Nutrition interventions needed to reduce child stunting

Long-term improvements must be made.

Issue: March 2008

Despite helping to improve children’s overall chances of survival, the promotion of breast-feeding is not enough to reduce the incidence of stunting in poorer areas of the world.

According to researchers, prevalence estimates of stunting in children aged younger than 5 years are as high as 178 million, with most of these children living in sub-Saharan Africa and south-central Asia.

Furthermore, stunted children, defined as those who have a height-for-age z score of less than -2, account for 46% of the 348 million children living in 36 countries.

Zulfiqar A. Bhutta, PhD, and colleagues reviewed a series of interventions that affect maternal and child nutrition-related outcomes, including the promotion of breast-feeding, strategies to promote complementary feeding with or without the promotion of food supplements and micronutrient interventions.

The researchers’ goal was to estimate the reduction in deaths related to stunting and lost disability-adjusted life-years that could result from implementing interventions in the 36 countries where 90% of the world’s stunted children live.

They also estimated the effects of these interventions on maternal deaths and disability-adjusted life-years within the same countries.

Their results were published in a recent issue of The Lancet.

Review of evidence

Using a cohort model to assess the potential effect of the interventions on children and their mothers, the researchers found that existing interventions designed to improve nutrition and prevent related disease successfully reduced stunting at 36 months by 36%; disability-adjusted life-years associated with stunting, severe wasting, intrauterine growth restriction and micronutrient deficiencies were reduced by approximately 25%.

“There are plausible interventions that can make a difference in the short-term to address maternal and child undernutrition, and these can be integrated for delivery,” Bhutta, professor and chair of the department of pediatrics and child health at Aga Khan University in Pakistan, told Infectious Diseases in Children.

“These… include maternal care during pregnancy and addressing micronutrient needs, strategies for promoting early and exclusive breast-feeding and appropriate coplementary feeding strategies. “In poor populations with food insecurity, these interventions need to be coupled with additional measures, such as food supplements or conditional cash transfers.”

According to the researchers, providing education about complementary feeding increased the height-for-age z score by 0.25 in countries with sufficient food supplies.

Providing food supplies increased the height-for-age z score by 0.41 in countries with insufficient food.

Effective micronutrient interventions for pregnant women included iron folate supplementation, which increased hemoglobin at term by 12 g/L, and micronutrients, which reduced the risk for low birth weight at term by 16%.

The researchers were pleased to find that the early implementation and integrated delivery of interventions had a considerable effect, according to Bhutta.

“The other relatively new documentation is that stunting peaks very early and the best gains are from interventions in the first two years of life,” he said. “This finding has huge implications for several nutrition programs which are targeting older children that we feel should be reviewed.” – by Cara Dickinson

For more information:

Bhutta ZA, Ahmed T, Black RE, et al. What works? Interventions for maternal and child undernutrition and survival. Lancet. 2008;doi:10.1016/S0140-6736(07)61693-6.