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All hands on deck: Halting the vicious circle of stunting in Sub-Saharan Africa

Emmanuel Skoufias's picture
Betty teaches mothers with small children about nutrition, Uganda. Photo: © Stephan Gladieu / World Bank

In a large, complex, or urgent situation, the command goes out: “All hands on deck!”

Sub-Saharan Africa faces such a clarion call now. It is the only region in the world with a growing number of children under the age of five who have stunted growth, meaning they are too short for their age. Although the number of children affected by stunting globally has decreased drastically since 1990, Africa is the only region that has seen an increase in the number of children stunted despite a decrease in the prevalence of stunting.

Poor sanitation is stunting children in Pakistan

Ghazala Mansuri's picture
A nutrition assistant measures 1 year old Gullalay’s mid-upper arm circumference (MUAC) at UNICEF supported nutrition center in Civil Dispensary Kaskoruna, Mardan District, Khyber-Pakhtunkhwa province, Pakistan.
With a stunting rate of 38 percent, Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven. In Sindh, for example, things have worsened over time, with one in two children now stunted. Credit: UNICEF


More than one in every three children born in Pakistan today is stunted.

Child stunting, measured as low height for age, is associated with numerous health, cognition and productivity risks with potential intergenerational impacts.

With a stunting rate of 38 percent (Demographic & Health Survey 2018), Pakistan is still among the group of countries with the highest rates of stunting globally and the pace of decline remains slow and uneven.

In Sindh, for example, things have worsened over time, with one in two children now stunted!

The policy response to this enormous health crisis has been almost entirely centered on interventions at the household level—reducing open defecation (OD), improving household behaviors like child feeding and care practices and food intake.  

A recent World Bank report, which I co-authored, suggests that a major shift is this policy focus is required for significant progress on child stunting.

The report begins by showing that over the past 15 years Pakistan has made enormous progress in reducing extreme poverty, with the poverty rate falling from 64 percent to just under 25 percent in 2016.

This has improved dietary diversity, even among the poorest, and increased household investment in a range of assets, including toilets within the home.

This has, in turn, led to a major drop in OD, from 29 percent to just 13 percent. Curative care has also expanded, with the mainstreaming of basic health units and the lady health worker program.
 

What does it take to achieve universal and equitable access to water and sanitation in Guatemala?

Marco Antonio Aguero's picture
See the full infographic on key findings of the Guatemala Water Supply, Sanitation, and hygiene (WASH) Poverty Diagnostic.

Water and sanitation data figures in Guatemala show a challenging reality. Nationally, 91 percent of the population has access to improved drinking water, an increase of 14 percent points since the establishment of the MDGs.
 
Despite the improvement in coverage in relative terms, in absolute terms there are still a significant number of Guatemalan households using water from precarious or unimproved sources such as unprotected wells, rivers, or lakes. In addition, water quality is a concern -- from the monitoring of 20% of the water systems in the country, 54% reported to be at high and imminent risk for human health.

Reaching for the SDGs: the untapped potential of Tanzania’s water supply, sanitation and hygiene (WASH) sector

George Joseph's picture


When it comes to economic success, Tanzania offers a model for the rest of Sub-Saharan Africa. Growth has averaged 6.5 percent per year over the past decade, and between 2007 and 2012 nearly a third of the poorest 40% of the population rose out of poverty. However, the progress towards improving water and sanitation access for all has not kept a similar pace.
 
A new report by the World Bank, ‘Reaching For The SDGs’ was launched by the Honorable Eng. Isack Kamwelwe, Minister of Water and Irrigation on March 20 in Dar es Salaam. In her welcome address, Ms. Bella Bird, Country Director for Tanzania, Malawi, and Burundi said, “adequate WASH is a crucial component of basic human necessities that allow a person to thrive in life”.  The report shows how water and sanitation services need to advance substantially in order to achieve much needed improvements in health and wellbeing that will help the country fulfill its true potential.  Progress in this area still has a long way to go.  

For Central Asia, investing in children’s health is the best investment for the future

Lilia Burunciuc's picture


Millions of children around the world are prevented from reaching their full developmental potential because of poor environment and nutrition. In the more extreme cases, these children face stunting — a condition that arises when children grow much less than is expected for their age.

In 2016, an estimated 155 million kids – about one quarter of all young children worldwide – were affected by stunting. Sadly, undernutrition claims about 3 million young lives every year – representing almost half of all deaths of children under the age of five.

Young children who lack access to pre-primary education also lack access to essential services that support a healthy childhood. Kids who are poorly nourished, who are stunted, and who do not receive adequate stimulation before their fifth birthday are likely to learn less at school and earn less as adults. They are also less ready to compete as adults in an increasingly digital economy.

In Central Asia, I am glad to say that we are starting to see progress on the path toward eliminating childhood stunting. In every country in the region, the share of children who are stunted is on the decrease. This is a remarkable achievement, due in large part to the commitment of governments and communities to address malnutrition. We must remain determined to ensure this progress continues.

Incentivizing collaboration to address childhood stunting

Craig Kullmann's picture

Childhood stunting is one of the most significant impediments to human development and economic growth, affecting approximately 155 million children under the age of five globally, with long-term consequences later in life such as impaired cognitive development, chronic disease, and lower earnings as adults. Evidence shows that there is an urgent need for collaboration between actions in water, sanitation, health, nutrition, and other sectors to effectively combat childhood stunting.
 

 
This was discussed during the recent World Bank-IMF Annual Meetings, where leaders from the World Bank and client countries met to talk about Changing Behaviors to Incentivize Collaboration to Address Childhood Stunting. Aimed to provide guidance on how to collaborate better across sectors and institutions, this event provided an opportunity to share the latest results from the global Water Supply, Sanitation, and Hygiene (WASH) Poverty Diagnostic Initiative, led by the World Bank’s Water and Poverty Global Practices in collaboration with the Health, Nutrition, and Population and Governance Global Practices.

When nutrition meets WASH: reflections from Ethiopia and Madagascar on fighting stunting

Claire Chase's picture

Co-author: Sophie Durrans, Research Uptake Officer at London School of Hygiene & Tropical Medicine

A child who is stunted early in life – who fails to grow as tall as expected for their age – often has reduced physical and mental development. Water supply, sanitation, and hygiene (WASH) influences a child's growth in multiple ways. Evidence across low and middle-income countries demonstrates that higher open defecation rates are associated with stunting and higher overall incidence of poverty.

Water and sanitation deprivation: What is next for Tajikistan?

Emcet O. Tas's picture
Also available in: Русский

Two years ago, I visited a village in Rudaki, a hilly district located to the south of Dushanbe, Tajikistan. It lies about forty kilometres from the capital, but it feels like a thousand kilometres away. On our drive up a hill, we saw women carrying buckets of water from a nearby spring. Moving further up, we saw children bathing and animals drinking from the same river. Once in the village, it was clear that life is largely shaped by water scarcity—the backyards were filled with pots and buckets, fuel and stoves for boiling water, and pit latrines that were no longer used because of lack of water. Although we could spot remnants of a once-functional water supply network, people living there had not had access to piped water for at least two decades. Without it, they were only able to practice the most basic forms of sanitation and hygiene. 
A community in Rudaki district, Tajikistan.
Photo credit: World Bank team.



The conditions we witnessed in Rudaki were harsh, but not rare. Located on the western tip of the Himalayas, Tajikistan is a country blessed with large fresh water resources in its lakes, rivers, and glaciers. Yet, access to safe drinking water and sanitation connected to a functioning sewer system is lacking, particularly for rural residents and the poor. Much of the existing infrastructure was built during the Soviet era and has not been upgraded for decades. Tajikistan is one of the few countries outside Africa that did not meet the Millennium Development Goal on drinking water and basic sanitation. Because poor water and sanitation conditions, together with poor nutrition and care, are key determinants of childhood stunting, Tajikistan’s childhood stunting rates remain high. Recent estimates indicate that in Tajikistan more than one in five children under the age of five are stunted and will not reach their full potential as adults.
 
In a new report, Glass Half Full: Poverty Diagnostic of Water Supply, Sanitation and Hygiene (WASH) Conditions in Tajikistan, we document the realities of Tajikistan’s WASH-deprived population. Our analysis builds on one of the largest data collection efforts of its kind – including national surveys of households and schools, water quality tests, ethnographic work, and case studies of existing WASH projects. It also includes poverty mapping and analysis of other secondary data, including a UNICEF nutrition survey that shared a subsample with our WASH survey.

Starting a marathon with a broken ankle: how poor water and sanitation sets children behind

Maximilian Leo Hirn's picture
Children in Koutoukalé, Niger

Have you ever wondered how your life chances are affected by where you were born? Odds of being born at all are already miraculously small, but only one in ten of us is born into the relative security of a high-income country. What if you are born in Niger or in the Democratic Republic of the Congo (DRC)? Before you could even walk or talk, your challenges would be daunting. That's because, despite progress, deaths of children under five years old are more than twenty times higher than in the EU and nearly ten times higher than in China.

Even if you survived, you would confront another major risk to your development: malnutrition. In Niger and DRC, almost one out of every two children is stunted. Stunting has significant and long-lasting negative effects on early childhood development, impeding physiological and mental development, and making small children more vulnerable to disease. Starting off in life stunted is akin to starting a marathon with a broken ankle.

Campaign Art: Why it’s imperative to scale-up maternal and child nutrition

Darejani Markozashvili's picture
People, Spaces, Deliberation bloggers present exceptional campaign art from all over the world. These examples are meant to inspire.

Maternal and child nutrition is a key driver for sustainable development, yet about 155 million children worldwide are still stunted (children below average height for their age). According to the 2008 Lancet Maternal and Child Undernutrition Series “more than a third of child deaths and 11% of the total diseases burden worldwide are due to maternal and child undernutrition.”

More recent estimates released in May 2017 by UNICEF, WHO, and World Bank suggest that number of children under 5 stunted has decreased from 254.2 million in 1990 to 154.8 million in 2016. While this a great progress in the last 26 years, 154.8 million stunted children is still a staggering number.
 

Source: WHO, UNICEF, World Bank
 


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