Nutrition
Situation in
Senegal
Marc Nene
ANALYSIS & PERSPECTIVE: 15 YEARS OF EXPERIENCE IN THE DEVELOPMENT OF NUTRITION POLICY IN SENEGAL
Nutrition
Situation in
Senegal
January 2018
Marc Nene
Analysis & Perspective: 15 Years of Experience in the
Development of Nutrition Policy in Senegal
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Acknowledgments
T
his report was written by Marc Nene, Ph.D. Candidate, Tufts University Friedman School
of Nutrition Science and Policy, with support from Andrea L. Spray (Consultant).
Reviewers. We are grateful to all reviewers of the reports of the series—Elodie Becquey (IFPRI),
Patrick Eozenou (World Bank), Dominic Haazen (World Bank), Derek Headey (IFPRI), Abdou-
laye Ka (CLM), Jakub Kakietek (World Bank), Ashi Kohli Kathuria (World Bank), Christine Lao
Pena (World Bank), Biram Ndiaye (UNICEF), Jumana Qamruddin (World Bank), Claudia Rokx
(World Bank). They each generously dedicated their time and effort, and their invaluable input
played an important role in the evolution of the series.
Partners. We would also like to give thanks to the following members of the task force of
development partner organizations, who provided guidance on the conceptualization, implemen-
tation and finalization of the series: Sophie Cowpplibony (REACH), Aissatou Dioum (UNICEF),
George Fom Ameh (UNICEF), Julie Desloges (Government of Canada), Aida Gadiaga (WFP),
Laylee Moshiri (UNICEF), Aminata Ndiaye (Government of Canada), Marie Solange N’Dione
(Consultant), and Victoria Wise (REACH).
Client. Finally, our greatest appreciation is extended to the dedicated staff of the CLM, whose
work is chronicled in the series, and the thousands of health workers and volunteers who are
daily delivering life-saving nutrition services to vulnerable populations throughout Senegal.
This work was conducted under the guidance of Menno Mulder-Sibanda (Task Team Lead and
Senior Nutrition Specialist, World Bank). The series was prepared by a team led by Andrea L.
Spray (Consultant). Aaron Buchsbaum (World Bank) supported publishing and dissemination,
along with Janice Meerman (Consultant) and Laura Figazzolo (Consultant). Information regard-
ing the financial support for the series is provided at the end of the report.
About the Series
T
he government of Senegal, through the Cellule de Lutte contre la Malnutrition (Nutrition
Coordination Unit) (CLM) in the Prime Minister’s Office is embarking on the development
of a new Plan Stratégique Multisectoriel de Nutrition (Multisectoral Strategic Nutrition
Plan) (PSMN), which will have two broad focus areas: (1) expanding and improving nutrition ser-
vices; and (2) a reform agenda for the sector. The reform agenda will include policy reorientation,
governance, and financing of the PSMN. The PSMN will discuss the framework and timeline for
the development of a nutrition financing strategy, which will require specific analysis of the sector
spending and financial basis, linking it to the coverage and quality of nutrition services.
Senegal is known for having one of the most effective and far-reaching nutrition service delivery
systems in Africa. Chronic malnutrition has dropped to less than 20 percent, one of the lowest in
continental Sub-Saharan Africa. Government ownership of the nutrition program has grown from
US$0.3 million a year in 2002 to US$5.7 million a year in 2015, increasing from approximately
0.02 percent to 0.12 percent of the national budget. Yet, these developments have not led to
enhanced visibility of nutrition-sensitive interventions in relevant sectors such as agriculture,
education, water and sanitation, social protection, and health. The absence of nutrition-sensitive
interventions in the relevant sectors, combined with the recent series of external shocks, has
favored continued fragmentation of approaches, discourse, and interventions that address nutri-
tion. In addition, there is no overall framework for investment decision making around nutrition,
which puts achievements made to date in jeopardy. Meanwhile, nutrition indicators are stagnat-
ing and other issues with major implications (such as low birth weight, iron deficiency anemia,
maternal undernutrition, and acute malnutrition) have received little or no attention.
A review of policy effectiveness can help raise the importance of these issues, including house-
hold and community resilience to food and nutrition insecurity shocks, as a new priority in nutrition
policy development. This series of analytical and advisory activities, collectively entitled Analysis
& Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal (“the se-
ries”), aims to support the government of Senegal in providing policy and strategic leadership for
nutrition. Further, the series will inform an investment case for nutrition (The Case for Investment
in Nutrition in Senegal) that will: (1) rationalize the use of resources for cost-effective interven-
tions; (2) mobilize actors and resources; (3) strengthen the visibility of nutrition interventions in
different sectors; and (4) favor synergy of interventions and investments.
The series was produced with guidance from a task force of development partner organizations
under the leadership of the World Bank, and in close collaboration with the CLM. The task force
comprised representatives from the following organizations: Government of Canada, REACH,
UNICEF and the World Bank.
Documents in the series:
Report Description
Nutrition Situation in Senegal An analysis of the nutritional status of key demographic groups in
Marc Nene Senegal, including the geographic and sociodemographic inequalities
in nutrition outcomes and their determinants.
Evolution of Nutrition Policy in An historical analysis of the nutrition policy landscape in Senegal,
Senegal including the evolution of nutrition policies and institutions and
Andrea L. Spray their respective implications for programming and prioritization of
interventions.
Political Economy of Nutrition An analysis of the policy and political levers that can be used
Policy in Senegal in Senegal to foster government leadership and galvanize the
Ashley M. Fox intersectoral coordination needed to mainstream nutrition into
government policies and programs, and effectively, efficiently, and
sustainably deliver nutrition interventions.
Nutrition Financing in Senegal An analysis of the allocated funding to nutrition interventions in
Marie-Jeanne Offosse N. Senegal from 2016 to 2019, estimates of budgetary capacity for
financing nutrition by government, and estimated costs for selected
high-impact interventions.
Capacities of the Nutrition Sector An analysis of the organizational and institutional capacities for
in Senegal addressing nutrition in Senegal, covering the CLM, key ministries, and
Gabriel Deussom N., Victoria other stakeholders contributing to improvements in nutrition at the
Wise, Marie Solange Ndione, central, regional, and local levels.
Aida Gadiaga
Cost and Benefits of Scaling Up Analysis of the relative costs and effectiveness of alternative scenarios
Nutrition Interventions in Senegal for scaling up nutrition interventions in Senegal over the five years
Christian Yao covering the PSMN.
Risks for Scaling Up Nutrition in Analysis of the potential risks to the scale-up of nutrition in Senegal,
Senegal their likelihood of occurrence, potential impact, and potential mitigation
Babacar Ba measures.
A Decade of World Bank Support The World Bank Independent Evaluation Group Project Performance
to Senegal’s Nutrition Program Assessment Report, which evaluates the extent to which World Bank
Denise Vaillancourt operations supporting nutrition in Senegal from 2002–14 achieved their
intended outcomes and draws lessons to inform future investments.
Acronyms
Acronym English Acronyme Français
CLM Nutrition Coordination Unit CLM Cellule de Lutte contre la
Malnutrition
DBM Double Burden of Malnutrition DFM Double Fardeau de la Malnutrition
DHS Demographic and Health EDS Enquête sur la Démographique et
Surveys la Santé
DPNDN National Policy for the DPNDN Document de Politique National de
Development of Nutrition Développement de la Nutrition
FAO Food and Agriculture FAO Organisation des Nations Unies
Organization of the United pour l’Alimentation et l’Agriculture
Nations
GDP Gross Domestic Product PIB Produit Intérieur Brut
MICS Multiple Indicators Cluster MICS Enquête à Indicateurs Multiples
Survey
NCD Noncommunicable Disease MNT Maladie Non-Transmissible
PSMN Multisectoral Strategic Nutrition PSMN Plan Stratégique Multisectoriel de
Plan la Nutrition
REACH Renewed Efforts Against Child REACH Efforts renouvelés contre la faim
Hunger and undernutrition et la sous-alimentation
SUN Scaling Up Nutrition Movement SUN Mouvement pour le Renforcement
de la Nutrition
UNICEF United Nations Children’s Fund UNICEF Fonds des Nations Unies pour
l’enfance
WFP World Food Programme PAM Programme Alimentaire Mondial
WHA World Health Assembly AMS Assemblée Mondiale de la Santé
WHO World Health Organization OMS Organisation Mondiale de la Santé
Unless otherwise indicated, child nutrition indicators referenced in this report are taken from the UNICEF-
WHO-World Bank Joint Child Malnutrition Estimates1.
Contents
Executive Summary 1
Introduction 3
Data Sources 7
Regional and Global Comparisons of Maternal and Child Nutrition 9
National Trend of Nutrition Indicators and Progress Toward the WHA 2025 Goals 15
Geographic and Sociodemographic Inequalities in Undernutrition Outcomes 19
Conclusion 25
Endnotes 27
References 29
List of Boxes
Box 1: The Relationship Between Income and Malnutrition 10
List of Figures
Figure 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa 11
Figure 2: Stunting in Children by Per Capita GDP 14
Figure 3: Overweight in Women by Per Capita GDP 14
Figure 4: Senegal’s Seasonal Calendar 16
Figure 5: Trends in Child Anthropometric Indicators in Senegal, 2000–14 16
Figure 6: Trends in Prevalence of Anemia in Senegal 2005–14 17
Figure 7: Trends in Prevalence of Exclusive Breastfeeding in Senegal 2010–14 17
Figure 8: Senegal’s Progress Toward the WHA 2025 Goals 18
Figure 9: Sociodemographic Disparities in Stunting of
Children Under Five in Senegal, 2000–14 22
Figure 10: Concentration Curves for Stunting in Senegal, 2000–14 23
List of Maps
Map 1: Population and Poverty in Senegal by Region, 2002–13 5
Map 2: Prevalence of Stunting Among Children Under Five by
Region of Senegal, 2005–14 20
Map 3: Prevalence of Wasting Among Children Under Five by
Region of Senegal, 2005–14 21
Photo: Adama Cissé/CLM
viii Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
Executive Summary
T
he government of Senegal’s engagement in result is a de facto divide in poverty between the north
the nutrition sector has steadily increased over and the south.
the past two decades, with the result that the
rate of child stunting, in particular, has improved dra- As with economic performance, the prevalence of
matically. The prevalence of under-five stunting has child stunting evolved in two major phases, with a
dropped to less than 20 percent, one of the lowest steep drop followed by recent stagnation. The preva-
prevalence rates in Sub-Saharan Africa. The objective lence of child stunting in Senegal is much lower than
of this report is to support the government of Senegal that observed in other countries with the same level
in the development of its Plan Stratégique Multisec- of income. However, progress against other forms of
toriel de la Nutrition (Multisectoral Strategic Nutrition malnutrition are mixed. The prevalence of under-five
Plan) (PSMN) by providing a detailed analysis of the wasting remained virtually stagnant between 2000 and
nutritional status of children under five and women of 2012–13. With over one-fifth of women of reproductive
reproductive age. More specifically, the report aims age underweight, Senegal has the fifth highest prev-
to describe the geographic and sociodemographic in- alence in Sub-Saharan Africa. With nearly two-thirds
equalities of various forms of malnutrition in Senegal of children under five suffering from anemia, Senegal
and their determinants. ranks in the middle of countries in Sub-Saharan Afri-
ca for under five anemia. Senegal ranks particularly
Since 2005, various shocks in Senegal, including the poorly in Sub-Saharan Africa in the prevalence of ane-
2008 global food, fuel, and financial crises, and a se- mia among women of reproductive age. However, the
ries of droughts, have contributed to uneven economic prevalence of all forms of anemia among both children
performance marked by poor economic growth. There ages 6 to 59 months and women ages 15 to 49 years
are marked regional disparities in the trend and a prev- has been decreasing steadily since 2005.
alence of poverty. The poverty headcount has declined
in the western and northern regions of the country and While its nutrition profile is still dominated by under-
in the central region of Diourbel, while simultaneously nutrition issues, Senegal is in the midst of a nutrition
increasing in some regions in the south and east. The transition and increasingly facing the double burden
Nutrition Situation in Senegal
1
of malnutrition (DBM), the coexistence of both under- in the reduction in child stunting between 2000 and
nutrition and overnutrition. Over one-fifth of women 2005, urban areas, male children, and the wealthiest
ages 15 to 49 years were estimated to be overweight socioeconomic groups benefited most.
or obese; the prevalence of overweight or obesi-
ty among women of reproductive age in Senegal is There are important regional disparities in the preva-
slightly higher than would be expected at its income lence of child wasting as well. However, the regions of
level. However, the proportion of children under five Saint-Louis and Louga, which have some of the lowest
who are overweight or obese has declined. prevalence rates of poverty and child stunting have,
along with the region of Tambacounda, consistently
As with poverty incidence, regional disparities in child exhibited the highest prevalence rates of child wasting.
stunting show a north-south divide, with the regions in Anemia among women of reproductive age remains a
the north and west exhibiting much lower prevalence severe public health problem in all regions of Senegal
rates than the regions in the center and the south. This despite improvement in some regions between 2005
north-south divide in child stunting has persisted for and 2010. Therefore, one of the key characteristics of
the past decade and has increased in recent years. nutrition outcomes in Senegal is their marked hetero-
Although almost all sociodemographic groups shared geneity across regions.
2 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
1
Introduction
I
n Senegal, the government’s engagement in the nu- problems with major implications, such as low birth
trition sector and the fight against malnutrition have weight, iron deficiency anemia, maternal undernutri-
steadily increased over the past two decades, trans- tion, and acute malnutrition, have received little or no
lating into, among other things, (1) the establishment attention, seriously threatening to reverse the gains
in 2001 of the Cellule de Lutte contre la Malnutrition achieved over the past several decades in the fight
(Nutrition Coordination Unit) (CLM) and its Bureau against malnutrition.
Exécutif National (National Executive Bureau); (2) an
increase in the government’s budget allocation to nu- Recognizing the need to strengthen the multisectoral
trition from an estimated US$0.3 million per year in approach to malnutrition in order to boost and sus-
2002 to US$5.7 million per year in 2015, increasing tain the improvement in the nutritional status of its
from approximately 0.02 percent to 0.12 percent of the communities, the government of Senegal joined the
national budget; and (3) the scaling up of communi- Scaling Up Nutrition (SUN)2 Movement in 2011 and
ty-based nutrition interventions. Nutrition indicators adopted the Renewed Efforts Against Child Hunger
improved in general as a result, and child stunting, in and undernutrition (REACH)3 approach in 2014. Fur-
particular, dropped to less than 20 percent, one of the thermore, the government of Senegal has adopted a
lowest prevalence rates in Sub-Saharan Africa. new nutrition policy, Document de Politique National
de Développement de la Nutrition (National Policy
However, these developments have not been ac- for the Development of Nutrition) (DPNDN), for the
companied by enhanced visibility of nutrition in period from 2015 to 2025 and has embarked on
sectors such as agriculture, education, social pro- creating a multisectoral nutrition strategy. The Plan
tection, and water and sanitation. This situation, Stratégique Multisectoriel de Nutrition (Multisectoral
compounded by the recent series of economic and Nutrition Strategic Plan) (PSMN) will incorporate a
climatic shocks, has favored an ad hoc response to sectoral reform program that aims to expand the cov-
food and nutrition insecurity in the country and per- erage of nutrition services and improve their quality
petuated a fragmentation of approaches, discourse, and scale up pro-nutrition sector interventions with
and interventions. Moreover, several other nutrition proven impact.
Nutrition Situation in Senegal
3
Objective of the Report (ANSD 2014). The estimated 3.5 percent annual
average population growth in urban areas over the
The objective of this report is to support the govern- same period was twice as high as that estimated in
ment of Senegal in the development of the PSMN by rural areas, probably reflecting in part the massive,
providing a detailed analysis of the nutritional status well-documented rural exodus (Gueye, Fall, and Tall
of key target groups, notably children under five and 2015). Furthermore, the population is unevenly dis-
women of reproductive age. More specifically, the tributed among the regions of the country. Indeed,
current report seeks to highlight the main geographic in 2013, as shown in map 1, the western regions of
and sociodemographic inequalities in nutrition in Sen- Dakar and Thies and the central region of Diourbel,
egal to enable more equity-focused policymaking and taken together, are home to nearly half the country’s
programming and accelerate progress toward interna- total population.
tionally agreed objectives such as the World Health
Assembly (WHA) 2025 nutrition goals.4 Following the trend of the country’s economic
performance from 2000 to 2011, the poverty head-
count dropped substantially between 2001 and
Country Context 2005, before virtually stagnating between 2005
and 2011. The poverty headcount, based on the na-
Senegal’s economy rebounded in 1995 and grew tional poverty line, decreased from 55.2 percent in
steadily until 2005 before slowing down. After a 2001, to 48.3 percent in 2006, and then to 46.7 per-
devaluation of its currency in 1994, and thanks to cent in 2011 (ANSD 2013). Poverty reduction during
a series of structural reforms and better public fi - the 2000s was mainly an urban phenomenon, nota-
nance management that boosted the export of key bly during the first half of the decade, with the region
commodities such as groundnuts and phosphate, of Dakar experiencing the largest reduction from 38
Senegal’s gross domestic product (GDP) grew on percent in 2001 to 28 percent in 2006. In 2011, as a
average by 4.4 percent each year between 1995 result of a more modest reduction in the poverty head-
and 2005, well above its average annual population count in rural areas over the same period, from 65
growth over the same period and translating into percent in 2001 to 59 percent in 2006, and a general
an annual average per capita GDP growth rate of stagnation of poverty across the board in the second
1.8 percent (World Bank 2015). Since 2005, various half of the 2000s, the prevalence of poverty in Dakar
shocks, including the 2008 global food, fuel, and is nearly half the prevalence observed in rural areas
financial crises and a series of droughts in 2006, (ANSD 2014).
2007, and 2011 (WFP 2014; World Bank 2015),
have, among other factors, led to uneven econom- Map 1 shows the regional disparities in the prevalence
ic performance marked by an annual average GDP of poverty in 2006 and 2011. Overall, the poverty
growth of 3.2 percent, barely enough to keep up headcount declined in the regions in the western and
with population growth and leading to a virtual stag- northern parts of the country and in the central region
nation of per capita GDP growth, which registered of Diourbel. At the same time, the situation worsened
negative values in 2006, 2009, and 2011.5 in some of the regions in the south and in the east,
thus creating some de facto divide between the north
Senegal’s population grew at a fast pace be- and the south of the country.
tween 2002 and 2013, driven mainly by population
growth in urban areas and the western and cen- Poverty is also strongly associated with working in the
tral regions. Between the two most recent censuses agricultural sector, with most of the poor living on sub-
of 2002 and 2013, the population grew by nearly 50 sistence agriculture or employed in agriculture-related
percent or an annual average growth of 2.5 percent activities (World Bank 2015).
4 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
MAP 1:
Population and Poverty in Senegal by Region, 2002–13
a. Population, 2002 b. Population, 2013
Total number of inhabitants < 500000 500000–999999 1000000–1499999
1500000–1999999 ≥ 2000000
c. Poverty Headcount, 2006 d. Poverty Headcount, 2011
Poverty headcount (%) < 30 30–39 40–49 50–59 60–69 ≥ 70
0 70 140 280 420 560
Km
Source: Based on DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Nutrition Situation in Senegal
5
Photo: Adama Cissé/CLM
2
Data Sources
T
he data used for the analyses in this report The MICS and DHS surveys are nationally and region-
come mainly from a series of one Multiple ally representative and provide detailed household
Indicators Cluster Survey (MICS) and four level and individual level economic, social, health,
Demographic and Health Surveys (DHS) conduct- food, and nutrition data on children under the age of
ed between 2000 and 2014. The MICS survey was five and on women ages 15 to 49 years.
conducted between May 5 and July 11, 2000 (Govern-
ment of Senegal and UNICEF 2000). The four DHS Regional and global comparisons relied exclusive-
surveys were carried out (1) between February 1 and ly on DHS data for nutrition indicators6 and on other
June 10, 2005 (Ndiaye and Ayad 2006); (2) between open-source data such as the World Bank’s World De-
October 13, 2010, and April 28, 2011 (ANSD and ICF velopment Indicators7 and the United Nations World
2012), and which was combined with a MICS survey; Population Prospects (UN DESA 2015) for aggregate
(3) between September 15, 2012, and June 15, 2013 economic and population information.
(ANSD and ICF 2013); and (4) between January 21
and October 20, 2014 (ANSD and ICF 2015).
Nutrition Situation in Senegal
7
Photo: Adama Cissé/CLM
3
Regional and Global Comparisons
of Maternal and Child Nutrition
Although its nutrition profile is still dominated by However, the prevalence of anemia among children
undernutrition issues, Senegal is in the midst of under five was 60.3 percent in 2014, placing Senegal
a nutrition transition and increasingly facing the in the middle of the countries in Sub-Saharan Africa for
DBM. In absolute terms, the prevalence of child stunt- which DHS data are available. Furthermore, Senegal
ing in Senegal is one of the lowest in Sub-Saharan ranks particularly poorly in Sub-Saharan Africa in the
Africa. Indeed, with 18.7 percent of children under five prevalence of anemia among women ages 15 to 49
too short for their age in 2014, Senegal has the second years, estimated to be 54.3 percent in 2010–2011,9 the
lowest prevalence of child stunting in Sub-Saharan Afri- last time a DHS survey with such data was collected
ca, bested only by Gabon (figure 1, panel a). Even more for this demographic group. With the exception of The
impressive, Senegal’s performance for child stunting is Gambia and Gabon, Senegal has the highest preva-
much lower than would be expected at its national in- lence of anemia among women ages 15 to 49 years
come level (figure 2). By both global and Sub-Saharan (figure 1, panel b).
Africa standards, Senegal is one the best performers in
comparisons of indicators of child undernutrition, such Underweight of women is also an issue. Indeed,
as stunting, and national income levels as measured the prevalence of chronic energy deficiency or un-
by per capita GDP.8 Indeed, the prevalence of child derweight among women of reproductive age was
stunting in Senegal is much lower than that observed in estimated at 22 percent in 2010–2011, making Sen-
countries with the same level of income, such as Côte egal the country with the fifth highest prevalence in
d’Ivoire and Cambodia, and on par with the prevalence Sub-Saharan Africa.
in countries with much higher income levels such as
Ghana, a country with a per capita GDP nearly twice as Despite limited information, there are indications
high as Senegal’s, and Peru, whose per capita GDP is that the problems of overweight and obesity and
nearly five times as high. their related NCDs are increasingly prevalent in the
country. Data from the 2010–11 DHS show that 21.3
The relationship between income and malnutrition is percent of women ages 15 to 49 years were estimated
further explained in box 1. to be overweight or obese. The World Health Organiza-
Nutrition Situation in Senegal
9
BOX 1: The Relationship Between Income and Malnutrition
tion (WHO) STEPS survey10 carried out in 2015 shows Africa, such as Cameroon, Ghana, Kenya, and Togo,
that hypertension affects 24 percent of the population, where the problem of overnutrition among women is of
2.1 percent have diabetes, and 19 percent have high much greater concern.
cholesterol. Estimates from WHO suggest that, togeth-
er, diabetes, cardiovascular diseases, and cancers are Overall, the nutrition profile of Senegal—characterized
responsible for nearly 20 percent of total adult deaths in by a moderate level of child stunting and low lev-
Senegal (WHO 2014). Furthermore, other surveys con- el of child overweight, high woman underweight and
ducted in the city of Dakar in 2009 and in the Saint-Louis anemia, and a slightly high level of overweight and
region in 2012 showed prevalence rates of type II di- obesity among women with growing rates of diet-relat-
abetes of 17.9 percent and 10.8 percent, respectively ed NCDs—is symptomatic of a country in the midst of
(Duboz et al. 2012; Seck et al. 2015). Another survey a nutrition transition (Popkin, Adair, and Ng 2012) and
conducted in 2010 in the city of Saint-Louis estimated suffering from the DBM at the population level (child
that 46 percent of the population ages 15 years and stunting and women overweight) (Subramanian, Per-
above suffered from high blood pressure, 36.3 percent kins, and Khan 2009), the household level (stunted child
from high cholesterol, and 15.7 percent from metabolic with overweight or obese mother) (Garrett and Ruel
syndrome (Pessinaba et al. 2013). 2005), and the individual level (overweight or obese
women suffering from anemia) (Asfaw 2007; Eckhardt
Contrary to what is observed with child stunting, the et al. 2007). This phenomenon has been observed in
prevalence of overweight or obesity among women countries experiencing a rapid economic transforma-
of reproductive age in Senegal is slightly higher than tion, which underlies a nutrition transition marked by a
would be expected at its income level (figure 3). In- decrease in physical activity, a shift in dietary patterns
deed, Senegal performs worse than countries with toward increased consumption of fats, meats, sugar,
higher income, such as Bangladesh and Cambodia, and refined grains, and a shift toward nutrition-related
but much better than many countries in Sub-Saharan NCDs (Popkin 1993; Popkin 1998; Popkin 2001).
10 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa
a. Children under age 5 stunting
Burundi 2010
Madagascar 2008
Malawi 2010
Ethiopia 2011
Rwanda 2010
Niger 2012
Benin 2006
Eritrea 2002
Congo, Dem. Rep. 2013
Mozambique 2011
Tanzania 2010
Zambia 2013
Lesotho 2009
Mali 2012
Sierra Leone 2013
Nigeria 2013
Burkina Faso 2010
Uganda 2011
Cameroon 2011
Zimbabwe 2010
Liberia 2013
Guinea 2012
Comoros 2012
Côte d’Ivoire 2012
São Tomé and Príncipe 2008
Swaziland 2006
Togo 2013
Kenya 2014
Gambia 2013
Congo, Rep. 2011
Namibia 2013
Ghana 2014
Senegal 2014
Gabon 2012
0 10 20 30 40 50 60
Percent
b. Anemia in women ages 15–49
Gabon 2012
Gambia 2013
Senegal 2010
Congo, Rep. 2011
Mozambique 2011
Côte d’Ivoire 2012
Mali 2012
Guinea 2012
Burkina Faso 2010
Togo 2013
Niger 2012
Sierra Leone 2013
São Tomé and Príncipe 2008
Ghana 2014
Benin 2012
Tanzania 2010
Cameroon 2011
Congo, Dem. Rep. 2013
Madagascar 2008
Swaziland 2006
Malawi 2010
Zimbabwe 2010
Lesotho 2009
Uganda 2011
Namibia 2013
Burundi 2010
Rwanda 2010
Ethiopia 2011
0 10 20 30 40 50 60
Percent
(continued on next page)
Nutrition Situation in Senegal
11
FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa (continued)
c. Children under age 5 overweight
Swaziland 2006
São Tomé and Príncipe 2008
Comoros 2012
Benin 2006
Malawi 2010
Sierra Leone 2013
Mozambique 2011
Gabon 2012
Lesotho 2009
Rwanda 2010
Cameroon 2011
Zambia 2013
Zimbabwe 2010
Madagascar 2004
Tanzania 2010
Kenya 2014
Congo, Dem. Rep. 2013
Nigeria 2013
Guinea 2012
Uganda 2011
Namibia 2013
Congo, Rep. 2011
Côte d’Ivoire 2012
Liberia 2013
Gambia 2013
Burundi 2010
Ghana 2014
Niger 2012
Burkina Faso 2010
Mali 2012
Togo 2013
Ethiopia 2011
Eritrea 2002
Senegal 2014
0 2 4 6 8 10
Percent
d. Women ages 15–49 overweight
Swaziland 2006
Gabon 2012
Lesotho 2009
Ghana 2014
Mauritania 2000
Comoros 2012
São Tomé and Príncipe 2008
Kenya 2014
Cameroon 2011
Namibia 2013
Zimbabwe 2010
Togo 2013
Benin 2012
Liberia 2013
Congo, Rep. 2011
Côte d’Ivoire 2012
Nigeria 2013
Zambia 2013
Gambia 2013
Tanzania 2010
Senegal 2010
Guinea 2012
Uganda 2011
Sierra Leone 2013
Mali 2012
Niger 2012
Malawi 2010
Mozambique 2011
Rwanda 2010
Congo, Dem. Rep. 2013
Burkina Faso 2010
Eritrea 2002
Burundi 2010
Chad 2004
Madagascar 2008
Ethiopia 2011
0 10 20 30 40 50
Percent
(continued on next page)
12 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa (continued)
e. Exclusive breastfeeding of children under 2
Rwanda 2010
Zambia 2013
Malawi 2010
Burundi 2010
Uganda 2011
Kenya 2014
Togo 2013
Liberia 2013
Lesotho 2009
Tanzania 2010
Ghana 2014
São Tomé and Príncipe 2008
Ethiopia 2011
Eritrea 2002
Madagascar 2008
Namibia 2013
Congo, Dem. Rep. 2013
Gambia 2013
Mozambique 2011
Mali 2012
Benin 2012
Senegal 2014
Swaziland 2006
Sierra Leone 2013
Zimbabwe 2010
Burkina Faso 2010
Niger 2012
Guinea 2012
Congo, Rep. 2011
Mauritania 2000
Cameroon 2011
Nigeria 2013
Côte d’Ivoire 2012
Comoros 2012
Gabon 2012
0 10 20 30 40 50 60 70 80 90
Percent
f. Children under age 5 wasting
Nigeria 2013
Niger 2012
Burkina Faso 2010
Eritrea 2002
Madagascar 2004
Mali 2012
Gambia 2013
Comoros 2012
São Tomé and Príncipe 2008
Ethiopia 2011
Guinea 2012
Sierra Leone 2013
Benin 2006
Congo, Dem. Rep. 2013
Côte d’Ivoire 2012
Togo 2013
Namibia 2013
Zambia 2013
Liberia 2013
Senegal 2014
Mozambique 2011
Congo, Rep. 2011
Burundi 2010
Cameroon 2011
Tanzania 2010
Uganda 2011
Ghana 2014
Malawi 2010
Kenya 2014
Lesotho 2009
Gabon 2012
Zimbabwe 2010
Rwanda 2010
Swaziland 2006
0 5 10 15 20
Percent
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Nutrition Situation in Senegal
13
FIGURE 2: Stunting in Children by Per Capita GDP
Prevalence of stunting (% of children under 5)
60
Yemen
Pakistan
40
Nigeria
Cote d’Ivoire
Kenya
Haiti Egypt
20 Senegal Ghana Gabon
Peru
0
0 5000 10000 15000 20000
GDP per capita, PPP (2011 internaional $)
Source: Based on data from World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world-
development-indicators; UN DESA 2015; DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Note: The sizes of the circles are proportional to the number of children under the age of five. The red lines indicate the model’s prediction.
FIGURE 3: Overweight in Women by Per Capita GDP
50
Honduras
Prevalence women overweight
40 Ghana
(% of women BMI >= 25.0)
Kenya
Cameroon
30 Togo
Cote d’Ivoire
20 Senegal Zambia
Cambodia
Bangladesh
Nepal
10
0
1000 2000 3000 4000 5000
GDP per capita, PPP (2011 internaional $)
Source: Based on data from World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world-
development-indicators; UN DESA 2015; DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Note: The sizes of the circles are proportional to the number of women ages 15 to 49 years. The red line indicates the model’s prediction.
14 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
4
National Trend of Nutrition
Indicators and Progress Toward the
WHA 2025 Goals
M
easures of nutritional status such as wast- National Trends
ing, stunting, and anemia have been shown
to exhibit seasonal variations, with preva- Similar to economic performance between 2000
lence rates generally surging during rainy seasons and 2014, the prevalence of stunting among chil-
and before the harvest as a result of food shortages, dren under the age of five evolved in two major
increased morbidity, and greater female participa- phases—a steep drop followed by stagnation
tion in the labor market (Martorell and Young 2012; (figure 5). From 2000 to 2005, child stunting dropped
Schwinger et al. 2014). Contrary to stunting, which is on average by 6 percent annually, falling from 26.8
less sensitive over the short run to shocks, wasting percent to 19.6 percent.11 Since 2005, considering
is a more transient condition and its prevalence can the anthropometric data from the 2010–11 DHS as
fluctuate considerably during the year (WHO, UNICEF, outliers,12 the prevalence of child stunting remained
and WFP 2014). As a result, prevalence of wasting es- virtually the same over the course of that decade,
timated with survey data at a single time point can be hovering around 19.0 percent until 2014. The average
a poor representation for conditions during the other estimates based on the DHS are 18.7 percent for both
periods of the year. The incidence rate is deemed a 2012–13 and 2014 surveys.13 However, the prelimi-
better indicator (Khara and Dolan 2014). nary results of the 2015 DHS put at 20.5 percent the
prevalence of child stunting (ANSD and ICF 2016).
The MICS and DHS surveys used for this analysis
were all conducted at different times of year, with some The prevalence of wasting among children under five,
not overlapping the lean and rainy season while others based on the available data, has virtually stagnated
overlapped partially or fully that period of peak in the between 2000 and 2012–13, hovering around 10.0
prevalence of child wasting (figure 4). In the following percent before dropping substantially in 2014. More
section, we will present the national trends in some specifically, the prevalence of child wasting fell from
nutrition indicators in Senegal. However, given the na- 9.7 percent in 2000, to 8.5 percent in 2005,14 and rose
ture of the surveys, the results should be interpreted to 8.8 percent in 2012–13. The estimate for the outlier
with caution, notably for wasting. year of 2010–11 was 10.1 percent. In 2014, the prev-
Nutrition Situation in Senegal
15
FIGURE 4: Senegal’s Seasonal Calendar
OCT OCT
NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP
Planting
Irrigated and market Rain-fed
Rain-fed harvest gardening harvest Lean season
harvest
Peak labor migration Rainy season
Livestock migration N to S
OCT OCT
NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP
Source: Famine Early Warning Systems Network (FEWS NET), http://www.fews.net/west-africa/senegal.
alence of child wasting was estimated at 5.9 percent above the median compared to the WHO child growth
with a lower bound for the 95 percent confidence in- standards, has declined since 2000 from 3.4 percent
terval at 4.9 percent, below the 5 percent maximum to 1.2 percent in 2014.
limit set for the WHA 2025 target. However, the pre-
liminary results of the Senegal 2015 DHS suggest a The prevalence of all forms anemia among both chil-
prevalence of global acute malnutrition or wasting of dren ages 6 to 59 months and women ages 15 to
7.8 percent and may signal a worsening situation. 49 years has been decreasing steadily since 2005.
Among children, anemia dropped by 27 percent, from
The proportion of children under five who are over- 82.6 percent in 2005 to 60.3 percent in 2014, an av-
weight or obese, as measured by a weight-for-height erage of 3.4 percent each year. Interestingly, Senegal
z-score superior to more than 2 standard deviations registered the most impressive progress very recent-
FIGURE 5: Trends in Child Anthropometric Indicators in Senegal, 2000–14
30
25
20
Percent
15
10
5
0
Stunting Wasting Overweight
2000 2005 2010–11 2012–13 2014
Source: Based on data from MICS for 2000 and DHS for all other years.
16 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
FIGURE 6: Trends in Prevalence of Anemia in Senegal 2005–14
a. Children under five anemia b. Women ages 15–49 anemia
90 70
80
60
70
50
60
50 40
Percent
Percent
40 30
30
20
20
10
10
0 0
Child Anemia Women Anemia
2005 2010–11 2012–13 2014
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
ly, between 2012–13 and 2014, with a 15.3 percent ready low prevalence of child overweight continues to
decrease in the prevalence of child anemia (figure 6, decline and can be considered under control as called
panel a). Among women, data are available only for for by the WHA goals.
the years 2005 and 2010–11, and the estimated prev-
alence of anemia suggests a very moderate decrease
from 59.1 percent to 54.3 percent15 or an average an- FIGURE 7:
Trends in Prevalence of Exclusive
nual rate of reduction of 1.7 percent (figure 6, panel b). Breastfeeding in Senegal 2010–14
The rate of exclusive breastfeeding in Senegal 45
(figure 1, panel e) is lower than that of many countries
40
in the Africa Region, with the prevalence declining
from an already low 39.0 percent in 2010–11 to 32.4 35
percent in 2014 (figure 7).16 30
25
Percent
Progress Toward the WHA 2025 Goals 20
15
At the current pace, Senegal is on course to reach
10
only the WHA 2025 goals related to child wasting and
child overweight (figure 8, panels b and c). Indeed, the 5
WHA calls for a reduction in the prevalence of child 0
wasting to under 5 percent. However, given the un- Exclusive Breastfeeding
certainty of the estimates of the prevalence of child 2010–11 2012–13 2014
wasting for the year 2014, it is plausible to argue that
Source: Based on data from DHS Program STATcompiler (database),
Senegal might already have reached that goal. The al- USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Nutrition Situation in Senegal
17
As for the other WHA goals—a reduction of 40 percent previously mentioned, the prevalence of child stunting
in the prevalence of child stunting (figure 8, panel a), an is stagnant at about 19 percent, and the country has
increase in the practice of exclusive breastfeeding to at experienced a relative setback over the past couple of
least 50 percent (figure 8, panel d), and a 50 percent years with a retreat in the practice of exclusive breast-
decrease in the prevalence of anemia among women feeding. The available data on women anemia suggest
of reproductive age (figure 8, panel e)—Senegal is that, at the current rate of decline, the prevalence of
gravely off course and will not reach these goals unless anemia in that demographic group will be about 42 per-
there is a dramatic increase in the pace of progress. As cent in 2025, nearly twice the objective of 26 percent.
FIGURE 8: Senegal’s Progress Toward the WHA 2025 Goals
a. Children under age 5 stunting b. Children under age 5 wasting
20 18.7 18.7 10 8.8
8
15
6
Percent
Percent
4.9
10 11.2 5.9
4
5
2
0 0
2012 2014 2025 2012 2014 2025
d. Exclusive breastfeeding
c. Children under age 5 overweight children under 6 months
1.5 1.4 50
1.2 50
1.4 37.5
40
32.4
1.0
30
Percent
Percent
20
0.5
10
0 0
2012 2014 2025 2012 2014 2025
e. Women ages 15–49 anemia
59.1
60 54.3
50
42.1
40
Percent
30
26.2
20
10
0
2012 2014 2025
Actual trend Required trend Projected trend
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Note: Unlike the other goals depicted here, for which the prevalence ideally should drop, the goal for exclusive breastfeeding is to increase in prevalence.
18 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
5
Geographic and Sociodemographic
Inequalities in Undernutrition
Outcomes
Geographic Disparities a general stagnation in the prevalence of child stunt-
ing in Senegal since 2005, the evolution at the regional
Overall, the regional inequalities in child stunting level has been uneven with some regions experiencing
show a north-south divide along the poverty inci- marked decreases while others stagnated or saw some
dence lines with the regions in the north and west increase. The impressive drop in child stunting experi-
exhibiting much lower prevalence rates than the enced by Senegal between 2000 and 2005 was mostly
regions in the center and the south. Map 2 depicts driven by improvements in the densely populated west-
the regional disparities in child stunting for each of the ern and central regions. Indeed, child stunting in regions
years 2000, 2005, 2012, and 2014. For consistency such as Dakar, Thies, Fatick, and Kaolack was more than
and to better appreciate trends at the regional level, halved during that period of time. All other regions also
the administrative organization of Senegal that existed saw some decrease in child stunting, with the exception
before 2002 is used.17 In 2014, the prevalence of child of Saint-Louis and Kolda. Since 2005, the northern re-
stunting in each of the northern, western, and west- gions have shown a consistent decline in child stunting,
ern half of the central regions of the country, namely with the prevalence in Saint-Louis dropping by half to
Saint-Louis, Louga, Diourbel, Thies, Fatick, and Da- about 14 percent in 2014. On the contrary, the region of
kar, was below 20 percent. However, in the southern Kaolack has seen a reversal of fortune with a steady in-
regions and the eastern half of the central region, the crease in the prevalence of child stunting between 2005
estimated prevalence of child stunting was deemed and 2014. Over the same period, progress in the west-
moderate, fluctuating between 20 and 29 percent, with ern regions and the regions of Diourbel and Fatick has
the exception of the extremely poor region of Kolda, stalled or has been inconsistent. Similarly, the region of
which exhibited a high prevalence of about 36 per- Tambacounda has seen no progress at all, while Kolda
cent. This north-south divide shows that child stunting remained a high prevalence area, thus increasing the
is strongly correlated with household income. gap between the north and the south.
The north-south divide for the prevalence of child Child wasting is less correlated with household
stunting has increased over the past decade. Despite income and has historically been a serious con-
Nutrition Situation in Senegal
19
MAP 2: Prevalence of Stunting Among Children Under Five by Region of Senegal, 2005–14
a. 2000 b. 2005
22.1%
25.4% 20.1% 28.1%
23.2% 9.2%
24% 27.6% 11% 19.2%
31.8% 16.1%
31.9% 19.2%
32.3% 29.1%
26% 35.6% 39.3%
18.4%
c. 2012 d. 2014
17.6% 16.4% 15.1% 13.5%
15.6% 12.2%
13.8%18.1% 18%
13.2%
21.8% 25.7%
13.8% 15.3%
27.7%
28%
15.1% 30% 20.7% 35.7%
Children under five (%) < 20 : Low prevalence 20–29 : Medium prevalence
30–39 : High prevalence ≥ 40 : Very high prevalence
0 70 140 280 420 560
Km
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
dition in the regions of Saint-Louis, Louga, and ing than the relatively better-off regions of Saint-Louis
Tambacounda. Map 3 shows the prevalence of child and Louga.
wasting in the regions of Senegal at different points
since 2000. As for child stunting, each survey shows Anemia among women of reproductive age is a se-
important regional disparities in the prevalence of vere public health problem in all regions despite
child wasting. However, the regions of Saint-Louis and improvement in some regions between 2005 and
Louga, which have some of the lowest rates of pover- 2010. Data from the 2010 DHS suggest that women
ty and child stunting and which experienced a strong ages 15 to 49 years are overburdened with anemia
reduction in stunting since 2005, have, along with in all regions of Senegal. Indeed, in all regions, the
the region of Tambacounda, consistently exhibited prevalence of anemia among women of reproduc-
the highest prevalence of child wasting in the coun- tive age is beyond the 40 percent critical threshold
try, hovering between 10 and 14 percent. The other for a severe public health problem. Between 2005
regions have shown considerable fluctuation in the and 2010, all regions experienced various degrees
prevalence of wasting between the different surveys of decrease in the prevalence rate of anemia among
as could be expected with such an indicator. Kolda, women with the exception of the regions of Dakar,
the region with the highest poverty incidence, has Tambacounda, and Matam, where the prevalence in-
consistently shown a lower prevalence of child wast- creased considerably.
20 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
MAP 3: Prevalence of Wasting Among Children Under Five by Region of Senegal, 2005–14
a. 2000 b. 2005
6.7% 13.4% 13% 12.7%
7.3% 6.6%
6.3% 11.3% 6% 9.3%
17.6% 9.1% 6.6%
10.4%
13% 11.5%
3.3% 9.3% 5.6% 8.9%
c. 2012 d. 2014
14% 11% 7.2% 10.5%
5% 4% 1.3%
9% 4.5% 4.2%
10% 11% 8.3%
4.6%
12% 10.4%
10% 10% 2% 3.9%
Children under five (%) < 5 : Acceptable 5–9 : Poor
10–14 : Serious ≥ 15 : Critical
0 70 140 280 420 560
Km
Source: Based on DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Sociodemographic Inequalities 11 percent in 2005, it declined by only 20 percent in ru-
ral areas over the same period, from 30 percent to 24
Although almost all sociodemographic groups percent (figure 9, panel a). Since 2005, the prevalence
shared in the reduction in child stunting between rates in both areas have remained stable hovering at
2000 and 2005, urban areas, male children, and the about 12 percent in urban areas and 23 percent in ru-
wealthiest socioeconomic groups benefited most. ral areas. Thus children in rural areas bear a burden
Figure 9 shows the trends in the prevalence of child stunt- twice that of those living in urban areas.
ing among various sociodemographic groups. Overall,
the prevalence of child stunting among all sociodemo- The gender gap drastically narrowed between 2000
graphic groups followed the same trends as the national and 2005 with male children experiencing a drop in
prevalence. Although some groups benefited more during the prevalence rate to a level on par with that ob-
the period of rapid decline from 2000 to 2005, prevalence served among female children (figure 9, panel b).
rates across almost all demographics have stagnated Although both female and male children saw a decline
since 2005, thus maintaining the status quo for inequality. in their respective prevalence rates between 2000 and
2005, the prevalence of stunting among boys fell from
In urban areas, although the prevalence of child stunt- 30 percent in 2000 to 21 percent in 2005, within the
ing was nearly halved from about 21 percent in 2000 to margin of error of the 19 percent prevalence estimated
Nutrition Situation in Senegal
21
FIGURE 9: Sociodemographic Disparities in Stunting of Children Under Five in Senegal, 2000–14
a. By place of residence b. By gender
35 35
30 30
25 25
Percent
Percent
20 20
15 15
10 10
5 5
0 0
2000 2005 2012–13 2014 2000 2005 2012–13 2014
Urban Rural Boys Girls
c. By wealth d. By education level
40 30
35
25
30
20
25
Percent
Percent
20 15
15
10
10
5
5
0 0
2000 2005 2012–13 2014 2000 2005 2012–13 2014
Poorest quintile Richest quintile No education Primary or more
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
among girls in 2005. The prevalence rates among both Because the drop in child stunting between 2000 and
boys and girls have stagnated since 2005 without any 2005 was weighted toward the wealthiest socioeco-
significant difference between the groups. nomic groups, as evidenced by trends in urban areas
and the richest quintiles (figure 9, panels a and c), the
As for the association of child stunting with the mother’s distribution of the burden of child stunting became more
level of education (figure 9, panel d), the prevalence unequal during that period (figure 10, panel a). How-
among children of women without any education is ever, between 2005 and 2012, the DHS data suggest
about 1.5 times higher than the prevalence of stunting an increase of the prevalence of child stunting in the
among the children of women who have completed at richest quintiles while the drop continued among the
least primary school. Furthermore, the gap between poorest quintiles (figure 9, panel c), thus resulting in a
the two groups has not changed since 2000, although less unequal distribution of the burden (figure 10, panel
the prevalence rate for both groups exhibited a down- b). More recent data from 2014, however, suggest an
ward trend between 2000 and 2005 before stagnating. increasing gap between the poorest and richest quin-
tiles (figure 9, panel c), suggesting a worsening of the
Panel c of figure 9 shows a social gradient of child distribution of the burden of child stunting in Senegal
stunting, with children in the poorest quintile exposed (figure 10, panel c) to the detriment of less advantaged
to a risk of stunting at least twice, and as much as three groups, notably in the rural areas, where poverty is
times, as high as that for children in the richest quintile. most concentrated (figure 9, panels a and c).
22 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
FIGURE 10: Concentration Curves for Stunting in Senegal, 2000–14
a. 2000–05 b. 2005 to 2012–13
100 100
Cumulative share of children
Cumulative share of children
under five stunted (%)
under five stunted (%)
80 80
60 60
40 40
20 20
0 0
0 20 40 60 80 100 0 20 40 60 80 100
Cumulative share of population Cumulative share of population
(poorest to richest) (%) (poorest to richest) (%)
2000 2005 Line of equality 2005 2012–13 Line of equality
c. 2012–13 to 2014
100
Cumulative share of children
under five stunted (%)
80
60
40
20
0
0 20 40 60 80 100
Cumulative share of population
(poorest to richest) (%)
2012–13 2014 Line of equality
Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.
Nutrition Situation in Senegal
23
Photo: Adama Cissé/CLM
24 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
6
Conclusion
A
key characteristic of nutrition outcomes in malnutrition and to design regionally appropriate strat-
Senegal is their marked heterogeneity across egies to overcome them. Given Senegal’s progression
regions. A crucial step in furthering the fight along the nutrition transition, a robust analysis includ-
against malnutrition in Senegal requires each region to ing stunting, wasting, anemia, and overweight and
undertake research to understand its specific drivers of obesity for each region is recommended.
Nutrition Situation in Senegal
25
Photo: Adama Cissé/CLM
26 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
Endnotes
1. Joint Child Malnutrition Estimates, UNICEF (Unit- which specified a set of six global nutrition targets
ed Nations Children’s Fund), WHO (World Health to be reached by 2025: (1) a 40 percent reduction
Organization) and World Bank (accessed 2017), in stunting of children under five; (2) a 50 percent
http://datatopics.worldbank.org/child-malnutrition/ reduction in anemia in women of reproductive age;
2. The SUN Movement is a global movement that (3) a 30 percent reduction in low birth weight; (4) no
began in 2010 that unites various actors including increase in childhood overweight; (5) an increase
governments, civil society organizations, United in the rate of exclusive breastfeeding in the first six
Nations agencies, and the private sector in a re- months to at least 50 percent; and (6) reduce and
newed global effort to end malnutrition in all its maintain childhood wasting at less than 5 percent.
forms. The core principle of the SUN Movement 5. World Development Indicators (database),
is that actions across multiple sectors, at multiple World Bank, Washington, DC (accessed 2016),
levels and with multiple stakeholders are nec- http://data.worldbank.org/data-catalog/world-
essary to sustainably and substantially reduce development-indicators.
malnutrition (SUN 2015). 6. DHS Program STATcompiler (database), USAID,
3. REACH was established in 2008 by the Food and Washington, DC (accessed 2016), http://www.
Agriculture Organization of the United Nations statcompiler.com/en/.
(FAO), United Nations Children’s Fund (UNICEF), 7. World Development Indicators (database),
the World Food Programme (WFP), and the World World Bank, Washington, DC (accessed 2016),
Health Organization (WHO) to assist governments http://data.worldbank.org/data-catalog/world-
of countries with a high burden of child and ma- development-indicators.
ternal undernutrition to develop capacities and 8. Measured using purchasing power parity.
coordinate actions to accelerate the scale-up of 9. DHS Program STATcompiler (database), USAID,
food and nutrition interventions (REACH 2012). Washington, DC (accessed 2016), http://www.
4. In 2012 the World Health Assembly (WHA) Resolu- statcompiler.com/en/.
tion 65.6 endorsed a comprehensive implementation 10. The WHO STEPwise approach to Surveillance
plan for maternal, infant, and young child nutrition, (STEPS) is a standard protocol for collecting, an-
Nutrition Situation in Senegal
27
alyzing, and disseminating data in WHO member 15. DHS Program STATcompiler (database), USAID,
countries. World Health Organization, http://www. Washington, DC (accessed 2016), http://www.
who.int/chp/steps/en/. statcompiler.com/en/.
11. DHS Program STATcompiler (database), USAID, 16. DHS Program STATcompiler (database), USAID,
Washington, DC (accessed 2016), http://www. Washington, DC (accessed 2016), http://www.
statcompiler.com/en/. statcompiler.com/en/.
12. There is anecdotal evidence that the anthropomet- 17. Before 2002, Senegal had 10 administrative re-
ric data from the 2010–11 DHS survey were poorly gions: Dakar, Ziguinchor, Diourbel, Saint-Louis,
collected. Furthermore, several partial surveys Tambacounda, Kaolack, Thies, Louga, Fatick,
conducted during the same period did not confirm and Kolda. In 2002, an administrative reform di-
the results of the 2010–11 DHS survey, which ap- vided the region of Saint-Louis into two regions:
pears invariably as an outlier in all the analyses Saint-Louis and Matam, increasing the number
we performed. of regions to 11. In 2008, another reform divided
13. DHS Program STATcompiler (database), USAID, the region of Kolda into Kolda and Sedhiou, Tam-
Washington, DC (accessed 2016), http://www. bacounda into Tambacounda and Kedougou, and
statcompiler.com/en/. Kaolack into Kaolack and Kaffrine, increasing the
14. DHS Program STATcompiler (database), USAID, number of regions to 14.
Washington, DC (accessed 2016), http://www.
statcompiler.com/en/.
28 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
References
Alderman, H., L. Haddad, D.D. Headey, and L. Smith. ——— . 2013. Enquête Démographique et de Santé
2014. “Association between Economic Growth and Continue (EDS: 2012–13). Calverton, Maryland,
Early Childhood Nutrition.” Lancet Global Health 2 U.S.: ANSD and ICF.
(9): e500.
——— . 2015. Enquête Démographique et de Santé
ANSD (Agence Nationale de la Statistique et de Continue (EDS: 2014). Calverton, Maryland, U.S.:
la Démographie). 2008. Résultats Définitifs du ANSD and ICF.
Troisième Recensement Général de la Population
et de l’Habitat (2002). Dakar, Sénégal: ANSD. ——— . 2016. Enquête Démographique et de Santé
Continue (EDS: 2015): Rapport sur les Indicateurs
——— . 2013. Deuxième Enquête de Suivi de la Pau- Clés 3ème Année. Calverton, Maryland, U.S.:
vreté au Sénégal (ESPS-II 2011): Rapport Définitif. ANSD and ICF.
Dakar, Sénégal: ANSD.
Asfaw, A. 2007. “Micronutrient Deficiency and the Prev-
——— . 2014. Rapport Définitif: Recensement Général alence of Mothers’ Overweight/Obesity in Egypt.”
de la Population et de l’Habitat, de l’Agriculture et Economics & Human Biology 5 (3): 471–83.
de l’Elevage (RGPHAE) 2013. Dakar, Sénégal:
ANSD. Bershteyn, A., H.M. Lyons, D. Sivam, and N.P. Myhr-
vold. 2015. “Association between Economic
ANSD (Agence Nationale de la Statistique et de la Growth and Early Childhood Nutrition.” Lancet
Démographie) and ICF International. 2012. En- Global Health 3 (2): e79-e80.
quête Démographique et de Santé à Indicateurs
Multiples au Sénégal (EDS-MICS 2010–11). Duboz, P., N. Chapuis-Lucciani, G., and L. Gueye.
Calverton, Maryland, U.S.: ANSD and ICF. 2012. “Prevalence of Diabetes and Associated
Nutrition Situation in Senegal
29
Risk Factors in a Senegalese Urban (Dakar) Pop- Ndiaye, S., and M. Ayad. 2006. Enquête Démo-
ulation.” Diabetes & Metabolism 38 (4): 332–36. graphique et de Santé au Sénégal 2005. Calverton,
Maryland, U.S.: Centre de Recherche pour le
Eckhardt, C.L., L.E. Torheim, E. Monterrubio, S. Développement Humain et ORC Macro.
Barquera, and M.T. Ruel. 2007. “The Overlap of
Overweight and Anaemia among Women in Three Pessinaba, S., A. Mbaye, G.A.D. Yabéta, H. Harouna,
Countries Undergoing the Nutrition Transition.” A.E. Sib, A.D. Kane, M. Bodian, M.B. Ndiaye, M.
European Journal of Clinical Nutrition 62 (2): Mbaye-Ndour, and K. Niang. 2013. “Enquête de
238–46. prévalence des facteurs de risque cardiovasculaire
en population générale à Saint-Louis (Sénégal).” An-
Ezzati, M., S. Vander Hoorn, C.M.M. Lawes, R. Leach, nales de Cardiologie et d’Angéiologie 62 (4): 253–58.
W.P.T. James, A.D. Lopez, A. D., A. Rodgers,
and C.J.L. Murray. (2005). “Rethinking the ‘Dis- Popkin, Barry M. 1993. “Nutritional Patterns and Tran-
eases of Affluence’ Paradigm: Global Patterns of sitions.” Population and Development Review 19
Nutritional Risks in Relation to Economic Devel- (1): 138–57.
opment.” PLoS Medicine 2 (5): e133. https://doi.
org/10.1371/journal.pmed.0020133. ——— . 1998. “The Nutrition Transition and its Health
Implications in Lower-Income Countries.” Public
Garrett, J.L., and M T. Ruel. 2005. “Stunted Child–Over- Health Nutrition 1 (1): 5–21.
weight Mother Pairs: Prevalence and Association
with Economic Development and Urbanization.” ——— . 2001. “The Nutrition Transition and Obesity in
Food & Nutrition Bulletin 26 (2): 209–21. the Developing World.” Journal of Nutrition 131
(3): 871S–873S.
Government of Senegal and UNICEF (United Nations
Children’s Fund). 2000. Rapport de l’Enquete sur Popkin, Barry M., L.S. Adair, and S.W. Ng. 2012.
les Objectifs de la Fin de Décennie sur l’Enfance “Global Nutrition Transition and the Pandemic of
(MICS II 2000). Dakar, Senegal: Direction de la Obesity in Developing Countries.” Nutrition Re-
Prévision et de la Statistique and UNICEF. views 70 (1): 3–21.
Gueye, Cheikh, A.S. Fall, and S.M. Tall. 2015. “Da- REACH. 2012. “REACH Renewed Efforts Against
kar, Touba and the Senegalese Cities Network Child Hunger and undernutrition.” REACH Part-
Produced by Climate Change.” Current Opin- nership (accessed July 6, 2016), http://www.
ion in Environmental Sustainability 13 (April): reachpartnership.org/home.
95–102.
Ruel, M.T., and H. Alderman. 2013. “Nutrition-Sensitive
Khara, T., and C. Dolan. 2014. “Associations between Interventions and Programmes: How Can They
Wasting and Stunting: Policy, Programming and Help to Accelerate Progress in Improving Maternal
Research Implications.” Technical Briefing Paper, and Child Nutrition?” Lancet 382 (9891): 536–51.
Emergency Nutrition Network, Oxford, England, U.K.
Schwinger, C., T.M. Lunde, P. Andersen, H. Kismul,
Martorell, R., and M.F. Young. 2012. “Patterns of Stunt- and J.V. Broeck. 2014. “Seasonal and Spatial
ing and Wasting: Potential Explanatory Factors.” Factors Related to Longitudinal Patterns of Child
Advances in Nutrition: An International Review Growth in Bwamanda, DR Congo.” Earth Perspec-
Journal 3 (2): 227–33. tives 1 (1): 1–11.
30 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal
Seck, S.M., D.G. Dia, D. Doupa, A. Diop-Dia, I. Thiam, Vollmer, S., K. Harttgen, M.A. Subramanyam, J. Fin-
M. Ndong, and L. Gueye. 2015. “Diabetes Burden lay, S. Klasen, and S.V. Subramanian. 2014.
in Urban and Rural Senegalese Populations: A “Association between Economic Growth and Ear-
Cross-Sectional Study in 2012.” International Jour- ly Childhood Undernutrition: Evidence from 121
nal of Endocrinology, September 30. https://www. Demographic and Health Surveys from 36 Low-In-
ncbi.nlm.nih.gov/pmc/articles/PMC4605376/. come and Middle-Income Countries.” Lancet
Global Health 2 (4): e225-e234.
Subramanian, S.V., J.M. Perkins, and K.T. Khan. 2009.
“Do Burdens of Underweight and Overweight Co- WFP (World Food Programme). 2014. Senegal—Analyse
exist among Lower Socioeconomic Groups in globale de la vulnérabilité, de la sécurité alimentaire
India?” American Journal of Clinical Nutrition 90 et de la nutrition (AGVSAN). Rome: WFP.
(2): 369–76.
WHO (World Health Organization). 2014. Noncommu-
SUN (Scaling Up Nutrition). 2015. “SUN Country nicable Diseases: Country Profiles 2014. Geneva,
Approach.” Scaling Up Nutrition Movement (ac- Switzerland: WHO.
cessed July 6, 2016), http://scalingupnutrition.org/
about/sun-country-approach. WHO, UNICEF, and WFP. 2014. Global Nutrition
Targets 2025: Wasting Policy Brief. Geneva, Swit-
U.N. DESA (Department of Economic and Social Af- zerland: WHO.
fairs). 2015. World Population Prospects: 2015
Revision, vol. I: Comprehensive Tables. New York: World Bank. 2015. Senegal Poverty Assessment: Re-
United Nations. port No: ACS10625. Washington, DC: World Bank.
Nutrition Situation in Senegal
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1818 H Street, NW
Washington, DC 20433
Funding for the report was provided by the World Bank, the Government
of Canada and the Japanese Trust Fund for Nutrition.
The task force providing oversight of the series was composed of
members of the following organizations: