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Childhood stunting

Published Jan 05, 2017 02:21am

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CHILDHOOD stunting is the physical manifestation of profound mental and developmental delays in growth. Technically, it is defined as the height for a child’s age below the fifth percentile on a reference growth curve. However, it can blight the future of a child as it lowers educational attainment and job earnings. Stunting affects a massive percentage of the world’s youth: nearly half of all children are stunted in Pakistan. Apart from particularly impaired cognitive development, stunting has staggering implications in other arenas; for instance, the GDP of countries is measurably lower.

Stunting echoes undernutrition during the most critical periods of growth and development in early life. It starts from pre-conception when an adolescent girl, who later becomes a mother, is undernourished and anaemic; it worsens when the diet of the infant is inadequate or poor. It is only in the last decade that research has shown that a well-known link between a physical marker such as height and a lifetime of chronic undernutrition was also related to weakened immunity, impaired brain development and developmental delays. In later life, this leads to increased risks of obesity and non-communicable diseases, such as diabetes and heart diseases in adulthood.

In the long term, stunting has been shown to be the best predictor of human capital, impacting economic productivity and development potential at the national level. The economic cost of undernutrition is significant both in terms of lost national productivity and economic growth. Studies show that adults who are stunted as children earn 20pc less than those who are not; they are 30pc more likely to live in poverty, and are less likely to work in skilled labour. While the human and societal costs of stunting are large, the costs of addressing the problem proactively are small while the benefits are dramatic.


Nearly 10 million children in Pakistan are stunted.


Research shows that it is not just a lack of calories, or vitamins and minerals, that cause stunting. In fact, causes of stunting can be attributed to repeated cases of diarrhoea, drinking unclean water, lack of proper early stimulation, inability to buy nutritious food, anaemia in mothers, early marriage leading to early pregnancies, decreased nutrient value of crops and a whole host of non-nutritional factors. In terms of magnitude, Pakistan has a serious problem with stunting with the third worst rates in the world — with 6pc of global cases, nearly 10 million children are affected. A huge proportion of these cases are considered severely stunted. To some extent, this situation has evolved because Pakistan has been fighting the other critical nutrition issue, starvation — technically called wasting. Limited nutrition funds are naturally focused on saving the lives of those children most at risk of dying. However, a decade of efforts has not prevented the problem and this has created chronic malnutrition that leads to stunting.

The sheer knowledge that this cannot be reversed makes it critical that stunting be prevented through well-timed interventions. We must start by focusing on what is called the ‘first thousand days’ — that is the time from conception of a child to two years of age. In this period, stunting is preventable and reversible. If fast reductions in stunting are to be achieved, the focus must be mostly, if not all, time and budgets included, on a handful of activities that have immediate effect on pregnant women and their babies during this period. Nutritionally, it is important that pregnant women take iron, folic acid and multivitamins. By ensuring that women take iodised salt, breastfeed within one hour of birth and then only provide breast milk to their babies for the first six months — nothing else, no formula, no goat’s milk and certainly no water — we can help children get an early start in life.

Another critical factor that weighs on the magnitude of stunting is hygiene and sanitation, which largely affects the household environment. It can be as simple as handwashing with soap before preparing food, after changing a child’s diapers and after using a toilet. Beyond these measures, longer-term planning can mitigate the issues leading to stunting in the first place. For example, improved crop yields and crops with higher nutrient content, income support programmes for needy families, early childhood education programmes, full immunisations for all, widespread treatment of diarrhoea, clean water and latrines, to name just a few.

Pakistan faces a colossal challenge given the absolute numbers of children afflicted by stunting. But it can remedy this situation so that by 2030, stunting is a relic of the past and no longer haunts our generations. Therefore, improving child nutrition is one of the best and most critical investments that Pakistan can make.

Angela Kearney and Michel Thieren are country representatives for Unicef and WHO.

Patrick Evans represents FAO and Stephen Gluning is acting country director for WFP.

Published in Dawn, January 5th, 2017

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The views expressed by this writer and commenters below do not necessarily reflect the views and policies of the Dawn Media Group.


Comments (15) Closed



Aussie Jan 05, 2017 05:38am

Who will fix the problem? These retards who created this problem won't.

Saqib Jan 05, 2017 08:57am

I don't hear any government functionary talking about this grave issue is their speeches. All I hear is CPEC CPEC CPEC, how every week another X billion dollar is added to the total of the project. How another road project is inaugurated. It makes one feel so sad, that our priorities are so skewed. Wouldn't it be joyful to hear how every week another million children have access to clean drinking water or nutritious food, or some of the other issue raised in this very informative article; alas our society also doesn't seem to care. Hope some humane person in the planning ministry is reading this article.

Asif Ali Jan 05, 2017 09:03am

We are third arms importer after Bharat, more worried about Kashmiri youths then ours.

nikus Jan 05, 2017 09:14am

notice the BMI. Other parameters are just immaterial. I was taking training on Big data -Hadoop (in Bangalore) and one of the girls in my batch was 4-10/4-11 and bellow 50KG. But I am sure,she will snatch job from a 70KG american man/lady.

Illawarrior Jan 05, 2017 10:02am

@Saqib Yes I hope the relevant ministries are reading this, and also the millions of people producing children that they cannot afford to feed properly.

Waqas Jan 05, 2017 12:27pm

Please build more Metros we need them !

PakistaniAT Jan 05, 2017 02:27pm

I am sure our government, the cabinet and the top bureaucrats have no idea what these guys are talking about?!

zaheer Jan 05, 2017 02:58pm

Moringa is the answer to this problem. Powdered Moringa leaves are an abundant source of rich vitamins . People of all ages can benefit from this miracle tree which grows widely in Pakistan. It helps lactating mothers by increasing the quantity of milk . All that is needed is to dry the Moringa leaves in shade, powder them in a grinder or by pounding them and take a teaspoon thrice daily lactating mothers require more-- this would definitely help eliminate stunting . I Iinvite researchers in this filed to contribute

khanm Jan 05, 2017 05:03pm

Thank god!!! we just woke up.. the entire nation has been stunted for so may decades..the only class that flourished are the elite cos they are well nourished.. this is specially for the people of the subcontinent.. People are like dirt. Their government can either nourish you and help you grow as a person or they can stunt your growth and make you wilt and die...

Amir Dewani-USA. Jan 05, 2017 05:31pm

The only favor (or disfavor) the present day bogus leaders are doing to those 'leaders of tomorrow', is that each one of the newly born child comes in this crazy world with a debt of Rs.1,20,000/-. Your PM is cutting ribbons/opening long term projects, and the stock of ribbons is almost exhausted, but will he ever visualize about the future of these children viz their needs for clean air, pure drinking water, nutritious food, schooling, medicine etc etc? It is all about being busy doing nothing! For sure, he has enough wealth to live abroad the moment his term expires, but what about those kids who have to be brought up and grow like flowers Question: Has the PM ever been seen opening a child-care/nursing center anywhere? And what about the Panama frauds? Sorry, I say this much against the will, but truth must be told.

zaheer Jan 05, 2017 05:46pm

Drumstick is the local name for Moringa Tree-- Simply google Moringa and you will get a wealth of information about the Moringa Tree

aslam bhatti Jan 05, 2017 07:31pm

Why is this not a front page story and talk shows discussions. Shame on us.

M. Emad Jan 05, 2017 08:44pm

Prevalence Childhood stunting (WHO/ UNICEF/ WB): India-48%, Pakistan-45%, Bangladesh-41.4%.

inayat H. Thaver Jan 06, 2017 09:40am

Dear Writers and Colleagues, Thanks for the editorial. I have some observations to make: 1. In Pakistan, we start "doing" something when the problem has already developed rather than preventing the problem.. 2. The case of malnutrition, especially the 'stunting' is the same old story; at least since last 4 decades, since 1976 nutrition survey, I have been witness to the fact that we have done at least 4-5 national wide and several smaller or cluster of districts' survey. The results are the same and trend of malnutrition is increasing.

Last but not the least, I wish to ask the representative of these big organizations who have written this editorial, what have they been contributing to make change since last 4 decades??? If these international agencies are mandated to focus of these issues with pretty good funds, where is their contribution. Of course, ultimately, its the responsibility of the state itself. let us hope serenity prevails around us

Allan (Canada) Jan 06, 2017 08:52pm

Child labour may be one of the causes. Seen many a child carrying heavy loads on their back and heads.