Geographic priorities in the global action plan for wasting: Burkina Faso, Ethiopia, Kenya and Malawi.

Abstract

Shifts in global aid funding threaten the sustainability of programmes addressing childhood wasting and population-based surveys used to inform their geographic targeting. Re-evaluating how priority regions are identified is essential to ensure constrained resources reach the greatest number of affected children. We examined how the Global action plan on child wasting prioritization strategies aligned with the geographic distribution of childhood wasting in four countries: Burkina Faso, Ethiopia, Kenya and Malawi. We used the two most recent Demographic and Health Surveys of each country to estimate the annual absolute burden of wasting in global action plan priority and non-priority areas. Prioritized areas consistently captured the highest wasting prevalence and, except in Kenya, experienced larger reductions in wasting prevalence over time. However, in Burkina Faso, Kenya and Malawi, between 43.6% (142 631/327 349) and 69.8% (992 370/1 422 301) of children with wasting lived in non-priority areas, largely in more populous regions with a lower prevalence of wasting but a high absolute burden. These findings highlight a key limitation of prevalence-based prioritization: low-prevalence areas can contain numerous affected children if they are more densely populated. While prevalence-based targeting has successfully delivered nutritional services to millions of children, targets of the global action plan and sustainable development goals are unlikely to be met without addressing the burden of wasting in non-priority areas. With global nutrition financing increasingly constrained, countries must adapt data systems to enable flexible prioritization that balances prevalence and burden, while implementing context-adapted strategies to cost-effectively expand coverage where the largest numbers of affected children live.