Appendix 2: Assessing progress against the global nutrition targets

The Global Nutrition Report tracks global and country progress against the global nutrition targets using the latest available data.

Prevalence estimates are used alongside information about rates of change to assess whether a country is ‘on course’ or ‘off course’ to meet each maternal, infant and young child nutrition target. This is when the global target is applied at the national level, assuming the same relative reduction in all countries.^[1]

Anaemia modelled estimates are produced by the WHO;^[2] estimates of low birth weight are produced by the United Nations Children’s Fund (UNICEF) and World Health Organization (WHO);^[3] and estimates of exclusive breastfeeding are produced by UNICEF.^[4] National prevalence estimates on child malnutrition are reported in the annual Joint Child Malnutrition Estimates produced by UNICEF, WHO and the World Bank.^[5]

The rules to determine which countries are on or off course are established with extensive technical input from WHO and UNICEF. The Global Nutrition Report employs the monitoring rules and classification of progress towards achieving the six nutrition targets proposed by the WHO/UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). The methodology and rules to track maternal, infant and young child nutrition targets were revised in 2017 by WHO and UNICEF to improve the quality of nutrition target monitoring.^[6]

At the country level, as at the global level, an average relative percentage change in prevalence of an indicator is calculated using a metric called the average annual rate of reduction (AARR). There are two AARR estimates calculated: the required AARR represents the value needed for a country to achieve the global target from the baseline year to 2025, and the current AARR reflects a country’s actual achievement based on the available data between the baseline year and the most recent year. The required AARR, current AARR and current prevalence are used to determine whether the country under assessment is on or off track for each indicator (Table A2).

In addition to those listed in Table A2, there are additional criteria for assessment and additional considerations.

• Stunting, wasting, overweight and exclusive breastfeeding: countries require at least two nationally representative survey data points since 2008 to assess recent progress, and one of these must have been since 2012 to reflect post-baseline status.
• If countries do not have any post-baseline status (2012) data, an assessment is reserved until estimates in the post-baseline period become available.
• Availability of nationally representative estimates approximately every three years aids effective progress-monitoring and supports reliable assessment.

The WHO Global Monitoring Framework for the Prevention and Control of Non-Communicable Diseases (NCDs) was adopted by the World Health Assembly in 2013 to effectively implement the NCD Global Action Plan and monitor progress in NCD prevention and control at the global level.

The framework includes nine voluntary targets tracked by 25 indicators of NCD outcomes and risk factors. The overarching goal is to reduce premature mortality due to NCDs by 25% by 2025. The 2016 Global Nutrition Report tracked target 7, ‘halt the rise in diabetes and obesity’. The 2018 Global Nutrition Report tracked additional targets on reducing salt/sodium intake by 30% at the population level (target 4) and reducing the prevalence of high blood pressure/hypertension by 25% (target 6).

Country progress towards the targets on raised blood pressure, diabetes and obesity is derived from modelled estimates and probabilities produced by the NCD Risk Factor Collaboration.^[7] Progress is characterised as ‘on course’ if the probability of meeting that target by 2025 is at least 0.50, or ‘off course’ if it is less than 0.50; ‘some’ progress is not assessed for NCD targets. Global progress is evaluated in the same manner and the probability of the target being reached is specified.

Progress on reducing salt intake is not assessed at the country level. However, using estimates from the Global Burden of Disease (IHME),^[8] the 2020 Global Nutrition Report estimates the current AARR as 0.2%. This is substantially lower than the required AARR of 2.4%, to reach the global target on salt reduction by 2025.