Undernourishment trends and determinants: an ecological study of 76 countries.

OBJECTIVES

Owing to the importance of global commitment to reduce undernourishment, knowing the trend of undernourishment and its associated macro-level factors is of great importance. The main aim of the present study was to investigate the undernourishment trend and its association with several country-level socio-economic and agricultural factors for 76 countries during 1991-2013.

STUDY DESIGN

The design of this study is a cross-country ecological study.

METHODS

Data on undernourishment and associated factors representing the four dimensions of food security were retrieved from the Food and Agriculture Organization and World Bank databases for 76 countries during 1991-2013. To define the determinants of undernourishment, countries were classified based on macro-level factors as the independent variables, and the trend of undernourishment was assessed within different tertiles of independent variables for the crude and adjusted model controlling other variables during 1991-2013 using tempo-spatial multilevel regression models.

RESULTS

Among all 76 countries and geographical regions, the prevalence of undernourishment had a significant declining trend; however, no significant changes were found in countries in the Eastern Mediterranean region including Iran, Iraq, Jordan, Tunisia and Yemen and South Asia region during 1991-2013. Countries in the lower categories of which experienced a higher human development index (HDI), literacy rate, as well as a lower under 5-child mortality rate and Gini coefficient experienced a greater decline for undernourishment when compared to others. No significant difference was found for undernourishment trends in countries within different tertiles of the growth of domestic product, percentage of agricultural land, food production index and livestock production index.

CONCLUSIONS

The significant difference in the declining trend of undernourishment within countries experiencing better status of the HDI, Gini coefficient literacy rate and child mortality highlights considering the whole food system approach to improve undernourishment, taking into account utility and stability dimension of national food security. More investment in increasing the HDI, health investment, education and equal income distributions might be helpful for reducing undernourishment prevalence.