Post by: Sophie Budge What?! I'm not small! It's the world that's too big! - Hiromu Arakawa A persistent and pressing issue, malnutrition is a key public health issue facing the globe. Of that fact, epidemiologists, nutritionists, public health specialists, economists, politicians and academics have no doubt. Stunting, a chronic form of malnutrition (or more precisely, undernutrition, although that itself is contentious [1]), is essentially a category of linear growth failure – ‘failure’ in comparison to a global reference standard of optimal child growth [2]. To be ‘stunted’ is to belong in the bracket of a HAZ score (height-for-age) <–2 SD below this global reference. And that’s so agreeable – an efficient, tidy measure which affords some order in a world overwhelmed with linking exposures to outcomes and outcomes to numbers. HAZ <–2 SD can be used to describe point prevalence and time trends of stunted children, both within and across populations, and at local, national and global levels. It’s used to a point which seems an infectious obsession (a key insight by the intrepid Lawrence Haddad). But what really does it mean for a child to be ‘stunted’? And why this obsession? And interventions which focus on stunting as an outcome − what exactly are they (we) trying to solve? Seven eight-year-old children stand in front of a wall with the line depicting the average height according to the WHO Child Growth Standards [3].
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