The State of the World's Children 1998: Fact Sheets

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Malnutrition: Causes

  • Malnutrition is a complex condition that can involve multiple, overlapping deficiencies of protein, energy and micronutrients — so called because they are nutrients needed by the body in only tiny amounts. A child becomes malnourished because of illness in combination with inadequate food intake. Insufficient access to food, poor health services, the lack of safe water and sanitation, and inadequate child and maternal care are underlying causes.

  • In as many as 35 of the poorest countries, 30-50 per cent of the population may have no access to health services at all.

  • More than 1.1 billion people lack access to safe drinking water and some 2.9 billion people lack access to adequate sanitation. The result is the spread of infectious diseases, including childhood diarrhoea, which in turn are major causes of malnutrition. Each year, diarrhoeal dehydration claims the lives of 2.2 million children under five in developing countries.

  • Inadequate care for children and women is an underlying cause of malnutrition only recently recognized in all its harmful ramifications. Good hygiene in and around the home and in handling food reduces the risk of illness. Care also includes all interaction between parent and child that helps children develop emotionally as well as physically. Several studies have found that malnourished children who were stimulated verbally and cognitively had higher growth rates than those who were not.

  • Discrimination against women and girls is an important basic cause of malnutrition. The very high rates of child malnutrition and low birthweight throughout much of South Asia are linked to such factors as women's poor access to education and their low levels of participation in paid employment, compared with other regions.

  • Breastfeeding is the foundation of good nutrition for infants, and inadequate breastfeeding can jeopardize infants' health and nutrition, particularly in areas where sanitation and hygiene are poor.

  • In some industrialized countries, widening income disparities, coupled with reductions in social protections, are having worrying effects on the nutritional levels of children.


  • Malnutrition contributes to over 6 million child deaths each year, 55 per cent of the nearly 12 million deaths among children under five in developing countries. Half of all children under five years of age in South Asia and one third of those in sub-Saharan Africa are malnourished.

  • Malnutrition leads to reduced productivity, hampering economic growth and the effectiveness of investments in health and education, and deepening poverty. Vitamin and mineral deficiencies are estimated to cost some countries the equivalent of more than 5 per cent of their gross national product in lost lives, disability and productivity.

  • In countries where infant mortality rates are high or moderately high, a bottle-fed baby in a poor community is 14 times more likely to die from diarrhoeal diseases and 4 times more likely to die from pneumonia than a baby that is exclusively breastfed.

  • In the United States, researchers estimate that 13 million children, more than one fourth of all children under the age of 12, have a difficult time getting all the food they need. In the United Kingdom, children and adults in poor families have been found to face increased risks due to poor diet, including premature births, low birthweights, anaemia, dental diseases, diabetes, obesity and hypertension. In the Russian Federation, the prevalence of stunting among children under two years of age increased from 9 per cent in 1992 to 15 per cent in 1994.


  • Over 12,700 hospitals in 114 countries are now baby-friendly, establishing a good start to breastfeeding for millions of babies.

  • Sixty per cent of all edible salt in the world is now iodized, helping reduce the toll of iodine deficiency disorders. Bolivia is the first and only country to certify that iodine deficiency has been virtually eliminated as a public health problem.

  • In 1997 alone, the lives of at least 300,000 young children were saved by vitamin A supplementation programmes in developing countries.

  • In Mbeya in Tanzania, a project improving health coverage and access to safe water, as well as growth monitoring and promotion, has produced a drop in moderate malnutrition of 11 percentage points. In contrast, malnutrition among children under five in areas not covered by the project actually increased by 7 percentage points.

  • In Brazil, the rate of malnutrition among children covered by a community-volunteer growth monitoring and promotion programme run by the Child Pastorate is half the national rate.

  • In a village in Niger, malnutrition rates have fallen by 10 percentage points as a result of a programme that helps women organize to reduce their workloads and enrich family diets with new foods.

  • Community volunteers in Oman's Al Dakhiliya region are helping reduce child malnutrition through improved care and health activities.

  • Nutrition promoters in Bangladesh are working in 1,000 community centres to help support breastfeeding and better caring practices for women and children.

  • Guatemala has brought vitamin A deficiency under control by fortifying sugar with the vitamin. Sugar is also being fortified with vitamin A in parts of Bolivia, Brazil, El Salvador, Honduras and the Philippines.

  • UNICEF supplied a total of 2.7 billion iron/folate tablets to 122 countries between 1993 and 1996 for distribution among pregnant women to help reduce iron deficiency anaemia and folate deficiency. Wheat flour is being fortified with iron in a number of countries in Latin America and the Middle East.

  • The nutrition of millions of children around the world has benefited from improvements in health services, particularly the achievement of immunization rates between 80 and 90 per cent in many countries.

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