Peer-reviewed article
Magnitudes of Various Forms of Undernutrition Among Children from the Composite Index of Anthropometric Failure in Sub-Saharan Africa: A Systematic Review and Meta-Analysis.
Misganaw Gebrie Worku, Itismita Mohanty, Zelalem Mengesha, Theo Niyonsenga ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This systematic review and meta-analysis examined undernutrition among children under five in Sub-Saharan Africa using the Composite Index of Anthropometric Failure (CIAF), which captures overlapping forms of malnutrition better than conventional measures. The review included 26 studies and found that over one-third of children in SSA experienced at least one form of undernutrition, with nearly one-third of these children affected by multiple coexisting forms. Stunting alone was the most common pattern, followed by stunting combined with underweight. The findings highlight the need for multi-dimensional nutrition strategies that address multiple forms of undernutrition simultaneously.
Key points
- Overall pooled prevalence of undernutrition among children in SSA was 37.45% (95% CI: 31.97, 42.92)
- 10% of children experienced at least one coexisting form of undernutrition
- 25.5% experienced at least one single form of undernutrition
- Stunting only was the most prevalent disaggregated pattern at 22.32%, followed by stunting with underweight at 10.15%
- Nearly one-third of undernourished children were affected by multiple forms of undernutrition
Limitations
This meta-analysis synthesizes prevalence data from 26 studies but does not evaluate the effectiveness of interventions to address undernutrition. The review provides regional pooled estimates but cannot explain the causal mechanisms or contextual factors driving undernutrition patterns, nor can it assess the impact of specific programmes designed to reduce these forms of malnutrition.
Abstract
Background: Nearly half of under-five deaths are linked to undernutrition. Most evidence on undernutrition relies on conventional anthropometric measures. Conventional anthropometric measures fail to capture its overlapping forms and are limited in providing the true burden and distinct disaggregated patterns of undernutrition. Using the Composite Index of Anthropometric Failure (CIAF), this study aims to provide updated regional and country-level pooled prevalence estimates of the overall burden and various single and coexisting patterns of undernutrition among children in Sub-Saharan Africa (SSA). Methods: We systematically searched Medline, CINAHL, Web of Science, Scopus, and Google Scholar for studies published between January 2006 and October 2023. Studies reporting the prevalence of aggregated CIAF or any of the disaggregated forms of CIAF (stunting only, wasting only, underweight only, stunting-underweight, wasting-underweight, and stunting-wasting-underweight) based on the 2006 World Health Organisation (WHO) growth standard were included. Data extraction was performed by two reviewers, and discrepancies were resolved by consensus. Pooled prevalences of various categories of undernutrition were estimated using a random effect model meta-analysis. Subgroup analysis and meta-regression were performed to identify possible sources of heterogeneity among the included studies. Publication bias was checked using the Asymmetry funnel plot and Egger's test. The protocol was registered on PROSPERO (CRD42023458796). Result: This systematic review and meta-analysis identified 3898 published studies from the database search, of which 26 were included. In SSA, the overall pooled prevalence of undernutrition among children was 37.45% (95% Confidence Interval (CI): 31.97, 42.92). Of these, 10% (95% CI: 8.02, 11.98) of children experienced at least one coexisting form, and 25.5% (95% CI: 16.78, 33.72) experienced at least one single form of undernutrition. Stunting only [22.32% (95% CI: 18.26, 26.39)] was the most prevalent disaggregated pattern of undernutrition, followed by the coexistence of stunting with underweight [10.15% (95% CI: 8.17, 12.13)]. Conclusions: Over one in three children in SSA experienced at least one form of undernutrition. Nearly one-third of these undernourished children were affected by multiple forms of undernutrition. The high prevalence of coexisting undernutrition indicates the need to develop multi-indicator nutrition strategies that could simultaneously address the various dimensions of undernutrition in children.