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Stunting of Growth in Developing Countries

Nabwera, Helen, Mwangome, Martha K. and Prentice, Andrew M. (2021) 'Stunting of Growth in Developing Countries' in: Nutrition and Growth. Yearbook 2021, 123, Karger, pp. 14-27.

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In 2019, 144 million children were stunted i.e. length for age more than 2 standard deviations below the median for the World Health Organisation (WHO) growth reference standards. The rate of decline required to meet the target of reducing the number of under 5’s who are stunted globally to 100 million by 2025 has not been achieved [1]. Progress has been particularly slow in sub-Saharan Africa that remains one of the regions with the highest burden of the problem. In 2020, this will be compounded by the impact of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V2) pandemic that has diminished livelihoods in many already vulnerable communities and significantly reduced access to, and coverage of, maternal and child health services particularly in low- and middle-income countries (LMICs), therefore increasing both poverty and food insecurity [2]. Stunting is an indicator of chronic malnutrition that is associated with adverse health and cognitive outcomes during childhood that persist into adulthood. Greater efforts are therefore required to understand the complex mechanisms of early childhood stunting, factors that influence its persistence in certain populations despite apparent reductions in poverty within regions and countries, to inform the design and implementation of future interventions.
In this chapter, we have selected recently published papers on stunting and growth in childhood based on research that seeks to elucidate the mechanisms of early childhood stunting and its impact on adolescent growth and pubertal development. We also include recent data on regional patterns of childhood stunting highlighting how between and within country inequities influence the trends that are observed over time. In addition, we include studies that explore the impact of economic growth on childhood stunting particularly across sub-Saharan African countries. We include data on recently completed intervention trials of both nutrition-sensitive and nutrition-specific interventions targeted at various timepoints in the lifespan including preconception, pregnancy and early infancy. One of the trials goes beyond reporting of the efficacy results alone and provides data on stakeholder (including both policy makers and the caregivers) perceptions of cost-effectiveness of the intervention therefore providing key data to inform implementation. Finally, in the perspectives we have included the insights on water sanitation and hygiene (WASH) interventions from three trials conducted in countries with high rates of childhood stunting - WASH-Benefits Bangladesh, WASH-Benefits Kenya and the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) in Zimbabwe. There was no evidence from these trials that low-cost water sanitation and hygiene (WASH) interventions alone or combined with nutrition (maternal and child) interventions sufficiently improved linear growth in early childhood in LMICs. The concept of “Transformative WASH” provides opportunities for multisectoral research and implementation of programmes that could potentially lead to improvements in child health, growth and developmental outcomes. Overall, the studies that we have chosen emphasise the need for better alignment of nutrition and health system interventions to ensure that the most vulnerable mothers and children (due to poverty, adverse climate change, humanitarian crises, or disabilities/cognitive impairment) have equitable access to multilevel interventions that work synergistically to address childhood stunting.

Item Type: Book Section
Subjects: WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 115 Nutritional requirements. Nutrition disorders
WS Pediatrics > Child Care. Nutrition. Physical Examination > WS 141 Physical examination. Diagnosis. Mass screening. Monitoring
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):
Depositing User: Claire McIntyre
Date Deposited: 12 Nov 2021 09:37
Last Modified: 12 Nov 2021 09:37


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