Asia Hunger Facts

What is the extent of hunger in Asia?

Although Africa is presented through many mediums as the center of world hunger, Asia has always had more hungry people, and more malnourished children, in large part because Asia has so many more people.

• 70% of all malnourished children in the world live in Asia.
• 512 million adults and children in Asia consume too few calories, which accounts for over 12% of the total population of Asia.
• The Subcontinent of Asia, including India and Bangladesh, has the highest rates (16%) of malnutrition and the most numbers of the hungry in Asia.
• In Asia, 17% of females and 13% of males are underweight on average (BMI<18.5).

However, there is some good news and progress in Asia:

• The Global Hunger Index (GHI) score for South Asia in 2013 decreased by 34% compared to the 1990 score.
• Although 512 million people are still hungry in Asia, this represents a 30 % decrease from the previous 739 million hungry people. Malnourishment has also decreased from 23.7% to present rates.

To learn more about the differences between hunger and malnutrition, as well as the difference between over- and under-nutrition, see our related fact sheet, Hunger and Nutrition.

Figure 1. Prevalence of undernutrition across different regions of Asia

Source: (UNICEF, World Health Organization, and World Bank, 2012)

Figure 2. Prevalence of stunting and wasting in Asia

Stunting

Stunting is the result of a biological process where children do not grow to reach their theoretical potential. It is recognized as one of the most significant impediments to human development and has long-lasting health and cognitive impacts. Stunting is the result of prolonged inadequate nutrition and repeated infection during the first two years of life.

• Asia is home to approximately 100 million of the 170 million stunted children in the world, or 58%.
• 100 million (28%) of children in Asia are stunted.
• India has the largest number of stunted children in the world. In 2013, this was estimated to be around 61.7 million children, or 48% of all the children in India. That is 62% of all stunted children in Asia, or 36% of all stunted children in the world (World Health Organization, 2012).
• Second to India in 1990, China used to have the highest percentage of stunted children in the world, but has made steady progress. There are now an estimated 12.7 million stunted children in China, which is 10% of all children across the country.

On a positive note, overall since 1990, Asia as a whole has seen a decrease in the prevalence of stunting, from 49% to 28% in 2010. This trend is expected to continue (de Onis, Blössner, & Borghi, 2012)

Wasting

Wasting, or low weight for height, can be the result of famine or other severe food shortages. Wasted children often appear very thin and lack the energy to laugh and play. Stunting and wasting are very closely tied with other health indicators. Together, health and nutrition determine the growth trajectory of a child. A child with poor health will not have the same appetite as a healthy child. That child will not be able to absorb the same amount of nutrients from the food they do eat, because much of their bodily energy will be directed towards fighting off illness. Similarly, a malnourished child will be much more susceptible to disease, particularly if they have micronutrient deficiencies

• In 2012, approximately 69% of all wasted children lived in Asia, and 71% of all severely wasted children (UNICEF et al., 2012).
• 8.5% of all Asian children are experiencing wasting, and South Asia as a whole has a 15.3% rate of wasting, the highest of any region in the world.
• The highest prevalence of wasting in Asia is in India, at around 20%; this is the third highest rate in the world.
• The lowest rates of wasting in Asia are in Mongolia and Hong Kong, both at approximately 1.5%
• Asian countries with wasting levels above ten percent — considered a serious public health problem that requires an urgent response — are India, Papua New Guinea, Bangladesh, Pakistan, Nepal, Cambodia, Indonesia, and Sri Lanka (OECD/World Health Organization, 2014).

Micronutrient deficiencies

Micronutrient deficiencies are the result of inadequate amounts of essential vitamins and minerals in the diet. This is different from protein-energy malnutrition, which is the result of inadequate calories in the diet. Three of the most significant micronutrient deficiencies in Asia and in the developing world are vitamin A deficiency, zinc deficiency and iron deficiency, usually assessed as anemia. Both of these deficiencies can be resolved through supplementation programs, but both remain a significant public health risk.

Vitamin A
Vitamin A deficiency is associated with blindness, child mortality and maternal mortality.

• In South Asia, 44-50% preschool-age children have severe vitamin A deficiency.
• In Pakistan, 30% of pregnant women were thought to be vitamin A deficient in 2006.
• 9.4% of the population of Pakistan suffered night blindness, and 60% of all under-5 deaths could be attributed to health complications due to vitamin A deficiency.
• Nearly 62% of preschool-age children in India are deficient in vitamin A.
• In Bangladesh, 51% of pregnant women consume a diet too low in Vitamin A, and around 18.5% of pregnant women exhibit clinical symptoms of vitamin A deficiency (Akhtar, Ismail, Atukorala, & Arlappa, 2013).

Zinc
Zinc deficiency is a major risk factor for morbidity and mortality, contributing nearly 800,000 additional mortality cases per year among children under 5 years. Zinc deficiency increases mortality associated with infections and in early pregnancy has been associated with complications in pregnancy outcomes at later stages.

• Prevalence of zinc deficiency among preschool-age children in five states in India was 44%, 50% among adolescent girls in Delhi, and 52% among non-pregnant women of central India (Akhtar et al., 2013).

Deficiency of Iron Consumption and Anemia
Anemia is the condition characterized by a lack of hemoglobin (iron-bearing molecules) in the bloodstream. Hemoglobin is required to carry oxygen to cells throughout the body. Anemia is often caused by an inadequate consumption of iron from the diet. Iron deficiency anemia significantly is known to slow brain development in children and is a key predictor of morbidity and mortality.

• In pregnant women, anemia can cause greater risk of maternal and child mortality, complications during childbirth and poor fetal development.
• In India, 66% non-pregnant women, 85% of pregnant women and 90% of adolescent girls have been found to be iron-deficient
• Anemia affects 91% of pregnant women and 65% children below 5 years in Pakistan.
• In Bangladesh, 40% of adolescent girls were found to be anemic.
• Across South Asia, it is estimated that 25,000 women die in childbirth due in significant part to severe anemia (Akhtar et al., 2013).

South Asia

South Asia includes the countries Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka.

• South Asia is bearing an increasingly larger share of the total of the world’s hungry people.
• In 1992 this region accounted for 28.8% of the world’s hungry people, however, in 2014 this had risen to 35.4%. This is partly due to a reduced prevalence of hunger in other parts of the world, but also due to a growing number of hungry people in this region. (FAO et al., 2015).
• South Asian children are the most likely to be moderately to severely underweight compared to children anywhere else in the world.
• In South Asia, 32% of all children are moderately or severely underweight, compared to 21% in Sub-Saharan Africa, which has the second highest global rate.

Causes of malnutrition in Asia

Malnutrition is defined as any disorder of nutrition. It may result from an unbalanced, insufficient or excessive diet or from impaired absorption, assimilation or use of foods. Overnutrition, a condition of excess nutrient and energy intake over time, may be regarded as a form of malnutrition when it leads to morbid obesity. Undernutrition is a condition of malnutrition caused by an inadequate food supply or an inability to use the nutrients in food. (Definitions from Mosby Medical Dictionary 2009) (Also see Hunger and Nutrition Factsheet)

Sanitation and hygiene
In many areas of Asia there are poor and insufficient sanitation and hygiene practices to prevent the spread of disease and infection

• In many areas of Asia there are poor and insufficient sanitation and hygiene practices to prevent the spread of disease and infection
• Open defecation is practiced by at least 72% of the rural population in India. Of the 1 billion people worldwide who have no toilets, India accounts for 60%. Open defecation leads to huge amounts of harmful bacteria in gutter water and open wells. Small children often have infections caused by these bacteria. Infections by coliform bacteria cause the intestines to work less efficiently at absorbing nutrients, often for life. This leads to malnutrition and stunted child growth (Spears, Ghosh, & Cumming, 2013).

Changing diets and obesity

• All across Asia, the availability of highly processed foods has increased drastically. These foods are high in calories, but low in nutrients and may not be fortified.
• Consumption of these processed foods by adults and children has led to the rise of over-nutrition, which is a cause of obesity.
• Traditional diet staples such as hardy millets contain large amounts of protein, fiber and essential minerals. These staple grains have been replaced by processed rice and wheat flours, which are very low in vitamins and minerals but high in carbohydrates. This contributes to the rise in overweight and the decline of protein consumption.
• In one household there may be both obese individuals and undernourished individuals, and each with micronutrient deficiencies. This is known as ‘triple-burden’ malnutrition, and is a growing problem in Asia.
• In the most recent data available, 12.2% of the population of India in 2010 was obese or overweight, in China 29%, and 34.1% in Thailand. These figures are expected to steadily increase (Ramachandran & Snehalatha, 2010). Overweight is defined as having a Body Mass Index (BMI), or weight-to-height ratio, greater than or equal to 25 and lower than 30, while obesity is defined as having a BMI equal to or greater than 30.

Gender inequality

• Most Asian countries have a higher than normal ratio of males to females (Guilmoto, 2009). One of the reasons for this is increased malnutrition among female children that leads to their demise. The tradition of son preference and poor care practices for girl children are other reasons.
• In several of these countries, women do not have access to the same education, health care or information technology as men. Women are often the primary care-takers of children, but they are inadequately informed about how to care for their own health and the nutrition needs of their children and they may have little say in the economic activities of their household.
• Increased female education and empowerment has been shown to significantly improve child nutrition and child health outcomes (DeSchutter, 2013).

Urban versus rural malnutrition

• In Asia, people living in rural environments are more likely to be malnourished than those in urban environments, especially children.
• In India in 2005, 33% of children in urban areas were malnourished, while 46% of rural children were malnourished (International Institute for Population Sciences (IIPS) and Macro International, 2007).
• In South Asia, approximately 48% of rural children were stunted, while 35% of urban children were stunted. Wasting had a similar but smaller relationship with approximately 16% and 12%.
• This could be due to a variety of factors. The factors that are statistically associated with better nutrition in urban areas are:
  — Maternal education: It is more likely that an urban mother will have a secondary education, and will have higher decision-making power in her household.
  — Hygiene and sanitation: The urban household is more likely to have access to and use a flush toilet, as opposed to open defecation or a pit latrine.
  — Economic status: Urban families also tend to have a better economic status than rural families (Smith, Ruel, & Ndiaye, 2005).

Author: Kathryn Merckel
PhD student, Nutrition, Cornell University
November 2, 2015

Bibliography

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