.int/nutrition/publications/globaltargets2025_policybrief_stunting/en/

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://www.who.int/elena/global-targets/en

Target 1: 40% reduction in the number of children under-5 who are stunted. http://www.who.int/elena/global-targets/en/#stunting

Target 4: No increase in childhood overweight. http://www.who.int/elena/global-targets/en/#childhoodoverweight  

Target 6: Reduce and maintain childhood wasting to less than 5%. http://www.who.int/elena/global-targets/en/#wasting  

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2004 8.6 View

Intermediate outcome indicators

Indicator Year Value Source
Children <5 years with diarrhoea receiving ORT (%) help
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Children with diarrhoea receiving oral rehydration therapy (ORT)

Children with diarrhoea receiving oral rehydration therapy

 

What does this indicator tell us?

This indicator is the prevalence of children with diarrhoea who received oral rehydration therapy.

 

How is it defined?

It is the proportion of children aged 0–59 months who had diarrhoea and were treated with oral rehydration salts or an appropriate household solution. The terms used for diarrhoea should cover the expressions used for all forms of diarrhoea, including bloody stools (consistent with dysentery) and watery stools, and should encompasses mothers' definitions as well as local terms.

 

What are the consequences and implications?

Diarrhoeal diseases remain one of the major causes of mortality among children under 5, accounting for 1.8 million deaths among children worldwide. As oral rehydration therapy is a critical component of effective management of diarrhoea, monitoring coverage with this highly cost–effective intervention indicates progress on an intermediate outcome indicator of the Global Nutrition Targets, prevalence of diarrhoea in children under 5 years of age.

 

Source

WHO. Global Health Observatory (GHO). http://www.who.int/gho.

 

Further reading

WHO Statistical Information System (WHOSIS). Children < 5 years with diarrhoea receiving oral rehydration therapy (percentage). http://www.who.int/whosis/indicators/2007DiarrhoeaChildORTFluids/en/.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

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2010-2011 70.1 View
Underweight (BMI <18.5 kg/m²) in women 15-49 years (%) help
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Underweight in women aged 15-49 years

Moderate and severe thinness, underweight, overweight, obesity

 

What do these indicators tell us?

The values for body mass index (BMI) are age-independent for adult populations and are the same for both genders. BMI may not, however, correspond to the same degree of fatness in different populations due, in part, to different body proportions. The health risks associated with increasing BMI are continuous, and the interpretation of BMI grading in relation to risk may differ for different populations.

Proportions of underweight in women aged 15-49 years and of overweight in women aged 18 years or more are included as intermediate outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework. Adult overweight is also included in the NCD Global Monitoring Framework as well as in the WHO Global Reference List of 100 Core Health Indicators.

 

How are they defined?

BMI is a simple index of weight-to-height commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). For example, an adult who weighs 58 kg and whose height is 1.70 m will have a BMI of 20.1: BMI = 58 kg/(1.70 m ´ 1.70 m) = 20.1

  • BMI < 17.0 indicates moderate and severe thinness
  • BMI < 18.5 indicates underweight
  • BMI 18.5–24.9 indicates normal weight
  • BMI ≥ 25.0 indicates overweight
  • BMI ≥ 30.0 indicates obesity

 

What are the consequences and implications?

Moderate and severe thinness: A BMI < 17.0 indicates moderate and severe thinness in adult populations. It has been linked to clear-cut increases in illness in adults studied in three continents and is therefore a further reasonable value to choose as a cut-off point for moderate risk. A BMI < 16.0 is known to be associated with a markedly increased risk for ill health, poor physical performance, lethargy and even death; this cut-off point is therefore a valid extreme limit.

Underweight: The cut-off point of 18.5 for underweight in both genders has less experimental validity as a cut-off point for moderate and severe thinness but is a reasonable value for use pending further, comprehensive studies. The proportion of the population with a low BMI that is considered a public health problem is closely linked to the resources available for correcting the problem, the stability of the environment and government priorities. About 3–5% of a healthy adult population have a BMI < 18.5.

Overweight: Overweight (BMI ≥ 25) is a major determinant of many noncommunicable diseases, including non-insulin-dependent diabetes mellitus, coronary heart disease and stroke, and increases the risks for several types of cancer, gallbladder disease, musculoskeletal disorders and respiratory symptoms. In some populations, the metabolic consequences of weight gain start at modest levels of overweight.

Obesity: Obesity (BMI ≥ 30) is a disease that is largely preventable through lifestyle changes. The costs attributable to obesity are high, not only in terms of premature death and health care but also in terms of disability and a diminished quality of life.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

 

Adult BMI < 18.5

(underweight)

5-9%:     Low prevalence (warning sign, monitoring required)

10-19%: Medium prevalence (poor situation)

20-39%: High prevalence (serious situation)

≥ 40%:   Very high prevalence (critical situation)

 

Reference: WHO, 1995.

 

Source of data

WHO. Global Health Observatory. http://www.who.int/gho.

NCD-Risc. Data downloads. http://www.ncdrisc.org/data-downloads.html.

 

Input data and methods are described in NCD-RisC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies with 128.9 million participants. Lancet 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3.

 

Further reading

WHO. Obesity and other diet related chronic diseases, list of publications. http://www.who.int/nutrition/publications/obesity_chronicdiseases/en/index.html

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Series No. 854. Geneva, World Health Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://who.int/elena/global-targets/en/  

Target 7: Halt the rise in diabetes and obesity. http://www.who.int/elena/global-targets/en/#diabetesobesity

NCD-RisC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies with 128.9 million participants. Lancet 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3.

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

 

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Adolescent birth rate (per 1,000  women aged 15-19 years) help
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Adolescent birth rate (per 1,000 women aged 15-19 years)

Adolescent birth rate (per 1,000 women aged 15-19 years)

 

What does this indicator tell us?

The adolescent birth rate, technically known as the age-specific fertility rate provides a basic measure of reproductive health focusing on a vulnerable group of adolescent women.

The indicator adolescent birth rate (per 1,000 women aged 15-19 years) is included as an intermediate outcome indicator in the core set of indicators for the Global Nutrition Monitoring Framework. 

 

How is it defined?

The annual number of births to women aged 15-19 years per 1,000 women in that age group. It is also referred to as the age-specific fertility rate for women aged 15-19.

 

What are the consequences and implications?

There is substantial agreement in the literature that women who become pregnant and give birth very early in their reproductive lives are subject to higher risks of complications or even death during pregnancy and birth and their children are also more vulnerable. Therefore, preventing births very early in a woman’s life is an important measure to improve maternal health and reduce infant mortality. Furthermore, women having children at an early age experience a curtailment of their opportunities for socio-economic improvement, particularly because young mothers are unlikely to keep on studying and, if they need to work, may find it especially difficult to combine family and work responsibilities. The adolescent birth rate provides also indirect evidence on access to reproductive health since the youth, and in particular unmarried adolescent women, often experience difficulties in access to reproductive health care.

 

Source

WHO. Global Health Observatory (GHO). http://apps.who.int/ghodata/.

 

Further reading

UNFPA. Adolescents and youth. http://www.unfpa.org/public/publications/pubs_youth.

WHO. Maternal, newborn, child and adolescent health. Topic: adolescent/young people. http://www.who.int/child_adolescent_health/documents/adolescent/en/index.html.

WHO. WHO Reproductive Health Library. Adolescent sexual and reproductive health. http://apps.who.int/rhl/adolescent/en.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

 

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2011 51.9 View
Overweight and obesity (BMI ≥25 kg/m2) in women ≥ 18 years (%) help
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Malnutrition in women

Moderate and severe thinness, underweight, overweight, obesity


What do these indicators tell us?

The values for body mass index (BMI) are age-independent for adult populations and are the same for both genders. BMI may not, however, correspond to the same degree of fatness in different populations due, in part, to different body proportions. The health risks associated with increasing BMI are continuous, and the interpretation of BMI grading in relation to risk may differ for different populations.

Proportions of underweight in women aged 15-49 years and of overweight in women aged 18 years or more are included as intermediate outcome indicators in the core set of indicators for the Global Nutrition Monitoring Framework. Adult overweight is also included in the NCD Global Monitoring Framework as well as in the WHO Global Reference List of 100 Core Health Indicators.

 

How are they defined?

BMI is a simple index of weight-to-height commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). For example, an adult who weighs 58 kg and whose height is 1.70 m will have a BMI of 20.1: BMI = 58 kg/(1.70 m ´ 1.70 m) = 20.1

  • BMI < 17.0 indicates moderate and severe thinness
  • BMI < 18.5 indicates underweight
  • BMI 18.5–24.9 indicates normal weight
  • BMI ≥ 25.0 indicates overweight
  • BMI ≥ 30.0 indicates obesity

 

What are the consequences and implications?

Moderate and severe thinness: A BMI < 17.0 indicates moderate and severe thinness in adult populations. It has been linked to clear-cut increases in illness in adults studied in three continents and is therefore a further reasonable value to choose as a cut-off point for moderate risk. A BMI < 16.0 is known to be associated with a markedly increased risk for ill health, poor physical performance, lethargy and even death; this cut-off point is therefore a valid extreme limit.

Underweight: The cut-off point of 18.5 for underweight in both genders has less experimental validity as a cut-off point for moderate and severe thinness but is a reasonable value for use pending further, comprehensive studies. The proportion of the population with a low BMI that is considered a public health problem is closely linked to the resources available for correcting the problem, the stability of the environment and government priorities. About 3–5% of a healthy adult population have a BMI < 18.5.

Overweight: Overweight (BMI ≥ 25) is a major determinant of many noncommunicable diseases, including non-insulin-dependent diabetes mellitus, coronary heart disease and stroke, and increases the risks for several types of cancer, gallbladder disease, musculoskeletal disorders and respiratory symptoms. In some populations, the metabolic consequences of weight gain start at modest levels of overweight.

Obesity: Obesity (BMI ≥ 30) is a disease that is largely preventable through lifestyle changes. The costs attributable to obesity are high, not only in terms of premature death and health care but also in terms of disability and a diminished quality of life.

 

Cut-off values for public health significance

Indicator

Prevalence cut-off values for public health significance

 

Adult BMI < 18.5

(underweight)

5-9%:     Low prevalence (warning sign, monitoring required)

10-19%: Medium prevalence (poor situation)

20-39%: High prevalence (serious situation)

≥ 40%:   Very high prevalence (critical situation)

 

Reference: WHO, 1995.

 

Source of data

WHO. Global Health Observatory.http://www.who.int/gho.

NCD-Risc. Data downloads. http://www.ncdrisc.org/data-downloads.html.

Input data and methods are described in NCD-RisC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies with 128.9 million participants. Lancet 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3.

 

Further reading

WHO. Obesity and other diet related chronic diseases, list of publications. http://www.who.int/nutrition/publications/obesity_chronicdiseases/en/index.html

WHO. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Technical Report Series No. 854. Geneva, World Health Organization, 1995. http://whqlibdoc.who.int/trs/WHO_TRS_854.pdf.

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://who.int/elena/global-targets/en/  

Target 7: Halt the rise in diabetes and obesity. http://www.who.int/elena/global-targets/en/#diabetesobesity

NCD-RisC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies with 128.9 million participants. Lancet 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3.

 

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2016 26.1 View
Overweight (BMI-for-age >+1 SD) in school-age children and adolescents 5-19 years (%) help
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Overweight in school-age children and adolescents

Overweight in school-age children and adolescents


What does this indicator tell us?

This indicator reflects the percentage of school-age children and adolescents 5-19 years who are classified as overweight based on age and sex specific values for body mass index (BMI). Overweight indicates excess body weight for a given height from fat, muscle, bone, water or a combination of these factors, whilst obesity is defined as having excess body fat.

Overweight in school-age children and adolescents 5-19 years is included as an intermediate  outcome indicator in the core set of indicators for the Global Nutrition Monitoring Framework. This indicator is also included in the NCD Global Monitoring Framework as well as in the WHO Global Reference List of 100 Core Health Indicators.

 

How is it defined?

Prevalence of overweight in school-age children and adolescents is defined as the percentage of children aged 5-19 years with sex-specific BMI-for-age above +1 SD from the WHO 2007 reference median. Prevalence of obesity in school-age children and adolescents is defined as the percentage of children aged 5-19 years with sex-specific BMI-for-age above +2 SD from the WHO 2007 reference median.

 

What are the consequences and implications?

The immediate consequences of overweight and obesity in school-age children and adolescents include greater risk of asthma and cognitive impairment, in addition to the social and economic consequences for the child, its family and the society. In the long term, overweight and obesity in children increase the risk of obesity, diabetes, heart disease, some cancers, respiratory disease, mental health, and reproductive disorders later in life. Furthermore, obesity and overweight track over the life course – an overweight adolescent girl is more likely to become an overweight woman and, thus, her baby is likely to have a heavier birth weight.

 

Source of data

WHO. Global Health Observatory.http://www.who.int/gho.

Input data and methods are described in NCD-RisC. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies with 128.9 million participants. Lancet 2017. DOI: http://dx.doi.org/10.1016/S0140-6736(17)32129-3.

 

Further reading

WHO. Growth reference 5-19 years. BMI-for-age (5-19 years). http://www.who.int/growthref/who2007_bmi_for_age/en/ 

WHO. Overweight and obesity. Fact sheet 311. http://www.who.int/mediacentre/factsheets/fs311/en/

WHO. Commission on Ending Childhood Obesity. http://www.who.int/end-childhood-obesity/en/

WHO. NCD Global Monitoring Framework. http://www.who.int/nmh/global_monitoring_framework/en/

WHO. Global Reference List of 100 Core Health Indicators. Geneva: World Health Organization, 2015. http://www.who.int/healthinfo/indicators/2015/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Interventions by global target. http://who.int/elena/global-targets/en/   

Target 7: Halt the rise in diabetes and obesity. http://www.who.int/elena/global-targets/en/#diabetesobesity

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2016 9.4 View

Process indicators

Indicator Year Value Source
Minimum dietary diversity (MDD) in children 6-23 months (%) help
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Children aged 6–23 months who receive a minimum dietary diversity

Infant and young child feeding

 

To enable mothers to establish and sustain exclusive breastfeeding for 6 months, WHO and UNICEF recommend:

·   initiation of breastfeeding within the first hour of life;

·   exclusive breastfeeding, i.e. only breast milk with no additional food or drink, not even water;

·   breastfeeding on demand, as often the child wants, day and night; and

·   no use of bottles, teats or pacifiers.

 

The recommendations for feeding infants and young children (6–23 months) include:

·   continuing breastfeeding;

·   introduction of solid, semisolid or soft foods at 6 months;

·   appropriate food diversity (at least four food groups per day);

·   appropriate frequency of meals: two to three times a day between 6 and 8 months, increasing to three to four times a day between 9 and 23 months with nutritious snacks offered once or twice a day, as desired;

·   safe preparation of foods; and

·   feeding infants in response to their cues.

 

The caring practice indicators for infant and young child feeding available on the NLIS country profiles include:

  • proportion of children aged 0–23 months who were put to the breast within 1 h of birth
  • proportion of infants under 6 months who are exclusively breastfed
  • proportion of infants aged 6–8 months who receive solid, semisolid or soft foods
  • proportion of children aged 6–23 months who receive a minimum dietary diversity; and
  • proportion of children aged 6–23 months who receive a minimum acceptable diet.

  

Early initiation of breastfeeding

What does this indicator tell us?

This indicator is the percentage of infants who are put to the breast within 1 hour of birth.

 

How is it defined?

Early initiation of breastfeeding is defined as the proportion of children born in the past 24 months who were put to the breast within 1 hour of birth.

 

What are the consequences and implications?

Breastfeeding contributes to saving children's lives, and there is evidence that delayed initiation of breastfeeding increases their risk for mortality.

 

Infants under 6 months who are exclusively breastfed

What does this indicator tell us?

This indicator is the percentage of infants aged 0–5 months who are exclusively breastfed.

 

How is it defined?

It is the proportion of infants aged 0–5 months who are fed exclusively on breast milk and no other food or drink, including water. The infant is however, allowed to receive ORS and drops and syrups containing vitamins, minerals and medicine.

 

What are the consequences and implications?

Exclusive breastfeeding is an unequalled way of providing the ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process, with important implications for the health of mothers. An expert review of evidence showed that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants.

Breast milk is the natural first food for infants. It provides all the energy and nutrients that the infant needs for the first months of life. It continues to provide up to one half or more of a child’s nutritional needs during the second half of the first year and up to one third during the second year of life.

Breast milk promotes sensory and cognitive development and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses, such as diarrhoea and pneumonia, and leads to quicker recovery from illness.

Breastfeeding contributes to the health and well-being of mothers, by helping to space children, reducing their risks for ovarian and breast cancers and saving family and national resources. It is a secure way of feeding and is safe for the environment.

 

Infants aged 6–8 months who receive solid, semisolid or soft foods

What does this indicator tell us?

The indicator is the percentage of infants who start solid, semisolid or soft foods at between 6 and 8 months of age. WHO recommends starting complementary feeding at 6 months of age.

 

How is it defined?

It is defined as the proportion of infants aged 6–8 months who receive solid, semisolid or soft foods.

 

What are the consequences and implications?

When breast milk alone no longer meets the nutritional needs of the infant, complementary foods should be added. The transition from exclusive breastfeeding to family foods, referred to as ‘complementary feeding’, typically occurs between 6 and 18–24 months of age. This is a very vulnerable period, and it is the time when malnutrition often starts, contributing significantly to the high prevalence of malnutrition among children under 5 worldwide.

 

Children aged 6–23 months who receive a minimum dietary diversity

What does this indicator tell us?

This indicator is the percentage of children aged 6–23 months who receive a minimum dietary diversity.

Proportion of children aged 6-23 months who receive a minimum dietary diversity is included as an interim process indicator in the core set of indicators for the Global Nutrition Monitoring Framework, while the original indicator “Minimum Acceptable Diet” is being further developed and validated under the leadership of the WHO-UNICEF Technical Expert Advisory group on nutrition Monitoring (TEAM). In June 2017, TEAM also recommended to revise the MDD indicator as defined by WHO (2008) to make it feasible and meaningful for Member State reporting. The revision concerned adding “breast milk” as an 8th food group and shifting the criterion for MDD accordingly, from 4 of 7 groups to 5 of 8 groups.

 

How is it defined?

As per revised recommendation by TEAM in June 2017, dietary diversity is present when the diet contained five or more of the following food groups:

·         breast milk;

·         grains, roots and tubers;

·         legumes and nuts;

·         dairy products (milk, yogurt, cheese);

·         flesh foods (meat, fish, poultry, liver or other organs);

·         eggs;

·         vitamin A-rich fruits and vegetables; and

·         other fruits and vegetables.

 

Children aged 6–23 months who receive a minimum acceptable diet

What does this indicator tell us?

This indicator is the percentage of children aged 6–23 months who receive a minimum acceptable diet.

Proportion of children aged 6-23 months who receive a minimum acceptable diet is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. 

 

How is it defined?

The composite indicator of a minimum acceptable diet is calculated from:

·    the proportion of breastfed children aged 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day and

  • the proportion of non-breastfed children aged 6–23 months who received at least two milk feedings and had at least the minimum dietary diversity not including milk feeds and the minimum meal frequency during the previous day.

Dietary diversity is present when the diet contained four or more of the following food groups:

·         grains, roots and tubers;

·         legumes and nuts;

·         dairy products (milk, yogurt, cheese);

·         flesh foods (meat, fish, poultry, liver or other organs);

·         eggs;

·         vitamin A-rich fruits and vegetables; and

·         other fruits and vegetables.

 

The minimum daily meal frequency is defined as:

  • twice for breastfed infants aged 6–8 months,
  • three times for breastfed children aged 9–23 months and
  • four times for non-breastfed children aged 6–23 months.

 

What are the consequences and implications?

A minimum acceptable diet is essential to ensure appropriate growth and development for feeding infants and children aged 6–23 months. Without adequate diversity and meal frequency, infants and young children are vulnerable to malnutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality.

 

Source of all infant and young child feeding indicators

WHO. Global Health Observatory (GHO). http://apps.who.int/gho.

UNICEF. Infant and Young Child Feeding database. https://data.unicef.org/topic/nutrition/infant-and-young-child-feeding/.

 

Further reading

WHO. Infant and young child feeding list of publications. http://www.who.int/nutrition/publications/infantfeeding/en/index.html.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

 

WHO. E-Library of Evidence for Nutrition Actions (eLENA):

·         Breastfeeding: early initiation. http://www.who.int/entity/elena/titles/early_breastfeeding/en/index.html.

·         Breastfeeding: exclusive breastfeeding. http://www.who.int/entity/elena/titles/exclusive_breastfeeding/en/index.html.

·         Breastfeeding: continued breastfeeding. http://www.who.int/entity/elena/titles/continued_breastfeeding/en/index.html.

·         Complementary feeding. http://www.who.int/entity/elena/titles/complementary_feeding/en/index.html.

WHO. WHO Global Data Bank on Infant and Young Child Feeding. Department of Nutrition for Health and Development (NHD), Geneva, Switzerland.http://www.who.int/nutrition/databases/infantfeeding/en/index.html.

WHO/UNICEF. Global Nutrition Monitoring Framework. Operational guidance for tracking progress in meeting targets for 2025. WHO, Geneva, 2017. http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/.

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Population using improved drinking-water sources (%) help
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% Population using improved drinking water sources

Improved sanitation facilities and drinking-water sources

 

What do these indicators tell us?

These indicators are the percentage of population with access to an improved drinking-water source and improved sanitation facilities.

 

How are they defined?

Improved drinking-water sources are defined in terms of the types of technology and levels of services that are likely to provide safe water. Improved water sources include household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collection. Unimproved water sources are unprotected wells, unprotected springs, vendor-provided water, bottled water (unless water for other uses is available from an improved source) and tanker truck-provided water. 'Reasonable access' is broadly defined as the availability of at least 20 litres per person per day from a source within 1 kilometre of the user's dwelling.

Improved sanitation facilities are defined in terms of the types of technology and levels of services that are likely to be sanitary. Improved sanitation includes connection to a public sewers, connection to septic systems, pour-flush latrines, simple pit latrines and ventilated improved pit latrines. Service or bucket latrines (from which excreta are removed manually), public latrines and open latrines are not considered to be improved sanitation.

What are the consequences and implications?

Access to safe drinking-water and improved sanitation are fundamental needs and human rights vital for the dignity and health of all people. The health and economic benefits of a safe water supply to households and individuals (especially children) are well documented. Both indicators are used to monitor progress towards the Millennium Development Goals.

 

Source

WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. http://www.wssinfo.org/.

 

Further reading

WHO. Water, Sanitation and Hygiene. http://www.who.int/water_sanitation_health/en/.

World Health Statistics, 2010. http://www.who.int/whosis/whostat/2010/en/index.html.

Global Health Observatory (GHO). http://www.who.int/gho/en/.

The WHO Indicator and Measurement Registry (IMR). http://apps.who.int/gho/indicatorregistry/App_Main/browse_indicators.aspx

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2015 55.3 View
Population using improved sanitation facility (%) help
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Population using an improved sanitation facility and improved drinking water sources

Improved sanitation facilities and drinking-water sources

 

What do these indicators tell us?

These indicators are the percentage of population with access to an improved drinking-water source and improved sanitation facilities.

 

How are they defined?

Improved drinking-water sources are defined in terms of the types of technology and levels of services that are likely to provide safe water. Improved water sources include household connections, public standpipes, boreholes, protected dug wells, protected springs and rainwater collection. Unimproved water sources are unprotected wells, unprotected springs, vendor-provided water, bottled water (unless water for other uses is available from an improved source) and tanker truck-provided water. 'Reasonable access' is broadly defined as the availability of at least 20 litres per person per day from a source within 1 kilometre of the user's dwelling.

Improved sanitation facilities are defined in terms of the types of technology and levels of services that are likely to be sanitary. Improved sanitation includes connection to a public sewers, connection to septic systems, pour-flush latrines, simple pit latrines and ventilated improved pit latrines. Service or bucket latrines (from which excreta are removed manually), public latrines and open latrines are not considered to be improved sanitation.

What are the consequences and implications?

Access to safe drinking-water and improved sanitation are fundamental needs and human rights vital for the dignity and health of all people. The health and economic benefits of a safe water supply to households and individuals (especially children) are well documented. Both indicators are used to monitor progress towards the Millennium Development Goals.

 

Source

WHO/UNICEF Joint Monitoring Programme (JMP) for Water Supply and Sanitation. http://www.wssinfo.org/.

 

Further reading

WHO. Water, Sanitation and Hygiene. http://www.who.int/water_sanitation_health/en/.

World Health Statistics, 2010. http://www.who.int/whosis/whostat/2010/en/index.html.

Global Health Observatory (GHO). http://www.who.int/gho/en/.

The WHO Indicator and Measurement Registry (IMR). http://apps.who.int/gho/indicatorregistry/App_Main/browse_indicators.aspx

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2015 31.9 View
Any antenatal iron supplementation (%) help
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Antenatal iron supplementation

Antenatal iron supplementation

 

What does this indicator tell us?

This indicator reflects the percentage of women who consumed any iron-containing supplements during the current or past pregnancy within the last 2 years. It provides information about the quality and coverage of perinatal medical services.

Daily iron and folic acid supplementation is currently recommended by WHO as part of antenatal care to reduce the risk of low birth weight, maternal anaemia and iron deficiency.  It is suggested that the supplement contains 30-60 mg of iron, with the higher dose preferred in settings where anaemia in pregnant women is a severe public health problem (40% or higher), along with 400 µg of folic acid.  Daily supplementation throughout pregnancy, beginning as early  as possible after conception is recommended in all settings. However, despite its proven efficacy and wide inclusion in antenatal care programmes, its use has been limited in programme settings, possibly due to a lack of compliance, concerns about the safety of the intervention among women with an adequate iron intake, and variable availability of the supplements at community level. Intermittent use of iron and folic acid supplements by non-anaemic women is a recommended alternative to prevent anaemia and improve gestational outcomes in areas where the prevalence of anaemia among  pregnant women is lower than 20%. The suggested dose is 120 mg elemental iron and 2800 µg (2.8 mg) folic acid provided weekly throughout the pregnancy, beginning as early as possible after conception.

This indicator is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. 

 

How is it defined?

The indicator is defined as the proportion of women who consumed any iron-containing supplements during the current or past pregnancy within the last 2 years. Data can be reported on any iron-containing supplement including iron and folic acid tablets (IFA), multiple micronutrient tablets or powders, or iron-only tablets which will vary by country policy.

 

What are the consequences and implications?

Improving the intake of iron and folic acid by women of reproductive age could improve pregnancy outcomes and enhance maternal and infant health. Iron and folic acid supplementation improve iron and folate status of women before and during pregnancy, in communities where food-based strategies are not yet fully implemented or effective. Folic acid supplementation (with or without iron) provided before pregnancy and during the first trimester of pregnancy is also recommended for decreasing the risk of neural tube defects.

Anaemia during pregnancy places women at risk for poor pregnancy outcomes, including maternal mortality and also increases the risks for perinatal mortality, premature birth and low birth weight. Infants born to anaemic mothers have less than one half the normal iron reserves. Morbidity from infectious diseases is increased in iron-deficient populations, because of the adverse effect of iron deficiency on the immune system. Iron deficiency is also associated with reduced work capacity and with reduced neurocognitive development.

 

Source

Demographic and Health Surveys. STATcompiler. http://www.statcompiler.com/.

 

Further reading

WHO. Weekly iron-folic acid supplementation (WIFs) in women of reproductive age: its role in promoting optimal maternal and child health. Geneva, World Health Organization, 2009. http://www.who.int/nutrition/publications/micronutrients/weekly_iron_folicacid.pdf.

WHO. Global Targets 2025 to improve maternal, infant and young child nutrition. http://who.int/nutrition/global-target-2025/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA):

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

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2015 40.8 View
Births in baby-friendly facilities (%) help
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Births in baby-friendly facilities

What does this indicator tell us?

The Baby-friendly Hospital Initiative (BFHI), launched by WHO and UNICEF in 1991, is part of a global effort to protect, promote and support optimal breastfeeding practices. ‘Baby-friendly’ facilities implement the Ten Steps to Successful Breastfeeding in order to protect, promote and support breastfeeding. The indicator reflects the proportion of babies born in facilities that have been designated as Baby-friendly.
Proportion of births in Baby-friendly facilities is included as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework.  

How is it defined?

This indicator is defined as the proportion of babies born in facilities designated as Baby-friendly in a calendar year. To be counted as currently Baby-friendly, the facility must have been designated within the last five years or been reassessed within that timeframe. Facilities may be designed as Baby-friendly if they meet the minimum Global Criteria, which includes adherence to the Ten Steps for Successful Breastfeeding and the International Code of Marketing of Breast-milk Substitutes. The Ten steps include having a breastfeeding policy that is routinely communicated to staff, having staff trained on policy implementation, informing pregnant women on the benefits and management of breastfeeding, promoting early initiation of breastfeeding, among others. The International Code of Marketing of Breast-milk Substitutes restricts the distribution of free infant formula and promotional materials from infant formula companies. 

What are the consequences and implications?

Research has found that adherence to BFHI’s Ten Steps leads to improved breastfeeding outcomes, which positively impact the health of both the mother and child. The more of the Steps that the mother experiences, the better her success with breastfeeding.  Improved breastfeeding practices worldwide could save the lives of over 800 000 children every year.

Source

WHO. National implementation of the Baby-friendly Hospital Initiative. 2017. 

Further reading

WHO, UNICEF. Global Targets 2025: Breastfeeding policy brief.  

WHO. Baby-friendly hospital initiative. http://www.who.int/nutrition/topics/bfhi/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA). Implementation of the Baby-friendly Hospital Initiative. http://www.who.int/elena/titles/implementation_bfhi/en/.

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

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2016 0.1 View
Availability of national-level provision for breastfeeding counselling services in public health and/or nutrition programmes help
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Availability of national-level provision for breastfeeding counselling services in public health and/or nutrition programmes

Availability of national-level provision for breastfeeding counselling services in public health and/or nutrition programmes

 

What does this indicator tell us?

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. Optimal practices include early initiation of breastfeeding within 1 hour, exclusive breastfeeding for 6 months followed by appropriate complementary with continued breastfeeding for 2 years or beyond.  Even though it is a natural act, breastfeeding is also a learned behaviour. Virtually all mothers can breastfeed provided they have accurate information, and support within their families and communities and from the health care system. They should also have access to skilled practical help from, for example, trained health workers, lay and peer counsellors, and certified lactation consultants, who can help to build mothers’ confidence, improve feeding technique, and prevent or resolve breastfeeding problems.

This indicator has been established as an interrim indicator to while the WHO-UNICEF Technical Expert Advisory group for nutrition Monitoring (TEAM) is further developing and validating the indicator “proportion of mothers receiving breastfeeding counselling, support or messages”, which is as a process indicator in the core set of indicators for the Global Nutrition Monitoring Framework. 

 

How is it defined?

The indicator is defined as availability of a national program that includes provision for delivering breastfeeding counselling services to mothers of infants 0-23 months of age through health systems or other community-based platforms.

 

What are the consequences and implications?

Counseling and informational support on optimal breastfeeding practices for mothers has been demonstrated to improve initiation and duration of breastfeeding, which in has many health benefits for both the mother and infant. Breast milk contains all the nutrients an infant needs in the first six months of life. Breastfeeding protects against diarrhoea and common childhood illnesses such as pneumonia, and may also have longer-term health benefits for the mother and child, such as reducing the risk of overweight and obesity in childhood and adolescence. Breastfeeding has also been associated with higher intelligence quotient (IQ) in children. Improved breastfeeding practices worldwide could save the lives of over 800 000 children every year.

 

 

Source

WHO. Global Nutrtion Policy Review. What does it take to scale-up nutrition action? Geneva, Switzerland, 2013. www.who.int/nutrition/publications/policies/global_nut_policyreview/en/

WHO. 2nd Global Nutrition Policy Review (forthcoming).

WHO. Global database on the Implementation of Nutrition Action (GINA). https://extranet.who.int/nutrition/gina/

UNICEF. Nutri-Dash. http://unicefnutridash.org

IBFAN. World Breastfeeding Trends. http://worldbreastfeedingtrends.org

 

Further reading

WHO, UNICEF. Global Strategy for Infant and Young Child Feeding, 2003. http://www.who.int/nutrition/publications/infantfeeding/9241562218/en/

WHO, UNICEF. Global Targets 2025: Breastfeeding policy brief.  http://who.int/nutrition/publications/globaltargets2025_policybrief_breastfeeding/en/

WHO. E-Library of Evidence for Nutrition Actions (eLENA).

 WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

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Policy, environment, and capacity indicators

Indicator Year Value Source
Nutrition professionals density (per 100,000 population) help
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Density of nutrition professionals

Trained nutrition professionals density

 

What does the indicator tell us?

The indicator ‘Density of trained nutrition professionals per 100 000 population’ reflects the capacity of a country to design and implement nutrition policies and programmes effectively.

The focus of the nutrition professional indicator is on individuals trained to pursue a nutrition professional career, described in most countries as dieticians or nutritionists (including nutrition scientists, nutritional epidemiologists and public health nutritionists). These individuals are trained sufficiently in nutrition practice to demonstrate defined competencies and to meet certification or registration requirements of national or global nutrition or dietetics professional organizations. This training at universities or other tertiary or higher education institutions may occur at Bachelor, Post-graduate certificate or Diploma, Masters and /or PhD degree levels.

Dieticians and nutritionists may complete the same training and perform the same functions in some countries but not others. Likewise, professional registration or accreditation of dieticians and/or nutritionists may be joint or separate, and may occur in some countries but not others. Countries are encouraged to implement professional registration or accreditation of dieticians and/or nutritionists to provide a guarantee of appropriate training and professional competence.

Number of trained nutrition professionals/100 000 population is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework.

 

How is it defined?

This indicator is defined as the number of trained nutrition professionals per 100,000 population in the country in a specified year.

 

What are the consequences and implications?

Trained nutrition professionals work at facilities including health facilities as well as at population and community levels and may influence nutrition policies, and designing and implementation of nutrition intervention programmes at various levels. They also play an important role in training of other health and non-health cadres to plan and deliver nutrition interventions in various settings. The requirement for a ‘trained nutrition professionals’ indicator is based on the recognition that availability, within a country, of sufficient workforce with appropriate training in nutrition will lead to better outcomes for country-specific nutrition and health concerns. Validation of the indicator has shown that it can predict several maternal, infant and young child nutrition outcomes.

 

Source

WHO. 2nd Global Nutrition Policy Review (forthcoming).


Further reading

Hughes R, Shrimpton R, Recine E, Margetts B. A competency framework for global public health nutrition workforce development: A background paper. 2011. World Public Health Nutrition Association. Accessible http://wphna.org/competency-standards/

Association for Nutrition. Registering as Registered Nutritionist. The UK Voluntary Register of Nutritionists Registration http://www.associationfornutrition.org

Ellahi B, Annan R, Sarkar S, Amuna P, Jackson AA. Building systemic capacity for nutrition: training towards a professionalised workforce for Africa. Proc Nutr Soc. 2015 Nov;74 (4):496–504.

WHO. Global nutrition monitoring framework: Operational guidance for tracking progress in meeting targets for 2025. 2017. http://www.who.int/nutrition/publications/operational-guidance-GNMF-indicators/en/.


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2016-2017 0.1 View
International Code on Marketing of Breast-milk Substitutes: Legal status of the Code help
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Monitoring and enforcement of the International Code on Marketing of Breast-milk Substitutes

Monitoring and enforcement of the International Code of Marketing of Breast-milk Substitutes

 

What does this indicator tell us?

This indicates whether a government has adopted legislation to monitor and enforce the International Code of Marketing of Breast-milk Substitutes, which helps create an environment that enables mothers to make the best possible feeding choice, based on impartial information and free of commercial influences, and to be fully supported in doing so.

 

How is it defined?

This indicator is defined on the basis of whether a government has adopted legislation for effective national implementation and monitoring of the International Code of Marketing of Breast-milk Substitutes. The Code is a set of recommendations to regulate the marketing of breast-milk substitutes, feeding bottles and teats. The Code aims to contribute "to the provision of safe and adequate nutrition for infants, by the protection and promotion of breastfeeding, and by ensuring the proper use of breast-milk substitutes, when these are necessary, on the basis of adequate information and through appropriate marketing and distribution" (Article 1).

 

What are the consequences and implications?

Improper marketing and promotion of food products that compete with breastfeeding often negatively affect the choice and ability of a mother to breastfeed her infant optimally. The Code was formulated in response to the realization that such marketing resulted in poor infant feeding practices, which negatively affect the growth, health and development of children and are a major cause of mortality in infants and young children.

Breastfeeding practices worldwide are not yet optimal, in both developing and developed countries, especially for exclusive breastfeeding under 6 months of age. In addition to the risks posed by the lack of the protective qualities of breast milk, breast-milk substitutes and feeding bottles are associated with a high risk for contamination that can lead to life-threatening infections in young infants. Infant formula is not a sterile product, and it may carry germs that can cause fatal illnesses. Artificial feeding is expensive, requires clean water, the ability of the mother or caregiver to read and comply with mixing instructions and a minimum standard of overall household hygiene. These factors are not present in many households in the world.

 

Source

WHO. Department for Child and Adolescent Health and Department of Nutrition for Health and Development.

 

Further reading

WHO. The International Code of Marketing of Breast-milk Substitutes. Frequently asked questions, 2008. http://www.who.int/nutrition/publications/Frequently_ask_question_Internationalcode.pdf.

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2016 Full provisions in law View
Maternity protection: Compliance with international labour standards help
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Maternity protection indicators (GNMF compliance)

Maternity protection indicators

 

What do these indicators tell us?

These indicators provide information on national policies for legal entitlement to maternity protection, including leave from work during pregnancy and after birth, as well breastfeeding entitlements after return to work.

Since the International Labour Organization (ILO) was founded in 1919, international labour standards have been established to provide maternity protection for women workers. The ILO Maternity Protection Convention, 2000 (No. 183) represents the minimum standards, whereas the accompanying ILO Maternity Protection Recommendation, 2000 (No. 191) encourages additional measures. Key elements of maternity protection include:

·         Maternity leave duration: The mother’s right to a period of rest in relation to childbirth is a crucial means of safeguarding health and nutrition of the mother and her child. Convention No. 183 states that maternity leave should not be less than 14 weeks, while Recommendation No. 191 suggests that maternity leave be at least 18 weeks.

·         Amount of maternity leave cash benefits: The right to cash benefits during absence for maternity leave is intended to ensure that the woman can maintain herself and her child in proper conditions of health and with a suitable standard of living. Maternity leave cash benefits aim to replace a portion of the income lost due to the interruption of the woman’s economic activities, giving practical effect to the provision for leave. Convention No. 183 states that cash benefits should not be less than two-thirds of the woman’s earnings prior to taking leave, while Recommendation No. 191 encourages raising the benefits to the full amount of previous earnings.

·         Source of maternity leave cash benefits: The source of benefits is important due to potential discrimination in the labour market if employers have to bear the full costs. Convention No. 183 stipulates that cash benefits shall be provided through compulsory social insurance or public funds, and that individual employers shall not be liable for maternity leave benefits without that employer’s specific agreement.

·         Breastfeeding breaks and breastfeeding facilities: The right to continue breastfeeding a child after returning to work is important since duration of leave entitlements generally is shorter than the WHO recommended duration of exclusive and continued breastfeeding. Convention No. 183 states that women shall have the right to one or more daily breaks or a daily reduction of hours of work for breastfeeding, which is to be counted as working time and remunerated accordingly. Recommendation No. 191 states that where practicable, provision should be made for the establishment of facilities for nursing under adequate hygienic conditions at or near the workplace.

A composite indicator on maternity protection is included as a policy environment and capacity indicator in the core set of indicators for the Global Nutrition Monitoring Framework. It currently uses the ILO classification of compliance with Convention 183 on three key provisions (leave duration, remuneration and source of cash benefits), but an alternative method taking into account higher standards as stated in Recommendation 191 as well as breastfeeding entitlements is under development. 

 

How are they defined?

The ILO periodically publishes information on the above key indicators, including the assessment of compliance with Convention No. 183, as part of the TRAVAIL Database of Conditions of Work and Employment Laws and the NATLEX Database of National Labour, Social Security and Related Human Rights Legislation. The legislative data are collected by ILO through periodical reviews of national labour and social security legislation and secondary sources, such as the International Social Security Association and International Network on Leave Policies and Research; as well as consultations with ILO experts in regional and national ILO offices around the world

The composite indicator on maternity protection included in the Global Nutrition Monitoring Framework is currently defined as whether the country has maternity protection laws or regulations in place compliant with the provisions for leave duration, remuneration and source of cash benefits in Convention 183. However, an alternative method is under development which may use a scale to indicate the degree of compliance is under development. This method will also take into account higher standards for leave duration and remuneration in Recommendation 191, as well as breastfeeding entitlements within both the Convention and Recommendation. 

 

 What are the consequences and implications?

Pregnancy and maternity are potentially vulnerable time for working women and their families. Expectant and nursing mothers require special protection to prevent any potential adverse effects for them and their infants. They need adequate time to give birth, to recover from delivery process, and to nurse their children. At the same time, they also require income security and protection to ensure that they will not suffer from income loss or lose their job because of pregnancy or maternity leave. Such protection not only ensures a woman's equal access and right to employment, it also ensures economic sustainability for the well-being of the family. Returning to work after maternity leave has been identified as a significant cause for never starting breastfeeding, early cessation of breastfeeding and lack of exclusive breastfeeding. In most low- and middle-income countries, paid maternity leave is limited to formal sector employment or is not always provided in practice. The ILO estimates that more than 800 million women lack economic security around childbirth with adverse effects on the health, nutrition and well-being of mothers and their children.

 

Source

ILO. Maternity protection database. http://www.ilo.org/travaildatabase/servlet/maternityprotection.

 

Further reading

ILO. Maternity and paternity at work: Law and practice across the world. Geneva, Switzerland, 2014. http://www.ilo.ch/global/topics/equality-and-discrimination/maternity-protection/publications/maternity-paternity-at-work-2014/lang--en/index.htm

ILO. Maternity cash benefits for workers in the informal economy. Social Protection for All Issue Brief, November 2016. http://www.social-protection.org/gimi/gess/RessourcePDF.action?ressource.ressourceId=54094

ILO. Maternity protection http://www.ilo.org/global/themes/equality_and_discrimination/maternityprotection/lang--en/index.htm.

ILO. Documentation for the maternity protection database http://www.ilo.org/travaildatabase/theme/mpd_documentation.pdf.

Rollins et al 2016. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387: 491–504.

ILO. NATLEX. Database of national labour, social security and related human rights legislationhttp://www.ilo.org/natlex  

International Social Security Association (ISSA).  Social Security Country Profiles https://www.issa.int/en_GB/country-profiles

International Network on Leave Policies and Research (INLPR). http://www.leavenetwork.org

WHO and UNICEF. Global Nutrition Monitoring Framework: Operational guidance for tracking progress in meeting targets for 2025. 2017 (forthcoming).

 

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2014 Does not meet three provisions of C183 View

Related links

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