5. Resultados
5.1 Presentación y discusión de resultados
5.1.1 Caracterización de la Mipyme
With regard to achievement of the underweight target of the MDGs, the table below shows the current status of underweight among children under five in ASEAN Member States and highlights which countries achieved the MDG target and which did not, based on the latest available data.
53 Viet Nam Multiple Indicator Cluster Survey (MICS) 2011.
Table 2: Prevalence of underweight in children under five in ASEAN Member States
Country Prevalence Underweight MDG target 1c Country Prevalence Underweight MDG target 1c
Brunei Darussalam 11% Data not
available Myanmar 23% After 2025
Cambodia 24% By 2018 Philippines 20% After 2025
Indonesia 20% By 2020 Singapore Data not
available availableData not
Lao People’s Democratic Republic 27% After 2025 Thailand 9% Achieved
Malaysia* 12% Achieved Viet Nam* 15% Achieved
Note: Countries have been colour-coded, based on the status for achieving the MDG target for underweight (Red: target not achieved, Yellow: on track to halve underweight before 2025, Green: target achieved). Assessments in column “MDG target 1c” originate from the Global Nutrition Report’s assessment of trends and status, which is based on data from WHO’s global targets tracking tool (available at http://www.who.int/nutrition/trackingtool/en/).35
Data updated to November 2015. Sources used for this figure: Brunei Darussalam (NHANNS 2012), Cambodia (2014 CDHS), Indonesia (Indonesia Basic Health Survey, RISKESDAS, 2013), Lao People’s Democratic Republic (Lao social indicator survey LSIS (MICS/DHS) 2012), Malaysia (NHMS 2015), Myanmar (MICS 2009–2010), Philippines (8th National nutrition survey Philippines 2013), Thailand (MICS 2012), Viet Nam (Nutrition surveillance profiles 2014). National data (with a few exceptions) originate from various household surveys included in the WHO/UNICEF/World Bank joint monitoring estimates 2015. Data for Singapore not available.
Wasting
In the ASEAN Member States, acute malnutrition remains an enormous challenge, with 5.4 million children estimated to be wasted (prevalence). Wasting is above the threshold of public health significance (5%) in 8 out of 10 ASEAN Member States (Figure 8). In many countries, prevalence figures for wasting have been stagnant during the last years, as in the case of Cambodia (decrease from 11% to 10% between 201054 and
201445), Indonesia (decrease from 15% to 12% between 199555 and 201347), Philippines (from 9% to 8%
between 199256 and 2013–1444), Thailand (increase from 5% to 6.7% between 200657 and 201241) and Viet
Nam (increase from 6% to 7% between 198758 and 201448).
Figure 8: Prevalence of wasting in children under five in ASEAN Member States
Note: Data updated to November 2015. The specific year of the survey is given in parenthesis. Sources used for this figure: Brunei Darussalam (NHANNS 2012), Cambodia (2014 CDHS), Indonesia (Indonesia Basic Health Survey, RISKESDAS, 2013), Lao People’s Democratic Republic (Lao social indicator survey LSIS (MICS/DHS) 2012), Malaysia (NHMS 2015), Myanmar (MICS 2009–2010), Philippines (8th National nutrition survey Philippines 2013), Thailand (MICS 2012), Viet Nam (Nutrition surveillance profiles 2014). National data (with a few exceptions) originate from various household surveys included in the WHO/UNICEF/World Bank joint monitoring estimates 2015. Data for Singapore not available.
* Newest data from Malaysia and Viet Nam not yet included in the global WHO/UNICEF/World Bank joint monitoring estimates 2015. 15 10 5 0 12 Indonesia (2013) 8 8 8 7 7 6 3 Per cen tage of childr en under fiv e (%) Cambodia (2014) Mala ysia (2015) * Myanmar (2009/10)Philippines (2013) T hailand (2012) Viet Nam (2014) * Lao PDR (2011/12) Brunei (2012) Prevalence of wasting > 5% (pink line): public health significance 10
54 Cambodia Demographic and Health Survey (CDHS) 2010. Demographic and Health Surveys. Phnom Penh, Cambodia and Calverton,
Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011 (and additional analysis). Source: JME database.
55 Indonesia multiple indicator cluster survey (MICS) 1995. Jakarta: UNICEF, 1997 (preliminary results provided by the Centres for Disease
Control and Prevention; and additional analysis). Source: JME database.
56 The 1992 regional nutrition survey (1994). Food and Nutrition Research Institute. Manila, Philippines; (and additional analysis). Source:
JME database.
57 National Statistical Office, Government of Thailand (2006). Thailand multiple indicator cluster survey (MICS) 2005–2006, Final report.
Bangkok, Thailand.
It is important to analyse both prevalence and burden of disease (number of cases59) by geographic area
when analysing wasting. In many instances, the areas with the highest prevalence might not overlap with the areas with the largest number of cases. This should be taken into consideration when prioritizing and planning interventions. In ASEAN Member States, the annual caseload of children suffering from severe wasting each year is approximately 4.3 million (annual expected caseload obtained through applying an incidence correction factor – see Figure 9). Globally, severely wasted children are nearly 12 times more at risk of dying than non-wasted children. Wasted children are also more likely to become stunted, and may face an increased likelihood of suffering from overweight and NCDs later in life.60
Figure 9: Annual caseload (number) of severely wasted children under five in ASEAN Member States by 2015
Note: The number of severely wasted children for each Member State is given in parenthesis. Data updated to October 2015. Source: NUTRIDASH 2014. Data for Brunei Darussalam, Malaysia** and Singapore not available in NUTRIDASH 2014.
* Source of data for Thailand is MICS 2012
**Malaysia’s current status on severe wasting among under-five children is not listed in Nutridash 2014. However, Malaysia’s NHMS 2015 estimated that the number of severely wasted children under five in Malaysia was 61,964.
12% 70% Lao PDR 31,041 children Indonesia 2,993,830 children Cambodia 89,682 children Myanmar 221,700 children Philippines 500,930 children Viet Nam 201,474 children Thailand* 223,788 children 1% 2% 5% 5% 5%
Anaemia
Maternal and child anaemia constitutes a moderate public health and nutritional concern for the majority of countries in ASEAN, based on WHO’s standard classification.61 In the region, approximately 36% of pregnant
women are anaemic.39 Furthermore, 38% of children 6–59 months, which is equivalent to 21.4 million
children, are also anaemic (Figure 10). Anaemia constitutes a severe public health problem for Cambodia (prevalence of anaemia in children 6–59 months is 55%, while prevalence of anaemia in pregnant women is
59 UNICEF (2015). Management of Severe Acute Malnutrition in Children: working towards results at scale. New York; UNICEF. Definition
of wasting (acute malnutrition): Low weight in relation to height. Definition of Severe Acute Malnutrition (SAM): Weight-for height < -3 SD of the median WHO growth standards and/or Bilateral Odema and/or MUAC <115 mm. Definition of Moderate Acute Malnutrition (MAM): Weight-for-height < -2 SD of the median WHO growth standards or MUAC 115-125 mm. Definition of prevalence of wasting: the total number of cases of wasting existing in a population at a point in time, based on a cross-sectional survey. Definition of the annual incidence or caseload of severe wasting: the occurrence of new cases of severe wasting in a population over a specific time period (usually a year). Incidence cannot be estimated in cross-sectional surveys of prevalence at a given point in time, therefore an incidence correction factor needed (prevalence x 2.6).
60 Khara T and Dolan C (2014). Technical Briefing Paper: The relationship between wasting and stunting: policy, programming and
research implications. ENN (http://www.ennonline.net/waststuntreview2014, accessed November 13, 2015).
61 WHO (2001). Iron Deficiency Anaemia: Assessment, Prevention, and Control. A guide for programme managers. Geneva; World Health
Organization (http://www.who.int/nutrition/publications/en/ida_assessment_prevention_control.pdf, accessed October 24, 2015). WHO Standard classification for anaemia: the prevalence of anaemia as a public health problem is categorized as follows: <5%, no public health problem; 5–19.9%, mild public health problem; 20–39.9%, moderate public health problem; ≥40%, severe public health problem.
at 51%). In the majority of countries, anaemia among children 6–24 months of age is a severe public health problem, with high prevalence rates. Even if some progress has been achieved since 1990 in many ASEAN Member States, anaemia is yet a moderate or severe public health problem in all countries and greater efforts are needed to reduce and eliminate anaemia. For example, Cambodia experienced a reduction of anaemia prevalence in children of 6–59 months of age between 200562 and 201054 (62% and 55%, respectively), but
figures have remained stagnant since then (prevalence of anaemia in 201445 was 56%). More contextual
research is needed in all countries in order to identify successful strategies that have led to the reduction of anaemia rates, such as the scale-up of anaemia prevention and reduction interventions, as well as barriers that might explain the stagnation of prevalence rates.
62 Cambodia Demographic and Health Survey 2005 (2006). Demographic and Health Surveys. Phnom Penh, Cambodia and Calverton,
Maryland, USA: National Institute of Public Health, National Institute of Statistics and ORC Macro (and additional analysis).
63 WHO (2015). The Global Prevalence of Anaemia in 2011. Geneva, World Health Organization. Note: This report is based on analyses
previously published to estimate trends (from 1995 to 2011) in the distribution of blood haemoglobin concentrations and the prevalence of anaemia in the same population groups. Due to the complex methodology used to calculate the estimates of this figure, new statistics from the most recent surveys have not been taken into consideration in order to ensure consistency and allow appropriate comparisons between ASEAN Member States.
64 Malaysia Annual Report 2014. Family Health. Health Information Management System. 65 Philippines. 8th National nutrition survey Philippines 2013.
66 Thailand SEANUTS: The nutrition status and dietary intake of 0.5-12 years old Thai children. 67 Thailand 4th National Health Exam Survey.
68 Thailand (2010). Administrative data. Bureau of Health Promotion.
Figure 10: Prevalence of anaemia in children 6–59 months, women of reproductive age (15–49 years of age) and pregnant women in ASEAN Member States63
Note: Data is based on WHO’s modelled estimates (from 1995 to 2011).63 Therefore, in order to ensure comparability, the most recent data for certain countries are not presented in this graph. Data is ordered by child prevalence rates. Notes from Member States: i) Singapore was unable to verify the estimates; ii) current prevalence of anaemia in pregnant women in Malaysia, based on government clinic attendance at 36 weeks of pregnancy: anaemia prevalence among pregnant mothers in Malaysia reduced dramatically from 32.6% in 2005 to 9.3% in 2014;64 iii) current prevalence of anaemia in the Philippines is 39.4% in children 6–59 months, 25.2% in pregnant women and 16.6% in lactating women;65 iv) current prevalence of anaemia in Thailand is 23.8% in children 6–59 months,66 24% in women of reproductive age67 and 18.3% in pregnant women.68
60 50 40 30 20 10 0
Cambodia Lao PDR Myanmar Philippines Indonesia Mala ysia
Viet Nam Thailand Singapor e
Brunei
% Pregnant women with anaemia
% Women of reproductive age with anaemia % Children 6- 59 months with anaemia
Anaemia is a severe public health problem (>40%) Anaemia is a moderate public health problem (>20%)
1922 28 24 30 29 14 23 31 20 27 32 22 30 32 25 32 35 16 30 51 33 55 40 31 36 42 20 28 18