SCN News No 36 - UNSCN

www.unsystem.org/scn FEATURES 15
appear that growth was protected during the first months of life. These findings highlight the need for prenatal
and early life interventions to prevent growth failure which mainly happens during the first 2-3 years of life.
Understanding the reasons for the high prevalence of stunting in each setting will be important for implementation
of appropriate interventions that will effectively tackle this form of undernutrition. Generally, interventions
should focus on the promotion and protection of exclusive breastfeeding for the first six months of life with
continued breastfeeding until 2 years or more; improving complementary feeding practices, including caregiver
feeding behaviours; and interventions for maternal nutrition to improve pregnancy outcomes. Appropriate
prevention and treatment of common early childhood illnesses would also be essential to improving child growth.
It is well known that complementary feeding diets are frequently deficient in key micronutrients and that the
proportion of energy provided by animal source foods tends to be low. In addition, the common practice of the
early introduction of complementary foods displaces breast milk and increases the chances of infectious
morbidity. Thus, to prevent stunting, greater attention will need to be placed on improving the duration of
exclusive breastfeeding as well as complementary foods and behaviours. Guidelines for complementary
feeding are available (PAHO/WHO 2003; WHO 2004) and it is important that clear and consistent messages
for how to feed infants and young children are disseminated at both facility and community levels. In addition,
maternal education affects how well these messages are received and translated into improved nutrition
outcomes. There is solid empirical evidence showing a strong association between low height-for-age and a
lack of maternal education, with rates of stunting declining as levels of education increase (de Onis 2003).
Therefore, elimination of stunting will require long-term investments to improve maternal education and
empowerment of women, and to reduce current poverty levels.
Although fewer children are severely wasted worldwide compared to those affected by stunting, these children
are at very high risk of death and their treatment should be taken as a priority. The scale up and improvement
of hospital-based case management to prevent this important cause of death is important, however, hospitalbased
management reaches only a small percentage of children. Therefore, equally important will be to
promote the new community-based approach currently recommended by UN agencies as an integral part of
the management of severely wasted children (WHO/WFP/UNSCN/UNICEF 2007). This is critical if we are to
reach the majority of children with severe wasting at the large-scale required to significantly impact this
important cause of death.
Conclusions
The causes of growth retardation are deeply rooted in poverty and lack of education. As the WHO Child
Growth Standards demonstrate, children up to the age of 5 years across large populations - regardless of their
racial or ethnic background - grow to remarkably similar heights when given the best possible growth
conditions in early life. To continue to allow underprivileged environments to affect children's development not
only perpetuates the vicious cycle of poverty but also leads to an enormous waste of human potential (Victora
et al 2008). Moreover, a growth standard based on a worldwide sample and recognition that environmental
differences – not genetic endowment – are the principal determinants of disparities in child growth should
contribute to fulfilment of accepted human rights principles, notably those stipulated in the Convention on the
Rights of the Child (WHO 2008b). If the nutritional well-being of people is a precondition for the development
of societies, it is all the more so where their most vulnerable members - children - are concerned. Efforts to
significantly accelerate economic development will be unsuccessful until optimal child growth and
development are ensured for the majority.
The WHO Child Growth Standards have been generally well received, providing an opportunity to redefine,
refocus and reenergize all actions to promote child growth and development. Their introduction into countries
can put a new focus on reducing malnutrition. As part of the implementation process, many countries that
previously only monitored weight-for-age are incorporating the measurement of height which will allow them not
only to assess stunting at an individual level, but equally importantly to monitor the growing problem of childhood
overweight and obesity (WHO 2008c). By doing so they will be better prepared to address the double burden of
malnutrition which increasingly is affecting all developing countries in the world.
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