Malnutirion/Underweight prevalence

Export Indicator

Ratio of the proportion of OVC compared to non-OVC who are malnourished (underweight).
What it measures

To assess progress in preventing relative disparity in malnutrition among orphaned and vulnerable children versus other children.
This indicator measures the level of malnutrition (underweight) among orphaned and vulnerable children versus other children. Weight-for-age reflects a combination of acute and chronic malnutrition for the child.


(1) Malnutrition rate among OVC (%) Numerator 1: Number of OVC aged 0–4 years who are malnourished (below -2 standard deviations from the median weight-for-age of WHO/NCHS reference population). Denominator 1: Number of OVC aged 0–4 years.


(2) Malnutrition rate among non-OVC (%) Numerator 2: Number of non-OVC aged 0–4 years who are malnourished (below -2 standard deviations from the median weight-for-age of WHO/NCHS reference population). Denominator 2: Number of non-OVC aged 0–4 years.


Orphan malnutrition ratio: The ratio of (1) OVC’ malnutrition rate to (2) non-OVC’ malnutrition rate.

Method of measurement

For reliable assessment of the nutritional status of children, a representative sample of the population of children should be used rather than the children seen at health facilities. Large household survey programmes such as DHS and MICS collect anthropometric data from children. Well-nourished young children of all populations follow very similar growth patterns. Thus the World Health Organization (WHO) recommends that the nutritional status of children sampled in surveys be compared with an international reference population defined by the U.S. National Center of Health Statistics (NCHS). The nutritional status of a child is thus expressed as the standard deviation units (z-scores) from the median for the reference population. Those children found to be more than 2 standard deviations below the median for the reference population are considered to be underweight. Typically, household surveys have only measured malnutrition for children below the age of 5; however, because most orphans are older, the sample size of orphans in this age range are often too small to compare with non-orphans. In the pilot surveys in Jamaica and Malawi, weight and age data were collected and analysed for children up to and including age 8 to avoid this limitation. (Children older than 8 were excluded because once they reach pre-adolescence their growth is erratic and because internationally agreed-upon cut-offs for boys over 10 and girls over 8 are not available.) The pilot surveys showed, however, that as children get older, the variations in underweight are small, and thus comparing children ages 5–8 is not useful.

Measurement frequency

Age group:

Education: N/A

Gender: N/A

Geographic location: N/A

Pregnancy status: N/A

Sector: N/A

Target: N/A

Time period: N/A

Type of orphan: N/A

Vulnerability status: N/A

Explanation of the numerator
Explanation of the denominator
Strengths and weaknesses

This indicator does not cover the majority of orphans who are older than age 5. Malnutrition rates have been reliably used globally; they will be useful to maintain for assessing malnutrition status among pre-school orphaned and vulnerable children living in households, and orphaned and vulnerable children living in institutional care arrangements. The data on underweight reflect a child’s overall growth progression during his/her lifetime. The status of orphaned or vulnerable might be a recent change and might not yet have affected the child’s nutrition status. Analysis of this indicator should consider the timing of these events.
National levels of child malnutrition are not expected to change markedly, except in situations of drought, famine or war. The situation of orphaned and vulnerable children may change more rapidly, however. The opportunity should be taken whenever there are national (or geographically representative) nutrition surveys to assess orphans and other children made vulnerable by HIV/AIDS. This core indicator can be accompanied by two additional indicators: (a) stunting (height-for-age) and (2) wasting (height-for-weight). Stunting reflects long-term malnutrition, whereas wasting reflects more recent or acute malnutrition. The Body Mass Index (BMI) can also be considered for adolescents, related to standard BMI-for-age curves; this is recommended by the U.S. Centers for Disease Control and Prevention as the only valid measure for adolescents.

Further information