Levels and trends in child malnutrition: UNICEF / WHO / The World Bank Group joint child malnutrition estimates: key findings of the 2021 edition

UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 1 Levels and trends in child malnutrition UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates Key findings of the 2021 edition These new estimates supersede former analyses and results published by UNICEF, WHO and the World Bank Group Stunting affected an estimated 22.0 per cent or 149.2 million children under 5 globally in 2020* STUNTING 149.2 million In 2020,* wasting continued to threaten the lives of an estimated 6.7 per cent or 45.4 million children under 5 globally WASTING 45.4 million An estimated 5.7 per cent or 38.9 million children under 5 around the world were affected by overweight in 2020* OVERWEIGHT 38.9 million * Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. 2 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Good nutrition sets children on the path to survive and thrive. Well-nourished children grow, develop, learn, play, participate and contribute – while malnutrition robs children of their full potential, with consequences for children, nations and the world. Stunting is the devastating result of poor nutrition in-utero and early childhood. Children suffering from stunting may never attain their full possible height and their brains may never develop to their full cognitive potential. These children begin their lives at a marked disadvantage: they face learning difficulties in school, earn less as adults, and face barriers to participation in their communities. Globally, 149.2 million children under 5 suffered from stunting in 2020.* These numbers may increase substantially due to constraints in accessing nutritious diets and essential nutrition services during the COVID-19 pandemic, with the full impact on stunting possibly taking years to manifest. Wasting in children is the life-threatening result of poor nutrient intake and/or disease. Children suffering from wasting have weakened immunity, are susceptible to long-term developmental delays and face an increased risk of death, particularly when wasting is severe. These children require urgent treatment and care to survive. In 2020,* 45.4 million children under 5 were affected by wasting, of which 13.6 million were severely wasted. The impact of COVID-19 has likely exacerbated these figures, and could mean that 15 per cent or 1.15 times more children were affected by wasting in 2020 than estimated1 due to deteriorations in household wealth and disruptions to the availability and affordability of nutritious * Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). food and essential nutrition services. Childhood overweight occurs when children’s caloric intake from food and beverages exceeds their energy requirements. It is shaped by industry marketing and greater access to processed foods, along with inadequate levels of physical activity, which can increase children’s risk of obesity and diet-related noncommunicable diseases later in life. There are now 38.9 million* children under 5 with overweight globally, an increase of nearly 6 million since 2000. Childhood overweight may also be negatively impacted by COVID-19, especially where fresh, nutritious food has been replaced by processed, unhealthy food, and where movement restrictions have constrained opportunities for physical activity for extended periods of time. The Joint Malnutrition Estimates (JME) published in April 2021 reveal insufficient progress to reach the World Health Assembly (WHA) targets set for 2025 and the Sustainable Development Goals (SDGs) set for 2030 (see page 25).2 The latest analysis indicates that only one quarter of all countries are ‘on track’ to halve the number of children affected by stunting by 2030, with an assessment of progress to date not being possible for another quarter of countries. Even fewer countries are expected to achieve the 2030 target of 3 per cent prevalence for overweight, with just 1 in 6 countries considered ‘on track’. Further, an assessment of progress towards the wasting target is not possible for nearly half of countries. More intensive efforts will be required if the world is to achieve global targets of reducing the number of children with stunting to 104 million by 2025 and to 87 million by 2030. Meanwhile, achieving the overweight goal would require a reversal of the current trajectory. Although malnutrition can manifest in multiple ways, the path to prevention is virtually identical: adequate maternal nutrition before and during pregnancy and while breastfeeding; optimal breastfeeding in the first two years of life; nutritious, diverse and safe foods in early childhood; and a healthy environment, including access to basic health, water, hygiene and sanitation services and opportunities for safe physical activity. Many of these vital pathways to good nutrition are under threat – including due to the COVID-19 pandemic – and have the potential to undermine progress towards ending malnutrition in all its forms. As the world responds to and recovers from the pandemic, urgent action is critical to protect maternal and child nutrition – especially in the most affected regions – and secure a future where the right to nutrition is a reality for every child. INTRODUCTION TOWARDS A FUTURE WITHOUT MALNUTRITION FOR EVERY CHILD NEW – JME country estimates This key findings report for the 2021 edition of the JME presents country level data for the first time. This is because a new country- level model has been developed to generate the country, regional and global estimates for stunting and overweight (see page 26). Additional work is ongoing to update methods for wasting and severe wasting; as such, the estimates presented for these two conditions are based on methods applied for previous editions of the JME. UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 3 Forms of malnutrition** highlighted in this key findings report Stunting and wasting Stunting and overweight Stunting refers to a child who is too short for his or her age. Children affected by stunting can suffer severe irreversible physical and cognitive damage that accompanies stunted growth. The devastating consequences of stunting can last a lifetime and even affect the next generation. ** Some children suffer from more than one form of malnutrition – such as stunting and overweight or stunting and wasting. There are currently no joint global or regional estimates for these combined conditions. The Joint Malnutrition Estimates for the year 2020 do not fully account for the impact of the COVID-19 pandemic. Household survey data on child height, weight and age – used to report on the JME indicators of stunting, wasting, severe wasting and overweight among children under 5 years of age – were not collected in 2020 due to physical distancing measures, with the exception of four surveys. This means that the estimates are based almost entirely on data collected before 2020. One of the covariates used in the country models for stunting and overweight takes the impact of COVID-19 partially into account, but is not expected to capture the full extent of the pandemic’s influence on malnutrition in 2020. The pandemic is expected to exacerbate all forms of malnutrition due to deteriorations in household wealth; constraints in the availability and affordability of nutritious food; disruptions in essential nutrition services; and limited opportunities for physical activity. The impact of the pandemic on stunting will likely unfold gradually, and may persist for years after COVID-19 is eradicated and economies recover. Given that stunting is the result of chronic or recurrent malnutrition, it will be influenced by how long these pandemic-related shocks to the economy, food systems and health systems persist. Maternal malnutrition experienced during the pandemic can also affect stunting by increasing the risk of low birthweight, a key predictor of impaired linear growth.3 Therefore, increased stunting prevalence may be apparent among children born during the first year of the pandemic before it is noticed in the entire under-five population that is used to monitor this indicator. Wasting and severe wasting, characterized by a loss of muscle and fat mass, can develop rapidly in the face of poor nutrient intake and/or disease. These conditions are expected to be most impacted by COVID-19 in the short-term and the prevalence-based estimates presented in this report for 2020 may in fact be around 15 per cent or 1.15 times higher than what is reported.1 Without representative data on wasting from countries during the pandemic, only modelled predictions are possible. Because losses in muscle and fat mass can be reversed rapidly once the pandemic subsides and large-scale data collection on child weight and height resumes, there may be no evidence remaining of how wasting prevalence was affected over the course of the pandemic. Among children who survive episodes of wasting during the pandemic, linear growth is likely to be affected; this means that some of the pandemic’s enduring impact on stunting may be attributable to prolonged and recurrent episodes of wasting. The pandemic may also lead to increases in childhood overweight, especially in settings where food choices and physical activity have been negatively influenced by COVID-19 mitigation strategies. The impact on overweight may persist through the lifetime of those affected, with poor dietary and physical activity habits (shaped by restrictions during COVID-19) that continue through adolescence and adulthood. While data are limited, deteriorations in children’s diet quality during the pandemic have been observed. In one country, decreases in physical activity during the pandemic were reported for 28 per cent of children aged 3 to 5 years, while increases in sweet snack food consumption were reported for 19 per cent of children.4 Wasting refers to a child who is too thin for his or her height. Wasting is the result of recent rapid weight loss or the failure to gain weight. A child who is moderately or severely wasted has an increased risk of death, but treatment is possible. Overweight refers to a child who is too heavy for his or her height. This form of malnutrition results when energy intakes from food and beverages exceed children’s energy requirements. Overweight increases the risk of diet-related noncommunicable diseases later in life. COVID-19 COVID-19 and the Joint Child Malnutrition Estimates 4 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition GLOBAL OVERVIEW Number (millions) of children under 5 affected by stunting, wasting and overweight, global, 2000–2020* Percentage of children under 5 affected by stunting, wasting and overweight, global, 2000–2020* Most children with malnutrition live in Africa and Asia *Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). In 2020,* more than half of all children under 5 affected by stunting lived in Asia and two out of fi ve lived in Africa Asia 53% Africa 41% In 2020,* almost half of all children under 5 affected by overweight lived in Asia and more than one quarter lived in Africa Asia 48% Africa 27% In 2020,* more than two thirds of all children under 5 affected by wasting lived in Asia and more than one quarter lived in Africa Asia 70% Africa 27% Stunting has declined steadily since 2000 – but faster progress is needed to reach the 2030 target. Wasting persists at alarming rates and overweight will require a reversal in trajectory if the 2030 target is to be achieved. P er ce n ta g e stunting overweightwasting 95% confidence interval N u m b er ( m ill io n s) N um be r (m ill io ns ) Pe rc en ta ge 0 5 10 15 20 25 30 35 40 20202015201020052000 0 20 40 60 80 100 120 140 160 180 200 220 20202015201020052000 20202015201020052000 0 5 10 15 20 25 30 35 40 upper 0 40 80 120 160 200 38.937.6 45.4 45.4 36.4 35.633.3 38.937.636.435.633.3 203.6 192.3 180.5 149.2 163.4 203.6 192.3 180.5 149.2 163.4 4.9 32.4 5.6 6.9 21.3 5.4 33.1 5.7 6.7 22.0 20202015201020052000 Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. See section about regional and global estimates on page 27 for an explanation of why only one time point is presented for wasting on the graphs above. UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 5 PROGRESS TOWARDS THE SDGs Only about one quarter of countries are on track to reach the 2030 SDG targets on stunting, wasting and overweight Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: *Percentages may not add up to 100 per cent due to rounding. **See notes on progress assessment categories on pages 16–17. ***Oceania excluding Australia and New Zealand The graphics above show progress towards the SDG 2.2 targets on stunting, wasting and overweight. The graphics in the left-hand column show progress by percentage of the global under-five population and the graphics in the two right-hand columns show progress by percentage of countries (globally and regionally). For the graphics by percentage of the under-five population (left column), each country was weighted by the under-five population, meaning that more populous countries contributed more to the percentages in each progress category than less populous ones. In contrast, for the graphs in the two columns on the right side, each country contributes equally towards the percentages, regardless of its population size. Availability of data to measure progress varies between the assessment by percentage of the population and the assessment by percentage of countries; it also varies by indicator and region. Almost all children live in countries where progress assessment is possible for all three indicators. Meanwhile, progress by country can only be assessed for about three quarters of countries for the stunting and overweight targets, and for about half of countries for the wasting target. When considering progress by under-five population, nearly 85 per cent of children live in countries showing at least some progress towards the stunting reduction target, with only 10 per cent living in countries that show no progress or a worsening situation. The situation is more concerning for overweight: half of children live in countries with no progress or a worsening situation. For wasting, nearly one third of children live in countries with no progress or a worsening situation. When considering progress by individual countries (at the global level), progress on stunting and overweight can be assessed for three quarters of all countries, while progress on wasting is only possible for about half of countries (see notes on JME methodology on pages 26-27). Overall, the greatest progress is being made towards the stunting target, with nearly two thirds of countries seeing at least some progress. In contrast, for overweight, about half of all countries have experienced no progress or are worsening. At the regional level, Northern America, Europe and Australia and New Zealand have the highest proportion of countries for which progress cannot be assessed across the three indicators. Conversely, Africa has the highest proportion of countries for which progress can be assessed for all three indicators. Asia is contributing most to the global percentage of countries that are ‘on track’ to meet the stunting target, with 21 out of 48 countries (or 44 per cent) on track; followed by Northern America, Europe and Australia and New Zealand with 14 out of 48 countries on track; and Latin America and the Caribbean, with 9 of 37 countries on track. While all regions have at least some countries on track to meet the stunting and wasting targets, in Latin America and the Caribbean, all countries for which progress for overweight could be assessed show no progress or a worsening situation, and in Northern America, Europe and Australia and New Zealand, almost all countries for which progress could be assessed (20 out of 21 countries) are not on track. Gaps in the available data in some regions make it challenging to accurately assess progress towards global targets. Regular data collection (every three to five years) is therefore critical to monitor and analyse country, regional and global progress on child malnutrition going forward. ST U N TI N G W A ST IN G G L O B A LG L O B A L R E G I O N A L Assessment not possible**Off track–worsening**Off track–no progress**Off track–some progress**On track** O VE R W EI G H T 0 20 40 60 80 100 Percentage* of countries Progress towards the child malnutrition SDG targets by: Percentage* of children Northern America, Europe and Australia and New Zealand Oceania*** Latin America and the Caribbean Asia Africa n=54 n=48 n=37 n=15 n=48 Northern America, Europe and Australia and New Zealand Oceania*** Latin America and the Caribbean Asia Africa n=54 n=48 n=37 n=15 n=48 Northern America, Europe and Australia and New Zealand Oceania*** Latin America and the Caribbean Asia Africa n=54 n=48 n=37 n=15 n=48 5%2% 42% 42% 36% 14% 21% 8% 21% 42% 6% 27% 22% 2% 8% 5% 36% 8% 25% 25% 28% 8% 9% 6% 49% 25% 17% 9% 32% 17% 6 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Percentage of children under 5 affected by stunting, by country, 20201 Percentage of children under 5 affected by stunting, by country, 2000 Source: UNICEF, WHO, World Bank Group, Joint Child Malnutrition Estimates, 2021 edition. Note: 1. Household survey data on child height were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting model takes the impact of COVID-19 partially into account (see page 3). These maps are stylized and not to scale; they do not refl ect a position by UNICEF, WHO or World Bank Group on the legal status of any country or territory or the delimitation of any frontiers. Distribution of stunting prevalence for each country with a modelled estimate presented for 2020.1 Distribution of stunting prevalence for each country with a modelled estimate presented for 2000. The number of countries with very high stunting prevalence has declined by half since 2000 – from 67 to 33 countries STUNTING COUNTRY TRENDS ≥30% (very high)20 – <30% (high)10 – <20% (medium)2.5 – <10% (low)<2.5% (very low) modelled estimate not presented UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 7 Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1.Household survey data on child height were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting model takes the impact of COVID-19 partially into account (see page 3). 2. Oceania excluding Australia and New Zealand. †Represents regions/sub-regions where the change has been statistically significant. See page 14 for the 95% confidence intervals for graphed estimates. Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1. Household survey data on child height were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting model takes the impact of COVID-19 partially into account (see page 3). 2. Oceania excluding Australia and New Zealand; †Represents regions/sub-regions where the change has been statistically significant. See page 15 for the 95% confidence intervals for graphed estimates. Progress to reduce stunting has not been equal across regions and sub-regions Trends in the percentage of children under 5 affected by stunting, by United Nations region/sub-region, 2000 and 20201 The number of children with stunting is declining in all regions except Africa Trends in the number (millions) of children under 5 affected by stunting, by United Nations region/sub-region, 2000 and 20201 STUNTING REGIONAL TRENDS 20202000 M ela ne sia M icr on es ia Po lyn es ia M id dl e A fri ca † Ea st er n A fri ca † W es te rn A fri ca † So ut he rn A fri ca † No rth er n A fri ca † So ut he rn A sia † So ut h- ea st er n As ia † W es te rn A sia † Ce nt ra l A sia † Ea st er n A sia † Ce nt ra l A m er ica † Ca rib be an † So ut h A m er ica † Ea st er n E ur op e So ut he rn Eu ro pe No rth er n E ur op e W es te rn Eu ro pe 0 10 20 30 40 50 Oceania1 Africa† Asia† Latin America and the Caribbean† Northern America Global†Australia and New Zealand Europe Pe rc en ta ge 41.4 43.6 15.2 6.7 30.7 13.9 1.9 30.7 32.6 36.8 23.3 30.9 21.4 21.8 27.4 10.0 4.9 11.3 16.6 11.8 8.6 4.5 6.6 2.9 4.0 2.3 3.2 22.0 41.5 37.7 18.5 10.4 35.6 49.1 39.9 28.3 37.0 48.3 38.0 24.3 44.9 29.0 18.0 19.5 15.7 6.6 10.1 6.8 4.3 14.7 33.1 29.1 2.9 2.3 3.2 25.5 Global prevalence 2020: 22.0% Global prevalence 2000: 33.1% Global number affected 2020: 149.2 M Global number affected 2000: 203.6 M 2020 2000 Nu m be r ( m illi on s) 54.4 million 61.4 million 135.9 million 79.0 million 10.2 million 5.8 million 0.4 million 0.6 million 2.4 million 1.8 million 0 10 20 30 40 50 60 70 80 90 Australia and New ZealandNorthern AmericaPolynesiaMicronesiaMelanesiaNorthern EuropeWestern Eu opeSouthern EuropeEastern EuropCaribbeanCentral AmericaSouth Am ricSouthern AfricaNorthern AfricaMiddle AfricaWestern Afr caEastern AfricaCentral AsiaWestern AsiaEastern AsiaSouth-eastern AsiaSouthern Asia Oceania2Africa†Asia† Latin America and the Caribbean† Europe So ut he rn As ia † So ut h- ea st er n A sia † Ea st er n As ia † W es te rn As ia † Ce nt ra l As ia † Ea st er n Af ric a W es te rn Af ric a† M id dl e Af ric a† No rth er n Af ric a So ut he rn Af ric a So ut h Am er ica † Ce nt ra l Am er ica † Ca rib be an † Ea st er n Eu ro pe So ut he rn Eu ro pe W es te rn Eu ro pe No rth er n Eu ro pe M ela ne sia M icr on es ia Po lyn es ia † No rt he rn Am er ic a Au st ra lia a nd Ne w Ze al an dNorthern America Australia and New Zealand 54.3 15.3 4.6 3.7 0.8 87.6 20.8 19.9 5.6 2.8 5.3 2.74.2 0.40.6 0.4 0.6 0.70.7<0.1<0.1 <0.1<0.1 <0.1<0.11.11.4 0.30.5 0.20.3 0.20.2 1.7 22.6 7.9 5.9 16.4 22.1 20.2 11.3 6.2 1.7 1.6 8 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Southern Asia has the highest stunting prevalence of any sub-region in the world Percentage of children under 5 affected by wasting, by country and United Nations sub-region, 20201 WASTING PREVALENCE Source: UNICEF, WHO, World Bank Group, Joint Child Malnutrition Estimates, 2021 edition. Note: 1. Country data are the most recent available survey estimates between 2010 and 2020; exceptions where older data are shown (2000–2009) are denoted with an asterisk (*) and where only data prior to 2000 are available the † footnote is used, denoting no recent data. The sub-regional estimates do not account for the impact of COVID-19, as household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys (see page 3). 2. Eastern Asia excluding Japan. 3. Oceania excluding Australia and New Zealand. 4. The Northern America sub-regional estimate is based on data from only the United States. There is no estimate available for the sub-regions of Europe or Australia and New Zealand due to insuffi cient population coverage. See section about regional and global estimates on page 27 for an explanation of why trend data are not available for wasting. These maps are stylized and not to scale; they do not refl ect a position by UNICEF, WHO or World Bank Group on the legal status of any country or territory or the delimitation of any frontiers. Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Notes: 1. Each marker refers to the most recent country estimate between 2010 and 2020; “no recent data” refers to the number of countries for which the most recent estimate is before 2010 and “no data” refers to the number of countries without an estimate. The regional estimates do not account for the impact of COVID-19, as household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys (see page 3). 2. Oceania excluding Australia and New Zealand. 3. Asia excluding Japan. There is no estimate available for Europe or Australia and New Zealand due to in- suffi cient population coverage. North America is not shown as it only includes two countries, of which only one has data. See section about regional and global estimates on page 27 for an explanation of why trend data are not available for wasting. Regional averages can mask wide variations in country prevalence Percentage of children under 5 affected by wasting, by country (dots) and United Nations region (bars), 20201 Oceania2 15 countries No recent data = 4 No data = 5 Asia3 48 countries No recent data = 7 No data = 3 Africa 54 countries No recent data = 4 Latin America and the Caribbean 37 countries No recent data = 3 No data = 10 9.0% 8.9% 6.0% 1.3% PERCENTAGE Very low Low Medium High Very high 0 5 10 15 20 25 ≥15% (very high) 10 – <15% (high) 5 – <10% (medium) 2.5 – <5% (low) <2.5% (very low) no data Distribution of wasting prevalence, by country, using the most recent available survey between 2010 and 2020. * * * * * * * * * * † † * * * * * * * * * * Southern Africa Eastern Africa Middle Africa Western Africa South America Caribbean Central America Northern Africa Western Asia Southern Asia South-eastern Asia Central AsiaNorthern America4 Eastern Asia2 Oceania3 0.9 2.8 0.2 1.4 6.9 6.2 3.2 5.2 3.5 6.6 2.3 1.7 8.2 9.0 14.1 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 9 More than half of all children aff ected by wasting live in Southern Asia Number (millions) of children under 5 affected by wasting, by United Nations sub-region, 20201 WASTING NUMBERS AFFECTED Asia is home to more than three quarters of all children suff ering from severe wasting Number of children under 5 affected by wasting and severe wasting, by United Nations region, 20201 Africa 12.1 million Latin America and Caribbean 0.7 million CaribbeanCentral America South America Middle Africa Southern Africa Asia2 31.9 million Eastern Africa Northern Africa Western Africa 1.0 4.6 25.0 1.5 0.2 Western Asia Central Asia South-eastern Asia Southern Asia Eastern Asia2 4.5 0.2 1.9 1.9 3.50.4 0.1 0.1 Oceania3 0.13 million Northern America4 <0.1 Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1.The estimates for the year 2020 do not account for the impact of COVID-19, as household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys (see page 3). 2. Asia excluding Japan. 3. Oceania excluding Australia and New Zealand. There is no estimate available for Europe or Australia and New Zealand due to insuffi cient population coverage. North America is not shown because wasting aff ects <0.1 million children. Aggregates may not add up due to rounding and/or lack of estimates for some regions. See section about regional and global estimates on page 27 for an explanation of why trend data are not available for wasting or severe wasting. Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1. The estimates for the year 2020 do not account for the impact of COVID-19, as household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys (see page 3). 2. Asia and Eastern Asia excluding Japan. 3. Oceania excluding Australia and New Zealand. 4. The Northern America sub-regional estimate is based on data from only the United States. There is no estimate available for Europe or Australia and New Zealand due to insuffi cient population coverage. Aggregates may not add up due to rounding and/or lack of estimates for some regions. See section about regional and global estimates on page 27 for an explanation of why trend data are not available for wasting. Africa GlobalLatin America and Caribbean Asia* Oceania** Africa Latin America and Caribbean Asia2 Oceania3 10.3 3.0 13.6 Global 0.130.7 0.05 0.13 M 0.05 0.1 45.4 million wasted of which 13.6 million are severely wasted 45.4 million with wasting, of which 13.6 million have severe wasting Number of children under 5 wasted (moderate and severe) Number of children under 5 wasted (severe only) Number of children under 5 with wasting (moderate and severe) Number of children under 5 with wasting (severe only) 31.9 12.1 13.6 M 45.4 M 10.3 M 31.9 M 3.0 M 12.1 M 0.7 M 0.1 Global wasting prevalence 2020: 6.7% Global severe wasting prevalence 2020: 2.0% Global number aff ected by wasting 2020: 45.4 M Global number aff ected by severe wasting 2020: 13.6 M 10 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Source: UNICEF, WHO, World Bank Group, Joint Child Malnutrition Estimates, 2021 edition. Note: 1.Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country overweight model takes the impact of COVID-19 partially into account (see page 3). These maps are stylized and not to scale and do not refl ect a position by UNICEF, WHO or World Bank Group on the legal status of any country or territory or the delimitation of any frontiers. The number of countries with low and very low levels of overweight decreased from 64 countries in 2000 to 56 countries by 2020 OVERWEIGHT COUNTRY TRENDS ≥15% (very high)10 – <15% (high)5 – <10% (medium)2.5 – <5% (low)<2.5% (very low) modelled estimate not presented Percentage of children under 5 affected by overweight, by country, 20201 Percentage of children under 5 affected by overweight, by country, 2000 Distribution of overweight prevalence for each country with a modelled estimate presented for 2020.1 Distribution of overweight prevalence for each country with a modelled estimate presented for 2000. UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 11 0 2 4 6 8 10 12 14 16 18 20 Ea st er n E ur op e No rth er n E ur op e So ut he rn Eu ro pe W es te rn Eu ro pe Po lyn es ia M ela ne sia M icr on es ia So ut h A m er ica Ca rib be an Ce nt ra l A m er ica No rth er n A fri ca So ut he rn A fri ca M id dl e A fri ca Ea st er n A fri ca † W es te rn A fri ca † W es te rn A sia Ea st er n A sia So ut h- ea st er n A sia † Ce nt ra l A sia † So ut he rn A siaOceania2 Africa AsiaLatin America and the Caribbean Northern America GlobalAustralia and New Zealand† Europe Pe rc en ta ge 16.9 9.1 8.3 9.9 2.5 5.4 8.3 8.0 6.0 8.0 8.4 8.2 7.5 8.2 6.6 6.3 5.3 4.8 4.0 2.7 12.1 13.0 8.3 7.9 7.5 5.6 5.7 5.2 4.86.2 7.2 4.5 5.2 6.9 5.2 4.2 7.0 5.8 6.7 6.2 10.9 10.6 7.7 4.5 6.0 3.7 9.6 3.3 5.9 5.3 4.4 6.8 7.3 8.1 11.9 7.7 20202000 Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1.Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country overweight model takes the impact of COVID-19 partially into account (see page 3). 2. Oceania excluding Australia and New Zealand. †Represents regions/sub-regions where the change has been statistically significant. See page 14 for the 95% confidence intervals for graphed estimates. Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1. Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country overweight model takes the impact of COVID-19 partially into account (see page 3). 2. Oceania excluding Australia and New Zealand. †Represents regions/sub-regions where the change has been statistically significant. See page 15 for the 95% confidence intervals for graphed estimates. OVERWEIGHT REGIONAL TRENDS Global prevalence 2020: 5.7% Global prevalence 2000: 5.4% Global number affected 2020: 38.9 M Global number affected 2000: 33.3 M Current levels of overweight have persisted for the last two decades in almost every region Trends in the percentage of children under 5 affected by overweight, by United Nations region/sub-region and global, 2000–20201 South-eastern Asia and Northern Africa are the only sub-regions with a significant increase in the number of children with overweight since 2000 Number (millions) of children under 5 affected by overweight, by United Nations region/sub-region, 2000 and 20201 0 1 2 3 4 5 6 7 8 9 10 20202000 Nu m be r ( m illi on s) 8.2 million 10.6 million 16.5 million 18.7 million 3.9 million 3.9 million 0.1 million 0.1 million 3.0 million 3.2 million Oceania2Africa†Asia Latin America and the Caribbean Europe Ea st er n As ia So ut he rn As ia So ut h -e as te rn As ia † W es te rn As ia Ce nt ra l As ia No rth er n Af ric a† Ea st er n Af ric a W es te rn Af ric a M id dl e Af ric a So ut he rn Af ric a So ut h Am er ica Ce nt ra l Am er ica Ca rib be an Ea st er n Eu ro pe W es te rn Eu ro pe No rth er n Eu ro pe So ut he rn Eu ro pe M ela ne sia M icr on es ia Po lyn es ia Northern America Australia and New Zealand† 7.4 4.5 4.2 2.2 0.5 6.1 6.0 2.0 1.8 2.62.5 1.01.1 0.20.2 0.10.1 2.0 1.6 <0.1<0.1 <0.1<0.1 0.3 0.1 1.61.7 0.6 0.4 0.50.3 0.50.5 0.6 2.3 1.8 1.0 2.5 3.8 2.7 1.8 1.5 0.6 0.8 12 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition stunting overweightwasting 95% confidence interval 44.7 29.1 4.4 4.0 20202000 0 10 20 30 40 50 20202000 20202000 20202000 Low-income Upper-middle-income High-income2Lower-middle-income 9.9 47.9 34.6 5.0 3.7 6.9 21.2 10.8 6.7 8.8 2.1 3.44.8 7.85.8 0.4 Pe rc en ta ge Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1. Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). 2. High-income countries: consecutive low (<50 per cent) population coverage for country data (e.g., from household surveys) in all time periods after 2010 for all indicators; interpret with caution. Stunting has declined by half in upper-middle income countries – but overweight is rising steadily, moving further away from the global target Percentage of children under 5 affected by stunting, wasting and overweight, by country income classifi cation, 2000–20201 Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1.Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). 2. High-income countries: consecutive low (<50 per cent) population coverage for stunting and overweight in 2020; interpret with caution. Based on FY2021 World Bank income classifi ca- tion. The values for “percentage change since 2000” are based on calculations using unrounded estimates and therefore might not match values calculated using the rounded estimates presented in this brochure. The number of children with overweight has remained unchanged for two decades Number of children under 5 affected by overweight, by country income classifi cation, 2000 and 20201 N um be r ( m ill io ns ) N um be r ( m ill io ns ) 0 20 40 60 80 100 120 140 160 High-Income2Upper-Middle- Income Lower-Middle- Income Low-Income 0 5 10 15 20 25 30 35 40 High-Income2Upper-Middle- Income Lower-Middle- Income Low-Income 20202000 20202000 33.9 36.5 123.4 88.5 42.4 3.2 2.2 3.5 3.9 12.2 12.1 13.5 3.9 5.1 -49.1% -28.3% 21.6 17.5 N um be r ( m ill io ns ) N um be r ( m ill io ns ) 0 20 40 60 80 100 120 140 160 High-Income2Upper-Middle- Income Lower-Middle- Income Low-Income 0 5 10 15 20 25 30 35 40 High-Income2Upper-Middle- Income Lower-Middle- Income Low-Income 20202000 20202000 33.9 36.5 123.4 88.5 42.4 3.2 2.2 3.5 3.9 12.2 12.1 13.5 3.9 5.1 -49.1% -28.3% 21.6 17.5 Upper-middle-income countries have halved the number of children aff ected by stunting in the last 20 years Number of children under 5 affected by stunting, by country income classifi cation, 2000 and 20201 COUNTRY INCOME CLASSIFICATION TRENDS$ UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 13 COUNTRY INCOME CLASSIFICATION SHARE BY INCOME GROUP Less than half of all children under 5 live in lower-middle income countries, but nearly two thirds of all children with stunting and three quarters of all children with wasting live there Source: UNICEF, WHO, World Bank Group Joint Malnutrition Estimates, 2021 edition. Note: 1. Share is relative to the total number affected across the four country-income groups; this varies from the global totals reported elsewhere in this brochure because the populations are based on the FY2021 World Bank income classification. The differences are as follows: Stunting official global estimate of 149.2 million; sum of four country-income groups = 148.8 million. Wasting official global estimate of 45.4 million; sum of country-income groups = 41.9 million. Overweight official global estimate of 38.9 million; sum of 4 country-income groups = 38.7 million. The percentages for overweight do not add up to 100 per cent due to rounding. 2. Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). While only about half of all children under 5 live in lower-middle-income countries, two thirds of all children affected by stunting and three quarters of all children with wasting live there Distribution of children under 5 in the world, by country income grouping, 2020 Distribution of children under 5 affected by stunting, wasting and overweight in 20202 29% 45% 16% 10% of all children under 5 live in high-income countries of all children under 5 live in upper-middle- income countries of all children under 5 live in lower-middle- income countries of all children under 5 live in low-income countries 25% 59% 14% 72% 17% 10% 1% 10% 13% 31% 45% Share1 of children under 5 affected by stunting in 20202 Share1 of children under 5 affected by wasting in 20202 Share1 of children under 5 affected by overweight in 20202 2% of all children affected by stunting live in high-income countries of all children affected by stunting live in upper-middle- income countries of all children affected by stunting live in lower-middle- income countries of all children affected by stunting live in low-income countries of all children affected by wasting live in high-income countries of all children affected by wasting live in upper-middle- income countries of all children affected by wasting live in lower-middle- income countries of all children affected by wasting live in low-income countries of all children affected by overweight live in high-income countries of all children affected by overweight live in upper- middle-income countries of all children affected by overweight live in lower-middle- income countries of all children affected by overweight live in low-income countries $ 14 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition GLOBAL AND REGIONAL PREVALENCE TABLE* Notes: 1. Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). 2. For wasting and severe wasting: Asia excluding Japan, Eastern Asia excluding Japan, and Eastern Europe and Central Asia excluding Russia. 3. Consecutive low (<50 per cent) population coverage; interpret with caution. Population coverage is based on an assessment of available data within distinct five-year periods and was calculated as the sum of country five-year average populations for which surveys are available in the dataset, divided by the the total of country five-year average population for all countries in the region. Estimates are flagged as having consecutive low population coverage when two five-year periods in a row are below 50 per cent. The population coverage for the most recent five-year period for the United Nations regions is available on page 28. 4. For wasting and severe wasting, the Northern America estimates were derived applying mixed-effect models with sub-regions as fixed effects5 data were available only for the United States, preventing the estimation of confidence intervals. Model selection is based on best fit. Stunting Overweight Wasting and severe wasting 2000 20201 2000 20201 20201 20201 % stunted (moderate and severe) foo tn ot e % stunted (moderate and severe) foo tn ot e % overweight (moderate and severe) foo tn ot e % overweight (moderate and severe) foo tn ot e % wasted (moderate and severe) foo tn ot e % wasted (severe) foo tn ot e Global 33.1 [32.4-33.7] 22.0 [21.3-22.7] 5.4 [5.1-5.7] 5.7 [5.3-6.3] 6.7 [5.5-7.9] 2.0 [1.6-2.5] United Nations Regions Africa 41.5 [40.7-42.3] 30.7 [29.9-31.6] 6.2 [5.8-6.6] 5.3 [4.8-5.9] 6.0 [5.0-7.1] 1.5 [1.2-1.9] Eastern Africa 49.1 [48.1-50.1] 32.6 [31.3-33.9] 5.3 [4.9-5.8] 4.0 [3.6-4.6] 5.2 [3.6-7.5] 1.0 [0.7-1.6] Middle Africa 44.9 [43.3-46.6] 36.8 [34.1-39.5] 5.9 [4.9-7.0] 4.8 [3.9-5.9] 6.2 [4.6-8.2] 1.9 [1.4-2.6] Northern Africa 28.3 [26.4-30.3] 21.4 [19.0-24.1] 10.9 [9.7-12.3] 13.0 [10.2-16.5] 6.6 [3.2-13.1] 2.7 [1.3-5.4] Southern Africa 29.1 [27.1-31.3] 23.3 [21.0-25.7] 10.6 [8.5-13.1] 12.1 [9.4-15.5] 3.2 [2.1-5.1] 0.7 [0.6-1.0] Western Africa 39.9 [38.1-41.8] 30.9 [29.7-32.1] 4.4 [3.6-5.3] 2.7 [2.4-3.1] 6.9 [5.9-8.1] 1.4 [1.2-1.7] Asia2 37.0 [36.1-38.0] 21.8 [20.6-23.1] 4.5 [4.1-4.9] 5.2 [4.5-6.0] 8.9 [6.7-11.2] 2 2.9 [2.1-3.7] 2 Central Asia 29.0 [27.8-30.2] 10.0 [9.1-11.0] 9.6 [8.1-11.2] 5.6 [4.5-7.1] 2.3 [1.5-3.6] 0.6 [0.2-1.6] Eastern Asia 19.5 [18.4-20.7] 4.9 [4.2-5.7] 6.0 [5.1-7.0] 7.9 [5.7-10.7] 1.7 [1.6-1.7] 2 0.4 [0.3-0.4] 2 Southern Asia 48.3 [46.5-50.2] 30.7 [28.3-33.1] 3.3 [2.8-4.0] 2.5 [2.0-3.2] 14.1 [10.2-19.3] 4.4 [3.2-6.1] South-eastern Asia 38.0 [37.1-39.0] 27.4 [25.7-29.2] 3.7 [3.3-4.1] 7.5 [6.1-9.2] 8.2 [5.9-11.2] 3.4 [1.5-7.4] Western Asia 24.3 [23.5-25.0] 13.9 [12.6-15.3] 7.7 [6.9-8.5] 8.3 [7.0-9.8] 3.5 [1.4-8.4] 1.1 [0.5-2.4] Europe 6.6 [5.2-8.4] 3 4.5 [3.3-6.1] 3 8.1 [6.2-10.6] 3 8.3 [5.8-11.8] 3 - - Eastern Europe 10.1 [7.0-14.3] 3 6.6 [4.1-10.4] 3 11.9 [7.6-18.3] 3 9.9 [5.3-17.8] 3 - - Northern Europe 4.3 [2.3-7.7] 3 2.9 [1.6-5.3] 3 6.2 [3.5-10.7] 3 8.3 [4.2-15.9] 3 - - Southern Europe 6.8 [4.7-9.7] 3 4.0 [2.6-6.0] 3 7.2 [5.2-10.0] 3 8.0 [4.9-12.7] 3 - - Western Europe 2.9 [1.7-5.1] 3 2.3 [1.4-3.7] 3 4.5 [2.8-7.1] 3 6.0 [3.5-9.9] 3 - - Latin American and Caribbean 18.0 [17.4-18.5] 11.3 [10.3-12.4] 6.8 [6.1-7.6] 7.5 [6.2-9.0] 1.3 [0.8-1.8] 0.3 [0.2-0.4] Caribbean 15.7 [14.8-16.6] 11.8 [10.5-13.1] 5.8 [4.7-7.1] 6.6 [5.3-8.1] 2.8 [2.0-3.9] 0.8 [0.6-0.9] Central America 25.5 [24.3-26.7] 16.6 [15.3-18.0] 6.7 [5.5-8.2] 6.3 [5.2-7.7] 0.9 [0.7-1.0] 0.2 [0.1-0.3] South America 14.7 [14.1-15.4] 8.6 [7.2-10.2] 3 7.0 [6.1-8.0] 8.2 [6.3-10.6] 3 1.4 [0.8-2.4] 3 0.3 [0.1-0.6] 3 Oceania excl. Australia & New Zealand 35.6 [30.3-41.2] 41.4 [33.4-49.8] 5.2 [3.9-7.0] 8.0 [5.1-12.4] 9.0 [5.4-14.6] 3.5 [2.6-4.8] Australia and New Zealand 1.9 [1.2-3.0] 2.3 [1.4-3.7] 3 7.7 [5.7-10.3] 16.9 [12.4-22.5] - - Northern America 3.2 [2.8-3.7] 3.2 [2.7-3.8] 7.3 [6.0-8.9] 9.1 [6.9-11.8] 0.2 4 <0.1 4 SDG Regions Australia and New Zealand 1.9 [1.2-3.0] 2.3 [1.4-3.7] 7.7 [5.7-10.3] 16.9 [12.4-22.5] - - Central Asia and Southern Asia 47.7 [45.9-49.5] 29.8 [27.5-32.1] 3.5 [3.0-4.1] 2.7 [2.1-3.3] 13.6 [9.3-17.9] 4.2 [2.9-5.6] Eastern Asia and South-eastern Asia 26.1 [25.3-26.8] 13.4 [12.6-14.2] 5.2 [4.6-5.9] 7.7 [6.2-9.5] 4.1 [3.1-5.1] 1.5 [0.5-2.5] Latin America and the Caribbean 18.0 [17.4-18.5] 11.3 [10.3-12.4] 6.8 [6.1-7.6] 7.5 [6.2-9.0] 1.3 [0.8-1.8] 0.3 [0.2-0.4] Northern America and Europe 5.4 [4.4-6.5] 4.0 [3.2-5.1] 7.8 [6.4-9.5] 8.6 [6.7-11.0] - - Oceania excl. Australia & New Zealand 35.6 [30.3-41.2] 41.4 [33.4-49.8] 5.2 [3.9-7.0] 8.0 [5.1-12.4] 9.0 [5.4-14.6] 3.5 [2.6-4.8] Sub-Saharan Africa 44.0 [43.1-44.8] 32.3 [31.5-33.2] 5.3 [4.9-5.8] 4.0 [3.7-4.3] 5.9 [5.0-6.9] 1.3 [1.1-1.5] Western Asia and Northern Africa 26.2 [25.2-27.2] 17.8 [16.4-19.3] 9.2 [8.5-10.0] 10.8 [9.2-12.6] 5.1 [2.3-8.0] 1.9 [0.9-3.0] UNICEF East Asia and Pacific 25.9 [25.1-26.7] 13.5 [12.7-14.3] 5.2 [4.6-5.9] 7.8 [6.4-9.6] 3.7 [2.3-5.1] 1.4 [0.4-2.5] Europe and Central Asia 11.1 [9.9-12.4] 3 5.7 [4.8-6.8] 3 8.2 [6.6-10.0] 3 7.9 [6.0-10.4] 3 - - Eastern Europe and Central Asia 17.9 [15.9-20.1] 8.1 [6.5-10.0] 10.9 [8.3-14.2] 8.7 [5.8-12.7] 1.9 [1.3-2.7] 2 0.6 [0.4-0.9] 2 Western Europe 3.9 [2.9-5.3] 3 2.8 [2.1-3.7] 3 5.3 [4.1-6.9] 3 7.0 [5.1-9.6] 3 - - Latin America and Caribbean 18.0 [17.4-18.5] 11.3 [10.3-12.4] 6.8 [6.1-7.6] 7.5 [6.2-9.0] 1.3 [0.8-1.8] 0.3 [0.2-0.4] Middle East and North Africa 24.1 [23.5-24.7] 15.6 [14.2-17.2] 9.9 [9.1-10.8] 12.0 [9.9-14.5] 6.3 [3.7-10.6] 2.5 [1.3-4.9] North America 3.2 [2.8-3.7] 3.2 [2.7-3.8] 7.3 [6.0-8.9] 9.1 [6.9-11.8] 0.2 4 <0.1 4 South Asia 49.4 [47.5-51.3] 31.8 [29.3-34.4] 3.2 [2.7-3.9] 2.2 [1.8-2.8] 14.7 [11.1-19.2] 4.5 [3.3-6.2] Sub-Saharan Africa 43.8 [43.0-44.7] 32.4 [31.5-33.2] 5.3 [4.9-5.7] 3.9 [3.6-4.3] 6.2 [5.3-7.2] 1.4 [1.2-1.7] East and Southern Africa 46.4 [45.4-47.5] 32.3 [31.1-33.5] 5.6 [5.2-6.0] 4.5 [4.1-5.0] 5.3 [3.7-7.4] 1.1 [0.8-1.7] West and Central Africa 41.1 [39.6-42.5] 32.5 [31.2-33.7] 4.9 [4.3-5.7] 3.4 [3.0-3.8] 7.2 [6.5-7.9] 1.7 [1.5-1.9] WHO African Region 43.6 [42.8-44.5] 31.7 [30.9-32.6] 5.5 [5.1-6.0] 4.2 [3.9-4.6] 5.8 [4.9-6.8] 1.4 [1.1-1.6] Region of the Americas 13.9 [13.5-14.4] 8.9 [8.2-9.7] 7.0 [6.3-7.7] 8.0 [6.8-9.3] 0.7 [0.3-1.5] 0.1 [0.0-0.3] South-East Asia Region 48.4 [46.6-50.2] 30.1 [27.7-32.7] 3.2 [2.6-3.8] 3.3 [2.7-4.1] 14.5 [11.0-18.9] 4.5 [3.3-6.2] Eastern Mediterranean Region 33.9 [32.6-35.3] 26.2 [24.5-27.9] 7.2 [6.6-7.9] 7.7 [6.4-9.1] 7.4 [5.7-9.5] 3.0 [2.2-4.1] Europe Region 11.0 [9.9-12.3] 3 5.7 [4.7-6.8] 3 8.1 [6.6-10.0] 3 7.9 [6.0-10.3] 3 - - Western Pacific Region 22.2 [21.3-23.1] 9.3 [8.6-10.0] 5.5 [4.8-6.3] 7.5 [5.8-9.7] 2.1 [1.4-3.1] 0.5 [0.3-0.8] World Bank Income Low income 47.9 [47.0-48.8] 34.6 [33.5-35.8] 5.0 [4.6-5.4] 3.7 [3.3-4.1] 6.9 [5.6-8.6] 1.6 [1.2-2.1] Middle Income 34.8 [34.0-35.6] 21.8 [20.8-22.7] 5.4 [5.1-5.8] 5.9 [5.3-6.6] 6.8 [3.7-9.9] 2.0 [0.9-3.0] Lower-middle income 44.7 [43.5-46.0] 29.1 [27.6-30.6] 4.4 [4.0-4.9] 4.0 [3.5-4.4] 9.9 [5.8-16.2] 2.8 [1.6-5.1] Upper middle income 21.2 [20.6-21.9] 10.8 [10.1-11.5] 6.7 [6.1-7.4] 8.8 [7.4-10.3] 2.1 [1.3-3.4] 0.6 [0.3-1.3] High income 4.8 [4.2-5.4] 3.4 [3.0-3.9] 3 5.8 [5.1-6.6] 7.8 [6.7-9.2] 3 0.4 [0.2-0.8] 3 0.0 [0.0-0.1] 3 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 15 GLOBAL AND REGIONAL NUMBERS (MILLIONS) AFFECTED TABLE* *Complete data series for stunting and overweight (2000, 2005, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019 and 2020) and the latest year for wasting (2020) estimates of prevalence and numbers affected can be found at the websites below for global as well as for the following groupings: (i) United Nations regions and sub-regions; (ii) UNICEF regions; (iii) WHO regions; (iv) World Bank country income classifications; (v) World Bank regions; (vi) SDG regions; and (vii) the Food and Agriculture Organization’s (FAO) low-income food deficient countries classification. These websites also contain a file with the country compositions for each grouping: UNICEF <https://data.unicef.org/topic/nutrition/malnutrition/> WHO <www.who.int/teams/nutrition-and-food-safety/databases/nutgrowthdb> World Bank Group <data.worldbank.org/child-malnutrition> Stunting Overweight Wasting and severe wasting 2000 20201 2000 20201 20201 20201 number (millions) stunted (moderate and severe) fo ot no te number (millions) stunted (moderate and severe) fo ot no te number (millions) overweight (moderate and severe) fo ot no te number (millions) overweight (moderate and severe) fo ot no te number (millions) wasted (moderate and severe) fo ot no te number (millions) wasted (severe) fo ot no te Global 203.6 [199.8-207.4] 149.2 [144.4-154.2] 33.3 [31.5-35.1] 38.9 [35.6-42.4] 45.4 [37.0-53.7] 13.6 [10.6-16.7] United Nations Africa 54.4 [53.4-55.4] 61.4 [59.8-63.1] 8.2 [7.6-8.7] 10.6 [9.6-11.7] 12.1 [10.0-14.1] 3.0 [2.4-3.7] Eastern Africa 22.6 [22.1-23.0] 22.1 [21.3-23.1] 2.5 [2.3-2.7] 2.7 [2.4-3.1] 3.5 [2.4-5.1] 0.7 [0.5-1.1] Middle Africa 7.9 [7.6-8.2] 11.3 [10.5-12.2] 1.0 [0.9-1.2] 1.5 [1.2-1.8] 1.9 [1.4-2.5] 0.6 [0.4-0.8] Northern Africa 5.9 [5.5-6.3] 6.2 [5.5-7.0] 2.3 [2.0-2.6] 3.8 [3.0-4.8] 1.9 [0.9-3.8] 0.8 [0.4-1.6] Southern Africa 1.7 [1.6-1.8] 1.6 [1.4-1.7] 0.6 [0.5-0.8] 0.8 [0.6-1.1] 0.2 [0.1-0.3] 0.1 [0.0-0.1] Western Africa 16.4 [15.6-17.1] 20.2 [19.4-21.0] 1.8 [1.5-2.2] 1.8 [1.5-2.0] 4.5 [3.8-5.3] 0.9 [0.8-1.1] Asia2 135.9 [132.3-139.5] 79.0 [74.7-83.6] 16.5 [15.1-18.0] 18.7 [16.2-21.6] 31.9 [23.9-39.9] 2 10.3 [7.3-13.2] 2 Central Asia 1.7 [1.6-1.8] 0.8 [0.7-0.9] 0.6 [0.5-0.7] 0.5 [0.4-0.6] 0.2 [0.1-0.3] 0.0 [0.0-0.1] Eastern Asia 19.9 [18.8-21.0] 4.6 [4.0-5.4] 6.1 [5.2-7.2] 7.4 [5.4-10.1] 1.5 [1.4-1.6] 2 0.3 [0.3-0.4] 2 Southern Asia 87.6 [84.3-91.0] 54.3 [50.1-58.6] 6.0 [5.1-7.2] 4.5 [3.5-5.6] 25.0 [18.0-34.1] 7.8 [5.6-10.8] South-eastern Asia 20.8 [20.2-21.3] 15.3 [14.4-16.3] 2.0 [1.8-2.3] 4.2 [3.4-5.1] 4.6 [3.3-6.3] 1.9 [0.9-4.2] Western Asia 5.6 [5.5-5.8] 3.7 [3.4-4.1] 1.8 [1.6-2.0] 2.2 [1.9-2.7] 1.0 [0.4-2.3] 0.3 [0.1-0.7] Europe 2.4 [1.9-3.1] 3 1.8 [1.3-2.4] 3 3.0 [2.3-3.9] 3 3.2 [2.3-4.6] 3 - - Eastern Europe 1.4 [1.0-2.0] 3 1.1 [0.7-1.7] 3 1.7 [1.1-2.6] 3 1.6 [0.9-2.9] 3 - - Northern Europe 0.2 [0.1-0.4] 3 0.2 [0.1-0.3] 3 0.3 [0.2-0.6] 3 0.5 [0.3-1.0] 3 - - Southern Europe 0.5 [0.3-0.7] 3 0.3 [0.2-0.4] 3 0.5 [0.4-0.7] 3 0.5 [0.3-0.8] 3 - - Western Europe 0.3 [0.2-0.5] 3 0.2 [0.1-0.4] 3 0.4 [0.3-0.7] 3 0.6 [0.4-1.0] 3 - - Latin American and Caribbean 10.2 [9.9-10.5] 5.8 [5.3-6.4] 3.9 [3.5-4.3] 3.9 [3.2-4.7] 0.7 [0.4-0.9] 0.1 [0.1-0.2] Caribbean 0.6 [0.6-0.6] 0.4 [0.4-0.4] 0.2 [0.2-0.3] 0.2 [0.2-0.3] 0.1 [0.1-0.1] <0.1 Central America 4.2 [4.0-4.4] 2.7 [2.5-2.9] 1.1 [0.9-1.4] 1.0 [0.8-1.2] 0.1 [0.1-0.2] <0.1 South America 5.3 [5.1-5.6] 2.8 [2.3-3.3] 3 2.5 [2.2-2.9] 2.6 [2.0-3.4] 3 0.4 [0.3-0.8] 3 0.1 [0.0-0.2] 3 Oceania excl. Australia & New Zealand 0.4 [0.4-0.5] 0.6 [0.5-0.7] 0.1 [0.0-0.1] 0.1 [0.1-0.2] 0.1 [0.1-0.2] 0.1 [0.0-0.1] Australia and New Zealand 0.0 [0.0-0.0] 0.0 [0.0-0.1] 3 0.1 [0.1-0.2] 0.3 [0.2-0.4] - - Northern America 0.7 [0.6-0.8] 0.7 [0.6-0.8] 1.6 [1.3-1.9] 2.0 [1.5-2.6] <0.1 4 <0.1 4 SDG Regions Australia and New Zealand 0.0 [0.0-0.0] 0.0 [0.0-0.1] 0.1 [0.1-0.2] 0.3 [0.2-0.4] - - Central Asia and Southern Asia 89.3 [86.0-92.7] 55.1 [50.9-59.5] 6.6 [5.6-7.8] 4.9 [4.0-6.1] 25.2 [17.3-33.1] 7.9 [5.3-10.4] Eastern Asia and South-eastern Asia 40.8 [39.6-42.0] 20.1 [18.9-21.4] 8.1 [7.2-9.2] 11.6 [9.3-14.3] 6.0 [4.5-7.4] 2.2 [0.7-3.7] Latin America and the Caribbean 10.2 [9.9-10.5] 5.8 [5.3-6.4] 3.9 [3.5-4.3] 3.9 [3.2-4.7] 0.7 [0.4-0.9] 0.1 [0.1-0.2] Northern America and Europe 3.1 [2.6-3.8] 2.4 [1.9-3.1] 4.5 [3.7-5.5] 5.2 [4.1-6.7] - - Oceania excl. Australia & New Zealand 0.4 [0.4-0.5] 0.6 [0.5-0.7] 0.1 [0.0-0.1] 0.1 [0.1-0.2] 0.1 [0.1-0.2] 0.1 [0.0-0.1] Sub-Saharan Africa 48.5 [47.5-49.4] 55.2 [53.7-56.7] 5.9 [5.5-6.4] 6.8 [6.3-7.4] 10.1 [8.6-11.7] 2.2 [1.9-2.6] Western Asia and Northern Africa 11.5 [11.1-12.0] 10.0 [9.2-10.8] 4.1 [3.7-4.4] 6.0 [5.1-7.1] 2.9 [1.3-4.5] 1.1 [0.5-1.7] UNICEF East Asia and Pacific 41.2 [40.0-42.5] 20.7 [19.5-22.0] 8.3 [7.4-9.4] 12.0 [9.8-14.8] 5.7 [3.5-7.9] 2.2 [0.5-3.8] Europe and Central Asia 5.6 [5.0-6.3] 3 3.2 [2.6-3.8] 3 4.1 [3.4-5.1] 3 4.4 [3.3-5.7] 3 - - Eastern Europe and Central Asia 4.7 [4.1-5.2] 2.5 [2.0-3.1] 2.8 [2.1-3.7] 2.6 [1.8-3.9] 0.4 [0.3-0.6] 2 0.1 [0.1-0.2] 2 Western Europe 1.0 [0.7-1.3] 3 0.7 [0.5-0.9] 3 1.3 [1.0-1.7] 3 1.7 [1.3-2.4] 3 - - Latin America and Caribbean 10.2 [9.9-10.5] 5.8 [5.3-6.4] 3.9 [3.5-4.3] 3.9 [3.2-4.7] 0.7 [0.4-0.9] 0.1 [0.1-0.2] Middle East and North Africa 9.0 [8.8-9.2] 7.7 [7.0-8.5] 3.7 [3.4-4.0] 5.9 [4.9-7.2] 3.1 [1.8-5.2] 1.2 [0.6-2.4] North America 0.7 [0.6-0.8] 0.7 [0.6-0.8] 1.6 [1.3-1.9] 2.0 [1.5-2.6] <0.1 4 <0.1 4 South Asia 86.8 [83.4-90.1] 53.8 [49.6-58.2] 5.6 [4.7-6.8] 3.7 [3.0-4.7] 24.8 [18.8-32.4] 7.6 [5.6-10.4] Sub-Saharan Africa 50.4 [49.4-51.4] 57.3 [55.8-58.9] 6.1 [5.6-6.5] 7.0 [6.4-7.6] 11.1 [9.3-12.8] 2.5 [2.1-3.0] East and Southern Africa 27.6 [27.0-28.3] 28.0 [27.0-29.1] 3.3 [3.1-3.6] 3.9 [3.5-4.4] 4.6 [3.2-6.5] 1.0 [0.7-1.5] West and Central Africa 22.8 [22.0-23.6] 29.3 [28.2-30.4] 2.7 [2.4-3.1] 3.0 [2.7-3.4] 6.5 [5.9-7.1] 1.6 [1.4-1.7] WHO African Region 48.6 [47.6-49.5] 54.9 [53.4-56.3] 6.2 [5.7-6.7] 7.3 [6.7-8.0] 9.9 [8.4-11.7] 2.3 [1.9-2.8] Region of the Americas 10.8 [10.5-11.2] 6.5 [6.0-7.1] 5.4 [4.9-6.0] 5.8 [5.0-6.8] 0.5 [0.2-1.1] 0.1 [0.0-0.3] South-East Asia Region 88.5 [85.2-91.8] 51.1 [46.9-55.4] 5.8 [4.8-6.9] 5.6 [4.6-6.9] 24.6 [18.7-31.9] 7.7 [5.6-10.4] Eastern Mediterranean Region 22.3 [21.4-23.2] 22.4 [21.0-23.9] 4.8 [4.3-5.2] 6.6 [5.5-7.8] 6.3 [4.9-8.1] 2.6 [1.9-3.6] Europe Region 5.6 [5.0-6.3] 3 3.2 [2.7-3.8] 3 4.2 [3.4-5.1] 3 4.4 [3.4-5.8] 3 - - Western Pacific Region 27.5 [26.4-28.7] 11.0 [10.2-11.9] 6.8 [5.9-7.8] 8.8 [6.8-11.4] 2.4 [1.6-3.6] 0.6 [0.4-1.0] World Bank Income Low income 33.9 [33.3-34.6] 36.5 [35.3-37.7] 3.5 [3.3-3.8] 3.9 [3.5-4.3] 7.3 [5.9-9.1] 1.7 [1.3-2.2] Middle Income 165.5 [161.8-169.2] 109.8 [105.1-114.5] 25.7 [24.1-27.5] 29.7 [26.7-33.1] 34.3 [18.8-49.8] 9.8 [4.7-15.0] Lower-middle income 123.4 [119.9-126.9] 88.5 [84.0-93.0] 12.2 [11.1-13.4] 12.1 [10.8-13.5] 30.1 [17.8-49.3] 8.6 [4.8-15.5] Upper middle income 42.4 [41.1-43.8] 21.6 [20.2-23.0] 13.5 [12.2-14.9] 17.5 [14.9-20.6] 4.3 [2.7-6.8] 1.2 [0.6-2.7] High income 3.2 [2.8-3.6] 2.2 [2.0-2.5] 3 3.9 [3.4-4.4] 5.1 [4.3-6.0] 3 0.2 [0.1-0.5] 3 <0.1 3 16 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Notes 1. The most recent estimate between 2000 and 2020 in the JME country dataset is reported for wasting. See page 29 for link to full country time series. 2. Household survey data on child height and weight were not collected in 2020 due to physical distancing policies, with the exception of four surveys. These estimates are therefore based almost entirely on data collected before 2020 and do not take into account the impact of the COVID-19 pandemic. However, one of the covariates used in the country stunting and overweight models takes the impact of COVID-19 partially into account (see page 3). 3. See page 24 for prevalence thresholds. For stunting and overweight, ‘no data’ is used for countries without any input data (e.g., household survey data) for use in the country-level models or where the modelled estimates remain pending final review. For wasting, ‘no recent data’ is used when the most recent data point is from before 2000 and ‘no data’ is used for countries without any data. 4. Notes on progress assessment: Progress was assessed against SDG target 2.2 for 20306 using an adapted version of rules from the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring.7 For stunting and overweight, the JME country modelled estimates from 2012 to 2020 were used to calculate the annual average rate of reduction (AARR) for countries with at least one input data point (e.g., from household surveys) more recent than 1999. For wasting, all available country data (e.g., from household surveys) between 2005 and 2020 in the 2021 JME country dataset were used to calculate the AARR for countries with at least two input data points, of which at least one was more recent than 2012. See Table 1 (page 17) for progress assessment rules by indicator. 5. The most recent country data point (e.g., from household surveys) used to generate the modelled stunting and overweight estimates is from before the year 2000; interpret with caution. 6. Modelled estimate pending final review. M O D E L L E D E S T I M A T E S Stunting (PERCENT) Overweight (PERCENT) Wasting1 (PERCENT) Country Name 2012value 20202 value 2020 threshold3 Progress assessment4 foo tno te 2012 value 20202 value 2020 threshold3 Progress assessment4 foo tno te Year Value Threshold3 Progress assessment4 Afghanistan 44.7 35.1 Very high 5.3 3.9 Low 2018 5.1 Medium Albania 17.6 9.6 Low 21.7 14.6 High 2017 1.6 Very low Algeria 12.6 9.3 Low 13.5 12.9 High 2019 2.7 Low Andorra - - No data - - No data - - No data Angola 32.4 37.7 Very high 2.9 3.5 Low 2015 4.9 Low Anguilla - - No data - - No data - - No data Antigua and Barbuda - - No data - - No data - - No data Argentina 7.8 7.8 Low 12.4 12.9 High 2019 1.6 Very low Armenia 14.0 9.1 Low 14.8 10.8 High 2016 4.4 Low Australia 2.1 2.1 Very low 14.2 18.5 Very high 2007 <0.1 Very low Austria - - No data - - No data - - No data Azerbaijan 17.2 16.3 Medium 11.1 9.4 Medium 2013 3.2 Low Bahamas - - No data - - No data - - No data Bahrain 6.3 5.1 Low 5 5.6 6.4 Medium 5 1995 - No recent data Bangladesh 38.1 30.2 Very high 1.7 2.1 Very low 2019 9.8 Medium Barbados 7.6 6.6 Low 10.8 11.4 High 2012 6.8 Medium Belarus 4.0 3.9 Low 9.2 6.8 Medium 2005 2.2 Very low Belgium 2.7 2.3 Very low 4.5 5.1 Medium 2014 0.4 Very low Belize 17.5 13.3 Medium 9.0 8.0 Medium 2015 1.8 Very low Benin 33.8 31.3 Very high 1.6 2.2 Very low 2018 5.0 Medium Bhutan 30.2 22.4 High 6.1 5.2 Medium 2010 5.9 Medium Bolivia (Plurinational State of) 20.3 12.7 Medium 9.0 8.8 Medium 2016 2.0 Very low Bosnia and Herzegovina 9.3 9.1 Low 18.9 12.8 High 2012 2.3 Very low Botswana 24.4 22.8 High 10.6 11.0 High 2007 7.3 Medium Brazil 6.3 6.1 Low 6.9 7.3 Medium 2007 1.8 Very low British Virgin Islands - - No data - - No data - - No data Brunei Darussalam 17.5 12.7 Medium 8.4 9.3 Medium 2009 2.9 Low Bulgaria 7.5 6.4 Low 8.2 5.7 Medium 2014 6.3 Medium Burkina Faso 33.9 25.5 High 1.7 2.6 Low 2019 8.1 Medium Burundi 56.8 57.6 Very high 2.3 3.1 Low 2019 4.8 Low Cabo Verde 12.2 9.7 Low 5 - - No data 5 1994 - No recent data COUNTRY PREVALENCE TABLE UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 17 i. Required AARR is based on the change in stunting prevalence corresponding to a 50 per cent reduction in the number of children affected by stunting between 2012 and 2030, considering the population growth estimated by the United Nations World Population Prospects. ii. Countries where the point estimate or lower 95 per cent confidence interval for the year 2020 is <3 per cent are considered on track. iii. Required AARR is based on the required change in overweight or wasting prevalence to reduce from the baseline (2012) prevalence to 3 per cent by 2030. iv. Countries where the point estimate for the year 2020 is <3 per cent are considered on track. v. Assessment is not possible for stunting and overweight where countries did not have any input data (e.g., household survey data) for the model that were more recent than 2000, and where modelled estimates remain pending final review. vi. Assessment is not possible for wasting where countries do not have at least two data points between 2005 and 2020, with at least one point being more recent than 2012. Progress assessment label Stunting (2030 target: reduce the number of children under 5 with stunting by 50 per cent) Overweight (2030 target: reduce the number of children under 5 with overweight to less than 3 per cent) Wasting (2030 target: reduce the number of children under 5 with wasting to less than 3 per cent) On track AARR > requiredi or prevalence <3%ii AARR > requirediii or prevalence < 3%iv AARR > requirediii or prevalence < 3%iv Off track (some progress) AARR < required, but > 0.5 AARR < required, but > 1.5 AARR < required, but > 2.0 Off track (no progress) -0.5 ≤ AARR < 0.5 -1.5 ≤ AARR < 1.5 -2.0 ≤ AARR < 2.0 Off track (worsening) AARR < -0.5 AARR < -1.5 AARR < -2.0 Assessment not possible Assessment not possiblev Assessment not possiblev Assessment not possiblevi M O D E L L E D E S T I M A T E S Stunting (NUMBERS) Overweight (NUMBERS) Wasting1 (NUMBERS) Country Name 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te Year Value Afghanistan 2417.6 1.4 1991.1 1.3 286.6 0.8 221.2 0.6 2018 287.4 Albania 29.9 <0.1 16.0 <0.1 36.8 0.1 24.3 0.1 2017 2.8 Algeria 541.6 0.3 468.9 0.3 580.3 1.6 650.4 1.7 2019 135.8 Andorra - - - - - - - - - - Angola 1554.8 0.9 2184.7 1.5 139.2 0.4 202.8 0.5 2015 255.5 Anguilla - - - - - - - - - - Antigua and Barbuda - - - - - - - - - - Argentina 283.6 0.2 291.5 0.2 450.9 1.2 482.0 1.2 2019 59.9 Armenia 29.3 <0.1 18.7 <0.1 30.9 0.1 22.1 0.1 2016 9.5 Australia 32.2 <0.1 35.1 <0.1 217.8 0.6 308.9 0.8 2007 <0.1 Austria - - - - - - - - - - Azerbaijan 132.6 0.1 134.5 0.1 85.6 0.2 77.6 0.2 2013 25.6 Bahamas - - - - - - - - - - Bahrain 6.2 <0.1 5.5 <0.1 5 5.5 <0.1 6.9 <0.1 5 1995 - Bangladesh 5690.2 3.3 4327.1 2.9 253.9 0.7 300.9 0.8 2019 1417.4 Barbados 1.3 <0.1 1.0 <0.1 1.8 <0.1 1.7 <0.1 2012 1.1 Belarus 21.9 <0.1 21.4 <0.1 50.4 0.1 37.3 0.1 2005 9.8 Belgium 17.5 <0.1 14.6 <0.1 29.2 0.1 32.3 0.1 2014 2.5 Belize 6.6 <0.1 5.2 <0.1 3.4 <0.1 3.2 <0.1 2015 0.7 Benin 553.3 0.3 597.3 0.4 26.2 0.1 42.0 0.1 2018 91.4 Bhutan 19.6 <0.1 14.3 <0.1 4.0 <0.1 3.3 <0.1 2010 3.9 Bolivia (Plurinational State of) 241.8 0.1 150.6 0.1 107.2 0.3 104.3 0.3 2016 23.5 Bosnia and Herzegovina 17.0 <0.1 12.1 <0.1 34.6 0.1 17.1 <0.1 2012 4.3 Botswana 63.3 <0.1 62.0 <0.1 27.5 0.1 29.9 0.1 2007 17.9 Brazil 927.5 0.5 883.0 0.6 1015.8 2.7 1056.7 2.7 2007 285.9 British Virgin Islands - - - - - - - - - - Brunei Darussalam 5.6 <0.1 4.0 <0.1 2.7 <0.1 2.9 <0.1 2009 0.9 Bulgaria 27.9 <0.1 20.0 <0.1 30.5 0.1 17.8 <0.1 2014 21.9 Burkina Faso 1012.4 0.6 885.5 0.6 50.8 0.1 90.3 0.2 2019 274.6 Burundi 967.5 0.6 1183.0 0.8 39.2 0.1 63.7 0.2 2019 95.9 Cabo Verde 6.4 <0.1 5.0 <0.1 5 - - - - 5 1994 - Table 1: Rules for progress assessment against child malnutrition indicators for SDG target 2.2 COUNTRY NUMBERS AFFECTED (THOUSANDS) TABLE 18 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition M O D E L L E D E S T I M A T E S Stunting (PERCENT) Overweight (PERCENT) Wasting1 (PERCENT) Country Name 2012value 20202 value 2020 threshold3 Progress assessment4 foo tno te 2012 value 20202 value 2020 threshold3 Progress assessment4 foo tno te Year Value Threshold3 Progress assessment4 Cambodia 34.4 29.9 High 2.1 2.1 Very low 2014 9.7 Medium Cameroon 32.5 27.2 High 6.9 9.6 Medium 2018 4.3 Low Canada - - No data 11.2 11.8 High - - No data Central African Republic 41.4 40.1 Very high 3.5 2.6 Low 2019 5.2 Medium Chad 38.7 35.0 Very high 2.4 3.4 Low 2019 13.9 High Chile 1.9 1.6 Very low 10.4 9.8 Medium 2014 0.3 Very low China 7.4 4.7 Low 7.2 8.3 Medium 2017 1.9 Very low Colombia 12.9 11.5 Medium 5.2 5.8 Medium 2016 1.6 Very low Comoros 32.3 22.6 High 10.9 9.6 Medium 2012 11.2 High Congo 23.4 18.0 Medium 5.1 5.1 Medium 2014 8.2 Medium Cook Islands - - No data - - No data - - No data Costa Rica 7.0 8.6 Low 8.3 8.1 Medium 2018 1.8 Very low Côte d'Ivoire 29.3 17.8 Medium 2.5 2.8 Low 2016 6.1 Medium Croatia - - No data - - No data - - No data Cuba 7.1 7.0 Low 9.2 10.0 High 2019 2.0 Very low Cyprus - - No data - - No data - - No data Czechia 2.4 2.5 Low 5.9 6.6 Medium 2001 4.6 Low Democratic People's Republic of Korea 26.1 18.2 Medium 1.3 1.9 Very low 2017 2.5 Low Democratic Republic of the Congo 42.8 40.8 Very high 4.6 4.2 Low 2017 6.4 Medium Denmark - - No data - - No data - - No data Djibouti 31.7 34.0 Very high 7.2 7.2 Medium 2012 21.5 Very high Dominica - - No data - - No data - - No data Dominican Republic 8.0 5.9 Low 7.8 7.6 Medium 2013 2.4 Very low Ecuador 24.1 23.1 High 7.3 9.8 Medium 2019 3.7 Low Egypt 22.5 22.3 High 15.8 17.8 Very high 2014 9.5 Medium El Salvador 16.0 11.2 Medium 6.0 6.6 Medium 2014 2.1 Very low Equatorial Guinea 25.5 19.7 Medium 8.8 9.3 Medium 2011 3.1 Low Eritrea 50.1 49.1 Very high 1.7 2.1 Very low 2010 14.6 High Estonia 1.3 1.2 Very low 5.1 5.7 Medium 2014 1.5 Very low Eswatini 29.2 22.6 High 10.6 9.7 Medium 2014 2.0 Very low Ethiopia 42.8 35.3 Very high 2.5 2.6 Low 2019 7.2 Medium Fiji 8.5 7.5 Low 4.8 5.2 Medium 2004 6.3 Medium Finland - - No data - - No data - - No data France - - No data - - No data - - No data Gabon 17.2 14.4 Medium 6.5 7.4 Medium 2012 3.4 Low Gambia 22.4 16.1 Medium 1.9 2.3 Very low 2020 5.1 Medium Georgia 9.2 5.7 Low 13.7 7.6 Medium 2018 0.6 Very low Germany 1.5 1.6 Very low 3.7 4.1 Low 2016 0.3 Very low Ghana 22.2 14.2 Medium 2.2 2.9 Low 2017 6.8 Medium Greece 2.1 2.2 Very low 14.2 13.9 High 2003 0.6 Very low Grenada - - No data - - No data - - No data Guatemala 47.5 42.8 Very high 5.4 5.1 Medium 2015 0.8 Very low Guinea 33.8 29.4 High 4.1 5.7 Medium 2018 9.2 Medium Guinea-Bissau 29.7 28.0 High 2.7 3.4 Low 2019 7.8 Medium Guyana 14.4 9.0 Low 5.9 6.6 Medium 2014 6.4 Medium Haiti 23.9 20.4 High 3.6 3.7 Low 2017 3.7 Low Holy See - - No data - - No data - - No data Honduras 22.7 19.9 Medium 5.0 5.7 Medium 2012 1.4 Very low Country prevalence table (cont.) UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 19 M O D E L L E D E S T I M A T E S Stunting (NUMBERS) Overweight (NUMBERS) Wasting1 (NUMBERS) Country Name 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te Year Value Cambodia 602.2 0.3 531.9 0.4 36.8 0.1 37.4 0.1 2014 171.0 Cameroon 1176.5 0.7 1119.5 0.8 249.8 0.7 395.1 1.0 2018 172.3 Canada - - - - 217.8 0.6 235.2 0.6 - - Central African Republic 306.1 0.2 296.0 0.2 25.9 0.1 19.2 <0.1 2019 37.9 Chad 949.2 0.5 1025.7 0.7 58.9 0.2 99.6 0.3 2019 400.4 Chile 23.7 <0.1 18.6 <0.1 129.7 0.4 113.9 0.3 2014 3.7 China 6390.9 3.7 3944.8 2.6 6218.2 16.8 6966.4 17.9 2017 1644.2 Colombia 476.3 0.3 426.7 0.3 192.0 0.5 215.2 0.6 2016 60.9 Comoros 36.0 <0.1 27.9 <0.1 12.1 <0.1 11.9 <0.1 2012 12.5 Congo 173.9 0.1 148.0 0.1 37.9 0.1 41.9 0.1 2014 62.8 Cook Islands - - - - - - - - - - Costa Rica 25.2 <0.1 29.9 <0.1 29.8 0.1 28.2 0.1 2018 6.3 Côte d'Ivoire 1013.3 0.6 735.4 0.5 86.5 0.2 115.7 0.3 2016 230.3 Croatia - - - - - - - - - - Cuba 43.6 <0.1 40.0 <0.1 56.5 0.2 57.1 0.1 2019 12.0 Cyprus - - - - - - - - - - Czechia 13.8 <0.1 14.0 <0.1 34.0 0.1 36.9 0.1 2001 19.4 Democratic People's Republic of Korea 429.8 0.2 317.8 0.2 21.4 0.1 33.2 0.1 2017 43.5 Democratic Republic of the Congo 5551.3 3.2 6457.6 4.3 596.6 1.6 664.8 1.7 2017 956.5 Denmark - - - - - - - - - - Djibouti 29.3 <0.1 33.7 <0.1 6.7 <0.1 7.1 <0.1 2012 19.9 Dominica - - - - - - - - - - Dominican Republic 79.7 <0.1 59.2 <0.1 77.7 0.2 76.2 0.2 2013 23.8 Ecuador 380.0 0.2 385.1 0.3 115.1 0.3 163.4 0.4 2019 62.1 Egypt 2411.9 1.4 2831.5 1.9 1693.7 4.6 2260.1 5.8 2014 1132.6 El Salvador 96.7 0.1 64.5 <0.1 36.3 0.1 38.0 0.1 2014 12.6 Equatorial Guinea 40.9 <0.1 39.3 <0.1 14.1 <0.1 18.6 <0.1 2011 4.8 Eritrea 267.3 0.2 243.1 0.2 9.1 <0.1 10.4 <0.1 2010 76.6 Estonia 1.0 <0.1 0.8 <0.1 3.9 <0.1 3.9 <0.1 2014 1.1 Eswatini 44.6 <0.1 32.5 <0.1 16.2 <0.1 13.9 <0.1 2014 2.9 Ethiopia 6274.8 3.6 5927.4 4.0 366.5 1.0 436.6 1.1 2019 1192.4 Fiji 7.9 <0.1 6.7 <0.1 4.4 <0.1 4.6 <0.1 2004 5.7 Finland - - - - - - - - - - France - - - - - - - - - - Gabon 43.7 <0.1 46.1 <0.1 16.5 <0.1 23.7 0.1 2012 8.8 Gambia 75.6 <0.1 65.9 <0.1 6.4 <0.1 9.4 <0.1 2020 20.9 Georgia 25.8 <0.1 15.3 <0.1 38.4 0.1 20.4 0.1 2018 1.8 Germany 50.9 <0.1 64.9 <0.1 125.7 0.3 166.4 0.4 2016 10.8 Ghana 832.5 0.5 592.1 0.4 82.5 0.2 120.9 0.3 2017 277.4 Greece 11.3 <0.1 9.0 <0.1 76.2 0.2 56.9 0.1 2003 3.1 Grenada - - - - - - - - - - Guatemala 919.4 0.5 884.0 0.6 104.5 0.3 105.3 0.3 2015 15.0 Guinea 617.8 0.4 617.4 0.4 74.9 0.2 119.7 0.3 2018 185.8 Guinea-Bissau 79.7 <0.1 85.4 0.1 7.2 <0.1 10.4 <0.1 2019 23.6 Guyana 10.5 <0.1 6.6 <0.1 4.3 <0.1 4.9 <0.1 2014 4.8 Haiti 303.6 0.2 257.6 0.2 45.7 0.1 46.7 0.1 2017 47.3 Holy See - - - - - - - - - - Honduras 231.8 0.1 202.4 0.1 51.0 0.1 58.0 0.1 2012 14.0 Country numbers affected (thousands) table (cont.) 20 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition M O D E L L E D E S T I M A T E S Stunting (PERCENT) Overweight (PERCENT) Wasting1 (PERCENT) Country Name 2012value 20202 value 2020 threshold3 Progress assessment4 foo tno te 2012 value 20202 value 2020 threshold3 Progress assessment4 foo tno te Year Value Threshold3 Progress assessment4 Hungary - - No data - - No data - - No data Iceland - - No data - - No data - - No data India 41.7 30.9 Very high 2.4 1.9 Very low 2017 17.3 Very high Indonesia 34.5 31.8 Very high 8.2 11.1 High 2018 10.2 High Iran (Islamic Republic of) 6.1 6.3 Low 8.4 9.4 Medium 2010 4.0 Low Iraq 19.2 11.6 Medium 9.2 9.0 Medium 2018 3.0 Low Ireland - - No data - - No data - - No data Israel - - No data - - No data - - No data Italy - - No data - - No data - - No data Jamaica 6.8 8.5 Low 7.2 6.8 Medium 2016 3.3 Low Japan 6.6 5.5 Low 2.0 2.4 Very low 2010 2.3 Very low Jordan 7.9 7.3 Low 5.7 7.1 Medium 2012 2.4 Very low Kazakhstan 11.1 6.7 Low 11.5 8.8 Medium 2015 3.1 Low Kenya 27.8 19.4 Medium 4.6 4.5 Low 2014 4.2 Low Kiribati 15.8 14.9 Medium 2.4 2.4 Very low 2018 3.5 Low Kuwait 4.8 6.0 Low 7.9 7.1 Medium 2017 2.5 Low Kyrgyzstan 16.0 11.4 Medium 7.6 5.8 Medium 2018 2.0 Very low Lao People's Democratic Republic 40.7 30.2 Very high 2.3 3.0 Low 2017 9.0 Medium Latvia - - No data - - No data - - No data Lebanon 12.9 10.4 Medium 19.8 19.7 Very high 2004 6.6 Medium Lesotho 37.7 32.1 Very high 7.0 7.2 Medium 2018 2.1 Very low Liberia 35.6 28.0 High 3.2 4.7 Low 2019 3.4 Low Libya 29.3 43.5 Very high 25.6 25.4 Very high 2014 10.2 High Liechtenstein - - No data - - No data - - No data Lithuania - - No data - - No data - - No data Luxembourg - - No data - - No data - - No data Madagascar 47.9 40.2 Very high 1.8 1.5 Very low 2018 6.4 Medium Malawi 43.8 37.0 Very high 5.7 4.7 Low 2019 0.6 Very low Malaysia 18.3 20.9 High 6.0 6.1 Medium 2019 9.7 Medium Maldives 17.2 14.2 Medium 5.8 4.6 Low 2017 9.1 Medium Mali 30.9 25.7 High 1.6 2.1 Very low 2019 9.3 Medium Malta - - No data - - No data - - No data Marshall Islands 36.2 32.2 Very high 4.1 4.2 Low 2017 3.5 Low Mauritania 27.0 24.2 High 1.9 2.7 Low 2018 11.5 High Mauritius 9.0 8.7 Low 5 7.4 7.6 Medium 5 1995 - No recent data Mexico 12.7 12.1 Medium 6.7 6.3 Medium 2019 1.4 Very low Micronesia (Federated States of) - - No data - - No data - - No data Monaco - - No data - - No data - - No data Mongolia 12.6 7.1 Low 10.2 10.1 High 2018 0.9 Very low Montenegro 8.2 8.1 Low 15.3 10.2 High 2018 2.2 Very low Montserrat - - No data - - No data - - No data Morocco 16.4 12.9 Medium 11.8 11.3 High 2017 2.6 Low Mozambique 42.9 37.8 Very high 5.7 6.0 Medium 2015 4.4 Low Myanmar 31.9 25.2 High 2.2 1.5 Very low 2018 6.7 Medium Namibia 24.1 18.4 Medium 4.3 5.0 Medium 2013 7.1 Medium Nauru 20.3 15.0 Medium 3.1 3.7 Low 2007 1.0 Very low Nepal 40.3 30.4 Very high 1.4 1.8 Very low 2019 12.0 High Netherlands 1.5 1.6 Very low 4.1 5.0 Medium 2009 1.0 Very low Country prevalence table (cont.) UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 21 M O D E L L E D E S T I M A T E S Stunting (NUMBERS) Overweight (NUMBERS) Wasting1 (NUMBERS) Country Name 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te Year Value Hungary - - - - - - - - - - Iceland - - - - - - - - - - India 52257.6 30.1 36115.8 24.2 3007.6 8.1 2220.7 5.7 2017 20097.8 Indonesia 8103.8 4.7 7523.3 5.0 1926.1 5.2 2626.1 6.8 2018 2483.7 Iran (Islamic Republic of) 397.2 0.2 481.2 0.3 547.0 1.5 717.9 1.8 2010 250.1 Iraq 919.2 0.5 624.1 0.4 440.5 1.2 484.2 1.2 2018 163.7 Ireland - - - - - - - - - - Israel - - - - - - - - - - Italy - - - - - - - - - - Jamaica 15.8 <0.1 19.6 <0.1 16.8 <0.1 15.7 <0.1 2016 8.0 Japan 366.6 0.2 262.8 0.2 111.1 0.3 114.7 0.3 2010 127.7 Jordan 86.1 <0.1 77.2 0.1 62.1 0.2 75.1 0.2 2012 26.4 Kazakhstan 197.7 0.1 128.7 0.1 204.9 0.6 169.0 0.4 2015 60.6 Kenya 1951.0 1.1 1366.6 0.9 322.8 0.9 317.0 0.8 2014 293.9 Kiribati 2.4 <0.1 2.3 <0.1 0.4 <0.1 0.4 <0.1 2018 0.5 Kuwait 14.5 <0.1 17.4 <0.1 23.8 0.1 20.6 0.1 2017 7.6 Kyrgyzstan 109.5 0.1 86.7 0.1 52.0 0.1 44.1 0.1 2018 16.0 Lao People's Democratic Republic 323.9 0.2 240.7 0.2 18.3 <0.1 23.9 0.1 2017 70.4 Latvia - - - - - - - - - - Lebanon 59.0 <0.1 58.9 <0.1 90.6 0.2 111.5 0.3 2004 28.6 Lesotho 92.7 0.1 81.4 0.1 17.2 <0.1 18.3 <0.1 2018 5.2 Liberia 237.6 0.1 207.3 0.1 21.4 0.1 34.8 0.1 2019 24.8 Libya 194.0 0.1 271.4 0.2 169.5 0.5 158.5 0.4 2014 67.7 Liechtenstein - - - - - - - - - - Lithuania - - - - - - - - - - Luxembourg - - - - - - - - - - Madagascar 1689.9 1.0 1652.0 1.1 63.5 0.2 61.6 0.2 2018 253.4 Malawi 1195.7 0.7 1081.9 0.7 155.6 0.4 137.4 0.4 2019 17.8 Malaysia 444.8 0.3 550.7 0.4 145.8 0.4 160.7 0.4 2019 254.2 Maldives 6.2 <0.1 5.1 <0.1 2.1 <0.1 1.6 <0.1 2017 3.4 Mali 955.7 0.6 926.6 0.6 49.5 0.1 75.7 0.2 2019 329.0 Malta - - - - - - - - - - Marshall Islands 2.8 <0.1 2.2 <0.1 0.3 <0.1 0.3 <0.1 2017 0.3 Mauritania 157.4 0.1 166.9 0.1 11.1 <0.1 18.6 <0.1 2018 76.8 Mauritius 6.6 <0.1 5.6 <0.1 5 5.4 <0.1 4.9 <0.1 5 1995 - Mexico 1418.7 0.8 1326.0 0.9 748.4 2.0 690.4 1.8 2019 157.4 Micronesia (Federated States of) - - - - - - - - - - Monaco - - - - - - - - - - Mongolia 40.7 <0.1 26.7 <0.1 33.0 0.1 37.9 0.1 2018 3.5 Montenegro 3.2 <0.1 3.0 <0.1 6.0 <0.1 3.8 <0.1 2018 0.8 Montserrat - - - - - - - - - - Morocco 537.3 0.3 428.9 0.3 386.6 1.0 375.7 1.0 2017 90.3 Mozambique 1862.9 1.1 1949.2 1.3 247.5 0.7 309.4 0.8 2015 204.9 Myanmar 1508.2 0.9 1136.2 0.8 104.0 0.3 67.6 0.2 2018 302.7 Namibia 74.4 <0.1 61.8 <0.1 13.3 <0.1 16.8 <0.1 2013 22.4 Nauru 0.3 <0.1 0.2 <0.1 <0.1 <0.1 <0.1 <0.1 2007 <0.1 Nepal 1181.1 0.7 822.9 0.6 41.0 0.1 48.7 0.1 2019 324.8 Netherlands 13.4 <0.1 13.7 <0.1 36.6 0.1 42.9 0.1 2009 9.9 Country numbers affected (thousands) table (cont.) 22 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition M O D E L L E D E S T I M A T E S Stunting (PERCENT) Overweight (PERCENT) Wasting1 (PERCENT) Country Name 2012value 20202 value 2020 threshold3 Progress assessment4 foo tno te 2012 value 20202 value 2020 threshold3 Progress assessment4 foo tno te Year Value Threshold3 Progress assessment4 New Zealand - - No data - - No data - - No data Nicaragua 17.4 14.1 Medium 7.2 7.5 Medium 2012 2.2 Very low Niger 48.3 46.7 Very high 0.9 1.9 Very low 2019 9.8 Medium Nigeria 38.0 35.3 Very high 2.5 2.7 Low 2020 6.5 Medium Niue - - No data - - No data - - No data North Macedonia 5.8 4.1 Low 13.4 10.0 High 2019 3.4 Low Norway - - No data - - No data - - No data Oman 11.3 12.2 Medium 3.0 4.8 Low 2017 9.3 Medium Pakistan 43.4 36.7 Very high 4.6 3.4 Low 2018 7.1 Medium Palau - - No data - - No data - - No data Panama 20.0 14.7 Medium 10.1 10.8 High 2008 1.2 Very low Papua New Guinea 47.2 48.4 Very high 8.1 8.9 Medium 2010 14.1 High Paraguay 9.6 4.6 Low 10.1 12.0 High 2016 1.0 Very low Peru 18.8 10.8 Medium 8.7 8.0 Medium 2019 0.4 Very low Philippines 32.2 28.7 High 3.4 4.2 Low 2018 5.6 Medium Poland 2.3 2.3 Very low 5.9 6.7 Medium 2011 0.7 Very low Portugal 3.8 3.3 Low 7.6 8.5 Medium 2016 0.6 Very low Qatar 6.0 4.6 Low 5 13.1 13.9 High 5 1995 - No recent data Republic of Korea 2.2 2.2 Very low 7.7 8.8 Medium 2009 1.2 Very low Republic of Moldova 7.1 4.9 Low 6.2 4.3 Low 2012 1.9 Very low Romania 10.6 9.7 Low 9.5 6.7 Medium 2002 3.5 Low Russian Federation - - No data - - No data - - No data Rwanda 40.5 32.6 Very high 5.7 5.2 Medium 2020 1.1 Very low Saint Kitts and Nevis - - No data - - No data - - No data Saint Lucia 2.7 2.8 Low 6.5 6.9 Medium 2012 3.7 Low Saint Vincent and the Grenadines - - No data - - No data - - No data Samoa 5.7 6.8 Low 6.7 7.1 Medium 2019 3.1 Low San Marino - - No data - - No data - - No data Sao Tome and Principe 18.3 11.8 Medium 2.7 4.0 Low 2019 4.1 Low Saudi Arabia 5.5 3.9 Low 6.2 7.6 Medium 2004 11.8 High Senegal 19.8 17.2 Medium 1.5 2.1 Very low 2019 8.1 Medium Serbia 6.2 5.3 Low 15.5 10.8 High 2019 2.6 Low Seychelles 8.0 7.4 Low 9.6 9.8 Medium 2012 4.3 Low Sierra Leone 35.4 26.8 High 3.4 4.7 Low 2019 5.4 Medium Singapore 3.2 2.8 Low 4.0 4.8 Low 2000 3.6 Low Slovakia - - No data - - No data - - No data Slovenia - - No data - - No data - - No data Solomon Islands 31.9 29.3 High 3.5 4.0 Low 2015 8.5 Medium Somalia 31.1 27.4 High 3.1 2.9 Low 2009 14.3 High South Africa 23.6 23.2 High 12.8 12.9 High 2017 3.4 Low South Sudan 32.1 30.6 Very high 6.4 5.7 Medium 2010 22.7 Very high Spain - - No data - - No data - - No data Sri Lanka 16.8 16.0 Medium 1.2 1.3 Very low 2016 15.1 Very high State of Palestine 10.3 7.8 Low 8.1 8.5 Medium 2020 1.3 Very low Sudan 36.0 33.7 Very high 2.5 2.7 Low 2014 16.3 Very High Suriname 8.7 8.0 Low 3.8 4.0 Low 2018 5.5 Medium Sweden - - No data - - No data - - No data Switzerland - - No data - - No data - - No data Country prevalence table (cont.) UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 23 M O D E L L E D E S T I M A T E S Stunting (NUMBERS) Overweight (NUMBERS) Wasting1 (NUMBERS) Country Name 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te Year Value New Zealand - - - - - - - - - - Nicaragua 116.6 0.1 92.6 0.1 48.3 0.1 49.3 0.1 2012 14.4 Niger 1782.3 1.0 2235.8 1.5 33.2 0.1 91.0 0.2 2019 453.2 Nigeria 11060.9 6.4 11980.4 8.0 727.7 2.0 916.3 2.4 2020 2191.1 Niue - - - - - - - - - - North Macedonia 6.5 <0.1 4.6 <0.1 14.9 <0.1 11.2 <0.1 2019 3.8 Norway - - - - - - - - - - Oman 37.1 <0.1 55.3 <0.1 9.9 <0.1 21.8 0.1 2017 39.4 Pakistan 10749.9 6.2 10262.4 6.9 1139.4 3.1 950.7 2.4 2018 1935.3 Palau - - - - - - - - - - Panama 75.4 <0.1 57.2 <0.1 38.1 0.1 42.0 0.1 2008 4.5 Papua New Guinea 488.0 0.3 535.9 0.4 83.7 0.2 98.5 0.3 2010 142.3 Paraguay 66.8 <0.1 32.3 <0.1 70.2 0.2 84.1 0.2 2016 6.6 Peru 557.7 0.3 306.0 0.2 258.1 0.7 226.7 0.6 2019 11.6 Philippines 3621.8 2.1 3046.9 2.0 382.4 1.0 445.9 1.1 2018 618.0 Poland 47.2 <0.1 43.4 <0.1 121.1 0.3 126.3 0.3 2011 15.5 Portugal 18.0 <0.1 13.2 <0.1 35.9 0.1 34.1 0.1 2016 2.5 Qatar 6.6 <0.1 6.2 <0.1 5 14.5 <0.1 18.8 <0.1 5 1995 - Republic of Korea 51.2 <0.1 41.7 <0.1 179.3 0.5 166.9 0.4 2009 27.6 Republic of Moldova 16.0 <0.1 9.9 <0.1 14.0 <0.1 8.7 <0.1 2012 4.3 Romania 116.7 0.1 91.1 0.1 104.6 0.3 63.0 0.2 2002 40.2 Russian Federation - - - - - - - - - - Rwanda 661.7 0.4 614.5 0.4 93.1 0.3 98.0 0.3 2020 20.7 Saint Kitts and Nevis - - - - - - - - - - Saint Lucia 0.3 <0.1 0.3 <0.1 0.7 <0.1 0.7 <0.1 2012 0.4 Saint Vincent and the Grenadines - - - - - - - - - - Samoa 1.6 <0.1 1.8 <0.1 1.8 <0.1 1.9 <0.1 2019 0.9 San Marino - - - - - - - - - - Sao Tome and Principe 5.5 <0.1 3.7 <0.1 0.8 <0.1 1.3 <0.1 2019 1.3 Saudi Arabia 163.2 0.1 116.2 0.1 183.9 0.5 226.4 0.6 2004 318.9 Senegal 452.6 0.3 449.8 0.3 34.3 0.1 54.9 0.1 2019 210.2 Serbia 28.8 <0.1 22.2 <0.1 72.1 0.2 45.3 0.1 2019 11.0 Seychelles 0.6 <0.1 0.6 <0.1 0.8 <0.1 0.8 <0.1 2012 0.3 Sierra Leone 382.9 0.2 310.5 0.2 36.8 0.1 54.5 0.1 2019 61.5 Singapore 6.7 <0.1 7.2 <0.1 8.4 <0.1 12.4 <0.1 2000 8.5 Slovakia - - - - - - - - - - Slovenia - - - - - - - - - - Solomon Islands 26.9 <0.1 30.2 <0.1 3.0 <0.1 4.1 <0.1 2015 7.9 Somalia 737.0 0.4 774.5 0.5 73.5 0.2 82.0 0.2 2009 317.4 South Africa 1357.7 0.8 1337.5 0.9 736.4 2.0 743.7 1.9 2017 197.1 South Sudan 539.2 0.3 522.5 0.4 107.5 0.3 97.3 0.3 2010 360.0 Spain - - - - - - - - - - Sri Lanka 296.4 0.2 265.7 0.2 21.2 0.1 21.6 0.1 2016 258.1 State of Palestine 67.3 <0.1 54.0 <0.1 52.9 0.1 58.9 0.2 2020 9.2 Sudan 2049.0 1.2 2136.3 1.4 142.3 0.4 171.2 0.4 2014 950.7 Suriname 4.6 <0.1 4.2 <0.1 2.0 <0.1 2.1 <0.1 2018 2.9 Sweden - - - - - - - - - - Switzerland - - - - - - - - - - Country numbers affected (thousands) table (cont.) 24 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition M O D E L L E D E S T I M A T E S Stunting (PERCENT) Overweight (PERCENT) Wasting1 (PERCENT) Country Name 2012value 20202 value 2020 threshold3 Progress assessment4 foo tno te 2012 value 20202 value 2020 threshold3 Progress assessment4 foo tno te Year Value Threshold3 Progress assessment4 Syrian Arab Republic 27.6 29.6 High 19.2 18.2 Very high 2010 11.5 High Tajikistan 26.5 15.3 Medium 5.6 3.5 Low 2017 5.6 Medium Thailand 13.9 12.3 Medium 8.7 9.2 Medium 2019 7.7 Medium Timor-Leste 52.8 48.8 Very high 3.0 2.6 Low 2013 9.9 Medium Togo 27.4 23.8 High 1.7 2.4 Very low 2017 5.7 Medium Tokelau - - No data - - No data - - No data Tonga 6.7 2.6 Low 13.2 12.6 High 2019 1.1 Very low Trinidad and Tobago 8.5 8.7 Low 9.5 11.0 High 2011 6.4 Medium Tunisia 9.1 8.6 Low 10.9 16.5 Very high 2018 2.1 Very low Turkey - - No data 6 - - No data 6 2018 1.7 Very low Turkmenistan 13.0 7.6 Low 5.0 3.8 Low 2019 4.1 Low Turks and Caicos Islands - - No data - - No data - - No data Tuvalu 10.0 9.7 Low 6.2 6.4 Medium 2007 3.3 Low Uganda 34.1 27.9 High 3.9 4.0 Low 2016 3.5 Low Ukraine 19.1 15.9 Medium 25.7 17.0 Very high 2000 8.2 Medium United Arab Emirates - - No data - - No data - - No data United Kingdom - - No data - - No data - - No data United Republic of Tanzania 38.3 32.0 Very high 4.7 5.5 Medium 2018 3.5 Low United States 2.7 3.2 Low 8.6 8.8 Medium 2018 0.1 Very low Uruguay 8.9 6.5 Low 9.8 10.3 High 2018 1.4 Very low Uzbekistan 14.2 9.9 Low 8.6 5.0 Medium 2017 1.8 Very low Vanuatu 27.3 28.7 High 4.8 4.9 Low 2013 4.7 Low Venezuela (Bolivarian Republic of) 12.5 10.6 Medium 6.4 6.7 Medium 2009 4.1 Low Viet Nam 25.9 22.3 High 4.2 6.0 Medium 2017 5.8 Medium Yemen 47.4 37.2 Very high 2.9 2.7 Low 2013 16.4 Very High Zambia 41.3 32.3 Very high 6.2 5.7 Medium 2018 4.2 Low Zimbabwe 31.4 23.0 High 4.7 3.6 Low 2019 2.9 Low Country prevalence table (cont.) Prevalence thresholds for wasting, overweight and stunting in children under 5 years New thresholds, presented in Table 2, were established through the WHO-UNICEF Technical Advisory Group on Nutrition Monitoring (TEAM)8 and released in 2018. These new thresholds have been used for development of prevalence-based assessments in maps and tables in this brochure. The thresholds were developed in relation to standard deviations (SD) of the normative WHO Child Growth Standards. The international definition of ‘normal’ (two SD from the WHO standards median) defines the first threshold, which includes 2.3 per cent of the area under the normalized distribution. Multipliers of this ‘very low’ level (rounded to 2.5 per cent) set the basis for establishing subsequent thresholds. Table 2. Prevalence thresholds and corresponding labels for stunting, wasting and overweight Labels Prevalence thresholds (%) Stunting Wasting and Overweight Very low < 2.5 < 2.5 Low 2.5 – < 10 2.5 – < 5 Medium 10 – < 20 5 – < 10 High 20 – <30 10 – < 15 Very high ≥ 30 ≥ 15 Additional information UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 25 M O D E L L E D E S T I M A T E S Stunting (NUMBERS) Overweight (NUMBERS) Wasting1 (NUMBERS) Country Name 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te 2012 value Share of 2012 global 20202 value Share of 20202 global foo tno te Year Value Syrian Arab Republic 748.5 0.4 568.1 0.4 520.7 1.4 349.3 0.9 2010 339.8 Tajikistan 291.4 0.2 207.6 0.1 61.6 0.2 47.5 0.1 2017 72.5 Thailand 557.0 0.3 442.3 0.3 348.7 0.9 330.8 0.9 2019 280.5 Timor-Leste 82.0 <0.1 86.9 0.1 4.7 <0.1 4.6 <0.1 2013 15.3 Togo 302.1 0.2 290.4 0.2 18.7 0.1 29.3 0.1 2017 67.1 Tokelau - - - - - - - - - - Tonga 0.9 <0.1 0.3 <0.1 1.8 <0.1 1.5 <0.1 2019 0.1 Trinidad and Tobago 8.3 <0.1 7.7 <0.1 9.3 <0.1 9.7 <0.1 2011 6.2 Tunisia 84.0 <0.1 86.4 0.1 100.7 0.3 165.7 0.4 2018 21.5 Turkey - - - - 6 - - - - 6 2018 114.7 Turkmenistan 75.1 <0.1 50.2 <0.1 28.9 0.1 25.1 0.1 2019 27.7 Turks and Caicos Islands - - - - - - - - - - Tuvalu 0.1 <0.1 0.1 <0.1 0.1 <0.1 0.1 <0.1 2007 <0.1 Uganda 2239.9 1.3 2175.1 1.5 256.2 0.7 311.8 0.8 2016 249.9 Ukraine 486.6 0.3 336.1 0.2 654.8 1.8 359.4 0.9 2000 177.3 United Arab Emirates - - - - - - - - - - United Kingdom - - - - - - - - - - United Republic of Tanzania 3164.5 1.8 3116.4 2.1 388.3 1.0 535.6 1.4 2018 326.1 United States 558.3 0.3 629.6 0.4 1778.4 4.8 1731.5 4.5 2018 19.5 Uruguay 20.9 <0.1 15.4 <0.1 23.0 0.1 24.4 0.1 2018 3.4 Uzbekistan 450.3 0.3 339.7 0.2 272.7 0.7 171.6 0.4 2017 61.4 Vanuatu 10.1 <0.1 12.1 <0.1 1.8 <0.1 2.1 <0.1 2013 1.8 Venezuela (Bolivarian Republic of) 367.0 0.2 250.5 0.2 187.9 0.5 158.3 0.4 2009 118.6 Viet Nam 1925.3 1.1 1760.0 1.2 312.2 0.8 473.5 1.2 2017 449.1 Yemen 1782.3 1.0 1530.9 1.0 109.0 0.3 111.1 0.3 2013 629.1 Zambia 1068.3 0.6 951.7 0.6 160.4 0.4 167.9 0.4 2018 121.3 Zimbabwe 670.0 0.4 482.4 0.3 100.3 0.3 75.5 0.2 2019 61.4 Country numbers affected (thousands) table (cont.) 2025 and 2030 global targets on stunting, wasting and overweight among children under 5 years of age Progress towards the 2030 SDG targets (presented on page 5 and in the country tables on pages 16 to 25) was assessed using the 2030 targets proposed as an extension of the 2025 global nutrition targets (Table 3).9 Table 3. The global nutrition targets endorsed by the World Health Assembly and their extension to 2030* for child malnutrition indicators Indicator 2025 target 2030 target Stunting Reduce the number of children under 5 who are stunted by 40% Reduce the number of children under 5 who are stunted by 50% Wasting Reduce and maintain childhood wasting to less than 5% Reduce and maintain childhood wasting to less than 3% Overweight No increase in childhood overweight prevalence Reduce and maintain childhood overweight to less than 3% NOTE: *Targets were set considering the baseline year 2012. 26 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition The UNICEF-WHO-World Bank JME Working Group was established in 2011 to address the call for harmonized child malnutrition estimates that would be instrumental in benchmarking progress on child malnutrition. The first edition of the JME was released in 2012 and provided estimates for stunting, wasting, severe wasting, underweight and overweight, as well as a detailed description of the methodology.10,11 Since its inception, the JME outputs have comprised a harmonized country-level dataset of primary data (e.g., national estimates based on household surveys), as well as regional and global model-based estimates. For the first time in 2021, the JME also includes country-level modelled estimates for stunting and overweight based on updated methodology12 developed by the JME Working Group in partnership with the University of South Carolina. The regional and global figures for stunting and overweight are now also based on these country model outputs, while they remain based on the previously applied sub-regional model for wasting and severe wasting.10, 11 Additional work is ongoing to update methods for wasting and severe wasting for which available data are not as stable as for stunting and overweight (see section about regional and global estimates on page 27). The JME process for the 2021 edition involved the following steps: (i) updating of the country dataset of primary sources (e.g., national household surveys); (ii) application of a country level model for stunting and overweight to generate annual estimates; (iii) generation of regional and global aggregates for stunting, wasting, severe wasting and overweight; and (iv) consultation with countries before finalizing and disseminating the 2021 estimates. Key parts of the JME are described in more detail below. Country-level estimates The JME country dataset The JME dataset of country estimates requires the collection of national data sources that contain information on child malnutrition – specifically, data on the height, weight and age of children under 5, which can be used to generate national- level prevalence estimates for stunting, wasting, severe wasting and overweight. These national-level data sources are mainly comprised of household surveys – e.g., Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), Standardized Monitoring and Assessment of Relief and Transition (SMART) surveys, and Living Standards Measurement Study (LSMS). Some administrative data sources (e.g., from surveillance systems) are also included where population coverage is high. As of the latest review closure on 31 January 2021, the primary source dataset contained 997 data sources from 157 countries and territories, with nearly 80 per cent of children living in countries with at least one data point on stunting, wasting and overweight that is less than five years old (see figure on page 28). This suggests that the global estimates are highly representative of the majority of children across the globe for the most recent period, although recentness of data varies greatly by region. The dataset contains the point estimate, and where available, the standard error, the 95 per cent confidence bounds and the unweighted sample size. Where microdata are available, the JME uses estimates that have been recalculated to adhere to the global standard definition.13 Where microdata are not available, reported estimates are used, except in cases where adjustments are required to standardize for: (i) use of an alternate growth reference from the 2006 WHO Growth Standards; (ii) age ranges that do not include the full 0–59-month age group; and (iii) data sources that were only nationally representative for populations residing in rural areas. Further details related to data source compilation, re-analysis of microdata, and data source review are provided elsewhere.14 The JME country dataset serves different purposes for different indicators. For wasting and severe wasting, the JME country dataset serves as the country estimates themselves (i.e., the wasting prevalence in the JME country dataset from a household survey for a country in a given year is the wasting prevalence reported for that country in that year). For stunting and overweight, the JME country dataset is used to generate country- modelled estimates which serve as the official JME estimates (i.e., the stunting prevalence from a household survey for a given country in given year is not reported as the prevalence for that country in that year; rather, it feeds into the modelled estimates described in the next section below). Country-level model for stunting and overweight estimates Rationale National surveys are administered sporadically, resulting in sparse data for many countries. This hampers efforts to monitor these countries’ progress towards targets, such as the SDGs. The use of statistical models at country level is important to enable comparisons across countries during the same year, filling in the gaps. In addition, statistical models are an efficient way to adjust for unwarranted variability. Model description The technical details of the statistical models are provided elsewhere.14 Briefly, for both stunting and overweight, prevalence was modelled at logit (log-odds) scale using a penalized longitudinal mixed-model with a heterogeneous error term. The quality of the models was quantified with model-fit criteria that balance the complexity of the model with the closeness of the fit to the observed data. The proposed method has important characteristics, including non-linear time trends, regional trends, country-specific trends, covariate data and a heterogeneous error term. All countries with data contribute to estimates of the overall time trend and the impact of covariate data on prevalence. For overweight, the covariate data consisted of linear and quadratic socio-demographic index (SDI),* and data source type. The same JME METHODOLOGY * SDI is a summary measure that identifies where countries or other geographic areas sit on the spectrum of development. Expressed on a scale of 0 to 1, SDI is a composite average of the rankings of the incomes per capita, average educational attainment, and fertility rates of all areas in the Global Burden of Disease study.15 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 27 covariates were used for stunting, plus an additional covariate of the average health system access over the previous five years.16 Model outcomes Annual country-level modelled estimates from 2000 to 2020 on stunting and overweight were disseminated by the JME in 2021 for 155 countries with at least one data point (e.g., from a household survey) included in the JME country dataset described above. Modelled country estimates were also produced for an additional 49 countries, used solely for generation of regional and global aggregates. Modelled estimates for these 49 countries are not shown because they did not have any household surveys in the JME country dataset or because the modelled estimates remained pending final review at the time of publication. The results for the 204 countries can be used to calculate estimates and uncertainty intervals for any groups of countries aggregated. The uncertainty intervals are important in monitoring trends, especially for countries with sparse data and where primary data sources present large primary data source sampling errors. When only sparse data are available in the most recent period, the inclusion of a survey can affect a substantial change in the predicted trajectory. For this reason, uncertainty intervals are needed to enhance trend interpretability in terms of the caution level employed. The uncertainty intervals for the new JME method have been tested and validated with various data types. Regional and global estimates Regional and global wasting and severe wasting estimates are only presented for the most recent year, 2020, unlike stunting and overweight estimates for which an annual time series is available from 2000 to 2020. This is because the JME are based on national-level country prevalence data, which come from cross-sectional surveys (i.e., a snapshot at one point in time) that are collected infrequently (every three to five years) in most countries. Since stunting and overweight are relatively stable over the course of a calendar year, it is reasonable to track changes in these two conditions over time with these data, whereas wasting is an acute condition that can change frequently and rapidly. An individual child can be affected by wasting more than once in a calendar year (i.e., can recover but then become wasted again in the same year), and the risk of wasting in many contexts can be driven by seasonal variations, which can result in seasonal spikes in prevalence. For example, wasting prevalence, in some contexts, may double between the post-harvest season (often associated with higher food availability and weather patterns that are less likely to cause disease) and the pre-harvest season (often associated with food shortages, heavy rains and related diseases that can affect nutrition status). Given that country surveys can be collected during any season, the prevalence estimate from any survey may be at a high or low; or it may fall somewhere in between if data collection spanned across several seasons. Thus, the prevalence of wasting captures the situation of wasting at a specific point in time and not over an entire year. Variations in seasons across surveys make it difficult to draws inferences on trends. The lack of methods to account for seasonality and incident cases of wasting and severe wasting are the main reasons why the JME does not present annual trends for these forms of malnutrition. Generation of regional and global estimates Different methods were applied to generate regional and global estimates for stunting and overweight compared to wasting and severe wasting as described below. In short, results from the new country-level model were used to generate the regional and global estimates for stunting and overweight, while the JME sub- regional multi-level model12,13 was used to generate the global and regional estimates for wasting and severe wasting. Stunting and overweight Global and regional estimates for all years from 2000 to 2020 were derived as the respective country averages weighted by the countries’ under-five population from The United Nations World Population Prospects, 2019 Revision, using model-based estimates for 204 countries. This includes 155 countries with national data sources (e.g. household surveys) included in the JME country dataset described above. It also includes 49 countries with modelled estimates generated for development of regional and global aggregates but for which country modelled estimates are not shown because they did not have any household surveys in the JME country dataset or because the modelled estimates remained pending final review at the time of publication. Confidence intervals were generated based on bootstrapping methodology. Wasting and severe wasting The wasting and severe wasting prevalence data from national data sources described in the above section about the JME country dataset were used to generate the regional and global estimates for the year 2020 using the JME sub-regional multi- level model,10, 11 applying population weights for children under 5 years of age from the United Nations World Population Prospects, 2019 Revision. Country consultations Joint UNICEF-WHO-World Bank Group country consultations were conducted from November 2020 to January 2021. The purpose of these consultations was to explain the updated methodology for stunting and overweight estimates to national governments; to ensure the estimates included all recent and relevant country data for stunting, wasting and overweight; and to engage with and receive feedback from national governments on the estimates. Following review of input received from national governments during the country consultations, eight additional sources were included in the JME country dataset before the estimates were finalized and disseminated through the 2021 edition of the JME. JME Methodology 28 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition Globally, nearly 80 per cent of children live in countries where at least one data point on stunting, wasting and overweight is less than 5 years old Percentage of the under 5 population by recentness of the latest available country stunting data (e.g., from household surveys) included in the JME, by region and global Percentage of countries by recentness of the latest available country stunting data (e.g., from household surveys) included in the JME, by region and global Percentage of the under 5 population by recentness of the latest available country overweight data (e.g., from household surveys) included in the JME, by region and global Percentage of countries by recentness of the latest available country overweight data (e.g., from household surveys) included in the JME, by region and global Recentness of the latest available country data point (e.g., from household surveys) on malnutrition among children aged under 5 years included in the JME Per cent of children under age 5 years Per cent of countries 0 25 50 75 100 Per cent of children under age 5 years 0 25 50 75 100 0 25 50 75 100 Per cent of countries 0 25 50 75 100 No Data 20 years or older 10 to less than 20 years 5 to less than 10 years 2 to less than 5 years Less than 2 years least recent most recent STUNTING OVERWEIGHT Global Northern America, Europe, Australia and New Zealand Oceania except Australia and New Zealand Latin America and the Caribbean Asia Africa Global Northern America, Europe, Australia and New Zealand Oceania except Australia and New Zealand Latin America and the Caribbean Asia Africa Note: Figures for wasting are the same as for stunting and are therefore not presented. The population coverage for the most recent five-year period is the value of the two green colours added together (i.e., the population coverage for stunting for the most recent five-year period in Africa is 78 per cent). These graphics show the recentness of the latest available country data points on malnutrition (e.g., from a household survey) among children under 5 years in the JME. The graphics in the left-hand column are by percentage of the under-five population and the graphics in the right-hand column are by the percentage of countries. Only stunting and overweight are shown because the data for wasting mirror those for stunting. For the graphics by percentage of the under-five population (left column), the availability of data for each country was weighted by the under-five population, meaning that more populous countries contributed more to the percentages in each category than less populous ones. The more green there is for a region, the higher the percentage of children under 5 living in countries with very recent data (i.e., at least one data point in the last 5 years); the more orange there is, the higher the percentage of children living in countries with very old data (i.e., the latest data point is 10–20+ years old). Globally, about 80 per cent of children live in countries where the malnutrition prevalence data are less than five years old, while less than 5 per cent of children live in countries with no data at all. This suggests that the modelled regional and global estimates are highly representative of the situation of the majority of children across the globe for the most recent period. The situation by percentage of countries (right-hand column) looks vastly different, with less than half of all countries having at least one data point in the last five years and one quarter of countries with no data at all. This indicates that the governments of many countries will not be able to adequately assess and plan programmes to combat malnutrition. The recentness of data varies greatly by region. For example, 91 per cent of children under 5 in Asia live in countries with recent data on stunting, wasting and overweight, while only 5 per cent of children in Oceania (excluding Australia and New Zealand) live in countries with recent data. While almost all children under 5 in Latin America and the Caribbean live in countries with some available data, about one third live in countries with very old data (i.e., where the latest estimates for stunting, wasting and overweight are more than 10 years old). Further, 10 countries in Latin America and the Caribbean (27 per cent of countries in that region) with very small populations do not have any data on child malnutrition at all. Gaps in the available data make it challenging to accurately estimate the prevalence of malnutrition. Regular data collection (every three to five years) is critical to properly plan and monitor programmes to combat child malnutrition at country, regional and global levels going forward. UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 29 This key fi ndings report of the 2021 edition of the JME summarizes the new country, regional and global numbers and main messages for offi cial United Nations data on child malnutrition. Additional information is available and the following materials can be downloaded from the links on the bottom right: • The latest country-level joint malnutrition dataset, a time series of country estimates from sources such as household surveys that were used to generate the joint child malnutrition country, regional and global modelled estimates for stunting and overweight and the regional and global modelled estimates for wasting and severe wasting • The country modelled estimates for stunting and overweight • The joint malnutrition global and regional estimates database by various regional groupings (e.g., United Nations, UNICEF, WHO, etc., regional groupings) and for more years than presented in this brochure • A reference document outlining the composition of the various regional groupings for which the joint estimates have been produced • Interactive dashboards, which allow users to visualize and export the global and regional estimates for a number of regional groupings ONLINE MATERIALS Summary of available materials Interactive dashboard overview Select your regional grouping (UNICEF, WHO, United Nations, World Bank Income) Select regions to view Select years to view Hover over data points for detailed information Options Tabs where you can select diff erent visualizations for global and regional data With these links you can view the dashboard and the data on the UNICEF, WHO or World Bank Group websites Download the graphics and data here Africa, 2020: 30.7 [29.9-31.6] Additional online materials Global targets tracking tool: https://www.who.int/tools/global-targets-tracking-tool This tool allows users to explore scenarios, taking into account different rates of progress for the six Global Nutrition Targets and the time left to 2025 using the latest global databases such as the UNICEF-WHO-World Bank Joint Malnutrition Estimates for stunting, wasting and overweight. UNICEF: <https://data.unicef.org/resources/jme> WHO: < www.who.int/teams/nutrition-and-food-safety/ databases/nutgrowthdb>; World Bank Group: <data.worldbank.org/child-malnutrition> 30 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition ENDNOTES Introduction (pages 2‒3) 1 Headey, Derek, et al. (Standing Together for Nutrition consortium), ‘Impacts of COVID-19 on childhood malnutrition and nutrition- related mortality’, The Lancet, vol. 396, no. 10250, August 2020, pp.519–521, <https://doi.org/10.1016/S0140-6736(20)31647-0>, accessed April 2021. 2 World Health Organization and United Nations Children’s Fund. ‘WHO/UNICEF discussion paper: The extension of the 2025 maternal, infant and young child nutrition targets to 2030’, WHO and UNICEF, Geneva and New York, 2017, <https://www.who. int/nutrition/global-target-2025/discussion-paper-extension- targets-2030.pdf>, accessed April 2021. 3 Christian, Parul, et al. ‘Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle- income countries,’ International Journal of Epidemiology, vol. 42, no.5, October 2013, pps. 1340-1355, <https://doi.org/10.1093/ije/ dyt109>, accessed April 2021. 4 Koletzko, Berthold, Holzapfel, Christina, Schneider, Ulrike, and Hans Hauner, ‘Lifestyle and Body Weight Consequences of the COVID-19 Pandemic in Children: Increasing Disparity’, Ann Nutr Metab, vol. 1, no. 3, January 2021, <https://doi.org/10.1159/000514186>, accessed April 2021. Global and regional tables (page 15) 5 de Onis, Mercedes et al., ‘Methodology for estimating regional and global trends of child malnutrition’, International Journal of Epidemiology, vol., 33, no. 6, December 2004, pps. 1260–1270, <https://doi.org/10.1093/ije/dyh202>, accessed April 2021. Country assessment tables (page 16‒17) 6 World Health Organization and United Nations Children’s Fund. ‘WHO/UNICEF discussion paper: The extension of the 2025 maternal, infant and young child nutrition targets to 2030’, WHO and UNICEF, Geneva and New York, 2017, <https://www.who. int/nutrition/global-target-2025/discussion-paper-extension- targets-2030.pdf>, accessed April 2021. 7 WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring, Methodology for Monitoring Progress Towards the Global Nutrition Targets for 2025 – Technical Report, World Health Organization and the United Nations Children’s Fund, 2017. Additional information (pages 24‒25) 8 de Onis, Mercedes, et al., ‘Prevalence thresholds for wasting, overweight and stunting in children under 5 years’, Public Health Nutrition, vol. 22, no. 1, 2018, pps. 175–179, <https://doi. org/10.1017/S1368980018002434>, accessed April 2021. 9 World Health Organization and United Nations Children’s Fund. ‘WHO/UNICEF discussion paper: The extension of the 2025 maternal, infant and young child nutrition targets to 2030’, WHO and UNICEF, Geneva and New York, 2017, <https://www.who. int/nutrition/global-target-2025/discussion-paper-extension- targets-2030.pdf>, accessed April 2021. JME methodology (page 26‒28) 10 United Nations Children’s Fund, World Health Organization, International Bank for Reconstruction and Development/The World Bank, UNICEF-WHO-World Bank Group Joint Child Malnutrition Estimates, UNICEF, New York; WHO, Geneva; World Bank, Washington, DC, 2012. 11 de Onis, Mercedes et al., ‘Methodology for estimating regional and global trends of child malnutrition’, International Journal of Epidemiology, vol., 33, no. 6, December 2004, pps. 1260–1270, <https://doi.org/10.1093/ije/dyh202>, accessed April 2021. 12 McLain, Alexander, Frongillo, Edward, Feng, Juan and Elaine Borghi, ‘Prediction intervals for penalized longitudinal models with multisource summary measures: an application to childhood malnutrition’, Statistics in Medicine, vol. 38, no. 6, March 2019, pps. 1002–1012, <https://doi.org/10.1002/sim.8024> accessed April 2021. 13 World Health Organization and United Nations Children’s Fund, Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old, WHO, Geneva; UNICEF, New York, 2019, <https://data.unicef.org/ resources/data-collection-analysis-reporting-on-anthropometric- indicators-in-children-under-5/>, accessed April 2021. 14 United Nations Children’s Fund, World Health Organization and World Bank Group, SDG Indicators 2.2.1 on stunting, 2.2.2a on wasting and 2.2.2b on overweight: Country consultation background document, <https://data.unicef.org/resources/jme- 2021-country-consultations/>, accessed April 2021. 15 GBD 2019 Risk Factors Collaborators, ‘Global burden of 87 risk factors in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019’, The Lancet, vol. 396, no. 10258, October 2020, pps. 1223–1249, <https://doi. org/10.1016/s0140-6736(20)30752-2> accessed April 2021. UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition 31 ACKNOWLEDGEMENTS This publication was prepared by: the Data, Analytics and Innovation Section of the Division of Data, Analytics, Planning and Monitoring, UNICEF New York, together with the Department of Nutrition and Food Safety, WHO Geneva, and the Development Data Group of the World Bank, Washington DC. Organizations and individuals involved in generating this publication: UNICEF: Chika Hayashi, Julia Krasevec, Richard Kumapley, Fikrewold Bitew and Vrinda Mehra WHO: Elaine Borghi, Elisa Dominguez, Monica Flores-Urrutia and Giovanna Gatica-Domínguez World Bank Group: Umar Serajuddin, Emi Suzuki Editorial: design: Nona Reuter (UNICEF); writing and editing: Julia D’Aloisio (UNICEF) Special thanks go to Víctor Aguayo (UNICEF), Francesco Branca (WHO) and Mark Hereward (UNICEF). We also thank Alexander McLain and Edward Frongillo from the University of South Carolina and Gretchen Stevens for their collaboration related to the country model for overweight and stunting estimates. 32 UNICEF/WHO/World Bank Group – Joint Child Malnutrition Estimates 2021 edition ISBN (UNICEF) 978-92-806-5219-2 ISBN (WHO) 978-92-4-002525-7 (electronic version) ISBN (WHO) 978-92-4-002526-4 (print version) © United Nations Children’s Fund (UNICEF), the World Health Organization, and the International Bank for Reconstruction and Development/The World Bank, 2021. Some rights reserved. This work is available under the CC BY-NC-SA 3.0 IGO licence. April 2021 Suggested citation: United Nations Children’s Fund (UNICEF), World Health Organization, International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: key findings of the 2021 edition of the joint child malnutrition estimates. Geneva: World Health Organization; 2021. Licence: CC BY-NC-SA 3.0 IGO. Email: data@unicef.org Email: nutrition@who.int Email: data@worldbank.org <data.unicef.org/nutrition>; <www.who.int/teams/nutrition-and-food-safety/databases/nutgrowthdb>; <data.worldbank.org>.