Menu ENN Search

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)

More like this

FEX: The current state of evidence and thinking on wasting prevention

Summary of research1 Background ENN produced a report, through the MQSUN+ programme, that synthesises existing evidence and stakeholder opinion on what works to prevent...

Wasting Prevention Survey - Introduction

Background The global burden of wasting (50.5 million children 0-59 months of age)1 is a major global public health crisis and progress in reducing levels towards World Health...

Wasting Prevention

Donors: DFID funded MQSUN+ facility Collaborators: MQSUN+/PATH; Rebecca Brown and Jose Luis Álvarez Morán (ENN Consultants) ENN project lead and contact: Carmel...

ENN Latest

ENN has released a new paper 'Wasting in the wider context of undernutrition: An ENN wasting position paper'. This position paper reflects how ENN views wasting in the...

FEX: Making connections: Joint meeting of WaSt Technical Interest Group and MAMI Special Interest Group

ENN coordinates two international technical groups, the Management of at-risk Mothers and Infants under six months Special Interest Group (MAMI SIG) and the Wasting and...

FEX: The relationship between wasting and stunting: policy, programming and research implications

Summary of review1 This summary was prepared by Tanya Khara, an independent consultant engaged by the ENN on this review. The review was made possible by the generous support...

Blog post: Stunting & Wasting in South Asia- Reflections from a Regional conference

Lire ce blog en francais Over the years the scope of ENN's work has expanded beyond a focus on humanitarian contexts to encompass a broader set of issues around drivers of...

Research and Reviews

Through our overview of programming experience and challenges, the ENN is in a good position to identify priority areas for research and reviews in the area of emergency...

Resource: Stunting in protracted crises: discussion paper

Currently, the level of attention afforded to linear growth below international standards (stunting) in humanitarian and protracted emergency contexts is below what is needed,...

Stunting in protracted emergencies

Donor: Irish Aid Collaborator: UNICEF ENN project lead and contact: Emily Mates Timeframe: until end 2018 Background ENN undertook a small scoping review regarding...

FEX: The relationship between wasting and stunting: a retrospective cohort analysis of longitudinal data in Gambian children from 1976 to 2016

View this article as a pdf Summary of research1 Location: Gambia What we know: There are gaps in understanding the relationship between wasting and stunting that often...

Blog post: Wasting and Stunting-making progress on understanding the links

Some of you will know that ENN has been coordinating a project with the expert steer of around 30 child growth and nutrition specialists from academia, donor and operational...

Blog post: Child wasting and stunting - are we where we need to be?

We've been on a high this week with the publication of the Viewpoint from the ENN coordinated Wasting-Stunting Technical Interest Group (WaSt TIG). 'Beyond wasted and...

FEX: Nutrition in emergencies: Do we know what works?

Summary of paper1 Location: Global What we know: Nutrition action in emergencies is well accepted and attracts significant resources. There is a lack of evidence on what are...

Wasting and Stunting-making progress on understanding the links

Friday 16th February, 2017 By Carmel Dolan, ENN Technical Director Some of you will know that ENN has been coordinating a project with the expert steer of around 30 child...

FEX: Editorial

View this article as a pdf Lisez cet article en français ici We are delighted to mark our 60th edition of Field Exchange with an issue dedicated to the continuum of...

The Wasting and Stunting Technical Interest Group (WaSt TIG): Investigating the relationship between wasting and stunting

Donor: Irish Aid, USAID, OFDA Collaborators: Technical Interest Group ENN project lead: Tanya Khara Timeframe: 2014 - ongoing Background While wasting and stunting share...

Resource: Children who are both wasted and stunted are also underweight and have a high risk of death: a descriptive epidemiology of multiple anthropometric deficits using data from 51 countries

Abstract Background: Wasting and stunting are common. They are implicated in the deaths of almost two million children each year and account for over 12% of...

Podcast: Is the separation between wasting and stunting justified?

In this episode ENN Technical Directors Tanya Khara and Carmel Dolan are joined by Martha Mwangome from the Kemri / Wellcome Trust research programme in Kenya and Dr Sophie...

FEX: Wasting and Stunting Technical Interest Group (WaSt TIG) meeting

On the 15th of January 2018 the Wasting and Stunting (WaSt) Technical Interest Group (TIG) held their third face-to-face meeting at Trinity College, Oxford. This group of 30...