Malnourished and surviving in South Asia, better nourished and dying young in Africa: What can explain this puzzle?

This paper examines the factors explaining the very different relationship between anthropometric shortfall and child mortality in South Asia and Sub Saharan Africa. While in the former, very high rates of anthropometric shortfall coexist with comparatively lower child mortality rates, rates of anthropometric shortfall in Sub Saharan Africa are much lower, yet under five mortality is much higher than in South Asia. This puzzle is examined using a panel data set of undernutrition, mortality, and their correlates. The analysis suggests that the unusually high rates of anthropometric shortfall in South Asia are partially due to the use of a US-based reference standard which appears to generate misleading international comparisons of undernutrition. The very high rates of under five mortality in Africa seem to be mostly due to very high fertility, high and rising HIV prevalence, and a possible multiplicative interaction of risk factors. Acknowledgements I would like to thank Amartya Sen and Allan Hill for helpful suggestions and discussions on this topic. I also want to thank Mercedes de Onis from WHO for kindly providing access to the WHO Global Database on Child Growth and Malnutrition; and thank Thomas Augustin, Jörg Baten, John Komlos, Hans Schneeweiß, T. Paul Schultz, Lisa Smith, and participants at the 1999 ESPE conference for helpful comments and suggestions. Finally, I thank Claudia Wink for excellent research assistance in assembling the data base and Alexandra Roth for assisting with the tables. Funding from the German Science Foundation (DFG) through the Sonderforschungsbereich 386: Analyse Diskreter Strukturen is gratefully acknowledged.