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Post a reply: Despite having worse wasting level and similar stunting level, why South Asia have less under five mortality than Sub Saharan Africa?

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Some background (all WHO 2016 data, Economy data World Bank):


Based on WHO’s rank of under-five mortality African countries make the lowest 19 countries with highest under five mortality rate. Out of the 50 highest mortality ranks, 40 countries are in Africa. Under five Mortality in sub Saharan African nations is 78 deaths per 1000 live births, a 106 deaths per 1000 live births decrease since 1990, while in Asia it is 86 deaths per 1,000 live births and this is a 81 deaths decrease per 1,000 live births since 1990. Even though Sub Saharan Africa’s reduction of under five mortality is far higher than that of South Asian, the under five mortality rate in Africa is still very high by 30 deaths, and even though Africa’s population is 58% of that of South Asia, the under-five mortality is higher in Africa by 1.2 million. Note: Under-5 mortality rate is probability of dying between birth and exactly 5 years of age, expressed per 1,000 live births.

The high level of mortality in Africa will be hard to describe when we see nutrition and other as both South Asia and Sub Saharan Africa have a relatively comparable infant and young child feeding practices, in some instances Africa is far better off. For instance, Early initiation of breast feeding is more practiced in Africa than India (51% and 39%, respectively), exclusive breasting on the other hand is more in South Asia (52%) than Sub Saharan Africa (42%), introduction to solid, semi-solid, or soft foods 6-8 months is high in Africa (71%) when compared to Asia (56%), in both areas minimum acceptable diet is received with few children (11% in South Asia to 12% in SSA). On the other hand continued breast feeding up to age 2 is higher in SA (68%) than SSA (50%).

The difference in mortality rate will become bizarre when we see the levels of stunting and wasting in both locations. Stunting is almost equal in SSA (34%) and SA (36%), wasting is twice higher in South Asia (16%) than Sub Sahara Africa (8%), Vitamin A supplementation (VAS) is 66% in SA and 72% in SSA and severe wasting twice higher in South Asia (5% vs 2%), and iodine consumption is 88% in SA and 80% in SSA. Per capita income (South Asia=USD 1,729, SSA=1,486), and GDP (SA=3.3 Trillion, SSA=1.67 Trillion)

What explains this phenomenon? What did South Asia did to decrease under five mortality when compared with Africa, given the level of wasting and stunting? Are there any studies?

Another unrelated question: World Bank’s Investment Bank’s investment framework for addressing malnutrition cites ‘not enough evidence on interventions that prevent wasting’. Hence, the framework concentrates on curative interventions. It calculates investments needed to meet WHA’s target of wasting and other indicators. Question: is that true we do not have enough information on interventions to prevent wasting?

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