Syndicate content

stunting

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
 

All hands on deck: new evidence on the need for a multi-sectoral approach to reducing childhood stunting

Emmanuel Skoufias's picture



In Indonesia, chronic malnutrition is widespread with more than one-third of young children being stunted. Despite the reduction of the poverty rate from 16.6% to 11.4% from 2007 to 2013, the rate of stunting amongst children under the age of five has remained alarmingly high, exceeding 37% in 2013, although that figure has declined in the last two years. Stunting has important lifelong consequences for health, as well as for cognitive development, education, human capital accumulation, and ultimately for economic productivity.

However, to reduce stunting it’s not only important to focus on the health sector. It also requires improvements in other sectors such as agriculture, education, social protection, and water, sanitation, and hygiene (WASH). As originally emphasized by the UNICEF conceptual framework, to ensure that a child receives adequate nutrition depends on four critical factors: care, health, environment, and food security, areas that straddle multiple sectors.

What cost childhood stunting? And what returns to programs combatting stunting?

Emanuela Galasso's picture
Child #115181 in the Demographic and Health Survey we’re looking at is 38 months old. Let’s call her María. Her older brother, child #115201, is 51 months old. Let’s call him Alejandro. Despite their 13-month age difference, María and Alejandro are both 92cm tall. María is rather short for her age – she’s at the 18th percentile of the reference population of well-nourished children. She’d be 96 cm if she were average. Alejandro is extremely short – he’d be over 10cm taller if he were average height for his age.

Do Cash Transfers Have Sustained Effects on Human Capital Accumulation?

Berk Ozler's picture

Cash transfers are great – lots of people are telling you that on a continuous basis. However, it is an open question as to whether such programs can improve the wellbeing of their beneficiaries well after the cessation of support. As cash transfer programs continue to grow as major vehicles for social protection, it is increasingly important to understand if these programs break the cycle of intergenerational poverty, or whether the benefits simply evaporate when the money runs out…

Helping children survive and thrive: How toilets play a part

Claire Chase's picture



While child mortality rates have plummeted worldwide, nearly one-third of all children under 5 in developing countries are stunted. Children who are stunted (having low height-for-age) suffer from a long-term failure to grow, reflecting the cumulative effects of chronic deficits in food intake, poor care practices, and illness. The early years of life, especially the first 1,000 days, are critical; if a child’s growth is stunted during this period, the effects are irreversible and have lifelong and intergenerational consequences on their future human capital and potential to succeed.  
 
For the water and sanitation community the year 2009 marked a turning point in our understanding of the role that Water, Sanitation and Hygiene (WASH) has on child stunting. A provocative Lancet article (Humphrey 2009) put forth the hypothesis that a key cause of child stunting is asymptomatic gut infection caused by ingestion of fecal bacteria. Small children living in poor sanitary environments are especially at risk, through frequent mouthing of fingers and objects during exploratory play, playing in areas contaminated with human and animal feces and ingesting contaminated food and water (Ngure et al. 2013). Researchers now estimate that up to 43 percent of stunting may be due to these gut infections, known as environmental enteric dysfunction (EED) (Guerrant et al. 2013).
 
Just last week estimates were released suggesting that poor sanitation is the second leading cause of child stunting worldwide (Danaei et al. 2016). In a key departure from previous work, the researchers defined risk as the sanitation level of a community, rather than an individual. This is consistent with mounting evidence showing that a community’s coverage of sanitation is more important than any one household’s (Andres et al. 2013). Across different studies, data sets and outcomes the evidence consistently shows that a threshold of around 60–70 percent household usage within a community is needed before the health and nutrition benefits of sanitation begin to accrue. Studies that have focused on an individual’s toilet use as a predictor, rather than a community’s use, may have vastly underestimated the impacts (Hunter and Prüss-Ustün 2016).  
 
As we advance our understanding of the ways in which a poor sanitary environment impacts growth in small children, we can better design water and sanitation interventions to target these pathways. While there is a role for multi-sectoral interventions, which can simultaneously target the underlying determinants of child undernutrition, such as food security, access to health services, and childcare practices — there are ways that the water sector can adapt its own approaches so that they are more nutrition-sensitive, and more impactful on nutrition. Here are four key actions:

Did Peru’s CCT program halve its stunting rate?

Berk Ozler's picture

On September 30, the Guardian ran several articles (see here, here, and an editorial here) linking the halving of Peru’s stunting rate (from 28 to 14% between mid-2000s and 2015) to its CCT program Juntos. Of course, it is great to hear that the share of stunted children in Peru declined dramatically over a short period. However, as I know that while CCT programs (conditional or not) have been successful in improving various outcomes including child health, the effect sizes are never this dramatic, I was curious to see whether the decline was part of a secular trend in Peru or actually could be attributed primarily to Juntos

There is enough evidence on humanitarian cash transfers. Or perhaps not?

Ugo Gentilini's picture

Take these two numbers: 165 and 1. The former is the number of children in millions who are chronically malnourished or ‘stunted’; the latter is the number of robust impact evaluations comparing cash and in-kind transfers on malnutrition.
 
I emphasize ‘comparing’ since there is plenty of evidence on individual cash and in-kind (and voucher) programs, but very few studies deliberately assessing them under the same context, design parameters, and evaluation framework.

In the poorest countries, an acute climate risk

Sri Mulyani Indrawati's picture

A man walks through a flooded rice field. © Nonie Reyes/World Bank

For the first time in history, the number of people living in extreme poverty has fallen below 10%. The world has never been as ambitious about development as it is today. After adopting the Sustainable Development Goals and signing the Paris climate deal at the end of 2015, the global community is now looking into the best and most effective ways of reaching these milestones. In this five-part series I will discuss what the World Bank Group is doing and what we are planning to do in key areas that are critical for ending poverty by 2030: good governancegender equality, conflict and fragility, preventing and adapting to climate change, and, finally, creating jobs.

Seawater is rising in coastal Bangladesh. The soil contains more and more salt as the sea encroaches on the land. As a result, farmers see their crops declining. Communities are hollowing out, as working-age adults move to cities. Freshwater fish are disappearing, reducing the amount of protein in local diets. And in the dry season, mothers have to ration drinking water for their children – in some areas, to as little as two glasses a day.
 
Climate change is finally being taken seriously in the developed world, but it is generally seen as a future threat, to be managed over the coming years.  For poor people in poor countries, particularly those living along coastlines, in river deltas, or on islands, it is a clear and present danger – and increasingly, a dominant fact of life.

Better together: Toilets and nutrition

Claire Chase's picture
​Studies show children grow taller and perform better
on cognitive tests in communities where residents have
access to improved sanitation and do not defecate
in the open. Photo credit: World Bank

Pages