Review of the links between wasting and stunting (WaSt)

Donor: Irish Aid

Collaborators: Technical Interest Group

ENN project lead: Carmel Dolan

Timeframe: 2014 - ongoing

Background

While wasting and stunting share many of the same causal pathways, there has been limited evidence to describe the relationship and associations between them, and whether one precedes, or predisposes, the other. Additionally, almost nothing has been written on the biochemical and physiological processes through which the relationship between wasting and stunting might be both mediated and magnified.

Growth monitoring

More evidence is required in order to better understand the complex relationships and associations between these two manifestations of undernutrition so that resources can be better targeted to prevent wasting and stunting and reduce associated child mortality. This is the main focus of the Wasting-Stunting (WaSt) Project.

Project summary

The WaSt project is guided by a Technical Interest Group (TIG) made up of 30 experts in child growth, nutrition, epidemiology and from those concerned with policy and programmes. In Phase one (2014/15) the ENN undertook a narrative review of the relationship between wasting and stunting to further the understanding of the links between the two conditions. The review concluded on the policy and programmatic implications for all actors concerned with addressing undernutrition.

A research prioritisation exercise was conducted with the WaSt TIG members and subsequently published. The ENN also carried out an analysis of five high burden country datasets to estimate the burden of concurrent wasting and stunting for the 2015 Global Nutrition Report.

UNICEF growth monitoring programme

In WaSt Phase two (2016-2017), the focus has been on utilising existing data sets for analysis. This has included a re-analysis of DHS and MICS datasets from 83 countries to generate a pooled prevalence estimate of the burden of concurrent of wasting and stunting in those countries. These findings were published in October 2017 with open access in Maternal and Child Nutrition in a paper entitled 'Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6–59 months from 84 countries’. These data were also used by the Global Nutrition Report 2016 (p.23).

Analysis of cross-sectional datasets (SMART surveys) has been carried out to examine concurrence in more detail and look at how best to identify concurrently wasted and stunted children. The findings were presented in a poster for the ACF Research Conference held in November 2017. One part of the analysis has been submitted for publication and the results of further analysis, which focus more on mortality, will be written up in the first quarter of 2018.

Data from the Medical Research Council (MRC) Gambia surveillance programme has been another key focus on the WaSt work with detailed analysis carried out on cohorts of 0-24 month age groups in relation to seasonality and growth, wasting as a risk factor for stunting and vice versa. This work is being written up for publication in the first quarter of 2018.

In addition to analysis of data, the WaSt Project has written a blog on its work and an article in Field Exchange as well as another article for Field Exchange on the findings from the SMART data analysis, Phase 1.

In January 2018, the third WaSt TIG face to face meeting was held in Oxford and one further day spent with the MAMI Special Interest Group to explore synergies. A report of this meeting will be available shortly. A report of the MAMI WaST meeting is available here.

For more information please contact Carmel Dolan and Tanya Khara.