GCRF-Measuring and Mapping the Prevalence and Patterning of Multiple Malnutrition in Young Children in West and Central Africa

Lead Research Organisation: Cardiff University
Department Name: Sch of Social Sciences

Abstract

Between 1990 and 2014, sub-Saharan Africa saw a 23% increase in the number of children experiencing stunting, with around 58 million children under 5 affected. Many of these children also experienced wasting, and the co-occurrence of these anthropometric deficits ("multiple malnutrition", MM) entail heightened morbidity risks. At household and community level, MM can refer to the co-existence of under- and over-nutrition, a pattern observed across many low and middle income countries (LMICs), and which the 2015 and 2016 Global Nutrition Reports have noted to be "the new normal". This project focuses on MM in young children in one of the world's poorest regions, the countries of West and Central Africa (WCA). Utilising data from existing household surveys from the 24 countries of WCA, the project will conduct quantitative analyses on anthropometric and demographic data and variables to explore the prevalence and patterning of MM. It will bring together individual and household level data from the surveys (DHS, MICS), and combine this information with macro-level indicators, of national governance, of public expenditure on health and nutrition, and of food prices, to examine the underlying, intermediate and basic causes of MM, as set out in UNICEF's conceptual framework on (mal)nutrition.
Malnutrition is associated with raised mortality risks, particularly in children; analysis of longitudinal survey data has shown that children experiencing multiple anthropometric deficits are 12.3 times more likely to die. Such children are likely to benefit most from nutrition and other child survival interventions (McDonald et al., 2013), as long as they can be indentified - which is not currently happening. Despite this, and the efforts and resources (national and international) which go to early child development programs in LMICs, a UNICEF/WHO/World Bank review of child malnutrition revealed that data on the prevalence and patterning of MM in young children are severely lacking, with no regional or global estimates of the number of children concurrently stunted and wasted. This knowledge gap is a real and ongoing problem for national governments and international agencies like UNICEF and the FAO. The analysis of existing household surveys, using advanced quantitative methods, will provide policy-relevant evidence on the determinants of MM for policy makers. We will also show how patterns of MM have changed over time, and identify key geographic and socio-demographic factors associated with MM.
The project focuses on children under 5 years of age, since this is a crucial period of physical development, and also because anthropometric data (heights, weights) on this age group are most reliable and routinely collected in national surveys. The WCA region has some of the world's poorest countries, many with high rates of child malnutrition. These countries also face on-going challenges of food security not least with respect to unstable food production in the context of increasing desertification, political and economic instability, and violent conflict (e.g. in northern Nigeria, Niger and Mali). WCA has excellent coverage in terms of the number of countries with existing survey data, all of which contain detailed, comparable data with which to investigate drivers of disparities in MM. Importatnly, the evidence generated by this project will aid assessment of progress towards the first three Sustainable Development Goals (SDG) - of ending poverty, hunger and reducing child mortality.

Planned Impact

The Emergency Nutrition Network [www.ennonline.net/] has noted that despite millions of children experiencing wasting and stunting concurrently, "in the humanitarian and development architecture...wasting programmes (are) still largely funded and implemented under the 'humanitarian' remit, while stunting resides under 'development'". This is because wasting is considered an acute condition and stunting a chronic condition. What is required is for programmes and resources to be brought together, to tackle multiple malnutrition simultaneously since, as Bergeron and Castleman (2012) note, "divergences between programs focused on acute malnutrition and those focused on chronic malnutrition constitute important impediments to the effective delivery of comprehensive services". At an international UNICEF/ECOWAS/ILO/CROP workshop on child poverty in Abuja (June 2016), the PI showed how spatial analyses of MM could benefit governments; this generated considerable interest and offers of support and collaboration (see UNICEF letter of support). The research team will work with UNICEF from the outset of the project to identify data and analytical needs, as well as pathways to influence policy in each of the 24 WCA countries.
Who will benefit from this research? The ultimate beneficiaries of this project will be children and families living in poverty, whose lives are blighted by malnutrition. Other beneficiaries will include international organisations (UNICEF, FAO, WFP and the WHO), national ministries of health and child welfare, and UK departments like DFID. NGOs like Save the Children, Oxfam and Action Aid, all of whom have used the PIs work on child poverty in the past, will be able to use the evidence of MM in their campaigns against poverty and promoting child well-being.
How will they benefit from this research? UNICEF's 2016 State of the World's Children report makes clear that "problems that go unmeasured often go unsolved. Consistent, credible data about children's situations are critical to the improvement of their lives and indispensable to realising the rights of every child... Data do not, of themselves, change the world. They make change possible, by identifying needs, supporting advocacy and gauging progress". This research responds directly to this call for credible and reliable evidence about a critical issue affecting the lives of millions of children, as highlighted in the last two Global Nutrition Reports. Regional events and workshop(s) will be held in Dakar and/or in Abuja to disseminate results, provide training to local researchers and build capacity for local UNICEF/NGO staff working on nutrition programmes. Participants at the workshop will include local researchers, national media, policy makers, local NGOs, and others UNICEF consider relevant to invite. Project findings and materials (including maps) will identify areas and communities with a high prevalence of MM, which will help clarify where resources should be targeted. Outputs will include presentations at academic conferences, newspaper articles, and material for the website of regional actors including the African Child Policy Forum and UNICEF. Outputs will be published in English and French, making them accessible to users and audiences in both Franco- and Anglo-phone Africa. Links with high level users of the data (national statistical offices), national governments and policy makers are already well established (evidenced by the PI's earlier work on child poverty for UNICEF), and where possible these contacts will be used to promote the project, and to influence priorities, policy and practice. Cardiff University will work with the Welsh Assembly's Wales for Africa programme, to link researchers at universities in Wales with researchers in WCA and also to build networks with development actors and agencies , like UNICEF, the World Food Programme and the UN Food and Agriculture Organisation (FAO).
 
Description The project had several significant achievements. These include:
(i) The first ever estimates of the extent and patterning of multiple malnutrition in West and Central Africa;
(ii) The first ever estimates of the extent and patterning of aggregate undernutrition, using the Composite Index of Anthropometric failure (CIAF), which revealed the number of malnourished children missed by conventional indicators;
(iii) The establishment of research collaborations beyond the region, in Uganda [UNICEF, Economic Policy Research Centre (EPRC)] and Ethiopia [African Child Policy Forum [ACPF)], which will lead to the wider use of the CIAF and measure of multiple malnutrition in other parts of Africa;
(iv) Knowledge exchange and training activities in Uganda (training workshops) and Cardiff (researcher visits) between UK academics and Ugandan researchers; knowledge exchange workshop in Addis Ababa, Ethiopia, in collaboration with the African Child Policy Forum (ACPF);
(v) Training of UK-based early career researchers in spatial analysis, at Southampton University (Hierarchical Modelling of Spatial and Temporal Data Course, five days, June 2017);
(vi) Preparation of manuscripts (journal articles, book chapters) about poverty, nutrition and the Sustainable Development Goals (SDGs). Currently under review:
• With Population Health - Assessing Progress towards SDG2: Trends and Patterns of Multiple Malnutrition in Young Children in West and Central Africa.
• With Social Indicators - Measuring Multidimensional Poverty According to National Definitions - Operationalising Target 1.2 of the Sustainable Development Goals.
Currently under preparation:
• A chapter on the relationship between poverty and hunger, achieving food security and improved nutrition among children in Sub-Saharan Africa for the forthcoming book Handbook of Children's Security, Vulnerability and Quality of Life: Global Perspectives. (Rees, Czhen, Gordon et al.)
• An article comparing extent and drivers of malnutrition in Ghana and Nigeria, to be submitted to the Bulletin of the World Health Organisation.
• An article examining the relationship between malnutrition and multidimensional poverty in Benin, to be submitted to PlosOne.
• An article looking at the extent of poverty, food insecurity and malnutrition among host and refugee communities in Uganda, to be submitted to the Journal of Refugee Studies.
(vii) Invitations to collaborate by Indian academics at BITS Pilani (Hyderabad) on malnutrition in India;
(viii) Presentations at conferences and meetings in the UK, including:
a. public talks at UNICEF Uganda in 2017 and 2018;
b. Second National Poverty Conference, Nuku'Alofa, Kingdom of Tonga, April, 2018;
c. the Building Global Partnerships for Global Challenges conference, University of Bristol, April 2018;
d. the What Works for Africa's Poorest Children? Social Policies and Programmes for Children Living in Extreme Deprivation conference, Kampala, Uganda, September 2018;
e. PROSPERED summer symposium, McGill University, Montreal, July 2018; and
f. Workshop on Multiple Malnutrition in Children in West and Central Africa: Key Findings, Addis Ababa, September 2018.
Exploitation Route -We have successfully applied for funding along with UNICEF Uganda and the EPRC to apply the methods developed to panel survey data for Uganda. UNICEF can use our work across the region to highlight the ongoing challenge of malnutrition, and the fact that there have been no significant reductions in its extent among children over a 20-year period.
-We were invited to collaborate with researchers at BITS Pilani, who are keen to use the methods and analytical frameworks on Indian data, including the National Family Household Survey (NFHS) and District Level Health Survey (DLHS); two academics (Dr Sunny Jose and Dr Bheemswar Reddy) will be visiting Cardiff to work with Dr Nandy and Dr Pomati in March 2019.
-In July 2018, following meetings with CARE Canada in Montreal, Dr Pomati and Dr Nandy applied for GCRF funding for CARE staff to travel to Cardiff in January 2019, for training on the analysis of nutrition data collected in CARE programmes in Ethiopia, Mozambique and Zambia. CARE's monitoring and evaluation specialists are considering including the CIAF in their programme evaluations going forward.
Sectors Government, Democracy and Justice,Other

URL http://www.cardiff.ac.uk/news/view/1205269-child-poverty-and-deprivation-among-ugandan-refugees
 
Description ESRC Impact Acceleration Project
Amount £24,500 (GBP)
Organisation Cardiff University 
Sector Academic/University
Country United Kingdom
Start 01/2017 
End 07/2017
 
Description ESRC Secondary Data Analysis Initiative - Global Challenges Research Fund
Amount £196,000 (GBP)
Funding ID ES/P00346X/1 
Organisation Economic and Social Research Council 
Sector Public
Country United Kingdom
Start 02/2017 
End 06/2018
 
Description GCRF - Nutrition and Population Dynamics using DHS data
Amount £18,500 (GBP)
Organisation Cardiff University 
Sector Academic/University
Country United Kingdom
Start 02/2018 
End 07/2018
 
Description GCRF Small Project
Amount £35,000 (GBP)
Organisation Cardiff University 
Sector Academic/University
Country United Kingdom
Start 03/2019 
End 07/2019
 
Description Newton Fund
Amount £82,000 (GBP)
Organisation Cardiff University 
Sector Academic/University
Country United Kingdom
Start 03/2019 
End 02/2020
 
Description Collaboration with CRONICAS, Lima Peru 
Organisation Cayetano Heredia University
Department Centre of Excellence in Chronic Diseases
PI Contribution Dr Nandy prepared an application for a British Council Newton Fund Institutional Link grant, to develop a collaboration with CRONICAS, and with Profs Antonio Bernabe Ortiz and J Jaime Miranda.
Collaborator Contribution CRONICAS prepared an application for a research programme to understand and model the distribution of the double burden of malnutrition in Peru. Staff from CRONICAS will visit Cardiff, and Cardiff researchers will visit Lima for KE and training activities during the grant.
Impact Journal paper accepted for publication in BMC Public Health: Within-country Migration and Obesity Dynamics: Analysis of 94,783 women from the Peruvian Demographic and Health Surveys [DOI: 10.1186/s12889-019-6586-7]
Start Year 2019
 
Description Collaboration with UNICAMP (Brazil) 
Organisation State University of Campinas
Country Brazil 
Sector Academic/University 
PI Contribution Nandy applied (and secured) GCRF Small Project funds to work with UNICAMP on applying the Consensual Approach to poverty in the context of Brazil.
Collaborator Contribution UNICAMP colleagues will facilitate the running of several focus groups which form an important part of the method; we will work together to secure funds to expand the work nationally, with other Brazilian institutions and funders.
Impact None presently.
Start Year 2018
 
Description EPRC collaboration on Child Poverty in Refugee Hosting Areas in Uganda 
Organisation Economic Policy Research Centre (EPRC)
Country Uganda 
Sector Academic/University 
PI Contribution CU provided training to EPRC researchers in using the Consensual Approach for poverty measurement; CU led on data analysis and writing of the final report (with EPRC and UNICEF).
Collaborator Contribution EPRC funded and carried out the research in country; EPRC researchers visited Cardiff in July 2018, for training and to present their work to an invited audience of researchers, policy makers, and students.
Impact Report: Child Poverty and Deprivation in Refugee-Hosting Areas (July 2018). Journal papers still in preparation.
Start Year 2018
 
Description PROSPERED 
Organisation McGill University
Country Canada 
Sector Academic/University 
PI Contribution The PROSPERED network is an ongoing collaboration between researchers at institutions in Canada, India, South Africa, Peru, the USA and the UK. Our research team contributes by attending workshops, conferences, student supervisions, and joint research projects.
Collaborator Contribution Partner meetings have been held around the world, including Bangalore, Los Angeles, Cape Town and Lima. Full details of the collaboration and partner activities are available at:https://www.prosperedproject.com/about/
Impact Outputs from the PROSPERED collaboration are detailed at:https://www.prosperedproject.com/publications/
Start Year 2017
 
Description Working with Bristol Poverty Institute on poverty analysis for UNICEF Uganda 
Organisation University of Bristol
Country United Kingdom 
Sector Academic/University 
PI Contribution Cardiff team members have jointly written the National Report on Child Poverty for UNICEF Uganda (2018), and applied for further funding to extend the work in coming years.
Collaborator Contribution UNICEF Uganda funded a team of researchers from Cardiff and Bristol universities, and facilitated meetings with the Uganda Bureau of Statistics and Economic Policy Research Centre.
Impact National Child Poverty report (due for release in 2019); Regional poverty reports (in development); Book chapter ["Multidimensional Child Poverty and the SDGs: From measurement to action"], forthcoming December 2019;
Start Year 2017
 
Description End of Project workshop with African Child Policy Forum, Addis Ababa 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact An end of project workshop was held, in conjunction with the pan-African advocacy group the African Child Policy Forum. Nandy and Pomati made several presentations across the day, about their work on poverty and undernutrition. The audience included representatives from the Ministries of Health, Education and Welfare, the African Union, UNICEF, UNDP, and research organisations working across Africa.
Year(s) Of Engagement Activity 2018
 
Description Healthy Childhoods Seminar 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact The talk entitled "What does a population approach mean for my research?" was given at the School of Biomedical Sciences, to an audience of undergraduates, postgraduates and staff, as part of the Healthy Childhood seminar series. The 40 minute talk sparked much interest and discussion, with audience members later emailing me to ask for further information. Following the talk I was invited to collaborate with colleagues in the Medical school on GCRF-related research proposals.
Year(s) Of Engagement Activity 2017
 
Description KE activity in UNICAMP, Brazil 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Third sector organisations
Results and Impact Nandy was invited to present at UNICAMP, in Campinas. Colleagues at UNICAMP were interested in Nandy's work on poverty and nutrition, and wanted him to explain it to an invited audience of academics, graduate students, policy makers and funders.
Year(s) Of Engagement Activity 2018
URL https://www.unicamp.br/unicamp/noticias/2019/02/08/pobreza-no-brasil-sera-pesquisada-em-colaboracao-...
 
Description KE and training activity in Kampala for EPRC and UNICEF 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact CU staff provided training to local EPRC and UNICEF researchers on the methods used as part of our SDAI grant, on undernutrition and multidimensional poverty.
Nandy and Pomati then gave talks to an invited audience of policy makers, representatives of local government ministries (health, education, gender and children), NGOs (BRAC), and PhD students.
Year(s) Of Engagement Activity 2018
 
Description Kampala Dec 2017 - research visit, training workshop and speaker series multiple malnutrition talk 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Policymakers/politicians
Results and Impact The talk was held at the UNICEF Uganda HQ in Kampala on Wednesday 20th December, 2017. The title of the talk was "The experience of "multiple malnutrition": Evidence from Uganda", where we outlined the work being done by SDAI-funded project, and presented analysis of data for Uganda, outlining the implications for the Sustainable Development Goals. The audience of 35 included development professionals, UNICEF staff, representatives of local NGOs and other UN agencies, diplomats, ministry officials and local researchers.The talk sparked much discussion and debate about the need for reliable and timely data on malnutrition, as well as the need for sub-national indicators of political and economic governance.
Year(s) Of Engagement Activity 2017
URL https://www.cardiff.ac.uk/news/view/1063531-building-research-capacity-in-uganda
 
Description Presentation to Boston University for developing institutional links 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Nandy present the work on undernutrition being done as part of the GCRF SDAI to a visiting panel of high-level delegates from Boston University (USA); Cardiff University is seeking to develop formal links with BU, and Nandy is part of these discussions, from the School of Social Sciences.
Year(s) Of Engagement Activity 2017
 
Description Talk to Boston university visitors, 14 November, 2017 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Other audiences
Results and Impact Talk entitled "Measuring and Mapping the Prevalence and Patterning of Multiple Malnutrition in Young Children in West and Central Africa" presented to a high-level panel of visiting academics and administrators to Cardiff University, to showcase GCRF-funded work being done at Cardiff University. The talk stimulated discussion about the project, about funding opportunities, and potential collaborations going forward.
Year(s) Of Engagement Activity 2017