Stunting remains prevalent in Keneba despite 40 years of unprecedented access to health care and reductions in disease

As part of her PhD, Dr Helen Nabwera performed a detailed analysis of growth records collected over the past four decades in Keneba and our other two core study villages in West Kiang. The results were published in Lancet Global Health in January 2017. Professor Sir Ian McGregor first chose Keneba as the centre of his field research in the late 1940’s where he started collecting demographic and health data in Keneba and 3 neighbouring villages (Manduar, Kantong Kunda and Jali).

In 1974, Professor Roger Whitehead relocated his nutrition research from Uganda (forced to relocate due to the instability in the country). Roger’s philosophy was “no survey without service” and he progressively strengthened the clinic and health outreach services that were provided by MRCG Keneba. The village of Jali elected not to be part of this more intensive relationship between MRCG and the local communities; so there have been 3 core villages for the past 40 years. The health inputs over the years have grown in intensity to the present day, with high levels of medical and health interventions.

The village of Jali elected not to be part of this more intensive relationship between MRCG and the local communities; so there have been 3 core villages for the past 40 years. The health inputs over the years have grown in intensity to the present day, with high levels of Why are children not growing better and why do they remain so anaemic? Helen was able to access 59,371 measurements on 3659 children with a median of 16 visits each (interquartile range 13-26). Secular trends in stunting, underweight and wasting at 2 years of age. Stunting (red); underweight (blue); wasting (green) where each is defined as proportion below -2 z-scores against WHO 2006. medical and health interventions.

Dr Helen Nabwera examining an infant in Keneba

Dr Helen Nabwera examining an infant in Keneba

As part of this health care, all children from the core villages are reviewed at birth and called for six weeks, three months and then three monthly regular follow-ups at the Well Baby Clinic where they have detailed anthropometric measurements taken. Their mothers are also free to bring the children to clinic whenever they are unwell. Through this, Helen was able to access 59,371 measurements on 3659 children with a median of 16 visits each (interquartile range 13-26).

Secular trends in stunting, underweight and wasting at 2 years of age. Stunting (red); underweight (blue); wasting (green) where each is defined as proportion below -2 z-scores against WHO 2006.

Secular trends in stunting, underweight and wasting at 2 years of age. Stunting (red); underweight (blue); wasting (green)
where each is defined as proportion below -2 z-scores against WHO 2006.

The unprecedented levels of health interventions brought to these villages would be prohibitively costly for a government of a low-income country to bring in nation-wide. Despite this, the key finding was that although stunting levels have halved, they remain unacceptably high with a prevalence of 30% in two-year-old children (see figure).

Other metrics of malnutrition including head circumference have also improved but still remain very far from acceptable compared to the World Health Organisation (WHO) reference curves.Notably, the growth faltering that occurs between 3 and 24 months is still almost universally prevalent. There has been a reduction of the seasonal variation that has been noted in this environment (children grow very poorly in the wet season), but it still remains very noticeable. Why are children not growing better and why do they remain so anaemic?

This data and evidence from a number of other studies suggest that a major cause is an inflammation caused by living in unhygienic environments. Other research teams will soon be reporting the results of the Water, Sanitation and Hygiene (WASH) Benefits studies in Kenya and Bangladesh and the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) Study in Zimbabwe. Our data suggest that these may yield limited efficacy and that we need more intensive WASH interventions before children will truly be able to make the best of the nutrients available to them and grow better.

 

Read more about the study on https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340725/