Wasted opportunity? What we do know about preventing wasting

By Carmel Dolan on 20 March 2019

Today, over 50 million children are wasted, which comes with an elevated risk of death. Even more, wasting prevalence hasn’t declined in recent years. The United Kingdom’s Department for International Development (DFID) are calling for a focus on how to prevent wasting to complement existing evidence-based treatment of children who are already affected.

Since early 2018, the Emergency Nutrition Network (ENN) has been working—through the MQSUN⁺ project—to improve the understanding of what is needed to prevent children from becoming wasted. ENN carried out two reviews as part of this project. We started with a rapid review of the state of knowledge about ‘The Aetiology of Wasting’ and then moved into a more detailed review of what the literature tells us about the ‘Current State of Evidence and Thinking on Wasting Prevention.’

Both reviews reveal interesting highlights:

Multiple factors which may change over time and with age can exert their influence in-utero (1)—contributing to a child becoming wasted. Though wasting can be rapid in onset—or 'acute'—it can also be considered 'chronic' in that some of its drivers, such as infection and environmental exposures, are often longstanding in nature. Once wasted, a child becomes vulnerable to repeated wasting episodes (2). Wasting is a complex and dynamic process: it is associated with metabolic disturbances, it can interfere with a child’s ability to attain optimal height (3), and it is associated with many of the same risk factors which are thought to cause stunting.  Overall, our knowledge of the physiology of wasting is limited (4). When we looked at the literature, it was not a surprise to see that the published evidence for how it is prevented is not particularly strong, as global research has historically focused more on stunting prevention.

Nevertheless, our review did find an upsurge over the last few years in the publication of evidence on what works for wasting prevention. The intervention areas with the most evidence of an association with child wasting are the use of supplementary food products and micronutrient supplementation for young children. There is mixed and largely inconclusive evidence on other intervention areas, such as breastfeeding promotion, cash-based interventions, agriculture, water, sanitation and hygiene, behaviour change or some combination of the above. When we consulted a range of stakeholders, they attributed the lack of firm evidence to a need for a more holistic approach to preventing wasting by tackling both immediate and underlying drivers. Many also noted that a better understanding of the aetiology of wasting could underpin this more holistic approach.

Despite the evidence outlined in these reviews, there are still key questions that need to be answered—through further research—in order to move forward in better preventing wasting. We recommend that any research being undertaken into the prevention of child undernutrition should include wasting. Too many opportunities have been missed in previous years to include wasting alongside stunting in prevention-focused research. ENN has since launched a research prioritisation exercise to determine what experts and key stakeholders believe are the most important areas of further study for wasting prevention. The results of this will be published later in 2019. Updates on these efforts will be promoted on ENN’s website.

Alongside this work, ENN is working to better understand how child wasting and stunting interact with each other, and more importantly, what we need to do differently in order to jointly prevent them. Our recent policy brief on this subject asks the nutrition community to overcome our separate ways of thinking on two of the most common forms of child malnutrition.

Contact: Tanya Khara (ENN Technical Director) with cc. Carmel Dolan (ENN Technical Director)