Mapping child growth failure in Africa between 2000 and 2015

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From: Nature(Vol. 555, Issue 7694)
Publisher: Nature Publishing Group
Document Type: Report
Length: 11,672 words
Lexile Measure: 1660L

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Author(s): Aaron Osgood-Zimmerman [1]; Anoushka I. Millear [1]; Rebecca W. Stubbs [1]; Chloe Shields [1]; Brandon V. Pickering [1]; Lucas Earl [1]; Nicholas Graetz [1]; Damaris K. Kinyoki [1]; Sarah E. Ray [1]; Samir Bhatt [2]; Annie J. Browne [3]; Roy Burstein [1]; Ewan Cameron [3]; Daniel C. Casey [1]; Aniruddha Deshpande [1]; Nancy Fullman [1]; Peter W. Gething [3]; Harry S. Gibson [3]; Nathaniel J. Henry [1]; Mario Herrero [4]; L. Kendall Krause [5]; Ian D. Letourneau [1]; Aubrey J. Levine [1]; Patrick Y. Liu [1]; Joshua Longbottom [3]; Benjamin K. Mayala [1]; Jonathan F. Mosser [1]; Abdisalan M. Noor [6, 7]; David M. Pigott [1]; Ellen G. Piwoz [5]; Puja Rao [1]; Rahul Rawat [5]; Robert C. Reiner [1]; David L. Smith [1]; Daniel J. Weiss [3]; Kirsten E. Wiens [1]; Ali H. Mokdad [1]; Stephen S. Lim [1]; Christopher J. L. Murray [1]; Nicholas J. Kassebaum (corresponding author) [1, 8]; Simon I. Hay (corresponding author) [1, 3]

Child undernutrition increases the risk of neonatal and child mortality and future maternal reproductive outcomes [1, 2, 3]. Child growth failure (CGF) is the specific subset of child undernutrition, excluding micronutrient deficiencies, that is characterized by the relationship between insufficient height and weight at a given age, and this subset is most universally described in terms of univariate growth standards, for which age-specific heights and weights are compared to healthy reference populations [4, 5]. In aggregate, univariate assessments of stunting, wasting and underweight (Extended Data Fig. 1) can serve as a comprehensive assessment of CGF. Prevalence of moderate and severe stunting, wasting and underweight among children aged 059 months is defined as the proportion of children with a height-for-age, weight-for-height or weight-for-age z score that is more than two standard deviations below the 2006 WHO (World Health Organization) growth reference population, respectively [4].

The Millennium Development Goals (MDG) had a single nutrition target: a 50% reduction in prevalence of underweight in children under five between 1990 and 2015. In 2012, WHO member states endorsed a broader agenda to improve nutrition by 2025: the Global Nutrition Targets (WHO GNT), including stunting, wasting, low birth weight and overweight [6] in children under five (see Extended Data Fig. 1). Sustainable Development Goal (SDG) 2.2 is even more aspirational, calling for an end to all forms of malnutrition by 2030, progress towards which can be seen as inseparable from many of the other SDG child health ambitions [7, 8, 9].

Quantitative assessments of levels and trends in CGF indicators serve as key input to discussions of progress and areas for improvement [1, 10, 11, 12, 13, 14]. According to findings from the Global Burden of Diseases, Injuries, and Risk Factors Study 2016 (GBD 2016), an estimated 36.6% of children under five were stunted, 8.6% wasted and 19.5% underweight in sub-Saharan Africa (SSA) in 2015 [1]. Furthermore, CGF was the second leading risk factor for child mortality in SSA, accounting for more than 23% of deaths of children under five in this region [1].


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Gale Document Number: GALE|A529350377