Nutrition Country Profiles -- A Quick Guide to Nutrition in 193 Countries (e.g. for Angola)

The recently released Global Nutrition Report  produced 193  Nutrition Country Profiles.

Each 2-page profile aims to have data on 82 nutrition related indicators.  Of course many of the indicators have no data, but most have a wealth of information.

But how useful are they?

We had a request for a briefing from a prominent journalist who is visiting Angola and I thought it would be a useful test case (admittedly n=1) to see how useful the Angola Nutrition Profile is (and I know very little about Angola).

(And before you tell me that the profile should be in Portuguese, we are doing just that, but for for now we only have the English version.)

So what does the Angola Profile say?

1. Angola's economy is growing fast (GDP/capita PPP more than doubled between 2000 and 2013).  We only have poverty rates for 2000 (54% below $1.25 a day--note, there is a mistake in the Profile with the two poverty rates have been transposed--we will fix).  As an aside: much of this economic growth is due to the oil industry, hence very dependent on oils prices which are very low right now--so the economy is particularly susceptible to economic volatility.  

2. Angola is 58% urban. Income inequality is very high.  Angola's Gini coefficient is 59--only South Africa and Lesotho are higher--Brazil is around 53.

3. Under 5 stunting rates have declined rapidly--from 62% in 1996 to 29% in 2007.  Unfortunately we do not have trend data on stunting rates by socioeconomic status (SES)--then we could look at how stunting is changing over time by high and low SES levels.  Wasting levels are high at 8% (above the 2025 WHA targets of under 5% but declining).  There are no data on under 5 or adolescent overweight  and adult overweight rats are 26%, not as high as many countries

4. Anemia in women of reproductive age is high at 45% which is in line with rates in Middle Africa (45%).  Under 5 vitamin A deficiency rates are very high at 64% but the data are very old (1999).  Vitamin A supplementation coverage is low at 44% (in 2012). For a predominantly urban population iodised salt coverage is also low at 45%.

5. Exclusive breastfeeding rates are very low at 11% and low for the region (about 20% during the same time period).  There are no data on the quality of infant and young child diets

6.  At the underlying levels, gender inequality data are missing, but female secondary education enrolment data are low (25%) compared to the all Africa average of 53%.  The availability of community health workers is low (1.66 per 1000 people) but in line with all Africa averages.  Undernourishment data (proxies for hunger) show steep declines from 2000 (49% hungry) to 2014 (18% hungry) but these estimates are very sensitive to assumptions about inequality which is very high in Angola and so they should be treated with caution, especially in the absence of poverty trends.  Access to improved water has increase (42% to 55% between 1990 and 2012), but this is slow compared to other countries.  Unimproved sanitation and open defecation were 71% in 1990 and 40% in 2012--a decent rate of decline, but with plenty of work to do.

7.  In terms of Government commitment, Angola is not a member of Scaling Up Nutrition.  Government expenditures on education are low (5.3% of total expenditures) compared to other African countries (12%) while health is low (4.1%)  but in line with the all-Africa average (5%).  The International Code of Marketing of Breast Milk Substitutes is not being implemented at the national level, maternity protection is partial, the protection and respect for the right to food is medium, no protocols/guidelines/standards are available of the management of non-communicable diseases and national development plans hardly feature nutrition (ranked last out of 83 countries).

In short?

1. Declines in stunting are rapid.  Wasting declining too.   Micronutrient malnutrition is high.
2. Economic growth is high, inequality also very high. Highly urban.
3. Coverage rates of nutrition programmes: could do better. Exclusive breastfeeding rates very low.
4. Underlying determinants: improvements but female secondary education and water/sanitation still weak spots
5. Commitment to nutrition?  Seems quite low.  Spending low, nutrition does not feature in development plans, no national implementation of breast milk substitute marketing code.

So the potential for further rapid declines in stunting and wasting and some progress on micronutrient malnutrition seems high because of the possibilities afforded by economic growth...

BUT

.. the commitment to nutrition improvement needs to increase.  The new funds coming into the exchequer can be used to improve female secondary education enrolment rates, reduce open defecation, increase nutrition programme coverage, promote exclusive breastfeeding.  The government should seriously consider joining SUN.

To do this will require (a) good governance of oil revenues to make sure there are funds flowing into the exchequer and (b) a commitment (and plan) to spend more of those funds on nutrition.  Civil society and external partners have a big role to play in helping (a) and (b) materialise.

Angola could be a real nutrition success story--but only if it wants to be.

Reflections on the Nutrition Country Profile?

I am biased, but I found it very useful to have everything in one place.   The only downside is that I often wanted to understand the Angola values in relation to all Africa averages and for that I had to  revert to the Report.  We will think about how to resolve this issue.