Ethiopia, November 18, 2020
The Ethiopian Public Health Institute (EPHI), the International Food Policy Research Institute (IFPRI), for the Ethiopia National Information Platform for Nutrition (NIPN) co-hosted a webinar on "Thought-Provoking Perspectives on Child Stunting" on 18 November.
Introduction: Dr. Aregash Samuel, Deputy Director of the Food Science and Nutrition Research Directorate at EPHI and the NIPN National Coordinator
Moderator: Cornelia van Zyl, Senior Technical and Policy Advisor at IFPRI for the NIPN
Presenters: Dr. Jef Leroy, Senior Research Fellow in IFPRI's Poverty, Health and Nutrition Division; Dr. Kaleab Baye, Associate Professor at the Center for Food Science and Nutrition, Addis Ababa University (AAU)
The past decade has seen unprecedented attention going to undernutrition. Drastically reducing child stunting has become a global development objective. The focus on linear growth retardation and stunting led to successful advocacy for nutrition but also revealed confusion and misunderstanding about the meaning of these terms among researchers, donors, and agencies active in nutrition.
The webinar aimed at demystifying the confusion. Dr. Jef Leroy presented the study, "Perspective: What Does Stunting Really Mean? A Critical Review of the Evidence". Dr. Leroy (IFPRI) and Dr. Edward Frongillo (University of South Carolina) conducted a critical review of the literature which challenges current views on the consequences of linear growth retardation and stunting. Dr. Leroy argued that while linear growth and stunting are very strongly associated with several problems including child development and reduced work capacity in adult life, stunting does not cause these problems but the deficient environment in which children grow up, does. For Dr Leroy, it is important to differentiate between two distinct uses of stunting. First, as stunting can lead to difficult childbirth and poor birth outcomes, it is an outcome of interest in and of itself. Second, stunting is a marker of a deficient environment and it predicts future problems. Dr. Leroy considered stunting as a good marker to measure child nutritional status at global and population level, to compare data across regions and countries and to measure progress. However, he recommends other metrics and approaches to be used to directly address the underlying causes of undernutrition at program and policy levels, rather than reverting to "stunting" to do so.
The webinar also discussed a significant and underappreciated additional factor to child growth faltering: Altitude. Dr Kaleab Baye presented the study "Evaluation of Linear Growth at Higher Altitude". Dr. Kaleab Baye (AAU) and Dr. Kalle Hirvonen (IFPRI), analyzed data from nearly 1 million children in 59 low- and middle-income countries and the study shares insights into the association between child growth faltering and residence at high altitude. Dr. Baye discussed key findings, including the potential mechanisms, such as lack of oxygen in the prenatal period that drive higher rates of growth faltering for children at higher altitude compared to those at lower altitude. He did not recommend, however, a downward adjustment of the child growth standards, but rather stressed the importance to conduct more research to identify interventions and healthcare guidance to support pregnancies at higher altitude.
These timely and interesting presentations were followed by a lively question and answer (Q&A) session.
The NIPN is a multisectoral initiative supported by the European Union, the Bill and Melinda Gates Foundation and the Foreign, Commonwealth and Development Office. The NIPN in Ethiopia is housed at EPHI, receives technical assistance from IFPRI under its Compact2025 initiative. The NIPN promotes evidence-based decision making for nutrition and supports the implementation of the National Food and Nutrition Policy.