Wasting and Stunting: Overcoming the divide
Wasting-Stunting (WaSt) Technical Interest Group (TIG)
Donor: Irish Aid, USAID, OFDA
Collaborators: Technical Interest Group
ENN project lead: Tanya Khara
Timeframe: 2014 - ongoing
Since the 1970s, nutritionists have categorised undernutrition in two major ways, children are either wasted or stunted.
There has very rarely been consideration for the relationship between these two types of undernutrition with limited evidence to describe the associations between wasting and stunting. Little has previously been known on:
- Whether one precedes, or predisposes, the other.
- The biochemical and physiological processes through which the relationship between wasting and stunting can be mediated and /or magnified.
- The scale of the problem on concurrent wasting and stunting.
- The link between concurrent wasting and stunting and its impact on child mortality.
The WaSt Technical Interest Group (TIG) was formed to examine this relationship. The group, coordinated by ENN is made up of 42 experts in child growth, nutrition, epidemiology.
ENN’s main role since the group's formation has been to harness the skills and enthusiasm of the TIG and facilitate a number of influential project workstreams. The backbone of the expert group is the maintenance of a creative, transparent forum to scrutinise and explore the relationship between wasting and stunting, allowing it to serve the nutrition and wider humanitarian and development sectors as a hub for evidence and expert opinion which is free from organisational agendas.
A governance note outlines the mechanisms for ways of working.
What we now know as a result of the WaSt Project and the WaSt TIG:
The work so far:
We have had three phases of work thus far and are currently in the fourth
Phase 1 (2013- 2015):
The WaSt TIG completed the following pieces of work
- A narrative review of the relationship between wasting and stunting to the understanding of the links between the two conditions.
- A research prioritisation exercise was conducted and subsequently published.
- An analysis of five high burden country datasets to estimate the burden of concurrent wasting and stunting for the 2015 Global Nutrition Report.
Phase 2 (2016- 2017):
The WaSt TIG completed the following pieces of work
- A re-analysis of DHS and MICS datasets from 84 countries to generate a pooled prevalence estimate of the burden of concurrent of wasting and stunting in those countries. (Open access paper published in Maternal and Child Nutrition Journal).
- These findings were also used by the Global Nutrition Report 2016 (p.23).
- An analysis of cross-sectional datasets (SMART surveys) to examine concurrence in more detail and look at how best to identify concurrently wasted and stunted children (findings have been published in Archives of Public Health).
- A related analysis focusing on identifying those children at most risk of mortality using cohort data from Niakhar, Senegal (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 (published in Maternal and Child Nutrition).
Phase 3 (2018- 2019):
The WaSt TIG developed the following pieces of work:
- A policy brief ‘Child wasting and stunting: Time to overcome the separation (2018)’ (also available in French, Spanish and Arabic)- a culmination of the research and discussion of the group over the last 4 years.
- A viewpoint article in the Lancet Child and Adolescent Health 'Beyond Wasted and Stunted - a paradigm shift is needed to fight child undernutrition'. (read more on a blog written by the WaSt TIG Coordinators)
- 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
- 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
- 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 links between the WaSt Project and the MAMI Special Interest Group were explored in a face to face meeting between the two working groups. A meeting report was produced.
- We evaluated the work within the WaSt Project through a Stories of Change report.
- A sub-working group of the WaSt TIG met in December 2019 to discuss their multiple cohort mortality analysis and related work exploring wasting stunting and mortality risk. Revisiting mortality and anthropometric deficits/reconsidering 'risk'.
Phase 4 (2020-):
In 2020, the WaSt TIG entered its fourth phase of the project, with work on key workstreams continuing. These include:
- A paper from Scientia on the work of the WaSt TIG which unpacks the story of the WaSt TIG to date and some of the key findings for a broader audience.
- An update to the systematic review which explores the latest evidence on the relationship between wasting and stunting, the interconnected physiological processes, the burden, aetiology and timing of wasting and stunting as well as concurrent wasting and stunting. A related technical briefing paper aims to unpack some of the key findings from the review, highlighting the programmatic and policy implications of some of the findings.
- Work exploring the sex differences in relation to wasting and stunting. This systematic review and meta-analysis explored sex differences in undernutrition and concluded that boys are more likely to be undernourished than girls.
- Work on the prevention of child wasting within the wider context of undernutrition, which updates previous reports on wasting by ENN and is accompanied by three podcasts, two podcasts exploring what Malawi and Pakistan are doing to prevent wasting as well as an interview to understand UNICEF's prevention plans.
- Further analysis on multiple cohort datasets on the identification of children at highest risk of mortality (in light of previous work on concurrent wasting and stunting and risk). Listen to the some of the reflections on this work in a presentation by Tanya Khara at the USAID Future of Food Assistance for Nutrition: Evidence Summit II
- We also published our WaSt study protocol entitled ‘Bringing new evidence on undernutrition and mortality risk into practice: Protocol for a prospective cohort study'. This outlines a study protocol to test whether weight-for-age and mid-upper arm circumference can be effectively utilised in existing programmes to capture children with single and dual nutritional deficits and reach considerably more children at a high risk of death.
As these pieces of work progress, we will update this page accordingly.
Further work planned for the next two years is outlined in the workplan.
For more information please contact Tanya Khara.
More like this
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...
Resource: The WaSt study Protocol and Opportunities for Collaboration: bringing new evidence on undernutrition and mortality risk into practice.
The ENN and the Wasting Stunting Technical Interest Group (WaSt TIG), with funding from USAID via the Bureau of Humanitarian Affairs (BHA) and Bureau for Global Health, in 2018...
In May, the Technical Interest Group (TIG) of the ENN-facilitated Wasting and Stunting (WaSt) project1 held its bi-annual meeting, made possible through the generous support of...
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...
Resource: Bringing new evidence on undernutrition and mortality risk into practice- Protocol for a prospective cohort study
Introduction The ENN coordinated Wasting and Stunting Technical Interest Group (WaSt TIG) have been investigating the relationship between wasting and stunting since 2014...
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...
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...
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...
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...
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...
en-net: ENN is looking for a consultant Senior Researcher (cohort studies) for the Wasting-Stunting Study.
Location: Home based with considerable international travel to Nigeria Level of effort and duration: This contract is for up to 95 days over 12 months, approximately 60 of...
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...
FEX: Response to malnutrition treatment in low weight-for-age children: secondary analyses of ComPAS trial data
View this article as a pdf Research summary1 Location: Kenya and South Sudan What we know: Children who are concurrently wasted and stunted (WaSt) have a very high mortality...
By Tanya Khara, ENN WaSt Project Consultant On January 29th 2016, the ENN with USAID OFDA and Irish Aid funding convened the second meeting of the Wasting and Stunting (WaSt)...
FEX: Children concurrently wasted and stunted: A meta- analysis of prevalence data of children 6-59 months from 84 countries
Research summary1 Location: Global What we know: Wasting and stunting are often present in the same geographical populations and can exist concurrently in the same children,...
View this article as a pdf By Lenka Blanárová and Grace Heymsfield Lenka Blanárová is Senior Nutrition Assessment Coordinator at Action Against...
A briefing note for policy-makers and programme implementers was released in June 2018 by the ENN-coordinated Wasting-Stunting Technical Interest Group (WaSt TIG). The brief,...
View this article as a pdf Lisez cet article en français ici Click here to listen to more information on the work being done in Pakistan on the ENN podcast channel By...
Research snapshot1 The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6-59 months living in the 1980s in Niakhar, a rural area of...
Summary of research* Location: Global. What we know: There is global momentum to bring down levels of undernutrition. Wasting and stunting frequently co-exist, but are often...
Reference this page
LD (). Wasting and Stunting: Overcoming the divide. www.ennonline.net/ourwork/reviews/wastingstunting