8 March 2017
Growth faltering in rural Gambian children after four decades of interventions: a retrospective cohort study published in The Lancet Global Health, shows that growth faltering remains common in children in sub-Saharan Africa and is associated with substantial morbidity and mortality.
Dr Helen Nabwera and colleagues describe how child growth in a rural African setting has changed during four decades of public health interventions. During the past 15 years, improvements have been achieved in overall mortality from acute childhood illnesses such as malaria, diarrhoea, and pneumonia. However, children with impaired growth are still at elevated risk of death from these common infections and are limited in their neurodevelopmental potential. Stunting (ie, low height-for-age) is the most common form of malnutrition, and the most difficult to prevent or treat.
Funded by UK Medical Research Council and the UK Department for International Development, he investigators analysed data from an unparalleled resource including studies conducted at MRC Unit The Gambia: longitudinal growth monitoring across three Gambian villages spanning 36 years. The long-term presence of a research programme in the community has facilitated free and accessible primary and antenatal care, universal improved water and sanitation, comprehensive immunisation, and systematic screening and treatment for malnutrition. This study therefore represents an unusual setting where the effects of full implementation of international guidelines for health promotion can be observed.
Research findings show the prevalence of stunting among 2-year-old children over the study period from 1976 to 2012, from 57·1% (95% CI 51·9–62·4) to 30·0% (27·0-33·0). This finding is, in itself, a substantial achievement that exceeds the prediction by Bhutta and colleagues in 2008 that 99% coverage with combined evidence-based interventions for under nutrition in the 36 highest-burden countries would reduce stunting prevalence among 2-yearold children by 36%. These research findings show the combination of nutrition-sensitive and nutrition-specific interventions has achieved a halving of under nutrition rates, but despite these intensive interventions substantial growth faltering remains.
Furthermore, the interventions included in this model; universal supplementation of energy, protein, vitamin A, and zinc, multiple micronutrient supplementation during pregnancy, intermittent preventive treatment for malaria, breastfeeding and complementary feeding support, and hygiene facilitation, together exceed those interventions undertaken in the three study villages. Hence tackling child malnutrition is key to achieving the third Sustainable Development Goal of good health and wellbeing for all.
We thank the study participants, MRCG Staff, UK Medical Research Council and UK Department for International Development.
Helen M Nabwera, Anthony J Fulford, Sophie E Moore, Andrew M Prentice
Read more about the study on the Scientific Reports website.