Identifying priority countries for scaling up small-quantity lipid-based nutrient supplements

Undernutrition is a cause of nearly half of all deaths among children under 5 years old. Small-quantity lipid-based nutrient supplements (SQ-LNS) have been shown to prevent child wasting, stunting, anaemia and mortality among children 6-23 months of age in low- and middle-income countries (LMICs). Scaling up effective preventive interventions is urgent given the current global food insecurity and nutrition crisis.

To prioritise SQ-LNS scale-up activities, we identified countries with the highest burdens of wasting, stunting and all-cause mortality among children 6-23 months of age at the national level using the most recent national survey data including the Demographic and Health Survey and Multiple Indicator Cluster Surveys, as well as the Lives Saved Tool in LMICs. National-level estimates informed a care cascade model to assess the potential impact of SQ-LNS on all-cause mortality, stunting and wasting. We also conducted a subnational level analysis among the 20 highest burden countries with the most recent available survey data to identify the highest burden regions.

Our analysis identified the top 20 countries with the highest burden of the three outcomes as: Niger, South Sudan, Yemen, Sudan, Somalia, Democratic Republic of Congo, Eritrea, Nigeria, Central African Republic, Guinea, Equatorial Guinea, Chad, Papua New Guinea, Benin, Mali, Angola, Pakistan, Timor-Leste, Sierra Leone and Côte d'Ivoire, although for some countries the survey data were collected >10 years ago. Some of these countries also ranked high in population estimates of acute food insecurity. The care cascade model demonstrates that a large number of cases of stunting and wasting and deaths could be potentially averted if SQ-LNS is provided.

Most of the top 20 countries are in Sub-Saharan Africa, with a few in South and Southeast Asia. This geographical concentration underscores the urgent need for targeted interventions in these regions to prevent child malnutrition.