Nutrition Situation in Senegal - World Bankpubdocs.worldbank.org/en/823161594228016301/1-Nutrition...WHO World Health Organization OMS Organisation Mondiale de la Santé Unless otherwise

AN

ALYSIS &

PERSPECTIVE: 15 YEA

RS OF EXPERIEN

CE IN TH

E DEV

ELOPM

ENT O

F NU

TRITION

POLICY IN

SENEG

AL

Nutrition Situation in

SenegalMarc Nene

Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal

Nutrition Situation in

Senegal

January 2018 Marc Nene

© 2018 International Bank for Reconstruction and Development / The World Bank1818 H Street NW, Washington, DC 20433Telephone: 202-473-1000; Internet: www.worldbank.org

Some rights reserved

This work is a product of the staff of The World Bank and the Cellule de Lutte Contre la Malnutrition (CLM; Nutrition Coordination Unit of the Government of Senegal) with other external contributions. The findings, interpretations, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. Responsibility for the content of this work lies solely with the author or authors. Neither The World Bank nor the CLM guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank or the CLM concerning the legal status of any territory or the endorsement or acceptance of such boundaries.

Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank or the CLM, all of which are specifically reserved.

Rights and Permissions

This work is available under the Creative Commons Attribution 3.0 IGO license (CC BY 3.0 IGO) http://cre-ativecommons.org/licenses/by/3.0/igo. Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions:

Attribution—Please cite the work as follows: Nene, Marc. 2018. “Nutrition Situation in Senegal.” Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal. World Bank, Washington, DC; CLM, Dakar, Sénégal. License: Creative Commons Attribution CC BY 3.0 IGO

Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank or the CLM and should not be considered an official World Bank or CLM translation. Neither The World Bank nor the CLM shall be liable for any content or error in this translation.

Adaptations—If you create an adaptation of this work, please add the following disclaimer along with the attribution: This is an adaptation of an original work by The World Bank and the CLM. Views and opinions expressed in the adaptation are the sole responsibility of the author or authors of the adaptation and are not endorsed by The World Bank or the CLM.

Third-party content—Neither The World Bank nor the CLM necessarily own each component of the content contained within the work. The World Bank and CLM therefore do not warrant that the use of any third-party-owned individual component or part contained in the work will not infringe on the rights of those third parties. The risk of claims resulting from such infringement rests solely with you. If you wish to re-use a component of the work, it is your responsibility to determine whether permission is needed for that re-use and to obtain permission from the copyright owner. Examples of components can include, but are not limited to, tables, figures, or images.

All queries on rights and licenses should be addressed to the Bureau Exécutif National de la Cellule de Lutte contre la Malnutrition (BEN / CLM), Rue 07 Point -E - BP 45001 Dakar – Fann, Sénégal; tél : 33 869 01 99; fax: 33 864 38 61; e-mail: [email protected].

Cover photo: Adama Cissé/CLM

Cover design: The Word Express, Inc.

http://i.creativecommons.org/l/by/3.0/88x31.png

Acknowledgments

This report was written by Marc Nene, Ph.D. Candidate, Tufts University Friedman School of Nutrition Science and Policy, with support from Andrea L. Spray (Consultant).

Reviewers. We are grateful to all reviewers of the reports of the series—Elodie Becquey (IFPRI), Patrick Eozenou (World Bank), Dominic Haazen (World Bank), Derek Headey (IFPRI), Abdou-laye Ka (CLM), Jakub Kakietek (World Bank), Ashi Kohli Kathuria (World Bank), Christine Lao Pena (World Bank), Biram Ndiaye (UNICEF), Jumana Qamruddin (World Bank), Claudia Rokx (World Bank). They each generously dedicated their time and effort, and their invaluable input played an important role in the evolution of the series.

Partners. We would also like to give thanks to the following members of the task force of development partner organizations, who provided guidance on the conceptualization, implemen-tation and finalization of the series: Sophie Cowpplibony (REACH), Aissatou Dioum (UNICEF), George Fom Ameh (UNICEF), Julie Desloges (Government of Canada), Aida Gadiaga (WFP), Laylee Moshiri (UNICEF), Aminata Ndiaye (Government of Canada), Marie Solange N’Dione (Consultant), and Victoria Wise (REACH).

Client. Finally, our greatest appreciation is extended to the dedicated staff of the CLM, whose work is chronicled in the series, and the thousands of health workers and volunteers who are daily delivering life-saving nutrition services to vulnerable populations throughout Senegal.

This work was conducted under the guidance of Menno Mulder-Sibanda (Task Team Lead and Senior Nutrition Specialist, World Bank). The series was prepared by a team led by Andrea L. Spray (Consultant). Aaron Buchsbaum (World Bank) supported publishing and dissemination, along with Janice Meerman (Consultant) and Laura Figazzolo (Consultant). Information regard-ing the financial support for the series is provided at the end of the report.

About the Series

The government of Senegal, through the Cellule de Lutte contre la Malnutrition (Nutrition Coordination Unit) (CLM) in the Prime Minister’s Office is embarking on the development of a new Plan Stratégique Multisectoriel de Nutrition (Multisectoral Strategic Nutrition

Plan) (PSMN), which will have two broad focus areas: (1) expanding and improving nutrition ser-vices; and (2) a reform agenda for the sector. The reform agenda will include policy reorientation, governance, and financing of the PSMN. The PSMN will discuss the framework and timeline for the development of a nutrition financing strategy, which will require specific analysis of the sector spending and financial basis, linking it to the coverage and quality of nutrition services.

Senegal is known for having one of the most effective and far-reaching nutrition service delivery systems in Africa. Chronic malnutrition has dropped to less than 20 percent, one of the lowest in continental Sub-Saharan Africa. Government ownership of the nutrition program has grown from US$0.3 million a year in 2002 to US$5.7 million a year in 2015, increasing from approximately 0.02 percent to 0.12 percent of the national budget. Yet, these developments have not led to enhanced visibility of nutrition-sensitive interventions in relevant sectors such as agriculture, education, water and sanitation, social protection, and health. The absence of nutrition-sensitive interventions in the relevant sectors, combined with the recent series of external shocks, has favored continued fragmentation of approaches, discourse, and interventions that address nutri-tion. In addition, there is no overall framework for investment decision making around nutrition, which puts achievements made to date in jeopardy. Meanwhile, nutrition indicators are stagnat-ing and other issues with major implications (such as low birth weight, iron deficiency anemia, maternal undernutrition, and acute malnutrition) have received little or no attention.

A review of policy effectiveness can help raise the importance of these issues, including house-hold and community resilience to food and nutrition insecurity shocks, as a new priority in nutrition policy development. This series of analytical and advisory activities, collectively entitled Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal (“the se-ries”), aims to support the government of Senegal in providing policy and strategic leadership for nutrition. Further, the series will inform an investment case for nutrition (The Case for Investment in Nutrition in Senegal) that will: (1) rationalize the use of resources for cost-effective interven-tions; (2) mobilize actors and resources; (3) strengthen the visibility of nutrition interventions in different sectors; and (4) favor synergy of interventions and investments.

The series was produced with guidance from a task force of development partner organizations under the leadership of the World Bank, and in close collaboration with the CLM. The task force comprised representatives from the following organizations: Government of Canada, REACH, UNICEF and the World Bank.

Documents in the series:

Report DescriptionNutrition Situation in SenegalMarc Nene

An analysis of the nutritional status of key demographic groups in Senegal, including the geographic and sociodemographic inequalities in nutrition outcomes and their determinants.

Evolution of Nutrition Policy in SenegalAndrea L. Spray

An historical analysis of the nutrition policy landscape in Senegal, including the evolution of nutrition policies and institutions and their respective implications for programming and prioritization of interventions.

Political Economy of Nutrition Policy in SenegalAshley M. Fox

An analysis of the policy and political levers that can be used in Senegal to foster government leadership and galvanize the intersectoral coordination needed to mainstream nutrition into government policies and programs, and effectively, efficiently, and sustainably deliver nutrition interventions.

Nutrition Financing in SenegalMarie-Jeanne Offosse N.

An analysis of the allocated funding to nutrition interventions in Senegal from 2016 to 2019, estimates of budgetary capacity for financing nutrition by government, and estimated costs for selected high-impact interventions.

Capacities of the Nutrition Sector in SenegalGabriel Deussom N., Victoria Wise, Marie Solange Ndione, Aida Gadiaga

An analysis of the organizational and institutional capacities for addressing nutrition in Senegal, covering the CLM, key ministries, and other stakeholders contributing to improvements in nutrition at the central, regional, and local levels.

Cost and Benefits of Scaling Up Nutrition Interventions in SenegalChristian Yao

Analysis of the relative costs and effectiveness of alternative scenarios for scaling up nutrition interventions in Senegal over the five years covering the PSMN.

Risks for Scaling Up Nutrition in SenegalBabacar Ba

Analysis of the potential risks to the scale-up of nutrition in Senegal, their likelihood of occurrence, potential impact, and potential mitigation measures.

A Decade of World Bank Support to Senegal’s Nutrition ProgramDenise Vaillancourt

The World Bank Independent Evaluation Group Project Performance Assessment Report, which evaluates the extent to which World Bank operations supporting nutrition in Senegal from 2002–14 achieved their intended outcomes and draws lessons to inform future investments.

Acronyms

Acronym English Acronyme Français

CLM Nutrition Coordination Unit CLM Cellule de Lutte contre la Malnutrition

DBM Double Burden of Malnutrition DFM Double Fardeau de la Malnutrition

DHS Demographic and Health Surveys

EDS Enquête sur la Démographique et la Santé

DPNDN National Policy for the Development of Nutrition

DPNDN Document de Politique National de Développement de la Nutrition

FAO Food and Agriculture Organization of the United Nations

FAO Organisation des Nations Unies pour l’Alimentation et l’Agriculture

GDP Gross Domestic Product PIB Produit Intérieur Brut

MICS Multiple Indicators Cluster Survey

MICS Enquête à Indicateurs Multiples

NCD Noncommunicable Disease MNT Maladie Non-Transmissible

PSMN Multisectoral Strategic Nutrition Plan

PSMN Plan Stratégique Multisectoriel de la Nutrition

REACH Renewed Efforts Against Child Hunger and undernutrition

REACH Efforts renouvelés contre la faim et la sous-alimentation

SUN Scaling Up Nutrition Movement SUN Mouvement pour le Renforcement de la Nutrition

UNICEF United Nations Children’s Fund UNICEF Fonds des Nations Unies pour l’enfance

WFP World Food Programme PAM Programme Alimentaire Mondial

WHA World Health Assembly AMS Assemblée Mondiale de la Santé

WHO World Health Organization OMS Organisation Mondiale de la Santé

Unless otherwise indicated, child nutrition indicators referenced in this report are taken from the UNICEF-WHO-World Bank Joint Child Malnutrition Estimates1.

Contents

Executive Summary 1

Introduction 3

Data Sources 7

Regional and Global Comparisons of Maternal and Child Nutrition 9

National Trend of Nutrition Indicators and Progress Toward the WHA 2025 Goals 15

Geographic and Sociodemographic Inequalities in Undernutrition Outcomes 19

Conclusion 25

Endnotes 27

References 29

List of Boxes

Box 1: The Relationship Between Income and Malnutrition 10

List of Figures

Figure 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa 11Figure 2: Stunting in Children by Per Capita GDP 14Figure 3: Overweight in Women by Per Capita GDP 14Figure 4: Senegal’s Seasonal Calendar 16Figure 5: Trends in Child Anthropometric Indicators in Senegal, 2000–14 16Figure 6: Trends in Prevalence of Anemia in Senegal 2005–14 17Figure 7: Trends in Prevalence of Exclusive Breastfeeding in Senegal 2010–14 17Figure 8: Senegal’s Progress Toward the WHA 2025 Goals 18Figure 9: Sociodemographic Disparities in Stunting of

Children Under Five in Senegal, 2000–14 22Figure 10: Concentration Curves for Stunting in Senegal, 2000–14 23

List of Maps

Map 1: Population and Poverty in Senegal by Region, 2002–13 5Map 2: Prevalence of Stunting Among Children Under Five by

Region of Senegal, 2005–14 20Map 3: Prevalence of Wasting Among Children Under Five by

Region of Senegal, 2005–14 21

viii Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal

Photo: Adama Cissé/CLM

1Nutrition Situation in Senegal

Executive Summary

The government of Senegal’s engagement in the nutrition sector has steadily increased over the past two decades, with the result that the

rate of child stunting, in particular, has improved dra-matically. The prevalence of under-five stunting has dropped to less than 20 percent, one of the lowest prevalence rates in Sub-Saharan Africa. The objective of this report is to support the government of Senegal in the development of its Plan Stratégique Multisec-toriel de la Nutrition (Multisectoral Strategic Nutrition Plan) (PSMN) by providing a detailed analysis of the nutritional status of children under five and women of reproductive age. More specifically, the report aims to describe the geographic and sociodemographic in-equalities of various forms of malnutrition in Senegal and their determinants.

Since 2005, various shocks in Senegal, including the 2008 global food, fuel, and financial crises, and a se-ries of droughts, have contributed to uneven economic performance marked by poor economic growth. There are marked regional disparities in the trend and a prev-alence of poverty. The poverty headcount has declined in the western and northern regions of the country and in the central region of Diourbel, while simultaneously increasing in some regions in the south and east. The

result is a de facto divide in poverty between the north and the south.

As with economic performance, the prevalence of child stunting evolved in two major phases, with a steep drop followed by recent stagnation. The preva-lence of child stunting in Senegal is much lower than that observed in other countries with the same level of income. However, progress against other forms of malnutrition are mixed. The prevalence of under-five wasting remained virtually stagnant between 2000 and 2012–13. With over one-fifth of women of reproductive age underweight, Senegal has the fifth highest prev-alence in Sub-Saharan Africa. With nearly two-thirds of children under five suffering from anemia, Senegal ranks in the middle of countries in Sub-Saharan Afri-ca for under five anemia. Senegal ranks particularly poorly in Sub-Saharan Africa in the prevalence of ane-mia among women of reproductive age. However, the prevalence of all forms of anemia among both children ages 6 to 59 months and women ages 15 to 49 years has been decreasing steadily since 2005.

While its nutrition profile is still dominated by under-nutrition issues, Senegal is in the midst of a nutrition transition and increasingly facing the double burden

2 Analysis & Perspective: 15 Years of Experience in the Development of Nutrition Policy in Senegal

of malnutrition (DBM), the coexistence of both under-nutrition and overnutrition. Over one-fifth of women ages 15 to 49 years were estimated to be overweight or obese; the prevalence of overweight or obesi-ty among women of reproductive age in Senegal is slightly higher than would be expected at its income level. However, the proportion of children under five who are overweight or obese has declined.

As with poverty incidence, regional disparities in child stunting show a north-south divide, with the regions in the north and west exhibiting much lower prevalence rates than the regions in the center and the south. This north-south divide in child stunting has persisted for the past decade and has increased in recent years. Although almost all sociodemographic groups shared

in the reduction in child stunting between 2000 and 2005, urban areas, male children, and the wealthiest socioeconomic groups benefited most.

There are important regional disparities in the preva-lence of child wasting as well. However, the regions of Saint-Louis and Louga, which have some of the lowest prevalence rates of poverty and child stunting have, along with the region of Tambacounda, consistently exhibited the highest prevalence rates of child wasting. Anemia among women of reproductive age remains a severe public health problem in all regions of Senegal despite improvement in some regions between 2005 and 2010. Therefore, one of the key characteristics of nutrition outcomes in Senegal is their marked hetero-geneity across regions.


1Introduction

In Senegal, the government’s engagement in the nu-trition sector and the fight against malnutrition have steadily increased over the past two decades, trans-

lating into, among other things, (1) the establishment in 2001 of the Cellule de Lutte contre la Malnutrition (Nutrition Coordination Unit) (CLM) and its Bureau Exécutif National (National Executive Bureau); (2) an increase in the government’s budget allocation to nu-trition from an estimated US$0.3 million per year in 2002 to US$5.7 million per year in 2015, increasing from approximately 0.02 percent to 0.12 percent of the national budget; and (3) the scaling up of communi-ty-based nutrition interventions. Nutrition indicators improved in general as a result, and child stunting, in particular, dropped to less than 20 percent, one of the lowest prevalence rates in Sub-Saharan Africa.

However, these developments have not been ac-companied by enhanced visibility of nutrition in sectors such as agriculture, education, social pro-tection, and water and sanitation. This situation, compounded by the recent series of economic and climatic shocks, has favored an ad hoc response to food and nutrition insecurity in the country and per-petuated a fragmentation of approaches, discourse, and interventions. Moreover, several other nutrition

problems with major implications, such as low birth weight, iron deficiency anemia, maternal undernutri-tion, and acute malnutrition, have received little or no attention, seriously threatening to reverse the gains achieved over the past several decades in the fight against malnutrition.

Recognizing the need to strengthen the multisectoral approach to malnutrition in order to boost and sus-tain the improvement in the nutritional status of its communities, the government of Senegal joined the Scaling Up Nutrition (SUN)2 Movement in 2011 and adopted the Renewed Efforts Against Child Hunger and undernutrition (REACH)3 approach in 2014. Fur-thermore, the government of Senegal has adopted a new nutrition policy, Document de Politique National de Développement de la Nutrition (National Policy for the Development of Nutrition) (DPNDN), for the period from 2015 to 2025 and has embarked on creating a multisectoral nutrition strategy. The Plan Stratégique Multisectoriel de Nutrition (Multisectoral Nutrition Strategic Plan) (PSMN) will incorporate a sectoral reform program that aims to expand the cov-erage of nutrition services and improve their quality and scale up pro-nutrition sector interventions with proven impact.


Objective of the Report

The objective of this report is to support the govern-ment of Senegal in the development of the PSMN by providing a detailed analysis of the nutritional status of key target groups, notably children under five and women of reproductive age. More specifically, the current report seeks to highlight the main geographic and sociodemographic inequalities in nutrition in Sen-egal to enable more equity-focused policymaking and programming and accelerate progress toward interna-tionally agreed objectives such as the World Health Assembly (WHA) 2025 nutrition goals.4

Country Context

Senegal’s economy rebounded in 1995 and grew steadily until 2005 before slowing down. After a devaluation of its currency in 1994, and thanks to a series of structural reforms and better public fi-nance management that boosted the export of key commodities such as groundnuts and phosphate, Senegal’s gross domestic product (GDP) grew on average by 4.4 percent each year between 1995 and 2005, well above its average annual population growth over the same period and translating into an annual average per capita GDP growth rate of 1.8 percent (World Bank 2015). Since 2005, various shocks, including the 2008 global food, fuel, and financial crises and a series of droughts in 2006, 2007, and 2011 (WFP 2014; World Bank 2015), have, among other factors, led to uneven econom-ic performance marked by an annual average GDP growth of 3.2 percent, barely enough to keep up with population growth and leading to a virtual stag-nation of per capita GDP growth, which registered negative values in 2006, 2009, and 2011.5

Senegal’s population grew at a fast pace be-tween 2002 and 2013, driven mainly by population growth in urban areas and the western and cen-tral regions. Between the two most recent censuses of 2002 and 2013, the population grew by nearly 50 percent or an annual average growth of 2.5 percent

(ANSD 2014). The estimated 3.5 percent annual average population growth in urban areas over the same period was twice as high as that estimated in rural areas, probably reflecting in part the massive, well-documented rural exodus (Gueye, Fall, and Tall 2015). Furthermore, the population is unevenly dis-tributed among the regions of the country. Indeed, in 2013, as shown in map 1, the western regions of Dakar and Thies and the central region of Diourbel, taken together, are home to nearly half the country’s total population.

Following the trend of the country’s economic performance from 2000 to 2011, the poverty head-count dropped substantially between 2001 and 2005, before virtually stagnating between 2005 and 2011. The poverty headcount, based on the na-tional poverty line, decreased from 55.2 percent in 2001, to 48.3 percent in 2006, and then to 46.7 per-cent in 2011 (ANSD 2013). Poverty reduction during the 2000s was mainly an urban phenomenon, nota-bly during the first half of the decade, with the region of Dakar experiencing the largest reduction from 38 percent in 2001 to 28 percent in 2006. In 2011, as a result of a more modest reduction in the poverty head-count in rural areas over the same period, from 65 percent in 2001 to 59 percent in 2006, and a general stagnation of poverty across the board in the second half of the 2000s, the prevalence of poverty in Dakar is nearly half the prevalence observed in rural areas (ANSD 2014).

Map 1 shows the regional disparities in the prevalence of poverty in 2006 and 2011. Overall, the poverty headcount declined in the regions in the western and northern parts of the country and in the central region of Diourbel. At the same time, the situation worsened in some of the regions in the south and in the east, thus creating some de facto divide between the north and the south of the country.

Poverty is also strongly associated with working in the agricultural sector, with most of the poor living on sub-sistence agriculture or employed in agriculture-related activities (World Bank 2015).

Nutrition Situation in Senegal 5

MAP 1: Population and Poverty in Senegal by Region, 2002–13

Source: Based on DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.

a. Population, 2002

c. Poverty Headcount, 2006

b. Population, 2013

d. Poverty Headcount, 2011

Total number of inhabitants < 500000 500000–999999 1000000–14999991500000–1999999 ≥ 2000000

< 30 30–39 40–49 50–59 60–69 ≥ 70Poverty headcount (%)

0 140 280 420 56070Km



2Data Sources

The data used for the analyses in this report come mainly from a series of one Multiple Indicators Cluster Survey (MICS) and four

Demographic and Health Surveys (DHS) conduct-ed between 2000 and 2014. The MICS survey was conducted between May 5 and July 11, 2000 (Govern-ment of Senegal and UNICEF 2000). The four DHS surveys were carried out (1) between February 1 and June 10, 2005 (Ndiaye and Ayad 2006); (2) between October 13, 2010, and April 28, 2011 (ANSD and ICF 2012), and which was combined with a MICS survey; (3) between September 15, 2012, and June 15, 2013 (ANSD and ICF 2013); and (4) between January 21 and October 20, 2014 (ANSD and ICF 2015).

The MICS and DHS surveys are nationally and region-ally representative and provide detailed household level and individual level economic, social, health, food, and nutrition data on children under the age of five and on women ages 15 to 49 years.

Regional and global comparisons relied exclusive-ly on DHS data for nutrition indicators6 and on other open-source data such as the World Bank’s World De-velopment Indicators7 and the United Nations World Population Prospects (UN DESA 2015) for aggregate economic and population information.



3Regional and Global Comparisons

of Maternal and Child Nutrition

Although its nutrition profile is still dominated by undernutrition issues, Senegal is in the midst of a nutrition transition and increasingly facing the DBM. In absolute terms, the prevalence of child stunt-ing in Senegal is one of the lowest in Sub-Saharan Africa. Indeed, with 18.7 percent of children under five too short for their age in 2014, Senegal has the second lowest prevalence of child stunting in Sub-Saharan Afri-ca, bested only by Gabon (figure 1, panel a). Even more impressive, Senegal’s performance for child stunting is much lower than would be expected at its national in-come level (figure 2). By both global and Sub-Saharan Africa standards, Senegal is one the best performers in comparisons of indicators of child undernutrition, such as stunting, and national income levels as measured by per capita GDP.8 Indeed, the prevalence of child stunting in Senegal is much lower than that observed in countries with the same level of income, such as Côte d’Ivoire and Cambodia, and on par with the prevalence in countries with much higher income levels such as Ghana, a country with a per capita GDP nearly twice as high as Senegal’s, and Peru, whose per capita GDP is nearly five times as high.

The relationship between income and malnutrition is further explained in box 1.

However, the prevalence of anemia among children under five was 60.3 percent in 2014, placing Senegal in the middle of the countries in Sub-Saharan Africa for which DHS data are available. Furthermore, Senegal ranks particularly poorly in Sub-Saharan Africa in the prevalence of anemia among women ages 15 to 49 years, estimated to be 54.3 percent in 2010–2011,9 the last time a DHS survey with such data was collected for this demographic group. With the exception of The Gambia and Gabon, Senegal has the highest preva-lence of anemia among women ages 15 to 49 years (figure 1, panel b).

Underweight of women is also an issue. Indeed, the prevalence of chronic energy deficiency or un-derweight among women of reproductive age was estimated at 22 percent in 2010–2011, making Sen-egal the country with the fifth highest prevalence in Sub-Saharan Africa.

Despite limited information, there are indications that the problems of overweight and obesity and their related NCDs are increasingly prevalent in the country. Data from the 2010–11 DHS show that 21.3 percent of women ages 15 to 49 years were estimated to be overweight or obese. The World Health Organiza-


tion (WHO) STEPS survey10 carried out in 2015 shows that hypertension affects 24 percent of the population, 2.1 percent have diabetes, and 19 percent have high cholesterol. Estimates from WHO suggest that, togeth-er, diabetes, cardiovascular diseases, and cancers are responsible for nearly 20 percent of total adult deaths in Senegal (WHO 2014). Furthermore, other surveys con-ducted in the city of Dakar in 2009 and in the Saint-Louis region in 2012 showed prevalence rates of type II di-abetes of 17.9 percent and 10.8 percent, respectively (Duboz et al. 2012; Seck et al. 2015). Another survey conducted in 2010 in the city of Saint-Louis estimated that 46 percent of the population ages 15 years and above suffered from high blood pressure, 36.3 percent from high cholesterol, and 15.7 percent from metabolic syndrome (Pessinaba et al. 2013).

Contrary to what is observed with child stunting, the prevalence of overweight or obesity among women of reproductive age in Senegal is slightly higher than would be expected at its income level (figure 3). In-deed, Senegal performs worse than countries with higher income, such as Bangladesh and Cambodia, but much better than many countries in Sub-Saharan

Africa, such as Cameroon, Ghana, Kenya, and Togo, where the problem of overnutrition among women is of much greater concern.

Overall, the nutrition profile of Senegal—characterized by a moderate level of child stunting and low lev-el of child overweight, high woman underweight and anemia, and a slightly high level of overweight and obesity among women with growing rates of diet-relat-ed NCDs—is symptomatic of a country in the midst of a nutrition transition (Popkin, Adair, and Ng 2012) and suffering from the DBM at the population level (child stunting and women overweight) (Subramanian, Per-kins, and Khan 2009), the household level (stunted child with overweight or obese mother) (Garrett and Ruel 2005), and the individual level (overweight or obese women suffering from anemia) (Asfaw 2007; Eckhardt et al. 2007). This phenomenon has been observed in countries experiencing a rapid economic transforma-tion, which underlies a nutrition transition marked by a decrease in physical activity, a shift in dietary patterns toward increased consumption of fats, meats, sugar, and refined grains, and a shift toward nutrition-related NCDs (Popkin 1993; Popkin 1998; Popkin 2001).

BOX 1: The Relationship Between Income and Malnutrition


FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa

0 10 20 30 40 50 60

Percent

Gabon 2012Senegal 2014

Ghana 2014Namibia 2013

Congo, Rep. 2011Gambia 2013

Kenya 2014Togo 2013

Swaziland 2006São Tomé and Príncipe 2008

Côte d’Ivoire 2012Comoros 2012

Guinea 2012Liberia 2013

Zimbabwe 2010Cameroon 2011

Uganda 2011Burkina Faso 2010

Nigeria 2013Sierra Leone 2013

Mali 2012Lesotho 2009Zambia 2013

Tanzania 2010Mozambique 2011

Congo, Dem. Rep. 2013Eritrea 2002Benin 2006Niger 2012

Rwanda 2010Ethiopia 2011

Malawi 2010Madagascar 2008

Burundi 2010a. Children under age 5 stunting

0 10 20 30 40 50 60

Percent

b. Anemia in women ages 15–49

Ethiopia 2011Rwanda 2010Burundi 2010Namibia 2013Uganda 2011Lesotho 2009

Zimbabwe 2010Malawi 2010

Swaziland 2006Madagascar 2008

Congo, Dem. Rep. 2013Cameroon 2011

Tanzania 2010Benin 2012

Ghana 2014São Tomé and Príncipe 2008

Sierra Leone 2013Niger 2012Togo 2013

Burkina Faso 2010Guinea 2012

Mali 2012Côte d’Ivoire 2012Mozambique 2011Congo, Rep. 2011

Senegal 2010Gambia 2013Gabon 2012

(continued on next page)


FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa (continued)

0 2 4 6 8 10

Percent

c. Children under age 5 overweight

Senegal 2014Eritrea 2002

Ethiopia 2011Togo 2013Mali 2012

Burkina Faso 2010Niger 2012

Ghana 2014Burundi 2010Gambia 2013Liberia 2013

Côte d’Ivoire 2012Congo, Rep. 2011

Namibia 2013Uganda 2011Guinea 2012Nigeria 2013

Congo, Dem. Rep. 2013Kenya 2014

Tanzania 2010Madagascar 2004

Zimbabwe 2010Zambia 2013

Cameroon 2011Rwanda 2010Lesotho 2009

Gabon 2012Mozambique 2011Sierra Leone 2013

Malawi 2010Benin 2006

Comoros 2012São Tomé and Príncipe 2008

Swaziland 2006

0 10 20 30 40 50

Percent

d. Women ages 15–49 overweight

Ethiopia 2011Madagascar 2008

Chad 2004Burundi 2010Eritrea 2002

Burkina Faso 2010Congo, Dem. Rep. 2013

Rwanda 2010Mozambique 2011

Malawi 2010Niger 2012

Mali 2012Sierra Leone 2013

Uganda 2011Guinea 2012

Senegal 2010Tanzania 2010

Gambia 2013Zambia 2013Nigeria 2013

Côte d’Ivoire 2012Congo, Rep. 2011

Liberia 2013Benin 2012Togo 2013

Zimbabwe 2010Namibia 2013

Cameroon 2011Kenya 2014

São Tomé and Príncipe 2008Comoros 2012

Mauritania 2000Ghana 2014

Lesotho 2009Gabon 2012

Swaziland 2006

(continued on next page)


FIGURE 1: Maternal and Child Nutrition in Senegal and Sub-Saharan Africa (continued)

Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.

0 10 20 30 40 9050 60 70 80

Percent

e. Exclusive breastfeeding of children under 2

Gabon 2012Comoros 2012

Côte d’Ivoire 2012Nigeria 2013

Cameroon 2011Mauritania 2000

Congo, Rep. 2011Guinea 2012

Niger 2012Burkina Faso 2010

Zimbabwe 2010Sierra Leone 2013

Swaziland 2006Senegal 2014

Benin 2012Mali 2012

Mozambique 2011Gambia 2013

Congo, Dem. Rep. 2013Namibia 2013

Madagascar 2008Eritrea 2002

Ethiopia 2011São Tomé and Príncipe 2008

Ghana 2014Tanzania 2010

Lesotho 2009Liberia 2013

Togo 2013Kenya 2014

Uganda 2011Burundi 2010Malawi 2010Zambia 2013

Rwanda 2010

0 205 10 15

Percent

f. Children under age 5 wasting

Swaziland 2006Rwanda 2010

Zimbabwe 2010Gabon 2012

Lesotho 2009Kenya 2014

Malawi 2010Ghana 2014

Uganda 2011Tanzania 2010

Cameroon 2011Burundi 2010

Congo, Rep. 2011Mozambique 2011

Senegal 2014Liberia 2013

Zambia 2013Namibia 2013

Togo 2013Côte d’Ivoire 2012

Congo, Dem. Rep. 2013Benin 2006

Sierra Leone 2013Guinea 2012

Ethiopia 2011São Tomé and Príncipe 2008

Comoros 2012Gambia 2013

Mali 2012Madagascar 2004

Eritrea 2002Burkina Faso 2010

Niger 2012Nigeria 2013


FIGURE 2: Stunting in Children by Per Capita GDP

Source: Based on data from World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world-development-indicators; UN DESA 2015; DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.Note: The sizes of the circles are proportional to the number of children under the age of five. The red lines indicate the model’s prediction.

FIGURE 3: Overweight in Women by Per Capita GDP

Source: Based on data from World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world-development-indicators; UN DESA 2015; DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.Note: The sizes of the circles are proportional to the number of women ages 15 to 49 years. The red line indicates the model’s prediction.

0

20

40

60

Pre

vale

nce

of s

tunt

ing

(% o

f chi

ldre

n un

der 5

)

0 2000015000100005000

Senegal

YemenPakistan

Nigeria

Gabon

Peru

EgyptGhana

HaitiKenya

Cote d’Ivoire

GDP per capita, PPP (2011 internaional $)

0

20

10

30

40

50

Pre

vale

nce

wom

en o

verw

eigh

t(%

of w

omen

BM

I >=

25.0

)

500040002000 30001000

GDP per capita, PPP (2011 internaional $)

Senegal

Nepal

Togo

ZambiaCambodia

Bangladesh

Honduras

Cameroon

Ghana

Kenya

Cote d’Ivoire


4National Trend of Nutrition

Indicators and Progress Toward the WHA 2025 Goals

Measures of nutritional status such as wast-ing, stunting, and anemia have been shown to exhibit seasonal variations, with preva-

lence rates generally surging during rainy seasons and before the harvest as a result of food shortages, increased morbidity, and greater female participa-tion in the labor market (Martorell and Young 2012; Schwinger et al. 2014). Contrary to stunting, which is less sensitive over the short run to shocks, wasting is a more transient condition and its prevalence can fluctuate considerably during the year (WHO, UNICEF, and WFP 2014). As a result, prevalence of wasting es-timated with survey data at a single time point can be a poor representation for conditions during the other periods of the year. The incidence rate is deemed a better indicator (Khara and Dolan 2014).

The MICS and DHS surveys used for this analysis were all conducted at different times of year, with some not overlapping the lean and rainy season while others overlapped partially or fully that period of peak in the prevalence of child wasting (figure 4). In the following section, we will present the national trends in some nutrition indicators in Senegal. However, given the na-ture of the surveys, the results should be interpreted with caution, notably for wasting.

National Trends

Similar to economic performance between 2000 and 2014, the prevalence of stunting among chil-dren under the age of five evolved in two major phases—a steep drop followed by stagnation (figure 5). From 2000 to 2005, child stunting dropped on average by 6 percent annually, falling from 26.8 percent to 19.6 percent.11 Since 2005, considering the anthropometric data from the 2010–11 DHS as outliers,12 the prevalence of child stunting remained virtually the same over the course of that decade, hovering around 19.0 percent until 2014. The average estimates based on the DHS are 18.7 percent for both 2012–13 and 2014 surveys.13 However, the prelimi-nary results of the 2015 DHS put at 20.5 percent the prevalence of child stunting (ANSD and ICF 2016).

The prevalence of wasting among children under five, based on the available data, has virtually stagnated between 2000 and 2012–13, hovering around 10.0 percent before dropping substantially in 2014. More specifically, the prevalence of child wasting fell from 9.7 percent in 2000, to 8.5 percent in 2005,14 and rose to 8.8 percent in 2012–13. The estimate for the outlier year of 2010–11 was 10.1 percent. In 2014, the prev-


alence of child wasting was estimated at 5.9 percent with a lower bound for the 95 percent confidence in-terval at 4.9 percent, below the 5 percent maximum limit set for the WHA 2025 target. However, the pre-liminary results of the Senegal 2015 DHS suggest a prevalence of global acute malnutrition or wasting of 7.8 percent and may signal a worsening situation.

The proportion of children under five who are over-weight or obese, as measured by a weight-for-height z-score superior to more than 2 standard deviations

above the median compared to the WHO child growth standards, has declined since 2000 from 3.4 percent to 1.2 percent in 2014.

The prevalence of all forms anemia among both chil-dren ages 6 to 59 months and women ages 15 to 49 years has been decreasing steadily since 2005. Among children, anemia dropped by 27 percent, from 82.6 percent in 2005 to 60.3 percent in 2014, an av-erage of 3.4 percent each year. Interestingly, Senegal registered the most impressive progress very recent-

FIGURE 4: Senegal’s Seasonal Calendar

Source: Famine Early Warning Systems Network (FEWS NET), http://www.fews.net/west-africa/senegal.

FIGURE 5: Trends in Child Anthropometric Indicators in Senegal, 2000–14

Source: Based on data from MICS for 2000 and DHS for all other years.

DEC

OCT

OCT

OCT

OCT

NOV JAN FEB MAR APR MAY JUN JUL AUG SEP

DECNOV JAN FEB MAR APR MAY JUN JUL AUG SEP

Rain-fed harvestIrrigated and marketgardening harvest

Peak labor migration

Livestock migration N to S

Planting

Lean season

Rainy season

Rain-fedharvest

0

5

10

15

20

25

30

Stunting Wasting Overweight2000 2005 2010–11 2012–13 2014

Per

cent


FIGURE 6: Trends in Prevalence of Anemia in Senegal 2005–14


0

40

50

60

10

20

30

70

80

90

Child Anemia Women Anemia

a. Children under five anemia b. Women ages 15–49 anemia

2005 2010–11 2012–13 2014

Per

cent

0

40

50

60

10

20

30

70

Per

cent

ly, between 2012–13 and 2014, with a 15.3 percent decrease in the prevalence of child anemia (figure 6, panel a). Among women, data are available only for the years 2005 and 2010–11, and the estimated prev-alence of anemia suggests a very moderate decrease from 59.1 percent to 54.3 percent15 or an average an-nual rate of reduction of 1.7 percent (figure 6, panel b).

The rate of exclusive breastfeeding in Senegal (figure 1, panel e) is lower than that of many countries in the Africa Region, with the prevalence declining from an already low 39.0 percent in 2010–11 to 32.4 percent in 2014 (figure 7).16

Progress Toward the WHA 2025 Goals

At the current pace, Senegal is on course to reach only the WHA 2025 goals related to child wasting and child overweight (figure 8, panels b and c). Indeed, the WHA calls for a reduction in the prevalence of child wasting to under 5 percent. However, given the un-certainty of the estimates of the prevalence of child wasting for the year 2014, it is plausible to argue that Senegal might already have reached that goal. The al-

ready low prevalence of child overweight continues to decline and can be considered under control as called for by the WHA goals.

FIGURE 7: Trends in Prevalence of Exclusive Breastfeeding in Senegal 2010–14


0

20

25

30

5

10

15

35

40

45

Exclusive Breastfeeding2010–11 2012–13 2014

Per

cent


As for the other WHA goals—a reduction of 40 percent in the prevalence of child stunting (figure 8, panel a), an increase in the practice of exclusive breastfeeding to at least 50 percent (figure 8, panel d), and a 50 percent decrease in the prevalence of anemia among women of reproductive age (figure 8, panel e)—Senegal is gravely off course and will not reach these goals unless there is a dramatic increase in the pace of progress. As

previously mentioned, the prevalence of child stunting is stagnant at about 19 percent, and the country has experienced a relative setback over the past couple of years with a retreat in the practice of exclusive breast-feeding. The available data on women anemia suggest that, at the current rate of decline, the prevalence of anemia in that demographic group will be about 42 per-cent in 2025, nearly twice the objective of 26 percent.

FIGURE 8: Senegal’s Progress Toward the WHA 2025 Goals

Source: Based on data from DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.Note: Unlike the other goals depicted here, for which the prevalence ideally should drop, the goal for exclusive breastfeeding is to increase in prevalence.

1.4

1.2 1.4

59.154.3

42.1

26.2

0

5

10

15

20a. Children under age 5 stunting b. Children under age 5 wasting

Per

cent

2012 2014 20250

2

4

6

8

10

Per

cent

2012 2014 2025

18.7 18.7

11.2

8.8

5.94.9

0

0.5

1.0

1.5c. Children under age 5 overweight

d. Exclusive breastfeedingchildren under 6 months

Per

cent

2012 2014 20250

10

20

30

40

50

Per

cent

2012 2014 2025

0

10

20

30

60

50

40

e. Women ages 15–49 anemia

Per

cent

2012 2014 2025

37.532.4

50

Actual trend Required trend Projected trend


5Geographic and Sociodemographic

Inequalities in Undernutrition Outcomes

Geographic Disparities

Overall, the regional inequalities in child stunting show a north-south divide along the poverty inci-dence lines with the regions in the north and west exhibiting much lower prevalence rates than the regions in the center and the south. Map 2 depicts the regional disparities in child stunting for each of the years 2000, 2005, 2012, and 2014. For consistency and to better appreciate trends at the regional level, the administrative organization of Senegal that existed before 2002 is used.17 In 2014, the prevalence of child stunting in each of the northern, western, and west-ern half of the central regions of the country, namely Saint-Louis, Louga, Diourbel, Thies, Fatick, and Da-kar, was below 20 percent. However, in the southern regions and the eastern half of the central region, the estimated prevalence of child stunting was deemed moderate, fluctuating between 20 and 29 percent, with the exception of the extremely poor region of Kolda, which exhibited a high prevalence of about 36 per-cent. This north-south divide shows that child stunting is strongly correlated with household income.

The north-south divide for the prevalence of child stunting has increased over the past decade. Despite

a general stagnation in the prevalence of child stunt-ing in Senegal since 2005, the evolution at the regional level has been uneven with some regions experiencing marked decreases while others stagnated or saw some increase. The impressive drop in child stunting experi-enced by Senegal between 2000 and 2005 was mostly driven by improvements in the densely populated west-ern and central regions. Indeed, child stunting in regions such as Dakar, Thies, Fatick, and Kaolack was more than halved during that period of time. All other regions also saw some decrease in child stunting, with the exception of Saint-Louis and Kolda. Since 2005, the northern re-gions have shown a consistent decline in child stunting, with the prevalence in Saint-Louis dropping by half to about 14 percent in 2014. On the contrary, the region of Kaolack has seen a reversal of fortune with a steady in-crease in the prevalence of child stunting between 2005 and 2014. Over the same period, progress in the west-ern regions and the regions of Diourbel and Fatick has stalled or has been inconsistent. Similarly, the region of Tambacounda has seen no progress at all, while Kolda remained a high prevalence area, thus increasing the gap between the north and the south.

Child wasting is less correlated with household income and has historically been a serious con-


dition in the regions of Saint-Louis, Louga, and Tambacounda. Map 3 shows the prevalence of child wasting in the regions of Senegal at different points since 2000. As for child stunting, each survey shows important regional disparities in the prevalence of child wasting. However, the regions of Saint-Louis and Louga, which have some of the lowest rates of pover-ty and child stunting and which experienced a strong reduction in stunting since 2005, have, along with the region of Tambacounda, consistently exhibited the highest prevalence of child wasting in the coun-try, hovering between 10 and 14 percent. The other regions have shown considerable fluctuation in the prevalence of wasting between the different surveys as could be expected with such an indicator. Kolda, the region with the highest poverty incidence, has consistently shown a lower prevalence of child wast-

ing than the relatively better-off regions of Saint-Louis and Louga.

Anemia among women of reproductive age is a se-vere public health problem in all regions despite improvement in some regions between 2005 and 2010. Data from the 2010 DHS suggest that women ages 15 to 49 years are overburdened with anemia in all regions of Senegal. Indeed, in all regions, the prevalence of anemia among women of reproduc-tive age is beyond the 40 percent critical threshold for a severe public health problem. Between 2005 and 2010, all regions experienced various degrees of decrease in the prevalence rate of anemia among women with the exception of the regions of Dakar, Tambacounda, and Matam, where the prevalence in-creased considerably.

MAP 2: Prevalence of Stunting Among Children Under Five by Region of Senegal, 2005–14


a. 2000

c. 2012

b. 2005

d. 2014

< 20 : Low prevalence 20–29 : Medium prevalence30–39 : High prevalence ≥ 40 : Very high prevalence

Children under five (%)

32.3%

22.1%25.4%

35.6%

31.8%

26%

24%

31.9%

27.6%23.2%

29.1%

28.1%20.1%

39.3%

16.1%

11%

19.2%

18.4%

19.2%9.2%

27.7%

16.4%

30%

17.6%

21.8%13.8%

15.1%

13.8%18.1%15.6%

28%

13.5%15.1%

35.7%

25.7%15.3%

18%

20.7%

13.2%12.2%

0 140 280 420 56070Km


Sociodemographic Inequalities

Although almost all sociodemographic groups shared in the reduction in child stunting between 2000 and 2005, urban areas, male children, and the wealthiest socioeconomic groups benefited most. Figure 9 shows the trends in the prevalence of child stunt-ing among various sociodemographic groups. Overall, the prevalence of child stunting among all sociodemo-graphic groups followed the same trends as the national prevalence. Although some groups benefited more during the period of rapid decline from 2000 to 2005, prevalence rates across almost all demographics have stagnated since 2005, thus maintaining the status quo for inequality.

In urban areas, although the prevalence of child stunt-ing was nearly halved from about 21 percent in 2000 to

11 percent in 2005, it declined by only 20 percent in ru-ral areas over the same period, from 30 percent to 24 percent (figure 9, panel a). Since 2005, the prevalence rates in both areas have remained stable hovering at about 12 percent in urban areas and 23 percent in ru-ral areas. Thus children in rural areas bear a burden twice that of those living in urban areas.

The gender gap drastically narrowed between 2000 and 2005 with male children experiencing a drop in the prevalence rate to a level on par with that ob-served among female children (figure 9, panel b). Although both female and male children saw a decline in their respective prevalence rates between 2000 and 2005, the prevalence of stunting among boys fell from 30 percent in 2000 to 21 percent in 2005, within the margin of error of the 19 percent prevalence estimated

MAP 3: Prevalence of Wasting Among Children Under Five by Region of Senegal, 2005–14

Source: Based on DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.

a. 2000

c. 2012

b. 2005

d. 2014

< 5 : Acceptable 5–9 : Poor10–14 : Serious ≥ 15 : Critical

Children under five (%)

12%

11%14%

10%

11%

4% 9%

10%

10%

5%

10.4%

10.5%7.2%

3.9%2%

8.3%4.6%

4.5% 4.2%1.3%

13%

13.4%6.7%

9.3%

17.6%

3.3%

6.3%

10.4%

11.3%7.3%

11.5%

13% 12.7%

8.9%

6%

6.6%9.1%

5.6%

9.3%6.6%

0 140 280 420 56070Km


among girls in 2005. The prevalence rates among both boys and girls have stagnated since 2005 without any significant difference between the groups.

As for the association of child stunting with the mother’s level of education (figure 9, panel d), the prevalence among children of women without any education is about 1.5 times higher than the prevalence of stunting among the children of women who have completed at least primary school. Furthermore, the gap between the two groups has not changed since 2000, although the prevalence rate for both groups exhibited a down-ward trend between 2000 and 2005 before stagnating.

Panel c of figure 9 shows a social gradient of child stunting, with children in the poorest quintile exposed to a risk of stunting at least twice, and as much as three times, as high as that for children in the richest quintile.

Because the drop in child stunting between 2000 and 2005 was weighted toward the wealthiest socioeco-nomic groups, as evidenced by trends in urban areas and the richest quintiles (figure 9, panels a and c), the distribution of the burden of child stunting became more unequal during that period (figure 10, panel a). How-ever, between 2005 and 2012, the DHS data suggest an increase of the prevalence of child stunting in the richest quintiles while the drop continued among the poorest quintiles (figure 9, panel c), thus resulting in a less unequal distribution of the burden (figure 10, panel b). More recent data from 2014, however, suggest an increasing gap between the poorest and richest quin-tiles (figure 9, panel c), suggesting a worsening of the distribution of the burden of child stunting in Senegal (figure 10, panel c) to the detriment of less advantaged groups, notably in the rural areas, where poverty is most concentrated (figure 9, panels a and c).

FIGURE 9: Sociodemographic Disparities in Stunting of Children Under Five in Senegal, 2000–14


0

20

25

30

5

10

15

35

20

25

30

5

10

15

35a. By place of residence b. By gender

Per

cent

2000 2005 2014 20142012–13 2000 2005 2012–130

Per

cent

Boys Girls

Poorest quintile Richest quintile No education Primary or more

Urban Rural

0

202530

51015

4035

20

25

30

5

10

15

c. By wealth d. By education level

Per

cent

2000 2005 2014 20142012–13 2000 2005 2012–130

Per

cent


FIGURE 10: Concentration Curves for Stunting in Senegal, 2000–14


0

40

60

80

20

100

40

60

80

20

100a. 2000–05 b. 2005 to 2012–13

Cum

ulat

ive

shar

e of

chi

ldre

nun

der f

ive

stun

ted

(%)

Cumulative share of population(poorest to richest) (%)


0Cum

ulat

ive

shar

e of

chi

ldre

nun

der f

ive

stun

ted

(%)

2012–13 2014 Line of equality

2005 2012–13 Line of equality2000 2005 Line of equality

0 20 40 60 80 100 0 20 40 60 80 100

0

40

60

80

20

100c. 2012–13 to 2014

Cum

ulat

ive

shar

e of

chi

ldre

nun

der f

ive

stun

ted

(%)


0 20 40 60 80 100




6Conclusion

A key characteristic of nutrition outcomes in Senegal is their marked heterogeneity across regions. A crucial step in furthering the fight

against malnutrition in Senegal requires each region to undertake research to understand its specific drivers of

malnutrition and to design regionally appropriate strat-egies to overcome them. Given Senegal’s progression along the nutrition transition, a robust analysis includ-ing stunting, wasting, anemia, and overweight and obesity for each region is recommended.




Endnotes

1. Joint Child Malnutrition Estimates, UNICEF (Unit-ed Nations Children’s Fund), WHO (World Health Organization) and World Bank (accessed 2017), http://datatopics.worldbank.org/child-malnutrition/

2. The SUN Movement is a global movement that began in 2010 that unites various actors including governments, civil society organizations, United Nations agencies, and the private sector in a re-newed global effort to end malnutrition in all its forms. The core principle of the SUN Movement is that actions across multiple sectors, at multiple levels and with multiple stakeholders are nec-essary to sustainably and substantially reduce malnutrition (SUN 2015).

3. REACH was established in 2008 by the Food and Agriculture Organization of the United Nations (FAO), United Nations Children’s Fund (UNICEF), the World Food Programme (WFP), and the World Health Organization (WHO) to assist governments of countries with a high burden of child and ma-ternal undernutrition to develop capacities and coordinate actions to accelerate the scale-up of food and nutrition interventions (REACH 2012).

4. In 2012 the World Health Assembly (WHA) Resolu-tion 65.6 endorsed a comprehensive implementation plan for maternal, infant, and young child nutrition,

which specified a set of six global nutrition targets to be reached by 2025: (1) a 40 percent reduction in stunting of children under five; (2) a 50 percent reduction in anemia in women of reproductive age; (3) a 30 percent reduction in low birth weight; (4) no increase in childhood overweight; (5) an increase in the rate of exclusive breastfeeding in the first six months to at least 50 percent; and (6) reduce and maintain childhood wasting at less than 5 percent.

5. World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world- development-indicators.

6. DHS Program STATcompiler (database), USAID, Washington, DC (accessed 2016), http://www.statcompiler.com/en/.

7. World Development Indicators (database), World Bank, Washington, DC (accessed 2016), http://data.worldbank.org/data-catalog/world- development-indicators.

8. Measured using purchasing power parity.9. DHS Program STATcompiler (database), USAID,

Washington, DC (accessed 2016), http://www.statcompiler.com/en/.

10. The WHO STEPwise approach to Surveillance (STEPS) is a standard protocol for collecting, an-


alyzing, and disseminating data in WHO member countries. World Health Organization, http://www.who.int/chp/steps/en/.


12. There is anecdotal evidence that the anthropomet-ric data from the 2010–11 DHS survey were poorly collected. Furthermore, several partial surveys conducted during the same period did not confirm the results of the 2010–11 DHS survey, which ap-pears invariably as an outlier in all the analyses we performed.





17. Before 2002, Senegal had 10 administrative re-gions: Dakar, Ziguinchor, Diourbel, Saint-Louis, Tambacounda, Kaolack, Thies, Louga, Fatick, and Kolda. In 2002, an administrative reform di-vided the region of Saint-Louis into two regions: Saint-Louis and Matam, increasing the number of regions to 11. In 2008, another reform divided the region of Kolda into Kolda and Sedhiou, Tam-bacounda into Tambacounda and Kedougou, and Kaolack into Kaolack and Kaffrine, increasing the number of regions to 14.


References

Alderman, H., L. Haddad, D.D. Headey, and L. Smith. 2014. “Association between Economic Growth and Early Childhood Nutrition.” Lancet Global Health 2 (9): e500.

ANSD (Agence Nationale de la Statistique et de la Démographie). 2008. Résultats Définitifs du Troisième Recensement Général de la Population et de l’Habitat (2002). Dakar, Sénégal: ANSD.

——— . 2013. Deuxième Enquête de Suivi de la Pau-vreté au Sénégal (ESPS-II 2011): Rapport Définitif. Dakar, Sénégal: ANSD.

——— . 2014. Rapport Définitif: Recensement Général de la Population et de l’Habitat, de l’Agriculture et de l’Elevage (RGPHAE) 2013. Dakar, Sénégal: ANSD.

ANSD (Agence Nationale de la Statistique et de la Démographie) and ICF International. 2012. En-quête Démographique et de Santé à Indicateurs Multiples au Sénégal (EDS-MICS 2010–11). Calverton, Maryland, U.S.: ANSD and ICF.

——— . 2013. Enquête Démographique et de Santé Continue (EDS: 2012–13). Calverton, Maryland, U.S.: ANSD and ICF.

——— . 2015. Enquête Démographique et de Santé Continue (EDS: 2014). Calverton, Maryland, U.S.: ANSD and ICF.

——— . 2016. Enquête Démographique et de Santé Continue (EDS: 2015): Rapport sur les Indicateurs Clés 3ème Année. Calverton, Maryland, U.S.: ANSD and ICF.

Asfaw, A. 2007. “Micronutrient Deficiency and the Prev-alence of Mothers’ Overweight/Obesity in Egypt.” Economics & Human Biology 5 (3): 471–83.

Bershteyn, A., H.M. Lyons, D. Sivam, and N.P. Myhr-vold. 2015. “Association between Economic Growth and Early Childhood Nutrition.” Lancet Global Health 3 (2): e79-e80.

Duboz, P., N. Chapuis-Lucciani, G., and L. Gueye. 2012. “Prevalence of Diabetes and Associated


Risk Factors in a Senegalese Urban (Dakar) Pop-ulation.” Diabetes & Metabolism 38 (4): 332–36.

Eckhardt, C.L., L.E. Torheim, E. Monterrubio, S. Barquera, and M.T. Ruel. 2007. “The Overlap of Overweight and Anaemia among Women in Three Countries Undergoing the Nutrition Transition.” European Journal of Clinical Nutrition 62 (2): 238–46.

Ezzati, M., S. Vander Hoorn, C.M.M. Lawes, R. Leach, W.P.T. James, A.D. Lopez, A. D., A. Rodgers, and C.J.L. Murray. (2005). “Rethinking the ‘Dis-eases of Affluence’ Paradigm: Global Patterns of Nutritional Risks in Relation to Economic Devel-opment.” PLoS Medicine 2 (5): e133. https://doi.org/10.1371/journal.pmed.0020133.

Garrett, J.L., and M T. Ruel. 2005. “Stunted Child–Over-weight Mother Pairs: Prevalence and Association with Economic Development and Urbanization.” Food & Nutrition Bulletin 26 (2): 209–21.

Government of Senegal and UNICEF (United Nations Children’s Fund). 2000. Rapport de l’Enquete sur les Objectifs de la Fin de Décennie sur l’Enfance (MICS II 2000). Dakar, Senegal: Direction de la Prévision et de la Statistique and UNICEF.

Gueye, Cheikh, A.S. Fall, and S.M. Tall. 2015. “Da-kar, Touba and the Senegalese Cities Network Produced by Climate Change.” Current Opin-ion in Environmental Sustainability 13 (April): 95–102.

Khara, T., and C. Dolan. 2014. “Associations between Wasting and Stunting: Policy, Programming and Research Implications.” Technical Briefing Paper, Emergency Nutrition Network, Oxford, England, U.K.

Martorell, R., and M.F. Young. 2012. “Patterns of Stunt-ing and Wasting: Potential Explanatory Factors.” Advances in Nutrition: An International Review Journal 3 (2): 227–33.

Ndiaye, S., and M. Ayad. 2006. Enquête Démo-graphique et de Santé au Sénégal 2005. Calverton, Maryland, U.S.: Centre de Recherche pour le Développement Humain et ORC Macro.

Pessinaba, S., A. Mbaye, G.A.D. Yabéta, H. Harouna, A.E. Sib, A.D. Kane, M. Bodian, M.B. Ndiaye, M. Mbaye-Ndour, and K. Niang. 2013. “Enquête de prévalence des facteurs de risque cardiovasculaire en population générale à Saint-Louis (Sénégal).” An-nales de Cardiologie et d’Angéiologie 62 (4): 253–58.

Popkin, Barry M. 1993. “Nutritional Patterns and Tran-sitions.” Population and Development Review 19 (1): 138–57.

——— . 1998. “The Nutrition Transition and its Health Implications in Lower-Income Countries.” Public Health Nutrition 1 (1): 5–21.

——— . 2001. “The Nutrition Transition and Obesity in the Developing World.” Journal of Nutrition 131 (3): 871S–873S.

Popkin, Barry M., L.S. Adair, and S.W. Ng. 2012. “Global Nutrition Transition and the Pandemic of Obesity in Developing Countries.” Nutrition Re-views 70 (1): 3–21.

REACH. 2012. “REACH Renewed Efforts Against Child Hunger and undernutrition.” REACH Part-nership (accessed July 6, 2016), http://www.reachpartnership.org/home.

Ruel, M.T., and H. Alderman. 2013. “Nutrition-Sensitive Interventions and Programmes: How Can They Help to Accelerate Progress in Improving Maternal and Child Nutrition?” Lancet 382 (9891): 536–51.

Schwinger, C., T.M. Lunde, P. Andersen, H. Kismul, and J.V. Broeck. 2014. “Seasonal and Spatial Factors Related to Longitudinal Patterns of Child Growth in Bwamanda, DR Congo.” Earth Perspec-tives 1 (1): 1–11.


Seck, S.M., D.G. Dia, D. Doupa, A. Diop-Dia, I. Thiam, M. Ndong, and L. Gueye. 2015. “Diabetes Burden in Urban and Rural Senegalese Populations: A Cross-Sectional Study in 2012.” International Jour-nal of Endocrinology, September 30. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605376/.

Subramanian, S.V., J.M. Perkins, and K.T. Khan. 2009. “Do Burdens of Underweight and Overweight Co-exist among Lower Socioeconomic Groups in India?” American Journal of Clinical Nutrition 90 (2): 369–76.

SUN (Scaling Up Nutrition). 2015. “SUN Country Approach.” Scaling Up Nutrition Movement (ac-cessed July 6, 2016), http://scalingupnutrition.org/about/sun-country-approach.

U.N. DESA (Department of Economic and Social Af-fairs). 2015. World Population Prospects: 2015 Revision, vol. I: Comprehensive Tables. New York: United Nations.

Vollmer, S., K. Harttgen, M.A. Subramanyam, J. Fin-lay, S. Klasen, and S.V. Subramanian. 2014. “Association between Economic Growth and Ear-ly Childhood Undernutrition: Evidence from 121 Demographic and Health Surveys from 36 Low-In-come and Middle-Income Countries.” Lancet Global Health 2 (4): e225-e234.

WFP (World Food Programme). 2014. Senegal—Analyse globale de la vulnérabilité, de la sécurité alimentaire et de la nutrition (AGVSAN). Rome: WFP.

WHO (World Health Organization). 2014. Noncommu-nicable Diseases: Country Profiles 2014. Geneva, Switzerland: WHO.

WHO, UNICEF, and WFP. 2014. Global Nutrition Targets 2025: Wasting Policy Brief. Geneva, Swit-zerland: WHO.

World Bank. 2015. Senegal Poverty Assessment: Re-port No: ACS10625. Washington, DC: World Bank.

1818 H Street, NWWashington, DC 20433

Funding for the report was provided by the World Bank, the Government of Canada and the Japanese Trust Fund for Nutrition.

The task force providing oversight of the series was composed of members of the following organizations: