An interesting study was published in the Public Health Nutrition journal that examined which type of interventions can reduce stunting, linear growth retardation, in children ages 6 to 36 months over a five year period in the Amhara region of Ethiopia. This region is generally considered food insecure and many of the poor households receive either food or cash transfers through the government’s safety net programme.
How to reduce stunting, which is a manifestation of chronic undernutrition resulting in short stature, cognitive impairment and long-lasting health impacts, is a key question for many working in global health and nutrition.
Populations received one of four interventions in the study:
- Nutrition education
- Water, Sanitation and Hygiene (WASH)
- All three of the above
Another comparison group was examined over the five years, who didn’t receive any interventions. Most of these homes received the safety net from the government.
The interventions were as follows:
So at the end of the day, what interventions worked to reduce stunting? Interestingly, the WASH group was the only group to show significant reductions in stunting as compared to baseline and the comparison group. However, reductions were only 12% over five years. They observed that other nutrition parameters, or process type indicators did not improve such as maternal nutrition status or dietary diversity. Perhaps if more was done to focus on these areas, the reductions would have been more profound. But, who knows! All of the groups saw improvements in knowledge about the causes in the areas of interventions, but little with stunting. Sort of depressing to say the least. I am still totally on the fence on education, leading to more knowledge, leads to improved outcomes. Seems logical, but even the wealthy can’t see to get healthy with their Haaavard degrees. Don’t totally buy it. Yet.
Some simple graphs from the paper show the stunting decreases over the five years. Nothing to write home about.
The impact of WASH on stunting has been shown before and further supports the evidence of tropical enteropathy associations with stunting. In contrast, the “integrated approach” seemed to have upward trends in stunting prevalence, although not significant. Interestingly, there was less usage of health facilities in the integrated and health groups. Why?