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The Wasting and Stunting (WaSt) project – investigating the relationship between wasting and stunting and exploring the implications for policy programmes and research

Donor: Irish Aid 

Collaborators: Technical Interest Group

ENN project lead: Carmel Dolan & Tanya Khara

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.

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. 

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 have been published in Archives of Public Health. A related analysis which focuses on identifying those children, including those concurrently wasted and stunted, at most risk of mortality using cohort data from Niakhar, Senegal has been published in Public Health Nutrition. An additional paper which specifically explores the patterns of concurrent wasting and stunting in children under 5yrs of age in the Niakhar Senegal cohort, highlighting the increased risk in boys, has also been published in Maternal and Child Nutrition.

The completion of the above analyses led to the development of a concept for a research study aiming to bring this learning on the relationship between wasting and stunting and their combined impact on mortality into existing programme practices. The concept was taken up by OFDA and funding has been secured for implementation in Nigeria starting in 2019. See this research summary. The study is being overseen by a sub-working group of the WaSt TIG.

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 has now been published and can be found here. 

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 the MAMI WaST meeting is available here.

In June 2018 the ENN-coordinated Wasting-Stunting (WaSt) Technical Interest Group (TIG) released a policy brief ‘Child wasting and stunting: Time to overcome the separation (2018)’ (also available in French, Spanish and Arabic). The brief is the culmination of the research and discussion of the group over the last 4 yrs and presents the compelling scientific grounds for concluding that the current separation between wasting and stunting in policy, programmes and research is not justified and may even be detrimental. It calls for a radical change in how we view, finance and intervene to reduce child wasting and stunting.

The WaSt TIG have taken this call further by publishing a viewpoint article in the Lancet Child and Adolescent Health 'Beyond Wasted and Stunted - a paradigm shift is needed to fight child undernutrition'. See also a blog from the WaSt TIG coordintors that coincides with it's launch.

The very first WaSt TIG podcast featuring members of the group discussing some of the analysis the group has produced over the last few years is available here.

For more information please contact Carmel Dolan and Tanya Khara. 

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

Improving screening for malnourished children at high risk of death: a study of children aged 6–59 months in rural Senegal

Concurrent wasting and stunting among under-five children in Niakhar, Senegal

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

Child wasting and stunting: Time to overcome the separation (2018) (also available in French, Spanish and Arabic)

Technical Briefing Paper: The relationship between wasting and stunting: policy, programming and research implications (2014)

Research Priorities on the Relationship between Wasting and Stunting

Children concurrently wasted and stunted: A meta-analysis of prevalence data of children 6 – 59 months from 84 countries

Wasting and stunting - similarities and differences: Policy and programmatic implications

Reference this page

Chloe Angood (2014). The Wasting and Stunting (WaSt) project – investigating the relationship between wasting and stunting and exploring the implications for policy programmes and research. www.ennonline.net/ourwork/reviews/wastingstunting

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