Menu ENN Search

Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries

Summary of research

By Tanya Khara, Martha Mwangome, Moses Ngari and Carmel Dolan

Tanya Khara and Carmel Dolan are ENN Technical Directors. They coordinate the ENN Wasting-Stunting (WaSt) Project and the WaSt Technical Interest Group.

Martha Mwangome is a Post-Doctoral Research Scientist at the KEMRI/Wellcome Trust Research Programme in Kenya and is actively involved in the ENN led WaSt Project.

Mosese Ngari is a PhD student and biostatistician at the KEMRI/Wellcome Trust Research Programme in Kenya offering statistical and data management support to child nutritional studies.

The full research study is available open access in 'Maternal and Child Nutrition' here. 

Reducing the prevalence of children who are wasted and stunted are global priorities. Wasting and stunting are often present in the same geographical populations (Victora, 1992) and it is recognised that children can be stunted and wasted at the same time, ‘concurrently wasted and stunted’ (IFPRI, 2015). Though the relationship between these manifestations of undernutrition at the level of the individual child and the mechanisms leading to this state of “concurrence” are poorly understood (Angood et al, 2016), evidence suggests that children with both deficits are at a greatly elevated risk of mortality (McDonald et al, 2013).

This paper highlights the issue that despite the above, there are no global estimates of the prevalence and burden of concurrence (UNICEF et al, 2016). It is in fact rarely reported, though the data required to estimate concurrence is readily available in national surveys (Saaka & Galaa, 2016). The authors note that reporting on global figures for the prevalence of different nutritional deficits separately, underestimates the true proportion of the global population affected by nutritional deficits as a whole and, ignores this critical proportion of children affected by multiple deficits who may require additional nutritional support.

The analysis presented in the paper aims to address this gap by providing the first multiple country estimates of the prevalence and burden of children aged 6–59 months concurrently wasted and stunted using data from Demographic and Health Surveys (DHS) and Multi?indicator Cluster Surveys (MICS). The aim was to approach a global estimate though sufficiently recent data (last 10yrs) was available for just 84 countries. For countries with more than one dataset available the most recent dataset was chosen. Country-specific estimates were calculated and pooled using the random-effects meta-analysis to yield the 84 country estimates (Hamza, Reitsma, & Stijnen, 2008). Burden by country was calculated using country population figures from the global joint estimates database (UNICEF et al, 2016). The analysis also explored age, sex, regional, and contextual differences, and estimated of the proportion of children affected by either of these conditions (wasted or stunted).

The pooled prevalence of children concurrently wasted and stunted in the 84 countries was found to be 3.0%, 95% CI [2.97, 3.06]. The prevalence of concurrence varied across countries from 0% in Montenegro to 8.0%, 95% CI [7.2, 8.9], in Niger. Nine countries had a concurrence prevalence greater than 5%. Six from sub-Saharan Africa (Niger, Burundi, Djibouti, Chad, Sudan, and South Sudan) and three from Asia (Timor-Leste, Yemen, and India). The authors note that a country prevalence of >5% severe wasting would warrant concern and intensification of efforts to identify and treat children. Though concurrence is associated with similar mortality risks, its prevalence is not monitored, and cases are not routinely identified, therefore, no specific action can be taken.

The estimated prevalences from this analysis were calculated to correspond to nearly 6 million children concurrently wasted and stunted in the 84 countries. The authors note that given the transitory nature of wasting in particular, where a child can experience several episodes of wasting during a set period, using cross-sectional data insufficiently estimates the actual prevalence (Garenne et al, 2009). This means that the above is likely to be an underestimate of the true burden of children experiencing these two deficits concurrently. See figure 1. For a graphical representation of the results by country.

Prevalence of concurrence was found to be highest in the 12 to 24 month age group 4.2%, 95% CI [4.1, 4.3], and was significantly higher among boys 3.54%, 95% CI [3.47, 3.61], compared to girls; 2.46%, 95% CI [2.41, 2.52]. Fragile and conflict-affected states reported significantly higher concurrence 3.6%, 95% CI [3.5, 3.6], than those defined as stable 2.24%, 95% CI [2.18, 2.30]. The authors note that these patterns mirror higher prevalences of wasting and stunting when analysed separately. Particularly in the case of the pattern of heightened nutritional vulnerability of boys, the data suggests that further investigation is needed.

The pooled 84 country prevalence estimate for children 6–59 months of age experiencing either wasting or stunting was found to be 38.9%, 95% CI [38.7, 39.0]. This means that only 61.1%, 95% CI [61.0, 61.3], of children in the 84 countries escape both conditions. The authors note that this is a very stark metric for understanding the extent of undernutrition in these countries and refer to country disaggregated data from this analysis that was reported in the Global Nutrition Report 2016, in which it can be seen that in a number of countries (Benin, Djibouti, Yemen, Niger, Chad, Guinea-Bissau, Ethiopia, Congo DRC, Burundi and Somalia, India, Pakistan, and Laos), over half the population of children is suffering from one of these deficits (IFPRI, 2016).

Given the high risk of mortality associated with concurrence, the authors conclude that the levels of prevalence and burden reported in their analysis, indicate that there is a need to systematically report on this condition within country and global monitoring systems and, for researchers programmers and policy makers to prioritise investigation into the extent to which these children are being reached through existing programmes.



Angood, C., Khara, T., Dolan, C., Berkley, J. A., & WaSt TIG. (2016). Research priorities on the relationship between wasting and stunting. PloS One , 11(5). e0153221.

Garenne, M., Willie, D., Maire, B., Fontaine, O., Eeckels, R., Briend, A., & Van den Broeck, J. (2009). Incidence and duration of severe wasting in two African populations. Public Health Nutr, 12(11), 1974-1982. doi:10.1017/S1368980009004972

Hamza, T. H., Reitsma, J. B., & Stijnen, T. (2008). Meta-analysis of diagnostic studies: a comparison of random intercept, normal-normal, and binomial-normal bivariate summary ROC approaches. Med Decis Making, 28(5), 639-649. doi:10.1177/0272989X08323917

IFPRI. (2015). Global Nutrition Report 2015: Actions and Accountability to Advance Nutrition & Sustainable Development. Panel 2.1 Extent of wasting and stunting in the same children. Washington, DC

IFPRI. (2016). Global Nutrition Report 2016: From Promise to Impact: Ending Malnutrition by 2030. Retrieved from Washington, DC

McDonald, C. M., Olofin, I., Flaxman, S., Fawzi, W. W., Spiegelman, D., Caulfield, L. Ezzati, M, Danaei, G., for the Nutrition Impact Model Study. (2013). The effect of multiple anthropometric deficits on child mortality: meta-analysis of individual data in 10 prospective studies from developing countries. Am J Clin Nutr, 97(4), 896-901. doi:10.3945/ajcn.112.047639

Saaka, M., & Galaa, S. Z. (2016). Relationships between Wasting and Stunting and Their Concurrent Occurrence in Ghanaian Preschool Children. J Nutr Metab, 2016, 4654920. doi:10.1155/2016/4654920

UNICEF, WHO, & Group, W. B. (2016). Levels and Trends in Child Malnutrition. WHO/UNICEF/World Bank Group Joint estimates. Retrieved from

Victora, C. G. (1992). The association between wasting and stunting: An international perspective. The Journal of Nutrition , 122(5), 1105–1110.

Funding clause:

This study is made possible by the generous support of the American people through the United States Agency for International Development (USAID) through the grant ENN AID-OFDA-G-15-00190 and through an Irish Aid Grant number 2016/RESNUT/001/ENN: the ideas, opinions and comments therein are entirely the responsibility of its author(s) and do not necessarily represent or reflect the view of USAID or the United States Government or Irish Aid policy.

Read more about ENN's Wasting and Stunting project here.


More like this

Resource: Children concurrently wasted and stunted: A meta ‐ analysis of prevalence data of children 6 – 59 months from 84 countries

Children can be stunted and wasted at the same time. Having both deficits greatly elevates risk of mortality. The analysis aimed to estimate the prevalence and burden of...

Review of the links between wasting and stunting

Donor: OFDA and Irish Aid Collaborators: Technical Interest Group ENN project lead: Carmel Dolan Timeframe: 2014 - ongoing Background While wasting and stunting share...

Wasting and Stunting concurrence meta-analysis

Important new study published with open access in Maternal and Child Nutrition 'Children concurrently wasted and stunted: A meta-analysis of prevalence data of children...

Blog post: Wasting and Stunting-making progress on understanding the links

Some of you will know that ENN has been coordinating a project with the expert steer of around 30 child growth and nutrition specialists from academia, donor and operational...

FEX: Predicting coexistence of wasting and stunting in Guinea-Bissau: A secondary data analysis

Summary of MSc thesis1 By Abbi Sage Abbi Sage is a recent MSc graduate in Nutrition for Global Health from the London School of Hygiene and Tropical Medicine. She is now part...

Wasting and Stunting-making progress on understanding the links

Friday 16th February, 2017 By Carmel Dolan, ENN Technical Director Some of you will know that ENN has been coordinating a project with the expert steer of around 30 child...

FEX: Relationships between wasting and stunting and their concurrent occurrence in Ghanaian pre-school children

Summary of research* Location: Ghana. What we know: Wasting is a short-term health issue, but repeated episodes may lead to stunting (long-term or chronic malnutrition). This...

NEX: Joint UNICEF/WHO/The World Bank Child malnutrition database

In September 2013 UNICEF, WHO and the World Bank updated their joint database on child malnutrition and released new global and regional estimates for 2012. For the first time,...

FEX: Update of UNICEF/WHO/World Bank database on child malnutrition

Summary of research1 Location: Global What we know: A joint database on child malnutrition is maintained by UNICEF, WHO and the World Bank. To date this has not included...

FEX: Wasting is associated with stunting in early childhood

Summary of published research1 Location: Africa, Asia, Latin America What we know already: Wasting and stunting are respectively short term and longer term conditions of...

FEX: The relationship between wasting and stunting: policy, programming and research implications

Summary of review1 This summary was prepared by Tanya Khara, an independent consultant engaged by the ENN on this review. The review was made possible by the generous support...

FEX: Improving estimates of numbers of children with severe acute malnutrition using cohort and survey data

Summary of Research Isanaka S, Boundy EO, Graise RF, Myatt M and Briend A. (2016). Improving Estimates of Numbers of Children With Severe Acute Malnutrition Using Cohort and...

FEX: Drought, conflict and undernutrition in Ethiopia

Summary of research1 Location: Ethiopia What we know: Conflict and drought can have negative impacts on child undernutrition. What this article adds: A recent pooled...

ENN Latest

A new study has been published under the ENN WAST project with open access in Maternal and Child Nutrition 'Children concurrently wasted and stunted: A meta-analysis of...

FEX: Planned ENN review of wasting and stunting linkages

Summary of article1 Location: Global What we know: The relationship between wasting and stunting is under researched and poorly understood. What this article adds: A...

Resource: Stunting in protracted emergencies: discussion paper

Currently, the level of attention afforded to linear growth below international standards (stunting) in humanitarian and protracted emergency contexts is below what is needed,...

FEX: Treatment of SAM and MAM in low- and middle-income settings: a systematic review

Summary of research1 Location: Global What we know: Worldwide, 33 million children under 5 years are moderately malnourished and 19 million are severely malnourished. The...

Blog post: Stunting & Wasting in South Asia- Reflections from a Regional conference

Lire ce blog en francais Over the years the scope of ENN's work has expanded beyond a focus on humanitarian contexts to encompass a broader set of issues around drivers of...

en-net: What is the proper micronutrient composition for supplementation to promote catch up growth in stunted children?

According to DHS 2005 of Ethiopia, prevalence of stunting and wasting are 51% and 12%, respectively, showing that both malnutrition should not be neglected. So we are planning...

FEX: Promoting community based management of severe acute malnutrition as a child survival intervention

By Andre Briend Andre is Adjunct Professor at the Department for International Health, University of Tampere School of Medicine, FIN-33014, Tampere, Finland and Department of...


Reference this page

Khara, T., Mwangome, M., Ngari, M. and Dolan, C. (2017). Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries. Field Exchange 57, February 2018.