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Best Practice in Preventing Child Wasting within the Wider Context of Undernutrition

Author: Kate Sadler, Tanya Khara and Natalie Sessions
Year: 2021
Resource type: Article

Introduction

UNICEF estimated that in 2020 nearly 150 million children under five years of age were stunted and approximately 50 million were wasted, numbers that are expected to rise as a result of the COVID-19 pandemic. The distribution of malnourished children varies between and within countries but the prevalence is highest among children in Asia. It now seems likely that the 2025 Global Nutrition Targets will not be met so millions of children will continue to experience the unacceptable consequences of undernutrition: many will die while the physical and mental development of the survivors will be impaired. The 16 million children who are both stunted and wasted are at particular risk. 

Considerable attention has been given to stunting prevention including, most recently, the ‘exemplar series’ in which an analysis of countries that have made good progress in reducing the prevalence of stunted children was conducted to learn lessons about what works in stunting prevention. However, far less attention has been paid to improving our understanding of how to prevent wasting. This knowledge gap is a serious problem because treatment does not address the immediate and underlying causes of wasting and one episode of wasting (even if treated) can leave a child more vulnerable to another episode. In addition, wasting and stunting are inextricably linked both through common causes and shared causal pathways and because episodes of wasting are now known to slow linear growth and therefore increase the risk of stunting. Some evidence also suggests that being stunted leads to an increased risk of wasting although the magnitude of risk and the causal mechanism are less clear. Add to this the increased risk of dying linked to being wasted, to being stunted and particularly to being wasted and stunted at the same time, and the need for an equal focus on prevention of both outcomes becomes more urgent (see Box 2). This brief is based on work since 2014 by the Wasting Stunting Technical Interest Group (WaSt TIG)3 and the Emergency Nutrition Network (ENN). It updates previous reports on wasting prevention by ENN and builds on ENN’s recent position paper on wasting. It attempts to begin to close the gap between what we know about how to prevent stunting and how to prevent wasting and is aimed at programmers, practitioners and policy makers involved in nutrition, many of whom will be national actors. As such, it highlights the practical implications for national policy and programmes as well as for global research investments. Recognising the differences in epidemiology, it is becoming increasingly clear that achieving global targets for either stunting or wasting are unlikely to be successful until prevention programming approaches and packages address the causes of both forms of undernutrition together. To do this, we need to challenge long held views that wasting is largely reversible and acute while stunting is irreversible and chronic and that they happen at different points in a child’s development and in different locations.4 With the recent launch of the United Nations (UN) Global Action Plan (GAP) on child wasting and the inclusion of prevention of wasting within WHO guidance development plans, it seems the right time to consolidate learning on what we know (see Box 2) and the gaps in evidence.

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Kate Sadler, Tanya Khara and Natalie Sessions (2021). Best Practice in Preventing Child Wasting within the Wider Context of Undernutrition. www.ennonline.net/bestpracticeinpreventingchildwasting

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