Stunting is a health problem that is very urgent to be addressed. This is associated with increased morbidity, mortality, development of cognitive impairment and an increased risk of various chronic diseases in the future. The research method uses a qualitative approach. With the literature review method, which includes activities related to library data collection methods, reading and recording, and managing research materials. The results of the study show that the treatment of stunting can be divided into 2 methods. First, specific interventions that contribute 30% to the success of treatment, are aimed at children within the First 1,000 Days of Life (HPK), are generally carried out by the health sector and are short-term in nature. This can be done through the target group of adolescents and women of childbearing age, pregnant women, nursing mothers and children 0-23 months, children 24-59 months through priority, important and conditional interventions. The two sensitive interventions, which contribute 70%, are aimed at various development activities outside the health sector targeting the general public. The types of interventions that can be carried out are increasing the supply of drinking water and sanitation, increasing access to and quality of nutrition and health services, increasing awareness, commitment, parenting practices, maternal and child nutrition, increasing access to nutritious food.
There have been steep falls in rates of child stunting in much of Sub-Saharan Africa (SSA). Using Demographic and Health Survey data, we document significant reductions in stunting in seven SSA countries in the period 2005-2014. For each country, we distinguish potential determinants that move in a direction consistent with having contributed to the reduction in stunting from those that do not. We then decompose the change in stunting and in proximal determinants into a part that can be explained by changes in distal determinants and a residual part that captures the impact of unmeasured factors, such as vertical nutrition programs. We show that increases in coverage of child immunization, deworming medication and maternal iron supplementation often coincide with a fall in stunting. The magnitudes and directions of changes in two other proximal determinants -- age-appropriate feeding and diarrhea prevalence -- suggest that these have not been strong contributors to the fall in stunting. Utilization of maternity care emerges from the decomposition analysis as the most important distal determinant associated with reduced stunting, and also with increased coverage of iron supplementation, and, to a lesser extent, with child immunization and deworming medication. This circumstantial evidence is strong enough to warrant more detailed investigation of the extent to which maternity care is an effective channel through which to target further attacks on the blight of undernourished children.
Leander R. Buisman, Ellen Van de Poel, Owen O’Donnell et al.
This issue of Abstract Digest brings to you a set of interesting articles on stunting burden, drivers, and learnings from countries that have been successful in reducing stunting, including a case study on Chhattisgarh. In addition, there are studies on anthropometric data quality assessment, and a study describing the health system components required for the delivery of nutrition-specific interventions. This issue also includes studies on COVID-19 and its implications for child nutrition. In this edition, we have included a Call for Action issued by leaders of four UN agencies to protect children's right to nutrition in the face of the COVID-19 pandemic. In India, a diverse group of nutrition stakeholders have pledged their renewed Commitment to Action for supporting efforts by the government and all of society.
BACKGROUND: Child stunting remains a persistent public health challenge in Peru. Although women's empowerment has been linked to improved child health, evidence on its domain-specific relationship with stunting remains limited. The objective of this study was to assess the association between women's empowerment, across attitudes towards violence, social independence, and decision-making, and child stunting in Peru. METHODS: We conducted an analytical cross-sectional study using nationally representative data from the 2021 Demographic and Family Health Survey (ENDES), including 16,650 mother-child pairs. Analyses of women's empowerment were conducted in a sub-sample with complete SWPER data (n = 12,696). Stunting was defined as height-for-age below - 2 standard deviations of WHO standards. Women's empowerment was measured using the SWPER Global index and categorised into tertiles. All analyses accounted for the complex survey design, including sampling weights. Crude and adjusted logistic regression models estimated odds ratios (ORs) with 95% confidence intervals (CIs). RESULTS: The overall prevalence of child stunting was 11.3%. Stunting disproportionately affected disadvantaged groups, particularly children living in rural areas and from lower wealth quintiles. In adjusted analyses, higher maternal decision-making was associated with lower odds of stunting (medium vs. low: aOR 0.65; 95% CI 0.46-0.92; high vs. low: aOR 0.48; 95% CI 0.34-0.69). No significant associations were found for attitudes towards violence or social independence after adjustment. CONCLUSIONS: Maternal decision-making empowerment is associated with lower odds of child stunting in Peru. These findings suggest that strategies aimed at improving child nutrition may benefit from incorporating interventions that strengthen women's agency within household decision-making.
Marisella Chumán-Sánchez, Brando Ortiz-Saavedra, Leonardo J. Uribe-Cavero et al.
Abstract Child malnutrition persists globally. While progress in reducing stunting has been witnessed over the last six years, this progress is not sufficient to meet Sustainable Development Goal targets on stunting. In Africa, child malnutrition is estimated to result in between 1.6 to 16% losses in gross domestic product. Undernutrition is also attributed as a cause of death for 11% of African children aged five years and below. Men and women play distinct roles in supporting a child's nutrition. Women frequently carry the bulk of the workload related to food, care, and health, all of which are critical factors in child nutrition. Using focus group discussions and individual interviews with communities in rural Central Malawi, we sought to understand the roles played by men and women in achieving child nutrition in this qualitative study. We found that both men and women were involved in productive, reproductive, and community work. However, consistent with the literature, women carried a disproportionate workload in supporting child nutrition compared to men. Women's heavier workloads often prevented them from being able to meet children's food needs. Nevertheless, shifts in gender roles were observed in some of the sampled communities, with men taking up responsibilities that have been typically associated with women. This undoing of gender roles did not necessarily increase women's power within the household. Improving gender equality and child nutrition will require efforts to redistribute gendered work and encourage men to move towards shared power over household decision-making and control over income with women.
Elizabeth Mkandawire, Clement Bisai, Elizabeth Dyke et al.
The main objective of this paper is to examine the effects of household shocks on the nutrition status of children between 0–59 months in Tanzania. The study employed the national panel survey data of Tanzania collected in three waves: 2008/09, 2010/11, and 2012/13. The study used the panel random-effects probit model to estimate the effects of household shocks on child nutrition status, measured by binary variables: stunting, wasting, and underweight. Findings indicated that weather shocks increase the probability of a child being stunted and underweight. Moreover, the results revealed that food price rise shocks and the death of a family member increase the probability of child-stunting. In addition, the findings indicated that food assistance reduces the probability of a child being stunted and underweight. These findings suggest the need for the government to improve food assistance programs to reach many people,especially the poor and marginalized households in a period of shocks. In addition, agricultural policies that aim at increasing productivity, such as irrigation schemes,should also be enhanced to enable food availability in the country; and protect children from malnutrition even after the occurrence of shocks.Galiano, A. & M. Vera-Hernandez. 2008. Health Shocks, Household Consumption, and Child Nutrition. Instituto Valenciano De Investigaciones Economicas.Gaydosh, L. 2015. Childhood Risk of Parental Absence in Tanzania. Demography, 52(4): 1121–1146. https: //doi.org/10.1007/s13524–015–0411–4.Groot, R. De, T. Palermo, S. Handa, L. Peter & R. Amber. 2017. Cash Transfers and Child Nutrition : Pathways and Impacts. May 2015, 621–643. https: //doi.org/10.1111/dpr.12255.Halmdienst, N. & R. Winter-Ebmer. 2014. Long-Run Relations Between Childhood Shocks and Health in Late Adulthood — Evidence from the Survey of Health, Ageing, and Retirement in Europe. 60(April): 402–434. https: //doi.org/10.1093/cesifo/ifu015.Hoddinott, J. & B. Kinsey. 2001. Child Growth in the Time of Drought. Oxford Bulletin of Economics and Statistics, 63(4): 409–436.Johnston, F. E., S. M. Low, Y. De Baessa & R. B. Macvean. 1987. Interaction of Nutritional and Socioeconomic Status as Determinants of Cognitive Development in Disadvantaged Urban Guatemalan Children. American Journal of Physical Anthropology, 73(4): 501–506. https: //doi.org/ 10.1002/ajpa.1330730412.Kousky, C. 2016. Impacts of Natural Disasters on Children. The Future of children, 73–92.Kumar, S., R. Molitor & S. Vollmer. 2016. Drought and Early Child Health in Rural India Population Council. Population and Development Review. https: //www.popcouncil.org/research/drought-andearly-child-health-in-rural-india.Leroy, J. 2011. ZSCORE06: Stata Module to Calculate Anthropometric Z-Scores Using the 2006 WHO Child Growth Standards. https: //econpapers.repec.org/repec: boc: bocode: s457279.Martin, W. & M. Ivanic. 2016. Food Price Changes, Price Insulation, and Their Impacts on Global and Domestic Poverty. in Food Price Volatility and Its Implications for Food Security and PolicySpringer International Publishing. https: //doi.org/10.1007/978–3–319–28201–5,_pp. 101–113. Martorell, R., L. K. Khan & D. G. Schroeder. 1994. Reversibility of Stunting: Epidemiological Findings in Children from Developing Countries. European Journal of Clinical Nutrition, 48(SUPPL. 1): S45–57. http: //europepmc.org/article/med/8005090.Martorell, R. 1999. The Nature of Child Malnutrition and Its Long-Term Implications. Food and Nutrition Bulletin. 20(3): 288–292.Mbegalo, T. 2016. The Impact of Food Price Changes and Land Policy Reforms on Household Welfare in Rural Tanzania (No. 217). Discussion Papers.Michaelsen, M. M. & S. Tolan. 2012. Children at Risk: The Effect of Crop Loss on Child Health in Rural Mexico #376. RUHR Economic Papers.Mikalitsa, S. M. 2015. Intrahousehold Allocation, Household Headship, and Nutrition of Under-Fives: A Study of Western Kenya | African Journal of Food, Agriculture, Nutrition and Development.Mkonda, M. Y. & He, X. 2018. Agricultural History Nexus Food Security and Policy Framework in Tanzania. Agriculture & Food Security, 1–12.Nsabimana, A. & J. T. Mensah,2020. WIDER Working Paper 2020 / 57 Weather Shocks and Child Nutrition Evidence from Tanzania. May.Ogasawara, K. & M. Yumitori. 2019. Early-Life Exposure to Weather Shocks and Child Height: Evidence from Industrializing Japan. SSM - Population Health, 7(November 2018): 100317.
Omitsu, M. & T. Yamano. 2006. The Impacts of Hurricane Mitch on Child Health: Evidence from Nicaragua.Outes-Leon, I. & A. Sanchez. 2008. An Assessment of the Young Lives Sampling Approach in Ethiopia. Young Lives Technical Note, 1(March): 1–37.Pitt, M. M. & M. R. Rosenzweig. 1985. Health and Nutrient Consumption Across and Within Farm Households. The Review of Economics and Statistics, 67(2): 212. https: //doi.org/10.2307/1924720.Rossel, J. D. 2008. The Impact of Climatic Shocks on Child Nutrition in Peru. Peruvian Young Lives Project, DFID. University of Oxford, UK. 38p.Sarris, A., S. Savastano & L. Christiaensen. 2006. The Role of Agriculture in Reducing Poverty in Tanzania: A Household Perspective from Rural Kilimanjaro and Ruvuma. FAO Commodity and Trade Policy Research Working Paper. 19: 1–37. www.fao.org/es/esc/.Shukur, G. & P. Mantalos. 2015. Size and Power of the RESET Test as Applied to Systems of Equations : A Size and Power of the RESET Test as Applied to Systems of Equations : A Bootstrap Approach. May. https: //doi.org/10.22237/jmasm/1099267800.Singhal, S. 2019. Early Life Shocks and Mental Health : The Long-Term Effect of the War In. Journal of Development Economics, 141(March 2018): 102244. https: //doi.org/10.1016/ j.jdeveco. 2018.06.002.Sulaiman, M., M. Parveen, M., & Das, N. C. 2009. Impact of the Food Price Hike on Nutritional Status of Women and Children. Research and Evaluation Division, BRAC. (Vol. 7, Issue 38)Tarrass, F. & M. Benjelloun. 2012b. The Effects of Water Shortages on Health and Human Development. in Perspectives in Public Health. 132(5): 240–244. SAGE https: //doi.org/ 10.1177/ 1757913910391040.United Nations Children's Fund. 1990. Strategy for Improved Nutrition of Children and Women in Developing Countries. A UNICEF Policy Review. ERIC Clearinghouse. https: //digitallibrary. un.org/record/132779.United Republic of Tanzania (URT). 2012. Demographic and Health Survey. 2012. Dar es Salaam: Ministry of Health and Social Welfare, Tanzania.World Health Organisation (WHO). 2011. WHO Child Growth Standards Are Based on Length/Height, Weight, and Age. 76–85. https: //doi.org/10.1080/08035320500495548.WHO, UNICEF & World Bank. 2018. Levels and Trends in Child Malnutrition: Key Findings of the 2018 Edition (No. WHO/NMH/NHD/18.9). Williams, R. & N. Dame. 2018. Panel Data for Linear Models. The Stata Journal, 18(2): 293-326.Woldehanna, T. 2010. Economic Shocks and Early Childhood Nutritional Achievements: A Case in 20 Villages of Rural and Urban Ethiopia. June 2009.Yamano, T., H. Alderman & L. Christiaensen. 2005. Child Growth, Shocks, and Food Aid in Rural Ethiopia. American Journal of Agricultural Economics, 87(2): 273–288. https: //doi.org/10.1111/ j.1467–8276.2005.00721.x.Yamauchi, F., & Larson, D. F. 2019. Intra-household resource allocation when food prices soar: Impacts on Child Growth in Indonesia (Vol. 1867). Intl Food Policy Res Inst., 2019 September 20
Monica Sebastian Kauky, Martin Chegere, Razack Bakari Lokina
Introduction: Stunting is a serious public health problem, especially in developing countries, and can long-term impact children's physical and cognitive development. The nutritional status of pregnant women plays an important role in the growth and development of the fetus, which can affect the risk of stunting in children after birth. This study aims to analyze the influence of the nutritional status of pregnant women on the incidence of stunting in early childhood. Research Methodology: This study uses a cohort study design involving pregnant women and their children under five years old. Data were collected through interviews, anthropometric measurements, and laboratory analysis to assess the mother's nutritional status, including macro and micronutrient intake. Result: The analysis showed a significant relationship between the nutritional status of pregnant women and the incidence of stunting in children. Pregnant women with good nutritional status have a lower risk of giving birth to stunted children compared to pregnant women who are malnourished. In addition, factors such as maternal education, economic status, and access to health services also contribute to the incidence of stunting. Conclusion: This study emphasizes the importance of adequate nutrition during pregnancy to prevent stunting in early childhood. Appropriate nutritional interventions and increased awareness of the importance of nutrition during pregnancy are urgently needed to improve maternal and child health. Recommendations for public health programs and nutrition policies were also discussed to address the stunting problem.
Background: Globally, multisectoral coordination for nutrition is needed to tackle multiple determinants of undernutrition and address unacceptably high rates of stunting in young children. Tanzania has strong national policies and implementation plans to strengthen multisectoral nutrition (MSN) governance, yet local actors must transcend sector silos to fully implement MSN actions in communities. Objectives: We engaged with Nutrition Officers in Regional Secretariats and District Councils to explore strategies, barriers, and facilitators for creating novel "MSN action teams." Methods: An initial "Learning Exchange" workshop gathered input from nutrition staff in 5 regions and invited their participation in mentoring and supporting MSN collaboration. Regional Nutrition Officers piloted action teams in their districts, supporting District Nutrition Officers to create teams of 3-4 officers from relevant sectors (agriculture, community development, health, education) to plan and implement community-based activities consistent with sector priorities and national policy. To learn from stakeholder experiences, longitudinal data were collected through individual semistructured interviews and documentation of activities; 27 officers were interviewed 1-4 times over 14 mo. Results: Four districts successfully created action teams that bridged communication gaps between administrators and implementors; made progress on advocacy, collaboration, and budgeting for nutrition; and initiated MSN implementation in communities. Participants identified strategies to overcome challenges to cross-sector collaboration including heavy workloads and limited resources and supervisor buy-in. Based on their experiences and innovations in creating MSN action teams, stakeholders shared valuable recommendations for peer learning across sectors to scale up MSN collaboration. Officers' presentation of insights to regional and district leaders buoyed interest in MSN action teams as a feasible and acceptable approach to strengthen local governance and implementation to improve child nutrition. Conclusions: Experience-based input from government officers engaged in novel community and intersectoral collaborations provided actionable guidance for putting national MSN policy into practice and leveraging the capacity of implementation staff.
Gina C. Klemm, Rosemary Kayanda, Aidan Kazoba et al.
Background Child undernutrition remains a major public health challenge in Tanzania and other low- and middle-income countries. Although women's empowerment is recognized as a key determinant of child nutrition, evidence based on its multidimensional measures from nationally representative data remains limited. Aim This study examines the association between women's empowerment and the nutritional status of under-five children in Tanzania. Methods Data were drawn from 1790 children under-five years of age in the 2021/22 Tanzania National Panel Survey. Child nutritional outcomes; stunting, wasting, and underweight were measured using anthropometric z-scores based on World Health Organization child growth standards. A multidimensional women's empowerment index was constructed across instrumental, enabling , and collective agency domains. Propensity score matching and logistic regression models were employed to assess the association between women's empowerment and child nutritional outcomes. Summary Women's empowerment was significantly associated with reduced odds of wasting, with children of empowered women having 69% lower odds of acute malnutrition than those of disempowered women. Domain-specific analyses indicated that women's financial autonomy, work-life balance, and group membership were associated with improved child nutritional outcomes, while associations with stunting and underweight were less consistent. These findings suggest that strengthening women's financial autonomy, promoting balanced work responsibilities, and supporting women's participation in community groups may contribute to reducing child malnutrition. Integrating gender-responsive and nutrition-sensitive policies could help improve child nutritional outcomes in Tanzania.
To the Editor, The recent correspondence highlighted the importance of education as a critical investment for improving the quality of life, with particular emphasis on its role in breaking the cycles of poverty and health disparities within communities.1 While these assertions resonate deeply, the situation in the Philippines presents a grim reality that underscores the deep interconnectedness of educational inequalities, child health and nutrition. The Philippines faces an uncomfortable truth: our children are among the ‘most unhealthy and educationally challenged in the region, with the lowest IQ among their peers’.2 The population of Filipino children aged 5–17 years old was estimated at 31.71 million in 2022.3 Within this demographic, about a third of them are stunted or chronically malnourished.4 The 2022 Global Nutrition Report also highlighted the prevalence of stunting among Filipino children under five, which stands at 28.8%, significantly higher than the Asian regional average of 21.8%.5 These statistics highlight the substantial challenges confronting Filipino children, where gaps in education and nutrition perpetuate a cycle of poverty and adverse health outcomes.
