The persistent global burden of severe acute malnutrition: Cross-country estimates, models and forecasts

Severe Acute Malnutrition (SAM) is a leading cause of childhood disease and death. Existing SAM data are sparse and depend on point prevalence measures that underestimate its true burden. Given the significance of SAM as an indicator of humanitarian progress and a driver of human development, a forecast of its long-term burden is needed. We use UNICEF prevalence data of severe wasting for 150 countries to measure SAM prevalence and build a model that we embed in International Futures. We estimate that, in 2014, there were 28.8 million SAM cases globally among children under age five and that this will decline to 21.7 million cases by 2030, with India accounting for 52% of this reduction, and growth (from 8.1 to 9.0 million cases) in Sub-Saharan Africa. Forecasts are sensitive to uncertainty around the drivers of SAM, particularly conflict. A 0.5 s d. variation in conflict relative to the Base Case forecast yields a range of 19.5–29.3 million cases globally in 2030. We also find that the drivers of SAM are forecast to decline more slowly than traditional drivers of undernutrition. SAM will therefore account for a growing share of children under five who are undernourished in the future. This growing share of SAM cases will be heavily concentrated in societies burdened by poor governance and conflict. The future of SAM is most sensitive to uncertainty associated with the future of internal conflict.