Declining child malnutrition: a reassessment.

BACKGROUND Monitoring of the progress towards the Millennium Development Goal (MDG) of halving the proportion of malnourished children before year 2015 relies on the estimated trends in child stunting and underweight from the WHO. METHODS Two methods are used for assessing the reliability of the WHO estimates of trends in child stunting. One method is to estimate changes over time with an alternative methodology and the same data set, and the other is to evaluate the inter-temporal comparability of the child surveys from India and China, the two countries that weigh most heavily in the WHO trend estimates. RESULTS The re-estimated global and regional trends in child stunting with the alternative method and same data set are similar to those derived by the WHO. The data analysis shows that the child surveys from India are not inter-temporarily comparable. When controlling for differences in state coverage and age cohorts in the surveys, the prevalence of child stunting in India remained unchanged in the 1990s. The unaltered prevalence of stunting followed a minuscule decline in poverty. In China, there was a significant increase in child stunting between 1987 and 1992 and then a decline by half up to 1998. This abrupt reversal in child stunting was matched by a parallel change in (rural) poverty. CONCLUSIONS The progress towards the MDG at the global level is on track owing to the large decline in China. In India, as in most of Africa, where no notable fall in child stunting took place over the 1990s, the rate of decline over the 2001-15 period must be very high for the MDG to be realized. For this to occur, large reductions in poverty through equitable and high income growth are necessary.