Child Malnutrition in Africa

At least 1 in 3 children under-five in Africa were stunted in 2011

Stunting hampers cognitive development of young children which under-
Approaches to prevent stunting
mines learning ability later in life. The effects of stunting are irreversible.
Interventions should focus on the critical 1,000
days window including pregnancy and before a
North Africa child turns two and include:
28 % • Improving women’s nutrition, especially
before, during and after pregnancy.
West Africa
38 % • Early and exclusive breastfeeding.
Eastern Africa
42 % • Timely, safe, appropriate and high-quality
complementary food.
Central Africa
36 %
• Appropriate micronutrients interventions.
• Infectious diseases, such as diarrhoea,
Stunting prevalence (%) pneumonia, malaria, etc. are important
%
%
determinants of stunting.
% Southern Africa
%
% or more 35 % • Access to safe drinking water, basic sanitation
and practicing appropriate hygiene behavior
Proportion of children aged 0-59 months who are below minus two standard
deviations from median height-for-age of the WHO Child Growth Standard.
greatly reduces the risk of some of these
Data range : 2007-2011 infectious diseases.
Five countries in Africa have more than 5 percent In Africa, boys are more likely to be stunted than girls
severe wasting
Children aged 0-59 months who are below minus three standard deviations Ratio of stunting (girls to boys) among children under-five years ,
from median weight–for-height of the WHO standard reference population, countries in Africa, data range 2007-2011
African countries 1.2

% severely wasted Girls are more stunted than boys

Year 1.1

South Sudan 2010 10

1.0
Parity
Nigeria 2008 7
0.9
Chad 2010 6
Mali 2006 6 0.8
Boys are more stunted than girls
Sudan 2010 5 0.7

Significant progress in exclusive breastfeeding in many African countries

Trends in % of infants (<6 months) who are exclusively breastfed, around 1995 and 2011
100
Total
~ 1995(Around 1995) 83 85
% children exclusively breastfed

Total
~ 2011(Around 2011)
(<6 months), around 1995 and

80
69 72
61 62
54 52
around 2011

60
48 50 48 51
41 44
34 35 34 37
40 32 30 29
27 24
19
20 13 11
1 3 4 3
0
Nigeria Niger Sierra Leone Central Liberia Democratic Mozambique Guinea United Madagascar Ethiopia Zambia Burundi Malawi Rwanda
('90,'08) ('92,'10) ('00,'10) African ('99,'10) Republic of ('97,'11) ('99,'08) Republic of ('97,'09) ('00,'11) ('96,'07) ('00,'10) ('00,'10) ('92,'10)
Republic the Congo Tanzania
('95,'10) ('95,'10) ('96,'10)

Source for all charts: UNICEF global databases 2013, based on DHS, MICS, and other national surveys 2007-2011
HIV/AIDS and Malaria in Africa

An estimated 3.1 million children under 15 years were living with HIV in Africa as of 2011; about 10 per
cent of which were newly infected, mainly through mother-to-child transmission of HIV
Coverage of Prevention of Mother To Child Transmission (PMTCT) and Key facts:
pediatric Anti-Retroviral Therapy (ART) coverage ; African regions, 2011 (%)
• Although progress has been made in Africa to
increase the prevention of mother to child
North Africa transmission (PMTCT) of HIV/AIDS and
80 West Africa
Central Africa
increasing pediatric anti-retroviral therapy
Eastern Africa
(ART) coverage, much more progress is
Southern Africa needed.
58 AFRICA
52
• In 2011, around 300,000 children were newly
infected with HIV in Africa.
38
40 • Across Africa, about 3% of all under-five
deaths are caused by HIV/AIDS, and in
26 27 Southern Africa, an estimated 11% of under-
21
five deaths are attributed to HIV/AIDS.
15 14
8
11
• Although some progress has been made, ARV
coverage for PMTCT varied from 8% in North
Africa to 80% in Southern Africa in 2011.
Coverage of the most effective ARVs for PMTCT Pediatric ART coverage

Source: WHO/UNICEF/UNAIDS, Towards the Elimination of Mother-to-child Transmission of HIV and

Keeping Their Mothers Alive: Abbreviated Progress Report 2012, preliminary report.

Major progress during the last decade in the use of Insecticide Treated Nets (ITNs) among children
• During the last decade, the Children under-five sleeping under ITNs in Africa, 2000 and 2012
proportion of children sleeping
under ITNs in sub-Saharan Africa
increased from less than 5 per cent
to over a third (37%).
• Countries in Africa are focused on
increasing coverage for ITN use
among children in the most
equitable manner: mass campaigns
which strive for universal coverage
to ensure that everyone is reached.

Malaria case management in endemic countries

• The use of Rapid Diagnostic Tests (RDT) to
confirm malaria infection before starting
treatment is still low
• In most endemic countries, less than 50% of
febrile children under-five who receive anti-
malarials are treated with artemisinin-
based combination therapy (ACT).

Source: UNICEF global databases 2013, based on DHS, MICS, and other national surveys as of May 2013
Birth registration, child marriage and
Female Genital Mutilation/Cutting (FGM/C)
The birth of less than half of children in Eastern
and West Africa has been registered More than 125 million girls and
Percentage of children under five who are registered
women alive today have undergone
87 some form of FGM/C in 29 countries
across Africa and the Middle East.
53 54
44

31
Another 30 million girls are at risk of
being cut in the next decade.
Eastern Africa West Africa Central Africa Southern Africa North Africa

In Central Africa, 1 in 2 young women were married or in union before age 18; nearly 1 in 5 of whom
were married or in union before age 15
Number of women 20-24 years old who were first married Percentage of women 20-24 years old who were first married or in union before
or in union before age 18, by sub-region ages 15 and 18, by region

Central Africa 18 31
West Africa 2.3 mn West Africa 15 26

Eastern Africa 2.2 mn Eastern Africa 10 27

Central Africa 456,000 Southern Africa 7 20

North Africa 3 14
Southern Africa 442,000
North Africa 258,000 World 11 23

Married or in union before age 15 Married or in union between ages 15 and 18

In almost all countries, prevalence of female genital mutilation/cutting is greater than support for
continuing the practice
Percentage of girls and women aged 15 to 49 years who have undergone FGM/C and percentage of girls and women aged 15 to 49
years who have heard about FGM/C and think the practice should continue
100

80
% girls and women aged 15
to 49 years who have
60
Percentage

undergone FGM/C

40
% girls and women aged 15
20
to 49 years who have heard
about FGM/C and think the
practice should continue
0

Source for all charts: UNICEF global databases 2013, based on DHS, MICS, and other national surveys 2002-2011
Education in Africa
In Africa, boys are more likely to be enrolled in Key facts:
primary school than girls • Over half of the world’s out-of-school children
Gender parity index of Net Enrolment Rate, African countries (30 million) live in Africa.
1.2
Girls are more likely to be enrolled
• Girls are more likely to be out of school than
1.1
boys.
• Children with disabilities are over-represented in
Parity
1 the out-of-school population.
• Progress in reducing the out-of-school children
0.9
population has slowed down since 2005.
Boys are more likely to be enrolled
0.8
• Many children fail to complete the full primary
circle and fail to master basic literacy and
0.7 numeracy skills.
30 million of the world’s out-of school children Primary school enrolment in West Africa lags
live in Africa behind the other African regions
Primary school age Out-of-School children, by sex, sub-Saharan Africa, 2011 Primary Net Enrolment Rates by sub-regions 1999 and 2010
100 96
1999 89 91
87 87
80
2010
80

64
60 56
53
16 million girls 14 million boys 45
Out-of-School Out-of-School 40
(54%) (46%)
20

0
West Africa Eastern Africa Central Africa South Africa North Africa

Only 5 out of 53 African countries have reached Even if they progress through the grades, many
Universal Primary Education primary school children do not acquire basic
knowledge and skills
Net enrolment/attendance rate, 2010 % of cohort who reach grade 4 and achieve a minimal education level
SACMEQ, 2007 PASEC, 2004 - 2008
100

80

60

40

20

Net enrolment/
attendance rate, 2010
<70% Did not reach grade 4
70 – 84%
85 – 94% Reached grade 4
95 – 100% Reached grade 4 and achieved minimum level of learning
Missing value
Note: The definition of minimum learning levels differs between the two surveys, the Southern and
Eastern Africa Consortium for Monitoring Educational Quality (SACMEQ) and the Programme of Analysis
Sources: UNICEF global databases, 2013 and UNESCO Institute of Statistics databases, 2013 of Education Systems of the CONFEMEN (PASEC) and thus the results are not comparable.
Source: EFA Global Monitoring Report 2012
Child Mortality in Africa

All regions in Africa have experienced marked declines in under-five mortality since 1990
In Africa, mortality rates among children under-five years of age (U5MR) have decreased by 45 per cent from 162 deaths per 1,000 live births in
1990, to 90 in 2012, but still half of the world's 6.6 million under-five deaths occur in Africa.

Under-five mortality rate (deaths per 1,000 live births) and Half of the world's 6.6 million
number of under five deaths by sub-region, 2012
under-five deaths are in Africa

Under-five mortality rate, 1990 & 2012

North Africa North Africa

83 1990
187,000 35
2012

Southern Africa
147
West Africa 89
1,386,000 172
Eastern Africa
Eastern Africa 86
1,136,000
West Africa
206
113
Central Africa
197,000 Central Africa
155
114

Under-five mortality rate

Africa
162
Southern Africa 90
428,000 90
World
48
0 50 100 150 200 250

Under-five deaths per 1,000 live births

Pneumonia, malaria and diarrhoea account for Close to 600,000 measles deaths averted by
40% of all under-five deaths in Africa vaccination in sub-Saharan Africa, since 2000
Distribution of under-five deaths in Africa by cause, 2012 Measles coverage and deaths averted
Pneumonia Estimated measles deaths Estimated measles deaths in
(neonatal) 3% Immunization (MCV4) coverage absence of vaccination
Pneumonia (post-
neonatal) 14% Preterm birth
complications 12% 700,000 80
Pneumonia Sub-Saharan Africa
17%
600,000
75
Neonatal Birth asphyxia 9%
34%
Estimated deaths

500,000
70
Other 19% All Other 400,000
Sepsis/meningitis/tet
22% anus 6% 65

300,000
Congenital
abnormalities 2%
Diarrhoea 60
10% 200,000
Measles 1% Other neonatal 1%

Meningitis 2% Malaria 100,000

55
13% Diarrhoea (neonatal)
Injury 4% 1%
0 50
Malaria 13% Diarrhoea (post- 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011
AIDS 3% neonatal) 10%

Globally, almost half of the under-five deaths are attributable to malnutrition

Source : Adapted from Simons et al. (Assessment of the 2010 global measles mortality reduction goal:
results from a model of surveillance data. Lancet 2012;379:2173-78) with updated measles mortality
Source: UNICEF analysis based on IGME and WHO & CHERG 2013 data through 2011 obtained from Dr Robert Perry, World Health Organization, Geneva, Switzerland.
 @UNICEF/NYHQ2010-2802/Asselin
Key statistics on child survival, protection and development
Children in Africa
Key Statistics
• Africa still has the highest under-five
mortality rates in the world and half
of the world's 6.6 million under-five
deaths are in Africa.
• Pneumonia, malaria and diarrhoea
account for 40% of all under-five
deaths in Africa.
• At least 1 in 3 children under-five in
Africa were stunted in 2011.
• Africa accounts for about 60 per
cent of all maternal deaths in the
world.
• In 2011, there were an estimated
3.1 million children under 15 years
living with HIV in Africa.
• In 2010, there were 219 million
malaria cases in Africa leading to
approximately 660,000 malaria
deaths.
• Less than half of children under-five
in Eastern and Western Africa have
been registered at birth.

Every Child Counts • 236 million people in Africa

practiced open defecation in 2011.

The child population in Africa is burgeoning; by 2050, 1 in every 3 children under 18

will be African
Number of births by UNICEF regions, 1950 - 2050

50 Sub-Saharan Africa
By 2050, 1 in every
3 births and almost
40
South Asia
1 in every 3
Population (in millions)

30
children under 18
East Asia and Pacific will be African
20
Between 2010 and 2025, the
child population of sub-
10
Saharan Africa will rise by
130 million.
0
1950 1970 1990 2010 2030 2050
CEE/CIS
Industrialized countries
East Asia and Pacific
Latin America and Caribbean
From around 2030, sub-
Middle East and North Africa
Sub-Saharan Africa
South Asia Saharan Africa will be the
single region with the
Source of chart: You, D., and D. Anthony. “Generation 2025: The critical importance of
understanding demographic trends for the children of the 21st century”. UNICEF greatest number of children
Occasional Paper, no. 1, September 2012.
under 18.

Prepared by: UNICEF Data & Analytics

Division of Policy and Strategy Find the latest statistics on children in Africa at the
September 2013 (with updated U5MR estimates) UNICEF-Statistics website: www.childfinfo.org
 Drinking Water and Sanitation in Africa
Since 1990, 351 million people gained access to an improved drinking water source in Africa.
Drinking water coverage trends in Africa and sub-regions, 1990-2011
3 3
8 Key facts:
10 10 17
19 22
25 14
12
20
11
• Drinking water coverage in Africa in-
33 creased from 56% in 1990, to 67% in 2011.
18
23
23 19
13 22 • This rate of progress is not sufficient to
30
24 meet the continent’s MDG drinking water
29 25 target of 78% by 2015.
29

29 • Just over a quarter (26%) of the African

Coverage (%)

38
33 population enjoys the convenience and
41 associated health benefits of a piped
54 33
56
72
drinking water supply on premises.
42 37 43 53 • Over the period 1990-2011 Africa’s
30 population grew from 411 million people
36 to just over 1 billion. While 351 million
31
26 gained access to an improved drinking
23
10 12 11 13 water source, the population without
8 7
1990 2011 1990 2011 1990 2011 1990 2011 1990 2011 1990 2011 access increased from 280 million in 1990,
Eastern West Central Southern North AFRICA
Africa Africa Africa Africa Africa to 340 million in 2011.
Piped on premises Other improved sources Unimproved sources Surface water

In Africa only 40% of the population uses an improved sanitation facility;

the population without access grew by 212 million despite 200 million people gaining access
• Open defecation rates in Eastern Africa declined most Sanitation coverage trends in Africa and sub-regions, 1990-2011
from 40% in 1990, to 25% in 2011.
• West and Central Africa made the least progress on 12
19 21
sanitation. 23
25 24
• In Southern Africa one-fifth (19%) of the population still 28
34
32 4 32
34
practices open defecation. 40 6
• Malawi, Angola, Ethiopia and Benin registered declines 11
in open defecation rates of 25 percentage points or 15
more since 1990. 5
13 21
22 29
Open defecation rates 1990 & 2011, selected countries 18 13 21
35 26
93 11
Coverage (%)

1990
80 16
2011 37
14 12
24 78
Percentage (%)

21 9
57 54 63
15
45 53
31 9 44
26 35 40
33
27 26 31
25
14
6
Malawi Angola Ethiopia Benin 1990 2011 1990 2011 1990 2011 1990 2011 1990 2011 1990 2011
Eastern West Central Southern North AFRICA
Africa Africa Africa Africa Africa
Source for all charts: UNICEF global databases 2013, based on DHS, MICS, and other
national surveys 2007-2011 Improved facilities Shared facilities Unimproved facilities Open defecation
 Maternal Health in Africa
Africa has the highest number of maternal deaths
- Globally, the maternal mortality ratio (MMR) declined from 400 maternal deaths per 100,000 live births in 1990 to 210 in 2010
- In sub-Saharan Africa the maternal mortality ratio is 500 per 100,000 live births.
- Africa accounts for about 60 percent of all maternal deaths in the world, largely due to limited access to emergency obstetric care and
insufficient maternal care during pregnancy and delivery.

Antenatal care during pregnancy with skilled The improvement of maternal health outcomes
health personnel is essential to ensure both requires key interventions:
mother and baby’s well-being
• Assistance from skilled health personnel at
Antenatal care: % of women (aged 15-49) attended at least once during delivery.
pregnancy by skilled health personnel (doctor, nurse or midwife)

59
• Improved access to emergency obstetric care
West Africa
68
50
• A minimum of four visits for antenatal care in
North Africa
79 order to ensure the well-being of mother and
Central Africa 77 babies.
82
Eastern Africa -
91 • Expanding access to information, counseling
Southern Africa 90 and supplies for a wide range of contraceptive
95
methods.
• Lowering birth rates among adolescents
Sub-Saharan Africa 69
79
63
~1990 • Antiretroviral therapy to all pregnant women
World
81 ~2011 who need it.
Note: Data coverage was insufficient to calculate regional estimates for Eastern Africa in 1990.

Skilled delivery care higher in urban than in rural Two out of five babies in Africa are born without
areas support from skilled health attendant
Skilled attendance at birth: % of births attended by skilled health personnel Skilled attendance at birth: % of births attended by skilled health personnel
(doctor, nurse or midwife), African regions by area of residence, 2011 (doctor, nurse or midwife), country data with regional estimates ,
Data range 2006 - 2011

91
86
84
North Africa
76 67%
72
Urban
West Africa
68 rural
Rural 45% Eastern Africa
51%
53
45 Central Africa
40 62%
33

Skilled attendance at birth

% or more
%
% Southern Africa*
%
West Africa Central Africa North Africa sub-Saharan World
Africa

Note: Data coverage were insufficient to calculate urban and rural estimates for Eastern and Southern Africa. Note: Data coverage was insufficient to calculate regional estimate for Southern Africa.

Source for all charts: UNICEF global databases 2013, based on DHS, MICS, and other national surveys as of May 2013