Child Anthropometrics and malnutrition. Interestingly, while rural areas face a higher burden of underweight and wasting, urban Malnutrition in Malawi areas have a higher prevalence of stunting, although the difference is not statistically In 2010/11, Malawi’s National Statistics Office, in significantly different (see Figure 1). collaboration with the World Bank, conducted the Third Integrated Household Survey (IHS3), which Figure 1: Malnutrition estimates, by rural and urban collects nationally representative data from 12,271 40   households on several dimensions of welfare and income-generating activities. The IHS3’ sample 30   Urban   forms the basis for wave 1 of the Integrated Rural   Household Panel Survey (IHPS). Wave 2 was 20   %   completed in 2013 and will be available in 2014. This note summarizes the anthropometric data and 10   resulting malnutrition indicators from IHS31. 0   Background: Child Anthropometrics Stunted   Underweight***   Wasted***   The three anthropometric indicators most often Note: *** Difference is significance at p<0.01 referenced for monitoring malnutrition in children are: stunting, or low height-for-age; underweight, Table 2 shows the regional averages for stunting, low weight-for-age; and wasting, low weight-for- underweight, and wasting among children under-5. height. More specifically, these figures represent All three indicators are significantly lower in the children whose height-for-age, weight-for-age, and Northern Region; 12, 39, and 29 percent of weight-for-height fall more than two standard children are stunted in the Northern, Central, and deviations below the median of internationally Southern regions, respectively. accepted growth standards. Thus, a child is labeled stunted if he or she has a height-for-age z- Table 2: Malnutrition estimates, by region score that is less than -2. Stunted  (%)   Underweight  (%)   Wasted  (%)   Table 1 shows the stunting, underweight, and Region   (SE)   (SE)   (SE)   wasting, prevalence estimates for Malawi. The North   12  (1)      2  (0)      2  (0)   data reveal that of children 6-59 months old, 31 Central     39  (2)      8  (1)      4  (1)   percent are stunted, 7 percent are underweight, South   29  (2)      6  (1)      3  (0)   and 3 percent suffer from wasting. Wasting is a measure of acute Table 1: Malnutrition estimates malnutrition; it typically results from   Prevalence  (%)    (Std.  Error)   severe cases of diarrhea or food insecurity, and thus looking at Stunted   31  (2)   geographic disparities in wasting Underweight   7    (1)   may help identify regions needing Wasted   3    (1)   immediate attention. The IHS3 was stratified by district and has 31 Geographic Differences in Malnutrition domains of analysis. The districts Looking at the data further, we can identify Neno, Phalombe, Dedza, and geographic areas with particularly high rates of Salima, all concentrated in the southern half of Malawi, have                                                                                                                 wasting prevalence estimates at 8 1 The final sample for this analysis included 7,714 children aged 6- 59 months. percent or above (see map).   Identifying Vulnerable Sub-Populations ownership of certain assets is strongly correlated In developing countries, boys typically exhibit with lowering all three malnutrition indicators. higher rates of malnutrition than girls. Uganda Children living in households without a refrigerator proves to be no exception; 34 percent of under-5 are more than twice as likely to be stunted, seven boys are stunted, compared to only 28 percent of times as likely to be underweight, and twice as under-5 girls (see Figure 3). likely to be wasted, than those whose households own a refrigerator (see Table 3). Similarly, Figure 3: Malnutrition estimates, by gender households owning a television have lower rates of 40   stunting, underweight, and wasting among children under-5. Boys   30   Girls   Table 3: Malnutrition and household assets %   20   Asset   Stunted     Underweight     Wasted     10                 TV  (%)   Owns  a  tv   26**      3***    2***     0   Stunted   Underweight   Wasted   No  tv   31**      7***    4***   Despite a consensus in the literature that children Fridge  (%)         living in households with female and/or educated heads tend to have better health outcomes, there Owns  a  fridge   14***   1***   2***   is no such difference observed for stunting, underweight, or wasting prevalence among No  fridge   31***   7***   4***   Malawian children. However, having a chronically Note: ** Difference is significant at p<0.05; *** Difference is ill household head is associated with higher rates significance at p<0.01 of wasting at 6 percent, compared to only 3 percent for children living with a healthy head of Analysis of the IHS3 anthropometric data suggests household. that Malawi faces a high burden of malnutrition, a conclusion that matches that of the current We used household consumption to create welfare literature. Identifying particularly vulnerable groups, quintiles. The poorest households are grouped such as children the Central and Southern regions, into the 1st quintile and the richest households fall boys, and those living in households without a into the 5th quintile. Overall, and perhaps refrigerator or television, can help policy makers surprisingly, we find no decrease in malnutrition as target nutrition programs more effectively. one moves from the poorest to the top quintile (see Figure 4). This brief was prepared by Ilana Seff, World Bank, Figure 4: Malnutrition estimates, by welfare quintile based on data collected by the National Statistics Stunted   Office as part of the Living Standards 0.6   Measurement Study – Integrated Surveys on 0.5   Underweight   Agriculture (LSMS-ISA) project. The full dataset is 0.4   available for download at NSO via Wasted   http://www.nsomalawi.mw/. 0.3   0.2   0.1   0     1st     2nd   3rd   4th   5th     (poorest)   (richest)   Although the welfare gradient does not seem to be associated with malnutrition, a household’s