Stunting In Young Children Research Articles

The Relationship Between Dietary Diversity And The Risk Of Stunting In Young Children In Indonesia

Introduction: Stunting, a form of chronic malnutrition, remains a significant public health issue in Indonesia, with high prevalence rates among young children. Dietary diversity has been identified as a crucial factor influencing the nutritional status and risk of stunting in this population. This study aimed to investigate the relationship between dietary diversity and the risk of stunting in young children in Indonesia. Materials & Methods: Literature searches were conducted on electronic databases such as PubMed, Embase, and the Cochrane Library. Articles that meet the inclusion criteria will be analyzed narratively. Results: The findings demonstrate a significant inverse relationship between dietary diversity and the risk of stunting. Children with higher dietary diversity were found to have a lower likelihood of being stunted compared to those with lower dietary diversity. The results also suggest that dietary diversity can serve as a proxy indicator for nutrient adequacy in this context. Conclusions: Promoting increased dietary diversity among young children and their mothers emerges as a key strategy to address the high prevalence of stunting in Indonesia. Interventions focusing on improving access to and consumption of a diverse range of nutritious foods, such as nutrition education, food production diversification, and food distribution programs, are recommended to contribute to the reduction of stunting in the country.

Maternal knowledge and family support for child food insecurity among households with stunting in young children

Bakcground: Stunting is a common health issue. In poor nations, particularly Indonesia, stunting is a long-term problem with chronic malnutrition that results in growth abnormalities in children, where the child's height is lower or shorter (stunted) than the average for their age.Purpose: To determine the relationship between maternal knowledge and family support for child food insecurity among households with stunting in young children.Method: Cross sectional research methodology is being used in this quantitative investigation. 110 toddlers from the Bojongnangka Tangerang Community Health Center's service region served as the study's population of interest. Simple random sampling is the sampling method employed. The measurements taken include the toddler's height and the answers to a questionnaire that the toddler's parents completed. SPSS 20 was used for data analysis. The Mann Whitney test was used to do univariate and bivariate analysis after the data had been gathered.Results: With a p value of 0.041, there is a significant correlation between the occurrence of staining and knowledge. Parental education (P=0.267), family skills (P=0.438), family attitudes (P=0.838), family emotional support (P=0.521), family informational support (P=0.707), and family appreciation support (P=0.872) do not significantly correlate with the prevalence of stunting.Conclusion: The prevalence of stunting in the Bojongnangka Tangerang Community Health Center is significantly correlated with knowledge.

Sistem Pakar Diagnosa Kelainan Stunting Balita Menggunakan Metode KNN Berbasis Web

Stunting in young children is a child nutrition problem in Indonesia. This research has the main objective of preventing and overcome it through a technique that can predict stunted babies based on data or information. This study using KNN method uses 125 test data and the value of k = 3 gives an accuracy of 96%. This includes 119 accurate predictions and 6 inaccurate predictions. The aim of this study is to predict the outcome of stunting in toddlers. If they fall into the stunting category, the parents of the toddler must pay more attention to the nutritional development of the toddler to be able to minimize the stunting rate in Indonesia.

Description of Knowledge of Stunting Children about Animal Food, Attitude and Behavior in Feeding at Gunggungan Lor Village, Probolinggo District

Severe nutritional deficiencies, including growth retardation, are infant conditions caused by malnutrition that result in being smaller than their age indicates. Factors that influence stunting in young children include direct factors such as diet and infectious diseases, as well as indirect factors such as nutrition, parenting, food transmission, and family knowledge. This research is useful to know of mothers of stunted infants about animal foods and their attitudes and behaviors when providing such foods in the village of Gungungan Roll, Probolinggo Regency. is. The research method used was descriptive. The study involved 38 mothers with stunted children aged 12 to 60 months. Data were collected by questionnaire-based interviews. Studies show that most stunted infants are between 42 and 58 months of age. The results also indicate a lack of animal protein due to low consumption of animal food. Most mothers have good knowledge (23 or 60.5%), agreeable attitudes (33 or 86.8%), but exhibit inadequate behavior (22 or 57.9%) in providing animal-based dishes. Mothers of stunted toddlers with good knowledge are more receptive and respond well to explanations about the condition, influencing their attitudes towards it.

Determinants of stunting in children aged between 6-23 months in Musanze region, Rwanda.

Under-nutrition causes approximately half of all deaths in young children every year globally which is exacerbated by the multiple malnutrition burden. Infant and young child feeding practices pose immediate effects on the nutrition status of under 2 years aged children and greatly influence the survival of a child. This study aimed at determining the implication of the infant and young child feeding practices in evaluating stunting in young children among other stunting risk factors. Analytical cross-section study was carried out in Musanze, a district of Rwanda and involved 241 mothers having children aged between 6 and 23 months. Data was collected using a validated semi-structured questionnaire with observations and check list guides. Chi-square test and logistic regressions were used to determine the associations and risk factors of various variables. The results show that minimum meal frequency (MMF) was attained at 83% rate, minimum dietary diversity (MDD) at 57%, minimum acceptable diet (MAD) at 53% with consumption of iron rich foods at 29%. Stunting prevalence was 28%. The MAD had a significant (p = 0.021) association with height-for-age Z-score of a child and was found to be the stunting's predictor. The child's sex, consumption of animal sourced foods, child underweight status and income type were revealed as other stunting risk factors. A holistic approach that promotes infant and young child feeding practices and complementary feeding in particular can contribute to the alleviation of the stunting burden in Rwanda. Further, other associated factors that influence child nutrition status should be taken into consideration by the policy decision makers and development partners when developing food and nutrition sensitive programs and interventions.

Prenatal Exposure to Ambient PM2.5 and Early Childhood Growth Impairment Risk in East Africa.

Height for age is an important and widely used population-level indicator of children's health. Morbidity trends show that stunting in young children is a significant public health concern. Recent studies point to environmental factors as an understudied area of child growth failure in Africa. Data on child measurements of height-for-age and confounders were obtained from fifteen waves of the Demographic and Health Surveys (DHS) for six countries in East Africa. Monthly ambient PM2.5 concentration data was retrieved from the Atmospheric Composition Analysis Group (ACAG) global surface PM2.5 estimates and spatially integrated with DHS data. Generalized additive models with linear and logistic regression were used to estimate the exposure-response relationship between prenatal PM2.5 and height-for-age and stunting among children under five in East Africa (EA). Fully adjusted models showed that for each 10 µg/m3 increase in PM2.5 concentration there is a 0.069 (CI: 0.097, 0.041) standard deviation decrease in height-for-age and 9% higher odds of being stunted. Our study identified ambient PM2.5 as an environmental risk factor for lower height-for-age among young children in EA. This underscores the need to address emissions of harmful air pollutants in EA as adverse health effects are attributable to ambient PM2.5 air pollution.

Translating Multisectoral Nutrition Policy into Community Practice: Participation of Nutrition Officers in Tanzania Fosters Effective Collaborative Strategies to Improve Child Nutrition

ABSTRACTBackgroundGlobally, multisectoral coordination for nutrition is needed to tackle multiple determinants of undernutrition and address unacceptably high rates of stunting in young children. Tanzania has strong national policies and implementation plans to strengthen multisectoral nutrition (MSN) governance, yet local actors must transcend sector silos to fully implement MSN actions in communities.ObjectivesWe engaged with Nutrition Officers in Regional Secretariats and District Councils to explore strategies, barriers, and facilitators for creating novel “MSN action teams.”MethodsAn initial “Learning Exchange” workshop gathered input from nutrition staff in 5 regions and invited their participation in mentoring and supporting MSN collaboration. Regional Nutrition Officers piloted action teams in their districts, supporting District Nutrition Officers to create teams of 3–4 officers from relevant sectors (agriculture, community development, health, education) to plan and implement community-based activities consistent with sector priorities and national policy. To learn from stakeholder experiences, longitudinal data were collected through individual semistructured interviews and documentation of activities; 27 officers were interviewed 1–4 times over 14 mo.ResultsFour districts successfully created action teams that bridged communication gaps between administrators and implementors; made progress on advocacy, collaboration, and budgeting for nutrition; and initiated MSN implementation in communities. Participants identified strategies to overcome challenges to cross-sector collaboration including heavy workloads and limited resources and supervisor buy-in. Based on their experiences and innovations in creating MSN action teams, stakeholders shared valuable recommendations for peer learning across sectors to scale up MSN collaboration. Officers’ presentation of insights to regional and district leaders buoyed interest in MSN action teams as a feasible and acceptable approach to strengthen local governance and implementation to improve child nutrition.ConclusionsExperience-based input from government officers engaged in novel community and intersectoral collaborations provided actionable guidance for putting national MSN policy into practice and leveraging the capacity of implementation staff.

Review on Public Health Effects of Aflatoxins in Milk and Milk-Based Foodstuffs of Dairy Cow

Aflatoxins are toxigenic metabolites that are definitely occurring by lethal strains of Aspergillus parasiticus and Aspergillus flavus that commonly dwell and colonize in feed components and various nutritive foodstuffs particularly milk and milk based products. This Review has three main objectives; those are causes of aflatoxin, effects and methods of control in milk and milk products. Drinking of cow milk polluted with aflatoxin may overwhelm immunity and subsidize to stunting in young children, as the young children are not immune-competent during early stage. It has been internationally assessed that aflatoxin is possibly accountable for 30% of the annual cases of liver cancer. Generally, control approaches of aflatoxin can be applied during pre-harvest, cautious management in the time of harvest and postharvest decontamination. Moreover, choosing breed for aflatoxin impervious crop diversities, prevention of aflatoxin production through biological decontamination by microorganisms and their metabolites, rejection of aflatoxin by physical means in addition to inactivation by chemicals are the typical approaches that have been described in different studies. For the reason that cow milk is the most important and principal diet of children, but the risk of exposed to the cancer are more in infants. In addition, according to various investigations it also well thought that young animals are also found to be more vulnerable to aflatoxin than adults. Thus; the contamination of cow milk and milk products by AFM1 should understood as undesirable for young human and animals.

Sustained intake of animal-sourced foods is associated with less stunting in young children.

The value of animal-sourced foods (ASFs) in providing key nutrients, particularly for child growth and where diets are of low quality, is understood mainly from cross-sectional assessment of current consumption. Longitudinal panel data from Nepal, Bangladesh and Uganda were used here to assess associations among previous (lagged) and contemporaneous ASF intake with linear growth of children aged 6-24 months. Lagged ASF consumption was significantly correlated with a 10% decline in stunting in Nepali children who consumed any ASF in the previous year, while current intake was associated with a 9% decline in stunting in Uganda. Previous consumption of two or more ASFs showed a stronger association, ranging from a 10% decline in stunting in Bangladesh to a 16% decline in Nepal. This novel lagged analysis emphasizes the need for regular and appropriate levels of ASF intake by young children to support healthy growth in resource-constrained settings.

The effect of malaria on stunting: an instrumental variables approach.

Previous studies have found mixed evidence for an effect of malaria on stunting, but have suffered from concerns about confounding and/or power. Currently, an effect of malaria on stunting is not included in the Lives Saved Tool (LiST) model. We used instrumental variables regression with the sickle cell trait and random assignment to bednets as instruments in the analysis of data on children aged 0-2 y from a bednet trial in western Kenya. We estimated that one additional clinical malaria episode per year increases the odds of a child being stunted by 6% (OR estimate: 1.06, 95% CI 1.01 to 1.11). Our finding that malaria affects stunting suggests that an effect of malaria on stunting in young children should be considered in the LiST model.

M-SAKHI-Mobile health solutions to help community providers promote maternal and infant nutrition and health using a community-based cluster randomized controlled trial in rural India: A study protocol.

Reduction of childhood stunting is difficult to achieve by interventions that focus only on improving nutrition during infancy. Comprehensive interventions that extend through the continuum of care from pregnancy to infancy are needed. Mobile phones are now successfully being used for behaviour change communication to improve health. We present the methodology of an mHealth intervention "Mobile Solutions Aiding Knowledge for Health Improvement" (M-SAKHI) to be delivered by rural community health workers or Accredited Social Health Activists (ASHAs) for rural women, below or up to 20weeks of pregnancy through delivery until their infant is 12months of age. This protocol paper describes the cluster randomized controlled trial to evaluate the effectiveness of M-SAKHI. The primary objective of the trial is to reduce the prevalence of stunting (height-for-age<-2 z-score) in children at 18months of age by 8% in the intervention as compared with control. The secondary objectives include evaluating the impact on maternal dietary diversity, birth weight, infant and young child feeding practices, infant development, and child morbidity, along with a range of intermediate outcomes for maternal, neonatal, and infant health. A total of 297 ASHAs, five trained counsellors, and 2,501 participants from 244 villages are participating in this study. The outcome data are being collected by 51 field research officers. This study will provide evidence regarding the efficacy of M-SAKHI to reduce stunting in young children in rural India, and if effective, the cost-effectiveness of M-SAKHI.

Concurrent anemia and stunting in young children: prevalence, dietary and non-dietary associated factors

BackgroundThe existing evidence is limited and contradicting on the co-occurrence of anemia and stunting (CAS) at individual level, despite a great overlap in their risk factors. We aimed to determine the prevalence of CAS, and the dietary and non-dietary factors associated with it, among infants and young children in Ethiopia.MethodWe used a nationally representative sample of 2902 children aged 6–23 months from the Ethiopian demographic and health survey, conducted in 2016. The study was cross-sectional in design. Samples were selected by two-stage clustering sampling method. CAS prevalence was estimated by various sociodemographic factors. To identify the dietary and non-dietary factors associated with CAS, we conducted hierarchical logistic regression analyses.ResultThe overall prevalence of CAS was 23.9%. The dietary factors found significantly linked to lower odds of CAS were use of vitamin A supplement [adjusted odds ratio (AOR) = 1.19, 95%CI = 1.06–1.33, P = 0.003], consumption of vitamin A rich fruit and vegetables (AOR = 1.15, 95%CI = 1.04–1.27, P = 0.006), meat (AOR = 1.55, 95%CI = 1.17–2.05, P = 0.002), legumes (AOR = 1.38, 95%CI = 1.05–1.81, P = 0.021), and meal frequency > 3 (AOR = 1.22, 95%CI = 1.04–1.37, P = 0.020). The non-dietary household and child factors found significantly linked to higher odds of CAS were rural residence (AOR = 1.29, 95%CI = 1.18–1.41, P < 0.001), low household wealth (AOR = 1.91, 95%CI = 1.53–2.39, P < 0.001), low caregivers’ education level (AOR = 2.14, 95%CI = 1.33–3.44, P < 0.001), male sex (AOR = 1.25, 95%CI = 1.04–1.50, P = 0.015), age 12–23 months (AOR = 1.65, 95%CI = 1.57–1.73, P < 0.001), history of infection (AOR = 1.14, 95%CI = 1.00–1.30, P = 0.048), and small birth size (AOR = 1.99, 95%CI = 1.58–2.51, P < 0.001).ConclusionAmong infants and young children in Ethiopia, there was a concerning high level of CAS, which was associated with various dietary and non-dietary factors. Enhanced public health/nutrition interventions, with due emphasis on the multifactorial nature of CAS, might stand an important consideration to reduce the burden of CAS in Ethiopia and beyond.

Mines: The local wealth and health effects of mineral mining in developing countries

We assess health and wealth impacts of mineral mining using micro-data from about 800 mines in 44 developing countries. Gains in asset wealth (0.3 standard deviations) coexist with a higher incidence of health conditions linked to heavy metal toxicity: anemia among women (ten percentage points), and stunting in young children (five percentage points). Consistent results emerge from a range of distinct identification strategies. Two difference-in-difference tests exploit information on mineral and pollutant characteristics to show that the observed health effects are due to pollution: impacts arise only near mines where metal contamination is to be expected, and the recovery of blood hemoglobin levels in women after childbirth shows a characteristic signature of lead toxicity. Our results add to the nascent literature on health-wealth tradeoffs near industrial operations in developing countries.

The co-occurrence of anaemia and stunting in young children.

Anaemia and stunting are prevalent nutritional problems among children of low-income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co-occur in affected individuals to a greater degree than by chance. In 2 populations of children-ages 6-18months in Bihar, India, (n=5,664) and 6-36months in Lambayeque, Peru (n=688)-we measured the frequency of the co-occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi-square test. We also built logistic regression models for each condition. The frequency of co-occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p=.97) and 31.5% (p=.85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.

Stunting-Related Knowledge: Exploring Sources of and Factors Associated with Accessing Stunting-Related Knowledge among Mothers in Rural Indonesia

Background: Stunting in young children continues to be a major concern in developing country settings, including middle income countries like Indonesia. Early intervention is critical to prevent increased morbidity and mortality, lower cognitive functioning, and diminished productivity in adulthood. Mothers may benefit from knowledge and information related to stunting causes and effects. Indonesia has readily adopted a variety of platforms, which are now being used to disseminate health information. The purpose of this study was to address two related research questions: 1) What are the primary sources of Indonesian mothers’ stunting-related knowledge? 2) What factors are associated with using these various platforms to access stunting-related information? Method: Mothers (n = 745) responded to questions about demographics and the source of stunting knowledge, which included hospitals, the Internet, midwives, posyandu (community health posts), and puskesmas (public health centers). Multivariate logistic regression was used to identify factors associated with mothers’ reported use of the three most common sources to acquire information about stunting, including posyandu, puskesmas and the Internet. Results: Eighty percent of mothers in this study sample used posyandu, 31.7% puskesmas, and 16.9% used the Internet as a source for stunting-related knowledge. For the three most common sources, factors associated with each included not accessing the other sources. Conclusions: Indonesian mothers are using a variety of platforms and services to acquire information about stunting. These sources are different one from another and each may be an important resource for disseminating health information, especially outside of urban centers. Results from this study may help to identify characteristics of Indonesian mothers who could benefit from acquiring stunting-related information in these formats. Each of these sources of information appears to be utilized by different groups of mothers. This is an important finding as it suggests that each may continue to be a resource for mothers that might not otherwise access stunting information. The Indonesian health system in rural settings has a history of support for posyandu and puskesmas. Moving forward, the Internet may also be used to improve outcomes for children of mothers that do not access information through these more traditional means.

Risk factors associated with stunting among infants and young children aged 6 - 23 months in Dedza district of central Malawi.

The prevalence of stunting is high in Malawi, affecting about one third (31.2%) of children aged 6-23 months. Persistent inappropriate feeding practices are some of the major causes of stunting in young children. This study was conducted to determine risk factors associated with stunting among infants and young children aged 6-23 months in Dedza district in Central Malawi. A cross-sectional study was conducted in 12 villages in Mayani Extension Planning Area (EPA), targeting households with children aged 6-23 months. A structured questionnaire was used to collect data from the primary caregivers on household socioeconomic characteristics, household food availability, dietary diversity, responsive feeding practices among mothers and caregivers, age of introduction of complementary foods, frequency of feeding, types of foods and dietary diversity of children. Anthropometric data (weight and recumbent length) for children were measured using standard procedures. The Multivariate Logistic Regression Analysis was performed to study the independent associations of various determinants on prevalence of stunting with prevalence of stunting as a dependent variable. A total of 303 households were sampled randomly; mothers and caregivers were interviewed and 306 children were assessed for nutritional status. Introduction of complementary food varied among mothers, 9.3% introduced earlier than 6 months, 71.1% at 6 months and 10.2% later than 6 months. Dietary diversity was low but increased significantly with age categories of children, 2.9% for children 6-8 months, 15.5% for 9-11 months and 24.6% for 12-23 months (p<0.01). Minimum meal frequency was significantly (p<0.001) higher in children 6-8 months (58.7%) than in children 12-23 months (1.9%). Overall, out of the 306 children 47.1% [95% CI (41.6-53.1)] were stunted. Stunting was significantly different between male [54.5%; 95% CI (47.0-63.5)] and female (39.5%; 95% CI (31.4-47.6)] children. Age of child when complementary feeding was started [AOR: 0.138; 95% CI (0.22-0.88)], number of young children in the household [AOR: 2.548; 95% CI (1.304-4.981)] and teenage mothers [AOR: 1.265; 95% CI (0.379-1.724)] were significant independent predictors of stunting. It can be concluded that prevalence of stunting is high among infants and young children in Dedza district. Training mothers and caregivers on recommended age of introducing complementary food to a child, composition of such food, dangers of teenage pregnancies and importance of child spacing should form part of nutrition education. Keywords: Nutritional status, dietary diversity, complementary feeding, meal frequency, responsive feeding

Health Extension Workers’ Knowledge and Knowledge-Sharing Effectiveness of Optimal Infant and Young Child Feeding Are Associated With Mothers’ Knowledge and Child Stunting in Rural Ethiopia

Little is known about how the knowledge and the knowledge-sharing effectiveness (KSE) of health extension workers (HEWs) affect maternal knowledge of optimal infant and young child feeding (IYCF) and their child's nutritional status. The objective of this study was to evaluate mothers' and HEWs' knowledge of key IYCF practices and to investigate whether mothers' knowledge and HEWs' KSE are associated with stunting in young children (aged 12-23 months). This cross-sectional study used face-to-face interviews to assess the IYCF knowledge of HEWs (n = 96) and mothers of 12- to 23-month-old children (n = 122) in Mecha district, West Gojam, Ethiopia. The association between HEWs' KSE and children's length-for-age z scores (LAZ) was investigated. Stunting (50%), underweight (34%), and wasting (10%) were highly prevalent. Less than half (45%) of the mothers had access to nutrition education through the health extension program, but those who had, had better knowledge of IYCF practices and thus lower rates of stunting ( P < .001). However, key IYCF practices were not well understood by the HEWs and this affected their KSE. The gap in KSE was negatively associated with LAZ ( r = -.475, P < .001) and remained significant even after adjusting for maternal height, socioeconomic status, and maternal education ( r = -.423, P = .002). Health extension workers' KSE is associated with child stunting. Future training of HEWs would benefit from emphasis on not only the content of the IYCF messages but also the process of delivery while increasing their counseling skills.

The association of serum choline with linear growth failure in young children from rural Malawi

Choline is an essential nutrient for cell structure, cell signaling, neurotransmission, lipid transport, and bone formation. Choline can be irreversibly converted to betaine, a major source of methyl groups. Trimethylene N-oxide (TMAO), a proatherogenic molecule, is produced from the metabolism of dietary choline by the gut microbiome. The relation between serum choline and its closely related metabolites with linear growth in children is unknown. The aim was to characterize the relation between serum choline and its closely related metabolites, betaine and TMAO, with linear growth and stunting in young children. We measured serum choline, betaine, and TMAO concentrations by using liquid chromatography isotopic dilution tandem mass spectrometry in a cross-sectional study in 325 Malawian children, aged 12-59 mo, of whom 62% were stunted. Median (25th, 75th percentile) serum choline, betaine, and TMAO concentrations were 6.4 (4.8, 8.3), 12.4 (9.1, 16.3), and 1.2 (0.7, 1.8) μmol/L, respectively. Spearman correlation coefficients of age with serum choline, betaine, and TMAO were -0.57 (P < 0.0001), -0.26 (P < 0.0001), and -0.10 (P = 0.07), respectively. Correlation coefficients of height-for-age z score with serum choline, betaine-to-choline ratio, and TMAO-to-choline ratio were 0.31 (P < 0.0001), -0.24 (P < 0.0001), and -0.29 (P < 0.0001), respectively. Serum choline concentrations were strongly and significantly associated with stunting. Children with and without stunting had median (25th, 75th percentile) serum choline concentrations of 5.6 (4.4, 7.4) and 7.3 (5.9, 9.1) μmol/L (P < 0.0001). Linear growth failure in young children is associated with low serum choline and elevated betaine-to-choline and TMAO-to-choline ratios. Further work is needed to understand whether low dietary choline intake explains low circulating choline among stunted children living in low-income countries and whether increasing choline intake may correct choline deficiency and improve growth and development. This trial was registered in the ISRCTN registry (www.isrctn.com) as ISRCTN14597012.

Implications of Acquired Environmental Enteric Dysfunction for Growth and Stunting in Infants and Children Living in Low- and Middle-Income Countries

Changes in small bowel function early in infancy in developing countries are increasingly being demonstrated, probably accompanied by altered mucosal architecture in most individuals, including reduced enterocyte mass and evidence of immune activation and inflammation in the mucosa. These alterations appear to be the result of factors of uncertain nature in the environment, and may be a cause of growth faltering and stunting in young children. For these reasons, this constellation of findings is being referred to as environmental enteropathy, or as we propose herein, environmental enteric dysfunction. If the causes were known and effective interventions were available, strategies and policies to intervene at--or possibly before--birth could be developed and promoted in order to prevent subsequent malnutrition and recurrent infection, which are known to interact in a cyclical and synergistic manner in a downward clinical course often ending in death. Resources would be mobilized and applied differently, and the emphasis would change from treatment to prevention. In order to move in this highly desired direction, investments in research will be required to establish the criteria to assess environmental enteric dysfunction, determine its predictive value for growth faltering and stunting, identify the causes, and propose and test potential interventions. The concepts and tools are available. What is required is the decision to move forward along this pathway to better health for infants and children in low-income countries.

Designing appropriate complementary feeding recommendations: tools for programmatic action.

Suboptimal complementary feeding practices contribute to a rapid increase in the prevalence of stunting in young children from age 6 months. The design of effective programmes to improve infant and young child feeding requires a sound understanding of the local situation and a systematic process for prioritizing interventions, integrating them into existing delivery platforms and monitoring their implementation and impact. The identification of adequate food-based feeding recommendations that respect locally available foods and address gaps in nutrient availability is particularly challenging. We describe two tools that are now available to strengthen infant and young child-feeding programming at national and subnational levels. ProPAN is a set of research tools that guide users through a step-by-step process for identifying problems related to young child nutrition; defining the context in which these problems occur; formulating, testing, and selecting behaviour-change recommendations and nutritional recipes; developing the interventions to promote them; and designing a monitoring and evaluation system to measure progress towards intervention goals. Optifood is a computer-based platform based on linear programming analysis to develop nutrient-adequate feeding recommendations at lowest cost, based on locally available foods with the addition of fortified products or supplements when needed, or best recommendations when the latter are not available. The tools complement each other and a case study from Peru illustrates how they have been used. The readiness of both instruments will enable partners to invest in capacity development for their use in countries and strengthen programmes to address infant and young child feeding and prevent malnutrition.