The first 1,000 days of life can make or break a person, not just in terms of physical growth but cognitive and social capabilities.

Neuroscientists believe 80% of the brain’s development occurs during this period, and beyond this critical window, though nutritional intervention could help a little, the chances of brain repair remain slim.

Researchers found that one-year-old children who were short in relation to their age were often behind in school at eight and scored lower on cognitive tests than their healthier peers.

Stunting reflects child malnutrition, and globally, 159 million children under five fall below the World Health Organisation Child Growth Standards median.

For instance, in Malawi, which has a high rate of stunting (42% in 2014) – children, by the age of three, have been found to be 10cm shorter than the World Health Organisation (WHO) standard.

Dwarfed by lack of proper hygiene and nutrition, these children can never scale higher than their ‘normal’ peers for sadly, theirs is a world of thwarted aspirations, compressed vision and constricted space.

Seeing the world through miniature lenses, they struggle in helplessness, very much like waiting for that trampled tuft of grass to sprout and outgrow the blooming blades in the garden.

When earlier studies view stunting as irreversible, these individuals see their fate as being sealed and could only question the unquestionable.

In some communities, being shorter than the average person is considered normal. Hence linear growth is often not visually recognised and this hampers routine assessment in primary health care settings. As a result, risk factors are undetected.

Key nutrients essential for neural development

Recent studies have found that growth faltering often begins in utero and continues for at least the first two years of post-natal life. But children who experienced greater than expected “catch-up” growth (stunted at one, but recovered by eight) are more likely to be in age-appropriate classes by the time they are eight years old and tend to demonstrate higher cognitive levels than those who remained relatively short.

Though stunting stems from a complex interaction of household, environmental, socioeconomic and cultural influences, nutritional deprivation during early post-natal life could lead to altered higher brain functions and varying degrees of mental retardation, in addition to the short stature.

In poor nations, the occurrence of stunting is higher than developed nations. Thus, raising household income for families in Mexico, Brazil, Ethiopia and Peru has helped, to a considerable extent, curb the transfer of poverty through generations.

Mothers are given incentives for prenatal checks through cash transfers schemes like Peru’s Juntos programme, as it is noted that if stunting begins in the womb, then maternal health is the key factor. Hence, shorter mothers are more likely to have stunted children.

The cash schemes in Peru also encourage the use of health facilities to track care and nutrition for children below the age of five. Meanwhile, efforts to provide schooling for children have resulted in cognitive gains for stunted children. Since 2005, Peru has witnessed a significant decline in the rate of stunting, from 30 – 15%.

In catastrophic crises like drought and famine, national feeding programmes in Peru, and mid-day feeding initiatives in India have enabled children to break through their stunted physiques.

Poor nations observe higher occurrence of stunting, as compared to the developed countries. Photo credit: Global Nutrition Report 2015/India Infoline
Poor nations observe higher occurrence of stunting, as compared to the developed countries. Photo credit: Global Nutrition Report 2015/India Infoline

Feeding interventions alone are not sufficient to spur growth

Besides nutritional factors, a clean and safe environment is pivotal to help address stunting.

Research shows that a quarter of all stunting is attributed to chronic diarrhoea in the first two years of a child’s life, and almost 90% of these cases have to do with the lack of clean water, sanitation and hygiene. Air pollution and the use of biomass fuel are hazards too.

In India, 50% of child malnourishment is linked to sanitation, clean water and hygiene practices, especially when statistics show that 595 million people in the country defecate in the open, without toilets or adequate facilities.

Every year, global records show 2.5 billion cases of diarrhoea in children below the age of five years. Repeated episodes of diarrhoea take away vital nutrients from the body and are said to be connected to chronic malnutrition, stunting and death.

Researcher Ibironke Olofin and her team found that infections like sepsis, meningitis, tuberculosis and hepatitis are associated with increased morbidity and mortality, suggesting a generalised immune disorder in children with severely stunted growth.

“Children thriving, not just surviving” – United Nations

At the core of United Nations’ global sustainable development goals is the task to enable these children to thrive and grow up as healthy and productive individuals.

An anthropological study echoes this vision, and challenges the once irreversible view of stunting through the case studies of the lives of children in Ethiopia, India, Peru and Vietnam over 15 years. Some of these children are now having their own children, paving the way for three generations.

Countries too are showing greater commitment and making strides in this aspect. Bangladesh has seen a tremendous drop from 51% to 36% in the rate of stunting over the last decade.

The WHO describes stunting as “completely preventable” and has set a global target to reduce by 40% the number of stunted under-5 years of age children by 2025. This translates into a 3.9% annual reduction, signalling a bold commitment to decrease the number of stunted children from 171 million in 2010 to about 100 million in 2025.

It is a loud call to increase global awareness of the magnitude of stunting and its consequences, and to combat linear growth failure while keeping child obesity at bay.

For now, the challenge remains: Can we strive to enable these individuals to thrive, to stand tall and relish brighter glimpses of the earth that belongs to all of humanity? Perhaps, somewhere, a new dawn is approaching. MIMS

Stunting is prevalent in cases of chronic undernutrition during the most critical periods of growth and development in a child’s life. Photo credit: Thousand Days
Stunting is prevalent in cases of chronic undernutrition during the most critical periods of growth and development in a child’s life. Photo credit: Thousand Days

 
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Sources:
https://www.theguardian.com/global-development/2017/sep/07/surviving-without-thriving-but-all-is-not-lost-for-the-worlds-stunted-children
http://onlinelibrary.wiley.com/doi/10.1111/mcn.12231/full
http://www.who.int/nutrition/healthygrowthproj_stunted_videos/en/
http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf
http://www.unicef.in/Whatwedo/10/Stunting
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0064636

Stunting is prevalent in cases of chronic undernutrition during the most critical periods of growth and development in a child’s life. Photo credit: Thousand Days
Stunting is prevalent in cases of chronic undernutrition during the most critical periods of growth and development in a child’s life. Photo credit: Thousand Days