This document discusses the drivers of undernutrition in Eastern and Southern Africa. It provides conceptual frameworks that show the complex interactions between nutritional status, food and nutrient intake, health, and the environment. The frameworks demonstrate how factors like poverty, inequality, climate change, conflicts, and poor governance can negatively impact nutrition outcomes in the region beyond just biological factors. Additionally, the document presents data showing that while economic growth has occurred in some countries, undernutrition has not improved at the same rate, calling for more integrated interventions. It also highlights the need to consider food systems and the co-existence of undernutrition and obesity in women in highly stunted regions.

1. Drivers of Undernutrition
Bruce Cogill Ph.D.
Bioversity International
Nutrition and Marketing Diversity Programme
Leader
AIFSC Workshop
“Food and nutrition in Eastern and Southern Africa”
Nairobi, Kenya
10-11 September
CGIAR Research Program on
Agriculture for Nutrition and Health 1

2. 2

3. Mean anthropometric z-scores using the WHO growth
standard
Wasting
Underweight
Stunting
Source: Victora CG, de Onis M, Hallal PC, Blössner M, Shrimpton R. Worldwide timing of growth faltering: revisiting implications for interventions using
the World Health Organization growth standards. Pediatrics, 2010 (Feb 15 Epub ahead of print) 3
3

4. Mean WAZ z scores by age using the new WHO
standard, according to region (1–59 months)
4
Source: Victora et al. Worldwide Timing of Growth Faltering: Revisiting Implications for Interventions. Figure 2. Pediatrics 2010;125

5. The conceptual framework of malnutrition
Poor Dietary Quality
5

6. S
Interventions
Nutritional Status H
O
R
- Breastfeeding T
- Complementary
feeding Food/nutrient R
- Vitamin A
Health O
intake
supplementation U
T
- Zinc
E
supplementation
S
- Hygiene
Health,
Food
Household Care
Care Water/
- Agriculture
Foodsecurity
Access Resources
Resources Sanitation L
- Poverty reduction
Services O
- Income generation
N
- Education
G
- Health systems
strengthening
INSTITUTIONS R
- Women’s
O
empowerment
U
POLITICAL & IDEOLOGICAL FRAMEWORK
T
E
ECONOMIC STRUCTURE S
RESOURCES
ENVIRONMENT, TECHNOLOGY, PEOPLE Adapted from Ruel (2008)
& UNICEF (1990) 6

7. What we do in Nutrition: Typical Interventions that
should work
Improving diet quality 1,000 days Nutrition service
and diversity delivery
Iron folate supplementation Promotion of breastfeeding (reduces Treatment of severe acute
(reduces maternal deaths by 23%) mortality by 13%) malnutrition in facilities (reduces
deaths by 55%)
Maternal multiple micronutrients Social and behavior change for
(reduces LBW infants by 16% and improved complementary feeding Zinc for management of diarrhea
reduces maternal anemia by 39%) (reduces stunting) (reduces mortality by 9%)
Calcium supplementation (reduces Maternal supplements of
risk of pre-eclampsia by 52%) energy, micronutrients, and protein
Conditional cash transfers with (reduces LBW infants by 32%)
nutrition education (reduces stunting) Deworming (reduces anemia and
Iron fortification and increases growth)
supplementation (reduces anemia by Neonatal vitamin A (reduces infant
28% and maternal mortality) mortality by 21% in South Asia)
Dietary diversification (e.g. reduces Delayed cord clamping (reduces
anemia and vitamin A deficiency) anemia)
Vitamin A fortification or
supplementation (reduces child
mortality by 23%)
Universal salt iodization (improves IQ 7
by 13 points)

8. Very useful as the conceptual framework is a causal model
that mainly focuses on biological factors MORE COMPLEX
In East Africa additional dimensions enhancing
undernutrition include:
• Socio-Economical (poverty, inequities, behaviors…)
• Environmental (sizeable proportion of land arid and semi-
arid, prolonged droughts followed by floods exacerbated
by climate change)
• Political (conflicts, poor governance, rent seeking…)
Governance
• Behaviours
8

9. Comparing Under Five Nutrition with
Changes in economic well being
No Change in
Wt/Age Ht/Age
Burkina
Faso, Mali, Mauriti
us, Lesotho and
South Africa
All other countries in
Blue had improved
nutrition during same
period as growth rates
Changes in Underweight in Blue
countries was 1.3% per year (1996-
2008) to close to zero Growth analysis from Radelet (2011) CGDEV
9
Nutrition data for Underweight and Stunting for same period from UNICEF UNDP

10. Food Systems, Food Environments, Econutrition
Interrelationships among nutrition, human health, agriculture and
food production, environmental health , and economic production
10

11. Underweight and obesity in women in 36 highest-stunting
burden countries*
*Data on both underweight and obesity prevalence for adult women were available for 29 countries. Stunting based on infants and
children under-five. Source: WHO Global Database on Body Mass Index (2010) http://apps.who.int/bmi/index.jsp11