malnutrition research report

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2020 Global Nutrition Report

The 2020 Global Nutrition Report looks beyond global and national patterns, revealing significant inequalities in nutrition outcomes within countries and populations. Based on the best-available data, in-depth analysis and expert opinion rooted in evidence, the report identifies critical actions to achieve nutrition equity. Everyone deserves access to healthy, affordable food and quality nutrition care. Photo: UNICEF/Vishwanathan.

The 2020 Global Nutrition Report in the context of Covid-19

The Global Nutrition Report's emphasis on nutritional well-being for all, particularly the most vulnerable, has a heightened significance in the face of this new global threat. The need for more equitable, resilient and sustainable food and health systems has never been more urgent.

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Executive summary

Malnutrition remains a pressing global challenge. Some progress has been made towards ending malnutrition. But this progress has been slow and deeply unfair. Now is the time to take action and overcome the barriers holding back progress to end malnutrition.

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Chapter One

Introduction: towards global nutrition equity

The vision of a world free from malnutrition means leaving no one behind. Understand why equity is the missing piece in the puzzle for ending malnutrition – and how a pro-equity agenda is needed to achieve the Sustainable Development Goals.

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Chapter Two

Inequalities in the global burden of malnutrition

Learn about how the burden of malnutrition is unequally distributed by examining factors such as location, age, sex, wealth and education. What progress is being made towards meeting nutrition targets at the global, regional and national levels?

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Chapter Three

Mainstreaming nutrition within universal health coverage

Nutrition care should form part of the wider package of primary healthcare. The commitment to provide universal health coverage presents an opportunity to make this a reality. Explore the benefits and challenges of mainstreaming nutrition care using the health system framework.

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Chapter Four

Food systems and nutrition equity

Food systems need to change: inequities currently impact the quality, availability and affordability of food. Explore how nutrition outcomes could be improved by rethinking food systems – especially the food environment – to ensure that healthy and sustainably produced food is the most accessible, affordable and desirable choice for all.

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Chapter Five

Equitable financing for nutrition

More investments and strengthened accountability will be needed to meet global nutrition goals. Whether using traditional resources or innovative approaches, financing should target those most in need. What might equity-focused investments to improve nutrition look like?

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Chapter Six

Ensuring equitable nutrition: a collective responsibility

We all have a role to play in ending malnutrition, and we must act now. From health systems to food systems, coordination, finance, and accountability – we can do better. Adopting a pro-equity agenda is vital to improve nutrition outcomes and ensure no one is left behind.

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Acronyms and abbreviations

A list of the acronyms and abbreviations we have used across the report

Shareable definitions of the terms we have used across the report

Endorsements, acknowledgements and suggested citation

Endorsements of the report, thanks to those involved in creating it and a suggestion for how to cite it

Dataset and metadata

The data, metadata and technical note used for the 2020 Global Nutrition Report

appendix one

Appendix 1: Nutrition indicators

The indicators the 2020 Global Nutrition Report uses to track progress on malnutrition

appendix two

Appendix 2: Assessing progress against the global nutrition targets

How the 2020 Global Nutrition Report tracks global and country progress against the global nutrition targets using the latest available data

appendix three

Appendix 3: Countries on track for the 2025 global nutrition targets

The 2020 Global Nutrition Report's assessment of country-level progress towards eight of the ten 2025 global nutrition targets

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Malnutrition articles from across Nature Portfolio

Malnutrition is a condition that develops when a person's dietary intake does not contain the right amount of nutrients for healthy functioning, or when a person cannot correctly absorb nutrients from food. The term malnutrition includes undernutrition, overnutrition or an incorrect balance of nutrients.

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Child Malnutrition

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Notes on the data

Stunting has declined steadily since 2000 – but faster progress is needed to reach the 2030 target. wasting persists at alarming rates and overweight will require a reversal in trajectory if the 2030 target is to be achieved.

Nearly half of all deaths in children under 5 are attributable to undernutrition; undernutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and delays recovery.

The interaction between undernutrition and infection can create a potentially lethal cycle of worsening illness and deteriorating nutritional status. Poor nutrition in the first 1,000 days of a child’s life can also lead to stunted growth, which is associated with impaired cognitive ability and reduced school and work performance.

We are still far from a world without malnutrition. While the 2023 edition of the UNICEF-WHO-World Bank Group Joint Malnutrition Estimates shows that stunting prevalence has been declining since the year 2000, more than one in five – 148.1 million children under 5 –were stunted in 2022, and at least 45.0 million suffered from wasting at any given point of time in the year. Meanwhile, the number of children under 5 affected by overweight worldwide has increased from 33.0 million in 2000 to 37.0 million in 2022.

Measures of child malnutrition are used to track development progress. Estimates of child malnutrition will help determine whether the world is on track to achieve the Sustainable Development Goals – particularly, target 2.2, to “end all forms of malnutrition by 2030”, which falls under goal 2 to “end hunger, achieve food security and improved nutrition, and promote sustainable agriculture”.

In 2022, three regions had very high stunting prevalence, with approximately one third of children affected. On the other hand, two regions Europe and Central Asia and Northern America, had low stunting prevalence. However, vast disparities within regions can exist. In Latin America and the Caribbean, for example, despite the 11.5 per cent regional prevalence, some individual countries are faced with high, and very high stunting prevalence, while others have very low prevalence below 2.5 per cent. Chronic undernutrition in Latin America and the Caribbean can vary widely between neighboring countries: In one country less than 1 in 8 are affected, while more than 2 in 5 of their peers in the country next door are at a disadvantage due to the irreversible physical and cognitive damage that can accompany stunted growth.

In 2022, 22.3 per cent, or more than one in five children under age 5 worldwide had stunted growth. That said, overall trends are positive. Between 2000 and 2022, stunting prevalence globally declined from 33.0 per cent to 22.3 per cent, and the number of children affected fell from 204.2 million to 148.1 million. In 2022, nearly two out of five children with stunting lived in South Asia while another two out of five lived in sub-Saharan Africa.

Wasting and severe wasting

Middle East and North Africa had the highest overweight prevalence in 2022 with 10.3 per cent affected, followed by Latin America and Caribbean at 8.6%. The lowest overweight prevalence in 2022 was seen in South Asia at 2.7 per cent followed by West and Central Africa at 3.1 per cent. East Asia and the Pacific had the highest number of overweight children in 2022 with nearly 11 million affected, followed by Middle East and North Africa with an estimated 5.0 million overweight children under 5 years. Overall, these two regions account for just over 2 out of 5 children affected by overweight in the world.

Black, R.E., et al., Maternal and Child Undernutrition and Overweight in Low-income and Middle-income Countries , Lancet , vol. 382, no. 9890, 3 August 2013, pp. 427–451.

United Nations Children’s Fund (UNICEF), World Health Organization (WHO), International Bank for Reconstruction and Development/The World Bank. Levels and trends in child malnutrition: UNICEF / WHO / World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2023 edition . New York: UNICEF and WHO; 2023.

Nutritional status

Malnutrition data, build and download your own customisable dataset, unicef-who-the world bank: joint child malnutrition estimates (jme) — levels and trends – 2023 edition.

The Extension of the 2025 Maternal, Infant and Young Child Nutrition Targets to 2030

Anthropometry data quality research priorities

UNICEF-WHO-World Bank: Joint Child Malnutrition Estimates (JME) – 2023 edition interactive dashboard

The State of Food Security and Nutrition in the World 2022

Joint Malnutrition Estimates 2021 – Technical notes on country consultations

Anthropometry Analyzer

Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years of age

Nutrition targets tracking tool

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*The reference population is based on the WHO Child Growth Standards, 2006

Please note that some children can suffer from more than one form of malnutrition – such as stunting and overweight or stunting and wasting. There are currently no joint global or regional estimates for these combined conditions, but UNICEF has a country-level dataset with country level estimates, where re-analysis was possible.

1. Growth standard (reference population)

Prevalence children under 5 affected by stunting, wasting and overweight is estimated by comparing actual measurements to an international standard reference population. In April 2006, the World Health Organization (WHO) released the WHO Child Growth Standards to replace the widely used National Center for Health Statistics (NCHS)/WHO reference population, which was based on a limited sample of children from the United States of America. The new standards are the result of an intensive study project involving more than 8,000 children from Brazil, Ghana, India, Norway, Oman and the United States. Overcoming the technical and biological drawbacks of the old reference population, the new standards confirm that children born anywhere in the world and given the optimum start in life have the potential to reach the same range of height and weight. It follows that differences in children’s growth to age 5 are more influenced by nutrition, feeding practices, environment and health care than by genetics or ethnicity.

The new standards should be used in future assessments of child nutritional status. It should be noted that because of the differences between the old reference population and the new standards, prevalence estimates of child anthropometry indicators based on these two references are not readily comparable. It is essential that all estimates are based on the same reference population (preferably the new standards) when conducting trend analyses.

2.  The Joint Malnutrition Estimates (JME) Methodology

The UNICEF-WHO-World Bank JME Working Group was established in 2011 to address the call for harmonized child malnutrition estimates that would be instrumental in benchmarking progress on child malnutrition. The first edition of the JME was released in 2012 and provided estimates for stunting, wasting, severe wasting, underweight and overweight, as well as a detailed description of the methodology (UNICEF & WHO, 2012). Since its inception, the JME outputs have comprised a harmonized country-level dataset of primary data (e.g., national estimates based on household surveys), as well as regional and global model-based estimates.

For the first time in 2021, the JME also includes country-level modelled estimates for stunting and overweight based on updated methodology (Mclain et al. 2019) developed by the JME Working Group in partnership with the University of South Carolina. The regional and global figures for stunting and overweight are now also based on these country model outputs, while they remain based on the previously applied sub-regional model for wasting and severe wasting (UNICEF & WHO, 2012). Additional work is ongoing to update methods for wasting and severe wasting for which available data are not as stable as for stunting and overweight. The JME process for the 2021 edition involved the following steps: (i) updating of the country dataset of primary sources (e.g., national household surveys); (ii) application of a country level model for stunting and overweight to generate annual estimates; (iii) generation of regional and global aggregates for stunting, wasting, severe wasting and overweight; and (iv) consultation with countries before finalizing and disseminating the 2021 estimates. These parts of the JME are described in more detail below.

2.1 The JME dataset of country estimates

The JME dataset of country estimates requires the collection of national data sources that contain information on child malnutrition, specifically that collected data on the height, weight and age of children under 5, which can be used to generate national-level prevalence estimates for stunting, wasting, severe wasting and overweight. These national-level data sources are mainly comprised of household surveys – e.g., Multiple Indicator Cluster Surveys (MICS), Demographic and Health Surveys (DHS), Standardized Monitoring and Assessment of Relief and Transition (SMART) surveys, and Living Standards Measurement Study (LSMS). Some administrative data sources (e.g., from surveillance systems) are also included where population coverage is high. As of the latest review closure on 31 January 2021, the primary source dataset contained 997 data sources from 157 countries and territories, with nearly 80 per cent of children living in countries with at least one data point on stunting, wasting and overweight that is less than 5 years old.

The dataset contains the point estimate, and where available, the standard error, the 95 per cent confidence bounds and the unweighted sample size. Where microdata are available, the JME uses estimates that have been recalculated to adhere to the global standard definition (UNICEF & WHO, 2019). Where microdata are not available, reported estimates are used, except in cases where adjustments are required to standardize for: (i) use of an alternate growth reference from the 2006 WHO Growth Standards; (ii) age ranges that do not include the full 0–59-month age group; and (iii) data sources that were only nationally representative for populations residing in rural areas. Further details related to data source compilation, re-analysis of microdata, and data source review are provided elsewhere (UNICEF & WHO, 2020).

2.2 Country-level model for stunting and overweight estimates  

2.2.1 Rationale

National surveys are administered sporadically, resulting in sparse data for many countries. This hampers efforts to monitor the countries’ progress towards targets, such as the SDG targets. The use of statistical models at country level is important to enable comparisons across countries at the same year, filling in the gaps. In addition, statistical models are an efficient way to adjust for unwarranted variability.

2.2.2 Model description

The technical details of the statistical models are provided elsewhere (UNICEF & WHO, 2020). modeled at logit (log-odds) scale using a penalized longitudinal mixed-model with a heterogeneous error term. The quality of the models was quantified with model-fit criteria that balance the complexity of the model with the closeness of the fit to the observed data. The proposed method has important characteristics, including non-linear time trends, regional trends, country-specific trends, covariate data and a heterogeneous error term. All countries with data contribute to estimates of the overall time trend and the impact of covariate data on the prevalence. For overweight, the covariate data consisted of linear and quadratic socio-demographic index (SDI)**, and data source type. The same covariates were used for stunting, plus an additional one of the average health system access over the previous five years (UNICEF & WHO, 2020).

2.2.3 Model outputs

Annual country-level modelled estimates from 2000 to 2020 on stunting and overweight were disseminated by the JME in 2021 for 155 countries with at least one data point (e.g. from a household survey) included in the country dataset of primary sources described in section 2.1 above. Modelled country estimates were also produced for an additional 49 countries, used solely for generation of regional and global aggregates. Modelled estimates for these 49 countries are not shown because they did not have any household surveys in the JME country dataset or because the modelled estimates remained pending final review at the time of publication. The results for the 204 countries can be used to calculate estimates and uncertainty intervals for any groups of countries aggregated. The uncertainty intervals are important in monitoring trends, especially for countries with sparse data and where primary data sources present large primary data source sampling errors (SSE). When only sparse data are available in the most recent period, the inclusion of a survey can affect a substantial change in the predicted trajectory. For this reason, uncertainty intervals are needed to enhance trend interpretability in terms of the caution level employed. The uncertainty intervals for the new JME method have been tested and validated with various data types.

2.3 Generation of regional and global estimates

Different methods were applied to generate regional and global estimates for stunting and overweight compared to wasting and severe wasting for the 2021 edition of the JME as described below. In short, results from the new country-level model were used to generate the regional and global estimates for stunting and overweight, while the JME sub-regional multi-level model (UNICEF & WHO, 2012, de Onis et al. 2004), was used to generate the global and regional estimates for wasting and severe wasting.

2.3.1 Stunting and overweight:

Global and regional estimates for all years from 2000 to 2020 were derived as the respective country averages weighted by the countries’ under-5 population from The United Nations World Population Prospects, 2019 Revision, using model-based estimates for 204 countries.  This includes 155 countries with national data sources (e.g. household surveys) included in the JME country dataset described in section 2.1 above. It also includes 49 countries with modelled estimates generated for development of regional and global aggregates but for which country modelled estimates are not shown because they did not have any household surveys in the JME country dataset or because the modelled estimates remained pending final review at the time of publication.  Confidence intervals were generated based on bootstrapping methodology.

2.3.2 Wasting and severe wasting:

The wasting and severe wasting prevalence data from national data sources described in se section 2.1 above were used to generate the regional and global estimates for the year 2020 using the JME sub-regional multi-level model (UNICEF & WHO, 2012, de Onis et al. 2004), applying population weights for children under 5 years of age from The United Nations World Population Prospects, 2019 Revision.

2.4 Country Consultations

For the estimates presented in the 2021 edition of the JME, joint UNICEF-WHO country consultations were conducted from November 2020 to January 2021. The purpose of these consultations was to explain the updated methodology for stunting and overweight estimates to national governments; to ensure the estimates included all recent and relevant country data for stunting, wasting and overweight; and to engage with and receive feedback from national governments on the estimates.

3. Other notes on the Joint Malnutrition Estimates

3.1 Explanation as to why trends are shown for stunting and overweight but only most current estimate for wasting and severe wasting :

The JME on wasting and severe wasting are based on national-level prevalence data alone and thus do not reflect the cumulative cases (incidence) that occur over the course of a year (Isanaka et al 2021). Wasting is a relatively short-term condition, which means that an individual child can be affected more than once in a calendar year (i.e., can recover but then become wasted again in the same year). The global prevalence-based estimates of 45.4 million children under 5 affected by wasting and 13.6 million affected by severe wasting in 2020 should therefore be viewed as an underestimate of the number of children affected and in need of treatment that year.

Wasting is also affected by seasonality, meaning that prevalence may vary greatly between the pre-harvest season (which is often associated with food shortages, heavy rains and related diseases that can affect nutrition status) and the post-harvest season (which is often associated with higher food availability and weather patterns that are less likely to cause disease) . Yet the country data that feed into the JME can be collected during any season. This means that prevalence for any given survey might be at a high or low; or it may fall somewhere in between if data are collected across seasons.

The lack of incidence data for wasting and severe wasting is a main reason why the JME does not present annual trends for these forms of malnutrition. Since the prevalence data are collected infrequently (every 3 to 5 years) in most countries and measure wasting at one point in time, it is not possible to capture the rapid fluctuations in wasting over the course of a given year or to adequately account for variations in seasons across survey years. In contrast, stunting and overweight are  relatively stable over the course of a calendar year, making it possible to track changes in these two conditions over time with prevalence data.

 3.2 Footnotes on population coverage

As started in the 2014 edition, a separate exercise was conducted to assess population coverage for the modelled global and regional estimates. This was important in order to alert the reader, via footnotes, to instances where estimates for some regions and years should be interpreted with caution due to low population coverage (defined as less than 50 per cent). A conservative method was applied looking at available data within mutually exclusive five-year periods around the projected years. Population coverage was calculated as:

Estimates are flagged as having consecutive low population coverage when at least two five-year periods in a row (e.g., when the assessment for 2000-2004 as well as the assessment for 2005-2009 both yield population coverage below 50 per cent).

3.3 Prevalence thresholds for wasting, overweight and stunting in children under 5 years

New thresholds, presented in the table below, were established through the WHO-UNICEF Technical Advisory Group on Nutrition Monitoring (de Onis et al. 2018) and have been used for development of prevalence-based maps. The thresholds were developed in relation to standard deviations (SD) of the normative WHO Child Growth Standards. The international definition of ‘normal’ (two SD from the WHO standards median) defines the first threshold, which includes 2.3% of the area under the normalized distribution. Multipliers of this “very low” level (rounded to 2.5%) set the basis to establish subsequent thresholds.

Prevalence thresholds (%) for severity of malnutrition among children under 5 years

3.4 Estimating country-level progress

Country-level progress in reducing malnutrition prevalence is evaluated by calculating the actual average annual rate of reduction (AARR) achieved by the country “to date”, and comparing this to the AARR needed in order to achieve target. For more information about how to calculate country-level AARR, please click here to read a technical note.  A  Nutrition Targets Tracking Tool which provides AARR levels for different scenarios is also available to investigate progress towards the 2025 World Health Assembly (WHA) nutrition targets for each country.

**SDI is a summary measure that identifies where countries or other geographic areas sit on the spectrum of development. Expressed on a scale of 0 to 1, SDI is a composite average of the rankings of the incomes per capita, average educational attainment, and fertility rates of all areas in the Global Burden of Disease study.

de Onis M, Blossner M, Borghi E, Morris R, Frongillo EA. Methodology for estimating regional and global trends of child malnutrition. International Journal of Epidemiology 33:1260-1270.

de Onis, M., et al. (2018). Prevalence thresholds for wasting, overweight and stunting in children under 5 years. Public health nutrition, 22(1), 175–179.

Isanaka S, Andersen CT, Cousens S, et al. Improving estimates of the burden of severe wasting: analysis of secondary prevalence and incidence data from 352 sites. BMJ Glob Health. 2021;6(3):e004342. doi:10.1136/bmjgh-2020-004342.

McLain AC, Frongillo EA, Feng J, Borghi E. Prediction intervals for penalized longitudinal models with multisource summary measures: an application to childhood malnutrition. Statistics in Medicine 38:1002-1012, 2019.

United Nations Children’s Fund, World Health Organization, The World Bank. UNICEF-WHO-World Bank Joint Child Malnutrition Estimates. (UNICEF, New York; WHO, Geneva; The World Bank, Washington, DC; 2012).

UNICEF & WHO 2019. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. Geneva: World Health Organization and the United Nations Children’s Fund (UNICEF), 2019. Licence: CC BY-NC-SA 3.0 IGO. Accessed online 23 October 2021, url: < https://data.unicef.org/resources/data-collection-analysis-reporting-on-anthropometric-indicators-in-children-under-5/ >

UNICEF-WHO-World Bank 2020. SDG Indicators 2.2.1 on stunting, 2.2.2a on wasting and 2.2.2b on overweight: Country consultation background document for 2021 edition of the Joint Malnutrition Estimates. (also available at: https://data.unicef.org/resources/jme-2021-country-consultations/ )

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• Child nutrition
• Child malnutrition
• Women's nutrition
• Low birthweight
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• Breastfeeding

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In the 21st century, malnutrition is considered as one of the many health inequalities affecting humanity worldwide, regardless of their income status. Malnutrition is a universal issue with several different forms. It has been observed that one or more forms of malnutrition can appear in a single country ...

Keywords : malnutrition, poverty, diet, eating habits, inequalities, low-income

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MALNUTRITION RESEARCH BY ORYEM JOSEPH

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Taha H Musa

JUNAID ABID

Malnutrition shows a decline in health due to the disproportion of nutrients and energy in the body. Malnutrition is one of the main risk factors related to children's morbidity and mortality. It is estimated that about 52.50% of child mortality is linked to malnutrition and its associated diseases. 1 Malnutrition is a crucial medical problem in approximately every region of the globe and particularly in Southern Asia and Sub-Saharan Africa. In several developing nations, stunting, underweight, and micronutrient deficiencies among children are common due to insufficient nutrition and ABSTRACT Background: Malnutrition is one of the main health issues among children. Malnutrition is more prevalent in developing countries. Malnutrition among children is affected by many factors. These factors are studied in many parts of the world but they are understudied in most the areas of Pakistan. This study aimed to assess the incidence of malnutrition and its associated factors among children in Murree, Rawalpindi, Pakistan. Methods: This descriptive cross-sectional study was carried out among children of Murree, Rawalpindi for about 6 months from August 2021 to January 2022. Simple random sampling along with an established inclusion and exclusion criteria was applied to enroll 316 participants. A self-adapted questionnaire was applied to take data after taking ethical approval from the institutional research board and informed consent from the participants. Results: The incidence of underweight, normal weight, overweight and obesity among school children of study population was 22.80%, 35.40%, 26.90%, and 14.90% respectively. The association between malnutrition and gender (p=0.001), birth weight (p=0.01), supplementation intake (p=0.03), filtered water use (p=0.02), hygiene (p=0.01), vaccination status (p=0.04), recurrent infection history (p=0.02), socioeconomic status (p=0.04), mother education (p=0.04), mother occupation (p=0.03), awareness of parents about balanced diet (p=0.02), and family size (p=0.04) was statistically significant, whereas association between nutritional status and age group (p=0.05) was insignificant. Conclusions: The incidence of underweight, overweight, and obesity was remarkable among children. Many factors such as gender, birth weight, supplementation intake, filtered water use, hygiene, vaccination status, recurrent infection, socioeconomic status, mother education, mother occupation, parental awareness about a balanced diet, and family size were found to associate with malnutrition among children.

Abdul Tauqeer

Eng Abdirahman

Abstract Background: Malnutrition is a severe problem that affects a child’s cognitive and physical development. An adequate, balanced nutrition is crucial for a proper physical, emotional, and mental development. Malnutrition remains one of the most common causes of morbidity and mortality among children under 5 children throughout the World. It is the most important risk factor for the burden of disease causing about 300, 000 deaths per year directly and indirectly responsible for more than half of all deaths in children. Child malnutrition is one of the most serious public health problems in the developing world. Objective: To assess prevalence of malnutrition and associated factors among children aged 5 years at Lasanod district, Sool region, October 2014. Methods: An institution based cross sectional study was done among MCHs under five children found in Lasanod town on October 2014. The sample size of the study was 113. A pretested structured questionnaire and interview guide were employed to obtain the necessary information for this study. The structured questionnaire were originally prepared in English language and then translated into the Somali language and then back to English. The collected data was analyzing using SPSS Version 20.0 and triangulated. Bivariate and multivariate logistic regressions were carried out. Result: The analysis this study revealed that, 57.5%, 25.6.9% and 33.7% of children were underweight ,wasted, and stunted respectively and also revealed that 3.5%, 10.6% and 13.3% of children were severe underweight , severe wasted and severe stunted. The main associated factors of malnutrition were found to be mother’s age at first birth, place of delivery and duration of breastfeeding. Conclusion and recommendation: - This study revealed that, prevalence of malnutrition was high and it was the top list among the health problems in Lasanod district. In Somalia where most mothers do not know nutritional status and nutrient foods, a lot should be done by different sectors. We suggest that under nutrition prevention programs and strategies in the region as well as other regions should target Nutritional status among mothers and their children in extensive way to bring further positive changes related to diet.

Journal of Nutritional Science and Vitaminology

Francis Nkrumah

American Journal of Public Health Research

Irene Sumbele

International Journal Foundation

This is cross-sectional community based study conducted in Angola area in Khartoum State of Sudan during period of 2015-2017. The aim of the study was to assess nutritional status of under five years old children and its associated risk factors using anthropometric measurements, interview of childcare givers, and observation on nutrition status indicators and socioeconomic profile of families. 282 children and their caregivers were selected and investigated using cluster sampling techniques and predesigned questionnaires and checklist. The results revealed that 19.1 of the studied children were severely malnourished, and 4.7 were moderately malnourished with children in age of one to two years were mostly affective with P value of < 0.05. Family size and parent education level also were reported among the major risk factors of malnutrition with P value of < 0.05. 96.6% of the children had episode of diarrhea at least once, and 81.1% had respiratory tract infection at least once. Few were exposed to frequently to those infectious diseases. The study concluded that severe and moderate malnutrition affect almost quarter of the children in the area especially in the age group of one to two years. Poor education and awareness on how to maintain children health generally is the main risk factor especially knowledge and skills on the causes of malnutrition, proper young children food and feeding practices, breastfeeding, and utilization of available health services. The study recommended extensive health education program along with family support through provision of nutrients high density food. Study Area: The area has a total population of the area 56,534 with 10,386 under five year old children according to the area popular committees. Household with children aged 6 to 59 months were selected for the study along with their mothers. Diarrheal diseases, malaria and acute respiratory infections were the major health problem among young children in the areas. There are five health centers providing PHC services and 5 private clinics. Diarrheal diseases, malaria and acute respiratory infections were the major health problem among young children in the areas. There are five health centers providing PHC services and 5 private clinics. Sample size: 282 children and their mother were selected using the following formula and based on prevalence rate of nutritional deficiency diseases in Khartoum State of which was estimated to be 10% according Khartoum State Ministry of Health, 2009 n = z 2 pq* design defect (d) 2 Where: n = sample size, Z = 1.96, P = prevalence rate of nutritional deficiency diseases= (10%), q = 1-p, d = 0.05, Design defect=2 n =(1.96) 2 X 0.9 X0.X 2 = 138.2976 X 2 = 276.59 (0.05) 2 (14) The number was rounded to 282 children taken into account the refusal which was estimated to be 9%. Cluster sampling techniques was used by dividing the area into 6 clusters, in each 47 children's and their mothers/caretakers were selected randomly (15). Data were collected in predesigned questionnaire and check list through interview with mothers and measuring weight and high of their children. Indicators used during this study were: height –for –age (for chronic malnutrition), weight for weight (for acute malnutrition) and edema (16,17). Weight: The Staler 25kg hanging spring scale marked out in steps 0.1 kg, was used instrument was adjusted to zero before used, the child freed from heavy clothing (16,17). Height: Children up to 2years (23 months 85 cm length) of age were measured on horizontal measuring board. Children over two years of age (or over 85cm) were measured standing on horizontal surface against vertical measuring device. The height was read out as before, to nearest 0.1cm (29) Age: The birth data was entered on the recording form from birth certificates where this document was not available we used date of birth given by mothers Edema: Presence of edema also was recording after examination of children using finger press on the abdomen and legs.

Geleta Asebe

Abdul-Rasheed L Sulaiman , Ahmed Olusi

The road to good health is through good food which depends on the socioeconomic condition of the giver of the food. Numerous studies had been conducted on the causes of child malnutrition among children less than 5 years, that of children between 8 and 16 years with keen interest on the socioeconomic context of the giver has not been well documented. This lacuna is what this paper filled. Cross-sectional household survey was used for the study. 322 respondents were selected using a multi stage cluster sampling design. A well-structured pretested questionnaire was used to elicit the socio-demographic data from the respondents, while the respondents' nutritional status was calculated using the Body Mass Index (B.M.I) method. Chi-square and bivariate logistics regression were used to test the hypotheses. The study discovered that parental education and parental income were the fundamental factors affecting child malnutrition in the study location. Hence, government should ensure that education is made compulsory and affordable to everyone. Also, the menace of poverty should be adequately addressed.

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Armed violence deepening malnutrition crisis for children in haiti, deadly malnutrition in the country amplified by escalating insecurity, blocked roads, and a crumbling health system pushing children to ‘the brink’, unicef warns.

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PORT AU PRINCE/NEW YORK, 26 March 2024 - The alarming surge in armed violence in areas of Haiti is creating heightened risk of furthering a malnutrition crisis in the country, UNICEF warned today.

The recent findings from the Integrated Food Security Phase Classification (IPC) analysis indicate an alarming 19 per cent increase in the number of children estimated to suffer from severe acute malnutrition (SAM) in Haiti this year. In addition, and as evidenced by the latest IPC analysis, 1.64 million people are facing emergency levels of acute food insecurity, (IPC Phase 4), which increases the risk of child wasting and malnutrition, especially in 8 areas of the country. 

The ongoing armed violence across Artibonite department and the West department, which encompasses Port au Prince, has restricted aid delivery and crumbled an already fragile healthcare system, posing an imminent threat to the lives of over 125,000 children at risk of SAM.

“The violence and instability in Haiti have consequences far beyond the risk of the violence itself. The situation is creating a child health and nutrition crisis that could cost the lives of countless of children,” said Catherine Russell, UNICEF Executive Director. “Thousands of children are on the brink, while life-saving supplies are ready to be delivered if violence stops and roads and hospitals are opened. This malnutrition crisis is entirely human made. Basic security is urgently needed for the people of Haiti, for the life-saving services they rely on, and for humanitarian workers to reach children and families in desperate need.”

Since January, the deteriorating security situation in Haiti has continued to worsen the humanitarian crisis, with serious consequences for UNICEF’s ability to store, deliver and restock desperately needed assistance.

Earlier this month, one of UNICEF's 17 containers was looted at Port-au-Prince's main port. The looted container held essential items for maternal, neonatal, and child survival, including resuscitators and related equipment. The ongoing insecurity has also left just two in five hospitals operational across the country. Meanwhile, only one in four health facilities are functioning in the Artibonite department, the nation’s main rice-growing region.

At the same time, the current insecurity in Port-au-Prince has made it virtually impossible for health and nutrition supplies to reach at least 58,000 children suffering from severe wasting in the metropolitan area. The Martissant road, the only humanitarian corridor from Port-au-Prince to the southern regions, remains blocked, leaving an estimated 15,000 children suffering from malnutrition at the brink of disaster.

And the insecurity plaguing much of Haiti’s capital is hampering the transport and resupply of Ready-to-Use Therapeutic Food (RUTF), used to treat children suffering from SAM, which could lead to supply chain disruptions and have serious consequences if the situation remains unchanged.

Despite the highly volatile environment, UNICEF is stepping up efforts to protect families and provide life-saving support, including for those who are trapped and cut off from essential services. Together with the Government and partners, UNICEF is helping to sustain national, regional, and – in the most insecure areas – neighborhood systems and services that protect children and families.

UNICEF is calling for:

• Accelerated efforts by the international community to protect civilians, restore law and order in the streets, and ensure safe movement of humanitarian workers and life-saving supplies, including RUTF;
• Increased immediate, flexible funding to meet the needs of the most vulnerable as the situation evolves, ensuring aid reaches affected populations as quickly as possible;
• And the protection of schools, hospitals, and other critical infrastructure children rely on, and for the safeguarding of humanitarian spaces.

Note for editors:

The Integrated Food Security Phase Classification (IPC) is an innovative multi-stakeholder global initiative aimed at enhancing food security and nutrition analysis. The IPC is the result and the function of a partnership which exists at global, regional and national levels. It is is thus founded on a strong governance structure that brings together governments, regional bodies and international agencies – and fosters rigorous processes, ownership and consensus-driven outcomes.

Using the IPC classification and analytical approach – governments, UN agencies, NGOs and other stakeholders work together to determine the severity and extent of acute and chronic food insecurity and acute malnutrition situations within countries, according to internationally recognized standards. 

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Fresh blow for Rwanda deportation plan as report shows extreme poverty and hunger

Foreign Office paper says not enough being done, with over half the population living on less than $1.90 a day

• UK politics – latest updates

New fears have arisen about the suitability of Rwanda as a destination to send UK asylum seekers after a damning government assessment about the prevalence of poverty and malnutrition in the country.

The paper, from the Foreign, Commonwealth and Development Office (FCDO), highlights key concerns about the state of Rwanda in a “problem statement”. More than half of the population – 56.5% – live on less than $1.90 a day and FCDO’s analysis finds that poverty reduction has “stagnated” since 2014.

It describes problems in Rwanda’s social protection programme, and how its reach to the population is “considerably below the level of need”. This means the impact on poverty reduction is lower than it could be “and therefore [brings] higher levels of malnutrition, lower levels of human capital development, lower levels of resilience at individual and system level”. Problems with the social protection programme include varying quality of implementation such as poor targeting and weak case management.

The FCDO commissioned research into why there had been a slowdown in poverty reduction in Rwanda and found land scarcity, limited livelihood options and climactic factors such as landslides had led people to reduce the number of meals they eat, buy food on credit and take their children out of school.

“Growth is not trickling down and leading to poverty reduction. More needs to be done … to establish sustainable livelihoods and effective pathways out of poverty,” the report states.

The Home Office has said it hopes to get the first asylum seekers on a flight in a matter of weeks to launch its controversial scheme to process some UK asylum claims there.

While the UK is a wealthy country, with its economy ranked the sixth largest in the world, Rwanda is ranked the 23rd poorest country in the world. In the year ending December 2023, asylum applications in the UK decreased by 17% to 67,337, with other European countries such as France and Germany receiving many more asylum applicants than Britain.

Michela Wrong, the author of Do Not Disturb, a critical assessment of Rwanda under the rule of the current president, Paul Kagame, said: “The bottom line is Rwanda is an incredibly poor country and it has a real problem with malnutrition. Rwanda has always been a bizarre choice to send asylum seekers to, given its poverty. It doesn’t have enough land to go round and many are engaged in subsistence farming.”

The document is part of a framework agreement to monitor a £64.5m grant of aid from the UK to Rwanda between 2019 and 2026, which includes £18.5m from the Swedish Development Agency. The monitoring contract to assess progress in the aid deal runs from 1 July 2023 until 31 March 2026.

The legal challenges against the government’s plan to send some asylum seekers to Rwanda, which was found by the supreme court to be unlawful , focused on concerns about its human rights record and lack of infrastructure to process a large number of individual asylum claims along with the risk of refoulement – forced return to a country where an asylum seeker’s life could be in danger.

But the impact of extreme poverty and malnutrition in Rwanda on arriving asylum seekers is seen as a significant concern. Earlier this month the National Audit Office found the Rwanda scheme would cost £1.8m for each of the first 300 asylum seekers sent there. It is not known how much of this will be spent on providing food and economic opportunities for asylum seekers.

Toufique Hossain, of Duncan Lewis solicitors, part of the legal team challenging the government’s Rwanda plan in domestic courts and the European court of human rights, said: “In Rwanda 56.5% of people are living below the international poverty line. The UK government’s obsession with the Rwanda scheme has wasted hundreds of millions of pounds of British taxpayers’ money.

“The government wants to transport vulnerable people, who have fled war and persecution, to endure more suffering in a country the UK accepts to be struggling with malnutrition and abject poverty, in circumstances where the UK’s supreme court has declared the country unsafe for those people. The plan is both morally and legally bankrupt.”

A government spokesperson said:“Rwanda is a suitable and safe country to relocate and support those who have no right to remain in the UK. Under our partnership we have invested £220m into Rwanda to boost economic growth. This funding has been focused in areas such as education, agriculture and healthcare to benefit both migrant and host communities.”

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Wfp kenya country brief, january 2024, attachments.

January in Numbers

1.4 million people assisted in January

7,829 MT of food commodities distributed

USD 3.9 million cash transfers made

USD 8.66 million net funding requirements across all activities for the next six months ( March-August 2024)

Food Security Situation

There is an improvement in food security across Kenya's 23 Arid and Semi-Arid Land (ASAL) counties. The population facing critical food insecurity (IPC phases 3 and 4) and requiring humanitarian assistance has decreased, dropping from 2.8 million in 2023 to 1.9 million up to the end of March. This positive trend is primarily attributed to the good performance of the October-December 2023 short rainfall season. Most regions received above-average rainfall, leading to improved livestock and crop production and overall food security. Even so, disparities exist across counties with six ASAL counties remaining classified as IPC Phase 3 (Crisis and above): Turkana, Garissa, Isiolo, Mandera, Marsabit, and Wajir. These areas are predominantly reliant on pastoral livelihoods and there is a need for continued monitoring and targeted assistance.

There is an improvement in the nutrition situation across the ASALs attributed to the improved food security. However, malnutrition remains a concern with the main drivers being cumulative effects of past droughts, poor child feeding practices, high disease burden and recurrent shocks. Approximately 847,932 children aged 6 to 59 months and 124,359 pregnant and breastfeeding women and girls (PBWGs) face acute malnutrition.

Operational Updates

Refugee operations

WFP maintained its critical role in supporting the food and nutritional needs of refugees and asylum seekers in Kenya. This included providing food assistance to 640,104 (50 percent women) refugees and asylum seekers residing in Dadaab and Kakuma refugee camps, and the Kalobeyei settlement. The assistance encompassed a diversified approach, utilizing both in-kind food distributions and cash transfers, offering beneficiaries flexibility in meeting their dietary needs.

WFP's intervention emphasized the specific needs of vulnerable groups. 63,128 PBWGs and children aged 6-59 months identified as malnourished or at risk received specialized nutritional support to prevent and treat moderate acute malnutrition (MAM). Integration of social behavior change communication activities promoted healthy dietary practices and empowered families to make informed decisions regarding their health and well-being.

Investing in the future through human capacity development, 95,415 (44 percent girls) primary school-going boys and girls received daily hot lunches through WFP's school feeding programme. School feeding addresses classroom hunger needs and supports improved cognitive development and school attendance, nurturing a brighter future for refugee children. Emergency food assistance and nutrition support to Kenyans

WFP's Lisha Jamii programme provided critical food assistance to vulnerable Kenyans across three counties, reaching 513,414 individuals (57 percent women). A two-pronged approach was used, distributing both in-kind food and cash-based transfers, offering beneficiaries greater flexibility in meeting their dietary needs. Additionally, the programme addressed the specific vulnerabilities of 184,537 PBWGs, and children aged 6 to 59 months, by providing them with specialized nutritional support to prevent and treat MAM. Food distribution to some of the planned 10 counties experienced delays due to logistical challenges caused by floods; distributions were rescheduled to February.

Capacity Strengthening and Innovation

• WFP supported the Ministry of Labour and Social Protection in conducting nationwide public participation forums for the draft Social Protection Bill, 2024. Held across seven locations – Mombasa, Kisumu, Eldoret, Nakuru, Isiolo, Thika, and Nairobi, the forums ensured a diverse range of voices were heard. Over 1,316 individuals (684 females), participated in shaping the transformative legislation. The Bill expands the scope of social protection by including income security, social health protection, and shock-responsive social protection, among other complementary programmes. The Bill, therefore, aims to address poverty, vulnerability, and social exclusion throughout individuals' lifespans, potentially improving the lives of millions of vulnerable Kenyans. Its expansive scope and commitment to inclusivity align with the WFP “Changing Lives" agenda.

Climate Resilience and Food Systems

In collaboration with the Kenya Agricultural and Livestock Research Organization (KALRO) and the Busia County Government, WFP spearheaded the cultivation and commercialization of the highyielding and drought-resistant Aspergillus Tolerant Groundnut (ATG) variety. This initiative aims to enhance food security and build resilience among smallholder farmers in Kenya. The project is driven by local demand from a Kenyan food company pioneering the introduction of peanut powder to the national market. This market-driven approach ensures the long-term sustainability of the programme by creating a guaranteed offtake channel for ATG produce. The harvested seeds from 50 hectares in Busia County will not be for immediate sale but rather distributed to 600 targeted smallholder farmers to scale up, establishing a sustainable supply chain of high-quality, aflatoxin-free groundnut seeds. To ensure the success of the initiative, 28 agricultural extension officers (70 percent women), were trained on good agronomic practices for ATG cultivation.

WFP also provided 75,784 smallholder producers with food assistance and cash transfers, providing a safety net against climate-related shocks to safeguard their livelihood.

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Joint World Bank, UN Report Assesses Damage to Gaza’s Infrastructure

Damages to Physical Structures Estimated at $18.5 billion as of end January

WASHINGTON, April 2, 2024  – The cost of damage to critical infrastructure in Gaza is estimated at around $18.5 billion according to a new report released today by the World Bank and the United Nations, with financial support of the European Union. That is equivalent to 97% of the combined GDP of the West Bank and Gaza in 2022.

The Interim Damage Assessment report used remote data collection sources to measure damage to physical infrastructure in critical sectors incurred between October 2023 and end of January 2024. The report finds that damage to structures affects every sector of the economy. Housing accounts for 72% of the costs. Public service infrastructure such as water, health and education account for 19%, and damages to commercial and industrial buildings account for 9%. For several sectors, the rate of damage appears to be leveling off as few assets remain intact. An estimated 26 million tons of debris and rubble have been left in the wake of the destruction, an amount that is estimated to take years to remove.

The report also looks at the impact on the people of Gaza. More than half the population of Gaza is on the brink of famine and the entire population is experiencing acute food insecurity and malnutrition. Over a million people are without homes and 75% of the population is displaced. Catastrophic cumulative impacts on physical and mental health have hit women, children, the elderly, and persons with disabilities the hardest, with the youngest children anticipated to be facing life-long consequences to their development.

With 84% of health facilities damaged or destroyed, and a lack of electricity and water to operate remaining facilities, the population has minimal access to health care, medicine, or life-saving treatments. The water and sanitation system has nearly collapsed, delivering less than 5% of its previous output, with people dependent on limited water rations for survival. The education system has collapsed, with 100% of children out of school.

The report also points to the impact on power networks as well as solar generated systems and the almost total power blackout since the first week of the conflict. With 92% of primary roads destroyed or damaged and the communications infrastructure seriously impaired, the delivery of basic humanitarian aid to people has become very difficult.

The Interim Damage Assessment Note identifies key actions for early recovery efforts, starting with an increase in humanitarian assistance, food aid and food production; the provision of shelter and rapid, cost-effective, and scalable housing solutions for displaced people; and the resumption of essential services.

About the Gaza Interim Damage Assessment Report

The Gaza Interim Damage Assessment report draws on remote data collection sources and analytics to provide a preliminary estimate of damages to physical structures in Gaza from the conflict in accordance with the Rapid Damage & Needs Assessment (RDNA) methodology. RDNAs follow a globally recognized methodology that has been applied in multiple post-disaster and post-conflict settings. A comprehensive RDNA that assesses economic and social losses, as well as financing needs for recovery and reconstruction, will be completed as soon as the situation allows. The cost of damages, losses and needs estimated through a comprehensive RDNA is expected to be significantly higher than that of an Interim Damage Assessment.

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Re-advertised job of Research Officer II - Internal/External

• Apr 09, 2024
• Addis Ababa, Ethiopia
• International Food Policy Research Institute,IFPRI

The International Food Policy Research Institute (IFPRI) to hire a Research Officer II who will support IFPRI researchers within development and agricultural economics research and contributing to research design and empirical analysis of primary and secondary data in IFPRI’s research areas:  ensuring sustainable food production; promoting healthy food systems; improving markets and trade; transforming agriculture; building resilience; and strengthening institutions and governance.

The Research Officer II will provide research and project-related support to the SAFA project in Ethiopia "Enhancing livelihood prospects for young people in Ethiopia".

IFPRI is one of the international agricultural research institutes organized under the CGIAR Consortium. The mandate of IFPRI is to identify and analyze alternative national and international strategies and policies for meeting world food needs in ways that conserve the natural resource base, with emphasis on low income and on the poorer groups in the countries. With a vision for a world free of hunger and malnutrition, IFPRI’s mission is to provide research-based policy solutions that sustainably reduce poverty and end hunger and malnutrition.

Main duties & responsibilities:

• Provide general research support, including data collection and analysis; preparation of presentation materials; support with manuscript preparation; etc.;
• Manage focus group discussions, key informant interviews, and other qualitative data collection tasks;
• Conduct statistical and econometric analyses;
• Process and synthesize secondary data, conduct advanced statistical analyses and translate the research findings into reports, briefs, articles, periodicals and newsletters;
• Conduct literature reviews and other background analysis to support design of calls for expressions of interest/proposals Draft, edit, and transcribe reports, manuscripts, proposals, and other documents;
• Organize seminars, workshops and other learning events;
• Assist in the preparation of reports and presentations, ensure timely and accurate dissemination of research findings to the relevant government authorities and donor agency;
• Manage routine administrative matters related to impact assessment studies, including communications with study teams;
• Read and critique completed impact studies and impact study designs;
• Communicate research findings to external audiences as appropriate;
• Any other responsibilities assigned by supervisor and/or management.

Minimum Requirements:

• Master’s degree in Economics, Agricultural Economics, or related discipline
• Broad/specialized knowledge of impact assessment methods, techniques, and processes

Experience:

• Five years’ experience after Masters’ degree in a similar position
• Research experience (having worked on seed systems, extension, and technology adoption)
• Experience in knowledge sharing/capacity development
• Proficiency in using statistical packages like Stata, R, and SAS.  In our working environment, Stata is most commonly used; knowledge of R would be a plus;
• Excellent quantitative analytical skills;
• Thorough knowledge of Microsoft Office applications for word processing, spreadsheets; experience with graphics and data management;
• Excellent knowledge of both written and spoken English;
• Prior knowledge of GIS and remote sensing would be advantageous;
• Professionalism and integrity: Able to apply ethics, principles, standards, and expertise in all areas of work; honest, above reproach, appropriate in actions and behaviors, and transparent in conduct;
• Results-oriented: Able to recognize bottlenecks timely and identify solutions; able to meet agreed-upon deadlines and set goals; focused on all tasks;
• Ability and willingness to travel nationally and internationally as necessary;
• Interpersonal relations: Good interpersonal communication and facilitation skills; able to work with and relate to others in mutual support and with respect towards common goals and shared vision; able to build and nurture strong and authentic reciprocal relationships; committed to non-domineering or patronizing attitudes and/or behaviors;
• Respect for diversity: Able to work effectively, respectfully, and inclusively with people from different backgrounds and with different perspectives is critical for all staff members;
• Communication: Able to express oneself, share and exchange information clearly and in a timely style;
• Innovation and creativity: Able to generate new ideas and ways of working to continuously improve existing work processes, practices, concepts.

Duty Station:  Addis Ababa, Ethiopia

Job level:    HG 14.

Monthly Base Salary:

• Birr 54,708 (Negotiable depending on the salary history of the candidate).

Terms of appointment:  This is a National Staff (NS) position and the appointment is fixed term for one year which will be renewable based on performance and funding availability. The ILRI remuneration package for nationally recruited staff in Ethiopia includes very competitive salary and benefits such as life and medical insurance, offshore pension plan, etc. The ILRI campus is set in a secure, attractive campus in Addis Ababa. Dining and sports facilities are located on site.

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Ross Douthat

Opinion Columnist

Scotland’s Censorship Experiment Threatens Free Expression

In 2002, the English journalist Ed West penned an essay entitled “Britain Isn’t a Free Country.” His evidence was straightforward: Through the aggressive enforcement of laws against hate speech, Britain was harassing, investigating and sometimes imprisoning its own citizens, effectively consigning the right to free expression to the dustbin of history.

West’s list of examples, which included some cases involving deeply unsympathetic racists and others that looked more like the criminalization of cultural conservatism, is worth revisiting now that Scotland has passed an especially expansive hate speech statute.

The new Scottish law criminalizes public speech deemed “insulting” to a protected group (as opposed to the higher bar of “abusive”), and prosecutors need only prove that the speech was “likely” to encourage hatred rather than being explicitly intended to do so. One can offer a defense based on the speech in question being “reasonable,” and there is a nod to “the importance of the right to freedom of expression.” But a plain reading of the law seems like it could license prosecutions for a comedian’s monologue or for reading biblical passages on sexual morality in public.

The law has attracted special attention because J.K. Rowling responded to its passage with a series of social media posts about transgender individuals that seemed to fall afoul of the law’s dictates. If they do, she wrote, “I look forward to being arrested when I return to the birthplace of the Scottish Enlightenment.”

My prediction is that neither Rowling nor any figure of her prominence will face prosecution. Rather, what you see in West’s examples is that the speech police prefer more obscure targets: the teenage girl prosecuted for posting rap lyrics that included the N-word or the local Tory official hauled in by the cops after posting to criticize the arrest of a Christian street preacher.

Which is, of course, a normal way for mild sorts of authoritarianism to work. Exceptions are made for prominent figures, lest the system look ridiculous, but ordinary people are taught not to cross the line.

Europe is often depicted as caught between an embattled liberal order and a post-liberal form of populism. But the reality is that there are two incipient European post-liberalisms, both responses to the challenges of managing aging, anxious societies being transformed by mass migration. One is the right-wing politics of national identity; the other is a more technocratic attempt to maintain social peace through a regime of censorship.

Scotland is experimenting with the second option. Both could usher out the liberal age as we have known it.

Lydia Polgreen

Ramy Youssef’s ‘S.N.L.’ Monologue Was a Love Letter to Muslim America

It is a rare thing in our rapidly secularizing country to be confronted with piety and devotion in popular culture. So it was a surprise, and a balm, to watch a man who prays daily and talks openly about his devout faith storm a bastion of earthly godlessness: “Saturday Night Live.”

I am referring, of course, to the comedian Ramy Youssef, who hosted the show on what he described in his opening monologue as “an incredibly spiritual weekend,” noting Ramadan, Easter and the arrival of a new Beyoncé album.

“I’m doing the Ramadan one,” he quipped, to peals of laughter, unspooling a very funny bit about how loving Muslims are. Youssef has mined his experience as a believer among the profane in gentle standup specials and a namesake sitcom. His entire monologue glowed with a welcoming warmth — Muslims, he seemed to say: We’re just like you.

In a country that is supposedly obsessed with diversity and inclusion, it is remarkable how rare it is to hear from a practicing Muslim in America.

Surveys by the Institute for Policy and Understanding, a nonpartisan research organization focused on Muslim Americans, have consistently found that Muslims are the most likely group to report religious discrimination in the United States. According to a Pew survey conducted in 2021, 78 percent of Americans said that there was either a lot or some discrimination against Muslims in our society. Muslims are no more likely to commit crimes than members of any other group, but crimes in which Muslims are suspects get outsized media coverage, research has shown .

It is no surprise, then, that Islamophobia is perhaps the most tolerated form of religious prejudice. Right now, Senate Republicans appear to have persuaded several Senate Democrats to vote against a Muslim judicial nominee after smearing him, with no evidence at all, as an antisemite.

Many of the skits that toyed with religion on “S.N.L.” on Saturday were funny — Ozempic for Ramadan! Genius. But part of me winced through them as well, because I saw in Youssef something that other members of minority groups have had to do to “earn” their place in the safety of the mainstream: the performance of normalcy, of being nonthreatening and sweet, the requirement to prove that your community belongs in America just like everyone else’s.

I loved Youssef’s monologue, in which he bravely pleaded, “Please, free the people of Palestine. And please, free the hostages. All of the hostages.”

“I am out of ideas,” Youssef declared toward the end of his monologue. “All I have is prayers.”

To which this nonbeliever can only say: Same, Ramy. Same.

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Nicholas Kristof

Israel’s Attack on Aid Workers Can Only Make Hunger in Gaza Worse

The Israeli strikes that killed seven aid workers overnight as they tried to avert famine in Gaza will be much debated, but three points seem clear to me.

First, the killings reinforce the widespread criticism that Israeli forces often appear to act recklessly in Gaza, with too little concern for civilian casualties. The latest deaths were unusual in that they included foreigners, even an American, but there is nothing new about Israeli strikes killing aid workers in Gaza: At least 196 humanitarian workers have been killed in Gaza and the West Bank since the war began in October, the United Nations says.

Second, the tragedy will compound the hunger crisis in Gaza that is already leading to deaths from starvation and risking both famine and epidemics. The result is that just as famine looms and children are dying, international efforts to ease it may be reduced, not amplified.

Third, Israeli credibility will take another hit, and America’s with it. Some elements of the Israeli narrative are entirely accurate: Hamas started the latest round of fighting and uses civilians as human shields. But Israel also argues that it is doing everything possible to reduce civilian casualties, and that is hard to argue in this case — and this is also an embarrassment for the Biden administration, which provides an endless flow of weaponry for airstrikes like these (although the origin of the particular weapons that killed these seven workers is unclear for now).

The seven people worked with World Central Kitchen, a charity founded by chef José Andrés, and were in clearly marked vehicles . The nonprofit group, which has now suspended its aid efforts in Gaza, said that it had cleared its movements with Israeli forces, and The Financial Times reported that the vehicles were hit over a two-kilometer stretch, implying targeting by multiple strikes rather than a single errant missile. Prime Minister Benjamin Netanyahu of Israel has promised an investigation.

The killing of humanitarians puts aid groups in an impossible situation. The organizations focus on easing suffering, yet they also must look after the safety of their own people. If Israel continues to kill aid workers at such a pace, it will be very difficult to distribute aid to the people who need it.

And increasingly, it may be essential to have trained aid workers to provide special emergency foods to children with severe acute malnutrition. All that is now uncertain.

The Biden administration is issuing tougher statements about the situation, but President Biden still seems unwilling to use his leverage to press Israel to ease up. Politico reported on Monday that the U.S. government is considering a major new weapons sale to Israel.

Michelle Cottle

Opinion Writer

An Abortion Rights Vote May Not Be Enough for Biden in Florida

Just when you thought it was safe to ignore Florida politics, up pops the state Supreme Court with an abortion-rights decision seemingly designed to provoke electoral turmoil this year.

The court allowed a six-week abortion ban to go into effect while ruling that Floridians can vote in November on a state constitutional amendment to protect abortion access before fetal viability (around 24 weeks). The combined rulings immediately shoved reproductive rights to the political front lines. But how will things shake out in this increasingly red state ? And not to make everything about the presidential race, but how much could it help President Biden?

The issue of reproductive rights has been a boon to Democrats pretty much everywhere it has appeared on the ballot, directly or otherwise, since the death of Roe v. Wade. And there’s reason to be optimistic that Florida’s amendment will succeed as well. Though passage requires at least 60 percent support, a November poll by the University of North Florida put support at 62 percent, including 53 percent of Republicans. And that was before things got real with the court ruling.

But can this new wrinkle save Biden there? I mean, this is Florida. The state didn’t show him the love in 2020, and more generally, its Democratic Party has been a hot mess for several years. Registered Republicans now outnumber Democrats by nearly one million . In 2022, Floridians re-elected Gov. Ron DeSantis with almost 60 percent of the vote. Ron. DeSantis .

More troubling, Republican state lawmakers have shown themselves happy to thwart the will of the public to tilt the field in their team’s favor. (See: voting rights of felons who have completed their sentences.) And it is the adopted — and spiritual — home of perhaps the ultimate Florida Man, Donald Trump. (When thinking of the MAGA king kicked back in his so-called Southern White House, I like to picture him with a state-appropriate mullet.)

With the proper mix of sweat and strategy, abortion rights advocates and Dems should be able to save reproductive rights in the state — not to mention force Republicans to burn time and cash there. But pry it away from Trump? That feels like a reach.

Zeynep Tufekci

A Farm Worker With Avian Flu Means a Rapid Response Is Urgent

The discovery of the country’s second human case of H5N1 avian flu, found in a Texas dairy farm worker following an outbreak among cows, is worrying and requires prompt and vigorous action.

While officials have so far said the possibility of cow-to-cow transmission “cannot be ruled out,” I think we can go further than that.

The geography of the outbreak — sick cows in Texas, Idaho, Michigan, Ohio and New Mexico — strongly suggests cows are infecting each other as they move around various farms. The most likely scenario seems to be that a new strain of H5N1 is spreading among cows, rather than the cows being individually infected by sick birds.

Avian flu is not known to transmit well among mammals, including humans, and until now, almost all known cases of H5N1 in humans were people in extended close contact with sick birds. But a cow outbreak — something unexpected , as cows aren’t highly prone to get this — along with likely transmission between cows, means we need to quickly require testing of all dairy workers on affected farms as well as their close contacts, and sample cows in all the dairy farms around the country.

It is possible — and much easier — to contain an early outbreak when an emergent virus isn’t yet adapted to a new host and perhaps not as transmissible. If it gets out and establishes a foothold, then all bets are off. With fatality rates estimated up to 50 percent among humans, H5N1 is not something to gamble with.

Additionally, H5N1 was found in the unpasteurized milk of sick cows. Unpasteurized milk, already a bad idea, would be additionally dangerous to consume right now.

Public officials need to get on top of this quickly, and transparently, telling us the uncertainties as well as their actions.

The government needs to gear up to potentially mass-produce vaccines quickly ( which we have against H5N1 , though they take time to produce) and ensure early supplies for frontline and health care workers.

It’s possible that worst-case scenarios aren’t going to come true — yet. But evolution is exactly how viruses get to do things they couldn’t do before, and letting this deadly one have time to explore the landscape in a potential new host is a disastrously bad idea.

Mike Johnson Is Trying to Explain Simple Math to the Far Right

I come today not to bury Mike Johnson, but to praise him.

No. Seriously. I mean it.

Johnson, the House speaker, sat down with Trey Gowdy of Fox News over the weekend to discuss “realistic expectations” for Republicans in this era of narrowly divided government.

Quipping that he was there as an “ambassador of hope on Easter Sunday,” Johnson offered “three simple things” his party should be focusing on: No. 1, “Show the American people what we’re for. Not just what we’re against.” No. 2, “We have to unite. We have to stand together.” And No. 3, “We’ve got to drive our conservative agenda and get the incremental wins that are still possible right now.”

Nos. 1 and 2 are the sort of meaningless boilerplate politicians are forever blathering about. But No. 3 was clearly the core message of his mission, and he really leaned in, repeatedly noting that his team’s right-wingers — with whom he has long identified, mind you — need to come to terms with the political reality of holding “the smallest majority in U.S. history.”

“We got to realize I can’t throw a Hail Mary pass on every single play,” he said, with that mild manner and beatific smile that makes him seem thoughtful and genial even when he’s speaking harsh truths. “It’s three yards and a cloud of dust. Right? We’ve got to get the next first down. Keep moving.”

Southerners do love their football metaphors.

When asked about Representative Marjorie Taylor Greene’s motion to remove him, he acknowledged that she is “very frustrated” with how certain negotiations have gone of late, especially when it comes to spending. “Guess what? So am I,” he said. But with Republicans clinging to the majority by their fingernails, “we’re sometimes going to get legislation that we don’t like.”

This kind of squish talk isn’t very MAGA. And working with Dems is what got the previous speaker kicked to the curb. (Poor Kev.) But Johnson is in some ways in a better spot than was Kevin McCarthy. A smattering of Democrats have suggested they would save Johnson from a coup attempt, especially on a key issue such as funding Ukraine. Plus, ousting another speaker so soon would only lock in House Republicans’ rep as a bunch of hopeless chaos monkeys — not a shrewd move in an election year.

This is not to say that Johnson is shaping up to be an effective or competent speaker. But it takes a certain courage to talk reality — and math — to today’s House Republicans. Kudos to him for going there.

David French

There’s Valuable Speech on Social Media, Even for Kids

Last week I wrote a rather long column arguing that blanket bans on social media for children are a bad idea, even if you are persuaded (as I am) that smartphones and social media are a significant reason for increasing childhood mental health struggles. My basic point was simple: The First Amendment rights of children and adults are too precious to diminish, especially when there are less restrictive alternatives for combating the problem.

I received an enormous amount of helpful feedback, but I want to briefly highlight one response. The American Enterprise Institute’s Brad Wilcox posted a thread on X that began like this: “Could not disagree more w/ @DavidAFrench here, partly because he doesn’t fully ack how much the teen problem w/ social media is not just about the message(s) but the *medium* itself. Social media does not function like some debating society for teens.”

I respect Wilcox greatly, and he’s got many valuable things to say about kids and social media, but he’s wrong in one key respect: Social media is, in fact, a debating society for teens, just as it is for adults. It’s often a miserable and contentious debating society, but social media is where an immense amount of our nation’s substantive debates takes place. Kids debate one another, and they read adult debates.

Protecting political speech is a core purpose of the First Amendment. As the Supreme Court held in Garrison v. Louisiana , “Speech concerning public affairs is more than self-expression; it is the essence of self-government.” One reason children enjoy First Amendment rights is that they are essentially citizens in training. They have to learn how to engage in political debate.

There are certainly issues with the medium itself, and there are ways to combat the pernicious effects of the medium without obliterating access to the content. The First Amendment, for example, permits reasonable and content-neutral restrictions on the time, place and manner of freedom of expression, and it’s easy to see a valid ban on smartphones during school hours. It’s also worth considering whether certain features of social media — such as infinite scroll — could be limited.

But it’s important to note that time, place and manner restrictions can’t function as a form of disguised content discrimination. If you’re looking for reasons to ban social media because of what’s on the platform, then you’re playing a dangerous constitutional game.

Jessica Grose

The Christians Who Aren’t Buying Donald Trump’s Sales Pitch

Last week, former President Donald Trump hawked his “God Bless the USA Bible” in a video posted to social media , stating “we must make America pray again.” In a story published today, The Times’s Michael C. Bender notes that Trump — despite a background few would call pious — “is framing his 2024 bid as a fight for Christianity, telling a convention of Christian broadcasters that ‘just like in the battles of the past, we still need the hand of our Lord.’”

A new report on religious change in the United States from The Public Religion Research Institute suggests that Trump’s attempts to tie Christianity tightly to a particular set of Republican political values may be turning some Americans away from Christianity.

P.R.R.I. surveyed Americans who left their childhood religions to become “unaffiliated,” a group that includes people who call themselves atheists, agnostics and nothing in particular. The vast majority of people who become unaffiliated are Christians. While the largest percentage say they left religion because they no longer believe the religion’s teachings, 47 percent of those who became unaffiliated say they did so because of negative treatment or teaching about L.G.B.T.Q. Americans, and 20 percent say they became unaffiliated because their church or congregation became too focused on politics.

“Among white Christian groups, the largest decline in the past decade took place among white evangelical Protestants, whose numbers saw a 3 percentage point decrease, from 17 percent in 2013 to 14 percent in 2023. In 2023, the percentages of white mainline/non-evangelical Protestants (14 percent) and white Catholics (12 percent) remain largely similar to those of 2013,” according to P.R.R.I.’s survey. Trump has frequently and closely aligned himself with white evangelical Christians.

P.R.R.I.’s findings align with what I learned last year when reporting on those leaving religion. As one woman I spoke to put it, she became less religious “because evangelicals became apostates who worship Trump, nationalism and the Republican Party.” Trump promoting a Bible is just another example of his modus operandi: He may make a quick buck, but at what cost to the institution in the long run?

Whether it’s a political or religious institution, the outcome always appears to be the same.

Patrick Healy

Deputy Opinion Editor

Have Swing Voters Stopped Listening to Joe Biden?

Every Monday morning on The Point, we kick off the week with a tipsheet on the latest in the presidential campaign. Here’s what we’re looking at this week:

One of the worst things that can happen to a president seeking re-election is to have voters stop listening to you. As the campaign unfolds this week, I’m curious whether President Biden says or does things that really command attention from voters, and in particular might be persuasive to swing voters.

My curiosity stems from reading the latest polls and my colleague Nate Cohn’s article on Saturday. This is how Nate summed up Biden’s standing in the race since his strong State of the Union speech on March 7: “It has gotten harder to see signs of any Biden bump. Taken together, new polls from Fox , CNBC and Quinnipiac suggested that the presidential race was essentially unchanged, with Mr. Trump still holding a narrow lead nationwide. The president’s approval rating doesn’t seem discernibly higher, either.”

Now, State of the Union speeches themselves rarely produce a bump. But Biden was a new man in March, with a sharper message, lots of campaigning, strong ads and any number of Trump comments to whack. Yet we enter April with Trump in a narrow lead.

Something is not working for Joe Biden right now. Trump is behind him in campaign money , tied up in court, making crazy comments and posting videos showing Biden hogtied. For all that, Biden doesn’t seem to have changed large numbers of minds. Are voters still listening to the president?

Previous presidents who lost re-election, including Trump, George H.W. Bush and Jimmy Carter, struggled to persuade voters they were effective and sympathetic. In their own ways, the three men were seen as all talk, no action, and that’s what some progressive Democrats and young voters think about Biden’s handling of the war in Gaza. While his administration is talking tougher about Prime Minister Benjamin Netanyahu of Israel, the bombs keep falling on Gaza (and more American bombs are on the way) and the aid keeps being blocked from reaching starving people.

And it’s not just Gaza: It’s immigration, abortion rights and, especially, the economy. Nate Silver had a striking chart last week showing how “even as consumer and investor sentiment has improved, President Biden’s approval rating hasn’t , or at least it hasn’t by much .”

Right now, Biden doesn’t have the same galvanizing, persuasive political narrative for swing voters that he had in 2020 — I think Trump nostalgia is very real — nor does he have the results enough voters want. Some voters have already written him off because of his age. But I think the bigger threat to re-election is that more voters will stop listening to him if he doesn’t offer a stronger narrative and stronger results.

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Impact of malnutrition on the academic performance of school children in Ethiopia: A systematic review and meta-analysis

Aregash abebayehu zerga.

1 Department of Nutrition, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

Sisay Eshete Tadesse

Fanos yeshanew ayele, segenet zewdie ayele.

2 Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia

This study aimed to identify the impact of malnutrition on the academic performance of children in Ethiopia.

The protocol of this study is registered in PROSPERO with a registration number CRD42021242269. A comprehensive search of studies from HINARY, MEDLINE (via PubMed), EMBASE, Cochrane Library, SCOPUS, Google Scholar, and Google was conducted. All published and unpublished studies conducted about the effect of any forms of malnutrition on academic performance of elementary school children in Ethiopia using the English language were included. Quality of the articles was assessed using the Joanna Briggs Institute critical appraisal tool. The pooled log odds ratio with 95% confidence interval was determined to identify the effect of malnutrition on academic performance. I-square statistics was applied to check the degree of heterogeneity between studies. The presence of publication or small study bias had been assessed by Funnel plots, Egger’s weighted regression test, and Begg’s rank correlation test.

A total of 10 studies were included in this study. The pooled prevalence of good academic performance among elementary school students in Ethiopia was 58% (95% confidence interval: 48%, 69%). Stunting (odds ratio = 0.48; 95% confidence interval: 0.30, 0.79), underweight (odds ratio = 0.38; 95% confidence interval: 0.27, 0.53), and iodine deficiency (odds ratio = 0.49; 95% confidence interval: 0.31, 0.78) had a significant association with the academic performance. Rural residence (odds ratio = 0.61; 95% confidence interval: 0.44, 0.83), being female (odds ratio = 0.53; 95% confidence interval: 0.37, 0.77), and uneducated parent (odds ratio = 0.51; 95% confidence interval: 0.44, 0.58) were also factors associated with good academic performance of primary school children in Ethiopia.

Conclusion:

This study concluded that malnutrition in the form of stunting, underweight, and iodine deficiency affected the academic performance of elementary school children in Ethiopia. So, the Ministry of Health worked better to strengthen the nutrition intervention at the critical periods of brain development.

Introduction

Malnutrition refers to deficiency, excess, or an impaired utilization of one or more essential nutrients. 1 It consists of both under and over-nutrition. 2 Undernutrition includes wasting, stunting, underweight, and micronutrient deficiencies. 3 Malnutrition in any of its forms is a significant public health problem. 4 Globally, 29.8% of school-age children have insufficient iodine intake. 5 In India, 54% of school children were under-nourished. 6 In Africa, the prevalence of iodine deficiency among school-age children was 39.3%. 7 In Ethiopia, the prevalence of wasting, underweight, and stunting among primary school children were 17.7%, 18.2%, and 21.3%, respectively. 8 Malnutrition has substantial effects on the neurological development and behavioral capacity of children. 9 Thus, malnourished children may never reach their full scholastic potential. Malnutrition among school age can result in impaired cognitive and motor development, which may undesirably upset academic performance through reduced learning capacity and poor school attendance. 10 , 11

Concurrent with malnutrition, quality of education is a big challenge in Ethiopia. 12 One of the sustainable development goals agenda is inclusive, equitable, and quality education. 13 Ethiopia is doing well in terms of enrollment and coverage of universal primary education. But the total score of grade 8 students has consecutively decreased from 41.1% in 2000 to 35.3% in 2010. 14 The dropout rate, grade repetition, and completion rate of elementary school student was 13.9%, 5%, and 71%, respectively. 15 A qualitative study reported that teachers have complained about their students’ poor academic performance in school. 12 Hence, poor academic achievement has been the main concern for teachers, parents, and students.

Academic performance can be affected by gender, age, residence, study hours, absenteeism, socio-economic status, illness, medium of instruction, and malnutrition. 16 – 18 Malnutrition is the main factor for poor academic performance and contributed to the development of other factors. 19 , 20 Studies showed that malnutrition among school-age children is a risk factor for high absenteeism, early dropouts, low school enrollment, and unsatisfactory classroom performance. 21 , 22

Efforts such as School Feeding Program have been made to improve the nutritional status, enrollment, attendance, retention, and completion rate of students. 23 – 25 However, still many school children suffer from poor nutrition and academic achievement. 22 In Ethiopia, studies investigated the effect of malnutrition on the academic performance of primary school children, but there is an inconsistency between their findings. For instance, a study from Dera District and southern Ethiopia reported that stunting was not a factor for academic performance. 26 , 27 Whereas studies from northwest Ethiopia and Lalibela stated that stunting and being underweight were factors for poor academic performance. 28 , 29 There is no nationally representative information on the effect of malnutrition on the academic performance of primary school children. The evidence generated by this study design would be stronger than individual studies to influence policymakers. 30 , 31 Therefore, this study aimed to determine the impact of malnutrition on the academic performance of primary school children in Ethiopia. “Does malnutrition affect the academic performance of elementary school children in Ethiopia?” was the research question of this study.

Materials and methods

Study design, search strategy, and protocol registration.

Systematic review and meta-analysis (SRMA) study design was applied for this study. The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guideline was applied to report this SRMA. 32 An extensive search of studies from HINARY, MEDLINE (via PubMed), EMBASE, Cochrane Library, SCOPUS, Google Scholar, and Google was done. “Nutritional status” OR “malnutrition” OR “under-nutrition” OR “stunting” OR “wasting” OR “underweight” OR “height-for-age z score” OR “weight-for-age z score” OR “weight-for-height z score” OR “iron deficiency” OR “iodine deficiency” AND “academic performance” OR “school performance” OR “school achievement” OR “academic achievement” OR “educational performance” AND “primary school children” OR “elementary school children” OR “student” AND “Ethiopia” were used as key terms. The search was undertaken from 1 February to 23 March 2021. This SRMA was registered in PROSPERO with a registration number CRD42021242269.

Inclusion criteria

All published and unpublished observational studies about the effect of malnutrition on the academic performance of elementary school children in Ethiopia were included. Under-nutrition among primary school children were the exposure variable. Normal nutrition among primary school children was the comparison variable/group for this study. Studies assessed academic performance of primary school children using at least two-semester average scores as a primary outcome were included. To get a more comprehensive result, no restriction was made by the year of publication (studies published until 23 March 2021 were included).

Exclusion criteria

Review articles, conferences, abstracts, editorials, and descriptive studies were excluded from this study. We also excluded studies that did not report the outcome of interest and at least one form of malnutrition.

Study selection and data extraction

The article searches and screening activity was performed by two reviewers (AAZ and SET). Articles were exported and managed using Endnote X8 software. Duplicates were identified and removed from the citation manager. Then the remaining articles were assessed for eligibility by title, abstract, and full-text level. Studies conducted out of Ethiopia and with unrelated topics were excluded. Then the abstract and full document of remaining articles was examined. Those studies that were not eligible based on the full-text assessment were excluded and reasons were described. 32 Studies that passed through this selection process were included in the review.

A data extraction sheet was developed using Microsoft Excel worksheet 2013 and the following variables were extracted from each eligible article:

• Study characteristics: name of first author, year of publication, region, study area, study design, and sample size.
• Outcome (number of children with good academic performance) and independent variables (count data with 2 × 2 table, and odds ratio (OR) with 95% confidence interval (CI; where count data not available)).

Quality assessment

The Joanna Briggs Institute (JBI) 33 critical appraisal tool was used to assess the quality of each paper. The tool has Yes, No, Unclear, and “not applicable” answers. A value was given 1 for “Yes” and 0 for “No” and “Unclear” responses. Three investigators (AAZ, FYA, and SZA) independently performed the quality assessment using the JBI criteria. Scores of each item were summed and converted into percentages. The quality scores of the three reviewers were averaged. Disagreement between investigators was solved by discussion and consensus. Agreement between the investigators were determined and there was substantial agreement (kappa = 0.77). 34 Finally, studies with higher scores (> 50%) were included in this SRMA.

Outcome assessment

The main objective of this study was to identify the effect of malnutrition (stunting, underweight, wasting, and micronutrient deficiency) on academic performance in log OR form. In addition to malnutrition, socio-demographic variables such as place of residence, educational status of the family (no-formal education versus formal education), student sex (male versus female), family size (⩾ 5 versus < 5), and income (low versus high) were extracted.

Statistical analysis

The extracted data were exported to STATA version 14.0 for the meta-analysis. The pooled prevalence was calculated to estimate the prevalence of good academic performance. The pooled log OR and its 95% CI was determined to identify the effect of malnutrition on the academic performance of primary school children. Heterogeneity was checked by Higgins’s I-square statistics in which I-square value of > 75%, 50% to 75%, and < 50% was reported as high, moderate, and low heterogeneity, respectively. 35 A random effect model with 95% CI was used to report heterogeneous findings. Meta-regression, subgroup analysis, and sensitivity analysis were conducted to identify the possible sources of heterogeneity. Publication bias was visually identified by funnel plots. The funnel plot asymmetry was statistically checked using Egger’s and Begg’s test. The visual asymmetry of the funnel plot and p-value < 0.05 of the Egger’s and Begg’s test was suggestive of publication bias. 35 , 36 Then, trims and fills analysis was conducted to deal with publication bias. Finally, data were presented in tables and figures.

Study selection and characteristics

A total of 1906 articles were retrieved by literature search. Of these, 398 were excluded because of duplication, 1490 did not have relation with the aim of the study, and 8 did not meet the eligibility criteria due to differences in outcome classification, 37 outcome measurement, 26 target population 38 , 39 and we cannot get the 2 × 2 table and the OR. 40 , 41 Finally, 10 articles were included in this SRMA ( Figure 1 ). All included articles were full text and done using a cross-sectional study design with one prospective cohort. 42 A total of 5626 students participated in the study with a minimum of 273 43 and a maximum of 1254 44 sample population. Studies were obtained from three regions of Ethiopia; Amhara, Oromia, and Southern Nations, Nationalities, and People (SNNP) region that published or posted from 2013 to 2021 ( Table 1 ).

PRISMA flow diagram of included studies in systematic review and meta-analysis of the impact of malnutrition on academic performance of primary school children in Ethiopia from 2013 to 2021.

Characteristics of studies included in this systematic review and meta-analysis about the impact of malnutrition on the academic performance of primary school children in Ethiopia from 2013 to 2021.

SNNP: Southern Nations, Nationalities, and People.

Pooled prevalence of good academic performance

The pooled estimate indicated that 58% (95% CI: 48%, 69%) of elementary school students have good academic performance in Ethiopia. The true heterogeneity among studies other than chance was 98.6% (I 2  = 98.6%, p-value < 0.001). The highest frequency was reported from Lalibela, Amhara region 85% (95% CI: 82%, 88%) and the lowest was from Meskan, SNNP region 32% (95% CI: 27%, 37%; Figure 2 ).

Forest plot for pooled prevalence of good academic performance among elementary school children in Ethiopia, 2013–2021.

Subgroup analysis

Based on the subgroup analysis, the academic performance was highest in Oromia 69% (95% CI: 59%, 78%) followed by Amhara 62% (95% CI: 42, 83%) and then SNNP 42% (95% CI: 32%, 52%). However, the I-square value was still high in each region. Hence, region is not the source of heterogeneity ( Figure 3 ).

Subgroup analysis by region for the pooled good academic performance of elementary school children in Ethiopia, 2013–2021.

Meta-regression and sensitivity analysis

Meta-regression was conducted by including sample size and publication year. But all of these variables were not the sources of heterogeneity (p > 0.05). Sensitivity analysis indicated that there was no study that influences the pooled effect ( Figure 4 ).

Sensitivity analysis for the academic performance of elementary school children in Ethiopia, 2013–2021

Test for publication bias

Visual observation of the funnel plot indicated the presence of some publication bias ( Figure 5 ). However, it was statistically disproved by the Egger’s (p = 0.96) and Begg’s test (p = 0.72).

Funnel plot to detect the presence of publication bias regarding the pooled prevalence of good academic performance among elementary school children in Ethiopia, 2013–2021.

Factors associated with academic performance

Stunting (OR = 0.48; 95% CI: 0.30, 0.79), underweight (OR = 0.38; 95% CI: 0.27, 0.53), and iodine deficiency (OR = 0.49; 95% CI: 0.31, 0.78) had significant negative association with good academic performance. Similarly rural residence (OR = 0.61; 95% CI: 0.44, 0.83), being female (OR = 0.53; 95% CI: 0.37, 0.77), and non-formal educated parent (OR = 0.51; 95% CI: 0.44, 0.58) had significant negative association with good academic performance of Ethiopian primary school children ( Table 2 ).

Factors associated with academic performance among elementary school children in Ethiopia, 2013–2021.

OR: odds ratio; CI: confidence interval.

This SRMA aimed to generate pooled evidence on the impact of different forms of malnutrition on the academic performance of elementary school children in Ethiopia. This study reported that the odds of good academic performance were 57% lower among stunted children than not stunted children. It is similar to studies from Burkina Faso, Vietnam, Benin, and a multi-country cohort study. 49 – 53 This is because stunting is often occurred within the first 1000 days of a child’s life (from conception up to the first 2 years of life) which is a period of children’s rapid brain development takes place. 54 , 55 Once occurred, stunting causes tissue damage, impaired differentiation, delayed myelination, and limited overall development of the brain. 56 , 57 Then it results in aberration of the temporal sequences of brain maturation and the foundation of neuronal circuits. 9 As a result, the brain’s cognitive process, motor and language development will be limited and causes a long-term permanent impact on academic performance of children. 58 This study reported that being underweight reduces the academic performance of children by 68%. However, a study from Bennin reported that underweight cannot affect the cognitive development of children. 51 Since most researchers focus on the effect of stunting on the academic performance, there is no adequate review to compare and set conclusion about underweight.

In this study, good academic performance was 50% lower among iodine-deficient children than in iodine-sufficient children. Similarly, most reviews reported that iodine deficiency is a risk factor for academic performance. 59 – 61 Iodine is an essential micronutrient needed for production of thyroid hormones. 62 Thyroid hormone is necessary for many body processes such as thermal and metabolic regulation, organ and neurological development, and function of the central nervous system by regulating the genetic expression and cell differentiation of the brain. 63 – 65 Therefore, iodine deficiency significantly lowers cognitive capacities ranging from mental retardation to impaired development of intelligence and academic performance. 59 Although iodine deficiency at early age poses irreversible damage, studies conducted among school-age children showed that iodine supplementation can still improve cognitive abilities. 66 , 67 So, iodine fortification should be strengthened to improve the academic performance of primary school children in Ethiopia. 66

In this review, students from rural residences had a lower academic performance than those from urban areas. This finding is in agreement with a policy-brief report of Ethiopia. 68 In contrast to this study finding, a review conducted on rural and urban areas reported that rural students had a better academic performance than urban students. 69 Then again, a study from Benin showed that place of residence had no association with academic performance. 51 This discrepancy might be due to the sociocultural difference between countries.

In this review, the odds of good academic performance were lower among girls than boys. This might be because better preferences had been given to boys and girls are often faced with the burden of household tasks, which hinders their ability to perform successfully at school. However, a review from the global north and south reported that girls were better in academic performance. 69 In addition, a systematic review in Trinidad and Tobago stated that females had better performance than males. 70

In this study, parents’ educational level had a significant association with the academic performance of primary school children. Students from non-educated parents were less likely to have good academic performance than students from formally educated parents. This finding was in agreement with a study from Benin. 51 This might be because children from uneducated parents get less support on doing assignments, project work, homework, class work, and other academic and social issues. Conversely, children from highly educated parents may consider their parents as role models for their academic success. 71

Limitation of the study

This study had the following limitations; first, this meta-analysis represented only studies reported from three regions of Ethiopia. Second, it was limited to articles written in the English language only. Third, the result was highly heterogeneous. Fourth, almost all of the included studies were cross-sectional, which may not show the cause–effect relationships. Fifth, due to the shortage of individual studies, this study cannot assess the effect of iron deficiency on academic performance.

Strength of the study

This review tried to include both published and unpublished studies.

This SRMA concluded that stunting, underweight, and inadequate iodine intake had a significant impact on the academic performance of children. Also being female, rural residents, and from uneducated parents had a negative association with academic performance of children in Ethiopia. So, the Ministry of Health worked better to strengthen the nutrition intervention at the critical periods of brain development. In addition, to improve the nutritional status and the related academic performance of elementary school children, the Ministry of Education enhanced the coverage of school feeding programs by emphasizing rural children, girls, and uneducated parents. Further research is recommended on the effect of iron deficiency/iron deficiency anemia on the academic performance of school children in Ethiopia.

Acknowledgments

We would like to acknowledge Wollo University, College of Medicine and health sciences, School of public health for providing us with basic training on SRMA.

Author contributions: All authors contributed to data analysis, drafting, and revising the article, gave final approval of the version to be published, and agreed to be responsible for all aspects of the work.

Data availability: All the required data are included in the manuscript.

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval: Ethical approval for this study was obtained from Wollo University, College of Medicine and Health Sciences Ethical Review Committee (CMHS 857/13/13).

Funding: The author(s) received no financial support for the research, authorship, and/or publication of this article.

Gaza Infrastructure Damages Estimated at $18.5 Billion in UN-World Bank Report

A views shows the damaged Al Shifa Hospital after Israeli forces withdrew from the hospital and the area around it following a two-week operation, amid the ongoing conflict between Israel and Hamas, in Gaza City April 2, 2024. REUTERS/Dawoud Abu Alkas

By Ismail Shakil and Kanishka Singh

WASHINGTON (Reuters) -The Gaza Strip suffered about $18.5 billion in damages to critical infrastructure in the first four months of the Israeli bombardment launched in response to the Oct. 7 Hamas attacks, according to a joint World Bank and the United Nations report released on Tuesday.

The interim damage assessment report, which received financial support from the European Union, estimates the damages are equivalent to 97% of the combined GDP of the West Bank and Gaza in 2022 and left 26 million tons of debris and rubble that would take years to remove.

WHY IT IS IMPORTANT

War in Israel and Gaza

The report details the scale of infrastructure destruction in the Israel-Gaza war and the dire state of the population in the narrow coastal enclave where health facilities have been shattered, the population is starving and aid work is hampered.

BY THE NUMBERS

The report found that damage to structures affects every sector, with housing accounting for 72% of the costs and public service infrastructure such as water, health, and education accounting for 19%, according to a statement from the World Bank.

Over a million people are without homes and 75% of the population is displaced, the World Bank said, adding that more than half the population of Gaza is on the brink of famine and the entire population is experiencing acute food insecurity and malnutrition.

"Catastrophic cumulative impacts on physical and mental health have hit women, children, the elderly, and persons with disabilities the hardest, with the youngest children anticipated to be facing life-long consequences to their development," the World Bank said.

Palestinian Islamist group Hamas attacked Israel on Oct. 7, killing 1,200 people and taking 253 hostages, according to Israeli tallies. Israel's subsequent military assault on Hamas-governed Gaza has killed over 32,000 people, according to the local health ministry, displaced nearly all of its 2.3 million population, put Gaza on the brink of starvation and led to genocide allegations that Israel denies.

Israel says it is targeting Hamas militants who use civilian buildings, including apartment blocks and hospitals, for cover. Hamas denies doing so. Israeli leaders have said Hamas can end the war by surrendering, freeing all hostages it holds in Gaza and handing over for trial those involved in the Oct. 7 attack.

(Reporting by Kanishka Singh and Ismail Shakil; Editing by Caitlin Webber and David Gregorio)

Copyright 2024 Thomson Reuters .

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