Reversing consequences of stunting

Munshi Jalal Uddin :
All children deserve the healthiest possible start in life. Stunting, or being too short for age, is an irreversible outcome of chronic nutritional deficiency during the first 1,000 days of a child’s life. And the damage it causes to a child’s development is permanent.
However, two out of five children under age five in Bangladesh do not currently meet their full height potential. What is the effect of this condition?
Findings of innumerable researches indicate that slow growth or stunting in height early in life have long-term effects on cognitive development, school achievement and economic productivity in adulthood. Other immediate causes of stunting include maternal and child infections, birth of disable or weak babies, and underlying causes related to hygiene, sanitation and poverty.
The evidence of these effects has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the burden of diseases and fostering economic development.
Stunting is one of three standard indices of physical growth that are used to describe the nutritional status of children. Two other indices are – weight-for-height or wasting and weight-for-age or underweight. Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Stunting is a measure of linear growth. The condition of stunting reflects the cumulative effect of chronic malnutrition. Wasting describes current nutritional status and indicates acute malnutrition. Underweight is a composite index of weight-for-height and height-for-age.
For each of these three indicators, World Health Organisation has set some reference median value, and a child who is below minus two standard deviations (-2 SD) from that is considered malnourished.
Level of stunting in Bangladesh
Bangladesh Demographic and Health Survey (BDHS) 2011 reveals that 41 per cent of children under five in Bangladesh are considered to be stunted, where 15 per cent are severely stunted (below -3SD from the WHO reference median).
The prevalence of stunting increases with age from 18 per cent among children under six months to 52 per cent among children of 18-23 months and then decreases to 42 per cent among children of 48-59 months. Rural children are more likely to be stunted than urban ones (43 per cent compared with 36 percent). Stunting is lowest in Khulna and Rajshahi (34 per cent each). In other divisions, stunting varies from 41 per cent in Chittagong to 49 per cent in Sylhet.
Children of mothers with no education are more than twice as likely to be stunted (51 per cent) as children of mothers who have completed secondary and higher education (23 per cent). A similarly large differential exists by wealth quintile.
Specific consequences of stunting
When a child is stunted, it means that essential physical and mental growth processes are being compromised. Specific consequences of stunting are mentioned below:
Health consequences
i) For infants and young children, stunting is associated with a weaker immune system and higher risk of severe infectious diseases. When undernourished children become adults, they are more likely to suffer from high blood pressure, diabetes, heart disease, and obesity.
ii) It is estimated that children under the age of five who are born to the shortest mothers (less than 145 centimetres) have a 40 per cent increased risk of mortality.
iii) Stunted women have higher maternal mortality rates and are more likely to have small and underweight babies – leading to a cycle of poor nutrition and poverty.
A low-birth-weight child is more likely to be shorter during adulthood than one not born with a low-birth-weight.
Education and economic consequences:
i) Stunted children are more likely to start school later and drop out, and are less able to learn due to compromised brain and mental development at a young age.
ii) Compromised growth has been linked to lower economic productivity and income. Studies have shown that a 1 per cent increase in height is associated with a 2.4 per cent increase in wages. Compounded over an entire lifetime, malnutrition can reduce a child’s earning potential by as much as 10 per cent.
iii) The effects of stunting impact an entire nation. It’s estimated that investing in infant and young child nutrition can increase a country’s gross domestic product by 2 to 3 per cent.
Experts say, quoting a recent study, that in spite of making substantial gains in the health sector, Bangladesh continues to pay a heavy price for malnutrition among children, with an annual loss of around 78 billion taka in economic productivity.
The references were made at the launching ceremony of a three-year nutrition project to be trenched over three remote upazillas in Bangladesh. The Dhaka Tribune reported this on its issue of May 18, 2013 under the title ‘Malnutrition continues to take a toll.’
Addressing Stunting
Feeding practices during the critical window of opportunity: The time between pregnancy and the first two years of life provide a ‘critical window of opportunity’ to prevent and reverse stunting before its effects are permanent.
Eliminating malnutrition in mothers can reduce disabilities in their infants by almost one third. So it is important that expectant mothers eat a variety of foods, receive essential micronutrients, and have adequate rest. Another blessing to reverse stunting is to be sucked from proper breastfeeding practice.
All children should be breastfed early (within one hour of birth) and exclusively for the first six months of life. No other food or liquid is needed, not even water. When children reach six months of age, they should receive enough healthy semi-solid and solid foods, along with continued breastfeeding through 23 months, to continue growing properly.
Social awareness: Huge social awareness is necessary for improving feeding practices. Awareness against some relevant issues likes child marriage, dowry and restricting or hindering women empowerment, etc. is also very important and necessary.
Implications for policies and programmes: By supporting and strengthening policies and programs that can improve feeding practices and relevant social awareness, we can reduce stunting and achieve greater health and economic prosperity in Bangladesh.
Bangladesh is on track
There has been some improvement in child nutritional status in Bangladesh over the past more than one decade, counting from the declaration of Millennium Development Goals. The level of stunting has declined from 51 per cent in 2004 and 43 per cent in 2007 to 41 per cent of children under five in 2011.
The pattern and change in wasting has been small and inconsistent. It increased from 15 per cent in 2004 to 17 per cent in 2007, and declined to 16 per cent of children in 2011. The level of underweight has been declining from 43 in 2004, to 41 per cent in 2007, and to 36 per cent in 2011. The Health Population Nutrition Sector Development Programme (HPNSDP) 2011-2016 targets for 2016 are 38 per cent for stunting and 33 per cent for underweight. If the current pace of decline is sustained, these targets should be achieved.
But to ensure it, policymakers, implementers, political and elected representatives, social leaders and all other concerned must continue and reinforce their efforts to prevent and reverse stunting.