The Global Burden of Stunting
Professor Zulfiqar A Bhutta
Robert Harding Chair in Global Child Health & Policy, the Hospital for Sick Children, Toronto, Canada & Founding Director, Center of Excellence in Women and Child Health, Karachi, Pakistan
Maternal and child malnutrition in low-income and middle-income countries encompasses a range of conditions including maternal wasting, micronutrient deficiencies, fetal growth restriction and linear growth retardation of which stunting (defined as being below 2 standard deviations of the WHO height or length for age standards). While the prevalence of stunting or linear growth of children younger than 5 years has decreased during the past two decades, it is largely concentrated in south Asia and sub-Saharan Africa affecting at least 165 million children in 2011. Data on short maternal stature and stunted adolescents is less readily available. Maternal undernutrition is known to contribute to fetal growth restriction, which in turn increases the risk of neonatal mortality and, among survivors, subsequent risks of stunting by 2 years of age. The Lancet Nutrition series estimated that undernutrition in the aggregate — including fetal growth restriction, stunting, wasting, and deficiencies of vitamin A and zinc along with suboptimum breastfeeding—was associated with 3·1 million child deaths annually or 45% of all child deaths in 2011.