Abstract
BackgroundWasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. The aim of this study was to elucidate shared risk factors and the temporal relationship between wasting and stunting among children under 2 years of age in rural Niger.MethodsFrom August 2014 to December 2019, anthropometric data were collected every 4 weeks from 6 to 8 weeks to 24 months of age for 6567 children comprising 139,529 visits in Madarounfa, Niger. Children were defined as wasted if they had a weight-for-length Z-score < − 2 and stunted if they had a length-for-age Z-score < − 2 using the 2006 World Health Organization child growth standards. Parental, child, and socioeconomic risk factors for wasting and stunting at 6 and 24 months of age and the relationship between episodes of wasting, stunting and concurrent wasting-stunting were assessed using general estimating equations.ResultsHalf of children (50%) were female, and 8.3% were born low birthweight (< 2500 g). Overall, at 24 months of age, 14% of children were wasted, 80% were stunted and 12% were concurrently wasted-stunted. We found that maternal short stature, male sex, and low birthweight were risk factors for wasting and stunting at 6 and 24 months, whereas higher maternal body mass index and household wealth were protective factors. Wasting at 6 and 24 months was predicted by a prior episodes of wasting, stunting, and concurrent wasting-stunting. Stunting at 6 and 24 months was similarly predicted by prior episodes of stunting and concurrent wasting-stunting at any prior age but only by prior episodes of wasting after 6 months of age.ConclusionsThese data support a complex and dynamic bi-directional relationship between wasting and stunting in young children in rural Niger and an important burden of concurrent wasting-stunting in this setting. Further research to better understand the inter-relationships and mechanisms between these two conditions is needed in order to develop and target interventions to promote child growth.Trial registrationClinicalTrials.gov Identifier: NCT02145000.
Highlights
Wasting and stunting, physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent
Wasting, defined by a low weightfor-length Z score (WLZ), is considered an indicator of acute undernutrition that is amenable to treatment and has long been the focus of humanitarian interventions that aim to reduce the immediate risk of death associated with wasting
As concurrent wastingstunting has been increasingly recognized as an important issue and associated with an even higher increased risk of death than wasting or stunting alone [14], we further considered concurrent wasting-stunting, defined as simultaneous WLZ < − 2 and length-forage Z score (LAZ) < -2
Summary
Physical growth manifestations of child undernutrition, have historically been considered separately with distinct interventions at the program, policy, and financing levels despite similar risk factors, overlapping burdens and multiplicative risk of death when the conditions are concurrent. Stunting, defined by a low length-forage Z score (LAZ), is an indicator of chronic undernutrition and has traditionally been the focus of development organizations that seek to monitor linear growth faltering. These two forms of under-nutrition constitute a significant public health burden worldwide, with approximately 7% of children under-five wasted and 22% stunted in 2020 [1]. Wasting and stunting can co-exist in the same setting and occur within the same child [2] Both manifestations of acute and chronic undernutrition share common risk factors, including infection, poor infant and young child feeding practices, inadequate diet and food insecurity, and poor maternal health and nutrition [3]. Despite the potential for inter-relationships and common risk factors, academic research, programs, and policies have traditionally focused on treating wasting or preventing stunting in isolation [7, 8]
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