Childhood stunting: a global perspective

Abstract

Childhood stunting is the best overall indicator of children's well-being and an accurate reflection of social inequalities. Stunting is the most prevalent form of child malnutrition with an estimated 161 million children worldwide in 2013 falling below -2 SD from the length-for-age/height-for-age World Health Organization Child Growth Standards median. Many more millions suffer from some degree of growth faltering as the entire length-for-age/height-for-age z-score distribution is shifted to the left indicating that all children, and not only those falling below a specific cutoff, are affected. Despite global consensus on how to define and measure it, stunting often goes unrecognized in communities where short stature is the norm as linear growth is not routinely assessed in primary health care settings and it is difficult to visually recognize it. Growth faltering often begins in utero and continues for at least the first 2 years of post-natal life. Linear growth failure serves as a marker of multiple pathological disorders associated with increased morbidity and mortality, loss of physical growth potential, reduced neurodevelopmental and cognitive function and an elevated risk of chronic disease in adulthood. The severe irreversible physical and neurocognitive damage that accompanies stunted growth poses a major threat to human development. Increased awareness of stunting's magnitude and devastating consequences has resulted in its being identified as a major global health priority and the focus of international attention at the highest levels with global targets set for 2025 and beyond. The challenge is to prevent linear growth failure while keeping child overweight and obesity at bay.

Keywords: child development; healthy growth; infant and child growth; malnutrition; stunting.

Figure 1

SD score distribution for length‐for‐age/height‐for‐age of Indian children compared with the World Health Organization (WHO) Child Growth Standards (India National Family Health Survey (NFHS‐3) 2005–6).

Figure 2

(a) Two Maldivian girls below 5 years of age – which is the stunted one? (Photo taken in the Maldives. © WHO/Mercedes de Onis, 2005) (b) Height‐for‐age measurements of two Maldivian girls plotted relative to the World Health Organization Child Growth Standards.

Figure 3

Measuring recumbent length in a child below 2 years of age – positioning of baby's feet and health worker's hands (Photo taken in Louboutigué village in the Sila Region, Chad. © UNICEF/NYHQ2011‐2162/Patricia Esteve, 2011).

Figure 4

Mean length‐for‐age/height‐for‐age z‐scores by age, relative to the WHO Child Growth Standards, according to WHO region (1–59 months) (reproduced with permission from Victora et al. 2010). AFRO, WHO regional office for Africa; EMRO, WHO regional office for the Eastern Mediterranean; EURO, WHO regional office for Europe; PAHO, Pan American Health Organization; SEARO, WHO regional office for South‐East Asia; WHO, World Health Organization.

Figure 5

Global and regional stunting prevalence and numbers (1990–2013).

Figure 6

National prevalence of stunting among children under 5 years of age (reproduced with permission from de Onis et al. 2013).

Figure 7

Effects of undernutrition on brain development (adapted from Cordero et al. 1993).