One third of stunting and a quarter of deaths among under 3s in poor countries could be prevented

Professor Simon Cousens, of the London School of Hygiene & Tropical Medicine, is one of the authors of a paper which appears as part of the Lancet Maternal and Child Undernutrition Series, which is being launched this week. Professor Cousens, along with four other series authors, is presenting his findings at a press event at the Science Media Centre.

178 million children under five are stunted, and most of these live in Sub-Saharan Africa and south-central Asia. 160 million stunted children (90%) live in just 36 countries, and make up 46% of the 348 million children in those countries. In addition, 19 million children are affected by severe acute malnutrition.

Historical evidence of improvements in nutrition in developed countries has shown that stature, living standards, reduced disease exposure and education are linked, and that almost all stunting is avoidable. Stunting is difficult to reverse after the age of three, so it is important to focus on interventions in pregnancy and in young children, especially those aged under two. In the past most nutrition programme reports and assessments have focused on weight gain rather than linear growth, and linear-growth retardation has been viewed as difficult to change. However, in the short term, about one third of stunting could be averted with existing interventions, say the authors. These include strategies to promote improved complementary feeding, micronutrient interventions, and interventions aimed at reducing the burden of disease.

In addition to reducing stunting, nutrition interventions, including breastfeeding promotion, could prevent about one quarter of child deaths in the 36 countries in which 90% of the world’s stunted children live, while universal supplementation with calcium, iron and folic acid of women during pregnancy could prevent around 100,000 maternal deaths (24% of the total) and 3.12 million DALYs.

Professor Cousens comments: ‘Much can be done now to improve the nutritional status of mothers and children with simple, evidence-based interventions. Although there are intergenerational effects of undernutrition which will take many years to eliminate, promotion of breastfeeding, improved complementary feeding practices, interventions to improve micronutrient status and interventions to reduce the burden of child disease can all have an immediate impact on child nutrition.

Attention to the continuum of maternal and child undernutrition is essential to attainment of several of the Millennium Development Goals and must be prioritised globally and within countries. Countries with a high prevalence of undernutrition must decide which interventions should be given the highest priority, and ensure their effective implementation at high coverage to achieve the greatest benefit.”