Category Sustainable diets and nutrition - Indicator 12
Milan Urban Food Policy Pact Monitoring Framework
Indicator 12: Prevalence of stunting for children under 5 years
MUFPP framework of actions’ category: Sustainable diets and nutrition
This indicator measures prevalence of stunting (poor linear growth) among children under
5 years. Stunting refers to low height for age, reflecting a sustained past episode or episodes
of under-nutrition and poor health.
Overview table
MUFFP Work stream Sustainable Diets and Nutrition
MUFFP action Address non-communicable diseases associated with poor diets and obesity,
giving specific attention where appropriate to reducing intake of sugar, salt,
transfats, meat and dairy products and increasing consumption of fruits and
vegetables and non-processed foods.
What the indicator Prevalence of stunting (poor linear growth) among children under 5 years.
measures Stunting refers to low height for age, reflecting a sustained past episode or
episodes of under-nutrition and poor
Which variables need to -Height and age
be measured / what -This indicator can be disaggregated by sex, age, household income, and other
data are needed socioeconomic and spatial qualifiers.
Unit of measurement Percentage of stunting among children under 5 years – Height (cm) for age
(i.e. Percentages, (months) <-2 SD of WHO Child Growth Standards median.
averages, number of
people, etc.)
Unit(s) of Analysis Children under 5 years
(i.e people under 5 years
old, etc.)
Possible sources of -Public school records, municipal public health records
information of such -Population surveillance data from WHO, national health departments
data -Primary data collection from primary health care providers
Possible methods/tools -Data analysis from existing records: data might already have been collected as
for data-collection part of school routine health checks where these measures are taken.
-Household surveys
Expertise required Data analysis, survey design and implementation.
Category Sustainable diets and nutrition - Indicator 12
Requires carrying height boards to measure heights of children and specific
training for accurate measurement. Requires determining child’s age in months
accurately.
Resources required/
estimated costs
Specific observations Data quality problems can be eliminated or minimised through proper survey
planning, thorough training, continuous standardization, and close field
supervision to ensure adherence to measurement protocols throughout the data
collection process.
This indicator will usually not allow to show observable changes in many small
scale interventions and over short periods of time.
Examples of application
Category Sustainable diets and nutrition - Indicator 12
Rationale/evidence
Children’s linear growth in the first five years of life is assessed by the stunting indicator. Stunting is
evidence that children are too short for their age, which in turn is a reflection of a chronic state of
undernutrition.
Undernutrition puts children at greater risk of dying from common infections, increases the frequency
and severity of such infections, and contributes to delayed 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. In 2016,
22.9% of children under age 5 worldwide had stunted growth. Overall trends are positive. From 2000-
2016, stunting prevalence declined from 32.7% to 22.9% globally, and the number of children affected
fell from 198 million to 155 million. In 2016, about one in two stunted children lived in South Asia and
one in three in sub-Saharan Africa1.
Despite improvements in the number of population-based, nationally representative surveys
conducted since 1990, many countries do not have high quality data on anthropometric indicators that
allow an examination of trends over time. In some instances, surveys have been completed and reports
written but documentation is either suboptimal or the reports are not made available2.
Glossary/concepts/definitions used
Stunting: The World Health Organisation defines stunting as the "height for age" value being less than
two standard deviations of the WHO Child Growth Standards median3.
Preparations
A meeting should be organised with all staff who will be involved in this activity to:
Familiarise them with the methodological guidelines
Agree on the objectives and scope of the analysis and data collection requirements
Develop/ adapt a survey design if primary data collection is needed, and
Agree on the frequency and period of data collection.
Data Collection and Analysis
For a detailed overview of the methodology for collecting and analysing data for child stunting
estimates, see the methodology chapter in the 2012 UNICEF-WHO global estimates report4.
References and links to reports/tools
De Onis, M., Brown, D., Blossner, M., & Borghi, E. (2012). Levels and trends in child malnutrition.
UNICEF-WHO-The World Bank joint child malnutrition estimates.
Levels and Trends in Child Malnutrition: Key findings of the 2017 edition (2017). UNICEF / WHO /
World Bank Group. Joint Child Malnutrition Estimates.
1
UNICEF (2018). Undernutrition contributes to nearly half of all deaths in children under 5 and is widespread in
Asia and Africa. Available from [Link]
2
De Onis, M., Brown, D., Blossner, M., & Borghi, E. (2012). Levels and trends in child malnutrition. UNICEF-
WHO-The World Bank joint child malnutrition estimates. Available from
[Link]
3
[Link]
4
De Onis, et al. (2012). Op. cit.
