Chronic undernutrition in the first 1,000 days can manifest as stunting in children under five — that is, attainment of length or height less than two standards deviations from the population mean for the child’s age. Undernutrition is associated with increased duration and severity of childhood infections, delayed physical, motor and cognitive development, a trajectory towards non-communicable disease and poor obstetric health in adulthood. More than half the deaths of children under five are due to malnutrition and its complications.
Getayeneh Antehunegn Tesema and colleagues from the University of Gondar, Ethiopia, have pooled prevalence and predictor data of chronic undernutrition in the under-fives from the most recent demographic health surveys of 12 East African countries. With data from almost 80,000 children and their families, the research team found that maternal age and education; family wealth, size and residence in urban or rural area; antenatal care, place and type of delivery; child age, sex, birth order and size at birth were among the significant predictors of stunting.
Tesema and colleagues’ paper reports that the regional prevalence of stunting is about 33%, ranging from 22% in Kenya to 53% in Burundi. Children born to younger and less-educated women, poorer and rural households were more likely to be stunted — these take-home messages are resonant with other previous studies, and yet Tesema and colleagues’ regional narrative is critical.
It reinforces the intractability of chronic childhood undernutrition, and the slow progress towards eradicating hunger in African countries. It reinforces that ‘hunger’ is a complex problem that extends far beyond the immediate supply and provision of nutrition, but has underlying social determinants — and hunger, fundamentally, has political solutions. Tesema’s regional narrative for East Africa does not explicitly take the locust outbreaks or COVID-19 pandemic into account — crises that are pushing millions towards food insecurity and testing the infrastructure that supports women’s education, health and obstetric care. Updates on the prevalence and associated factors of chronic undernutrition among under-fives in East Africa, such as Tesema’s, are critical to flag the direction of progress.
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Mullen, A. Chronic challenge of undernutrition in the under-fives. Nat Food 2, 222 (2021). https://doi.org/10.1038/s43016-021-00274-0