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      Stop stunting: improving child feeding, women's nutrition and household sanitation in South Asia

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          Abstract

          The latest available data indicate that 38% of South Asia's children aged 0–59 months are stunted. Such high prevalence combined with the region's large child population explain why South Asia bears about 40% of the global burden of stunting. Recent analyses indicate that the poor diets of children in the first years of life, the poor nutrition of women before and during pregnancy and the prevailing poor sanitation practices in households and communities are important drivers of stunting, most likely because of underlying conditions of women's status, food insecurity, poverty, and social inequalities. With this evidence in mind, UNICEF Regional Office for South Asia convened the Regional Conference: Stop Stunting: Improving Child Feeding, Women' s Nutrition, and Household Sanitation in South Asia (New Delhi, November 10–12, 2014). The Conference provided a knowledge‐for‐action platform with three objectives: (1) share state‐of‐the‐art research findings on the causes of child stunting and its consequences for child growth and development and the sustainable growth and development of nations; (2) discuss better practices and the cost and benefits of scaling up programmes to improve child feeding, women's nutrition, and household sanitation in South Asia; and (3) identify implications for sectoral and cross‐sectoral policy, programme, advocacy and research to accelerate progress in reducing child stunting in South Asia. This overview paper summarizes the rationale for the focus on improving child feeding, women's nutrition, and household sanitation as priority areas for investment to prevent child stunting in South Asia. It builds on the invited papers presented at or developed as a follow on to the Stop Stunting Conference.

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          Most cited references18

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Long-term consequences of stunting in early life.

            This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood. © 2011 Blackwell Publishing Ltd.
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              Linear growth deficit continues to accumulate beyond the first 1000 days in low- and middle-income countries: global evidence from 51 national surveys.

              Growth faltering is usually assessed using height-for-age Z-scores (HAZs), which have been used for comparisons of children of different age and sex composition across populations. Because the SD (denominator) for calculating HAZ increases with age, the usefulness of HAZs to assess changes in height over time (across ages) is uncertain. We posited that population-level changes in height as populations age should be assessed using absolute height-for-age differences (HADs) and not HAZs. We used data from 51 nationwide surveys from low- and middle-income countries and graphed mean HAZs and HADs by age. We also calculated annual changes in HAZs and HADs and percentage of total height deficit accumulated annually from birth to age 60 mo using both approaches. Mean HAZ started at -0.4 Z-scores and dropped dramatically up to 24 mo, after which it stabilized and had no additional deterioration. Mean HAD started at -0.8 cm, with the most pronounced faltering occurring between 6 and 18 mo, similar to HAZ. However, in sharp contrast to HAZ, HAD curves had continued increases in the deficit of linear growth from 18 to 60 mo, with no indication of a leveling off. Globally, 70% of the absolute deficit accumulated in height (HAD) at 60 mo was found to be due to faltering during the first "1000 days" (conception to 24 mo), but 30% was due to continued increases in deficit from age 2 to 5 y. The use of HAZ masks these changes because of age-related changes in SD. Therefore, HAD, rather than HAZ, should be used to describe and compare changes in height as children age because detecting any deficit compared with expected changes in height as children grow is important and only HAD does this accurately at all ages. Our findings support the current global programmatic momentum to focus on the first 1000 d. Research is needed to better understand the dynamics and timing of linear growth faltering using indices and indicators that accurately reflect changes over ages and to identify cost-effective ways to prevent growth faltering and its consequences throughout the lifecycle. © 2014 American Society for Nutrition.
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                Author and article information

                Journal
                Matern Child Nutr
                Matern Child Nutr
                10.1111/(ISSN)1740-8709
                MCN
                Maternal & Child Nutrition
                John Wiley and Sons Inc. (Hoboken )
                1740-8695
                1740-8709
                17 May 2016
                May 2016
                : 12
                : Suppl Suppl 1 ( doiID: 10.1111/mcn.2016.12.issue-S1 )
                : 3-11
                Affiliations
                [ 1 ]Regional Nutrition Advisor for South Asia, United Nations Children's Fund (UNICEF), Regional Office for South Asia KathmanduNepal
                [ 2 ]Senior Research Fellow, International Food Policy Research Institute (IFPRI) New DelhiIndia
                Author notes
                [*] [* ]Correspondence: Dr. Víctor M. Aguayo, United Nations Children's Fund (UNICEF), Regional Office for South Asia, PO Box 5815, Lekhnath Marg Kathmandu, Nepal. E‐mail: vaguayo@ 123456unicef.org
                Article
                MCN12283
                10.1111/mcn.12283
                5084809
                27187906
                affc77dd-2132-43bd-b6c8-570a8e33dcb5
                © 2016 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd

                This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Page count
                Pages: 9
                Categories
                Introduction
                Stop Stunting in South Asia. Improving Child Feeding, Women's Nutrition and Household Sanitation. This supplement was funded and made open access by UNICEF Regional Office for South Asia
                Introduction
                Custom metadata
                2.0
                mcn12283
                mcn12283-hdr-0001
                May 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:4.9.6 mode:remove_FC converted:28.10.2016

                stunting,child feeding,women's nutrition,household sanitation,south asia

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