Stunting in Children..Alarming Indicators and Significant Economic Cost

In 2015, all UN member states adopted the Sustainable Development Goals (SDGs)as a global call to action to end poverty, protect the planet and ensure that all people enjoy peace and prosperity by 2030, and various governments and relevant institutions have sought to develop plans to achieve these goals, primarily the preservation of human health and well-being as a means and end of development.

The first of the Sustainable Development Goals States “the eradication of poverty in all its forms everywhere”, the second emphasizes the need to” eradicate hunger, provide food security and improved nutrition and promote sustainable agriculture“, and the third goal States”ensuring the enjoyment of healthy lifestyles and well-being for all at all ages

Efforts aimed at reducing malnutrition diseases – most notably stunting – are still falling short of achieving the target, and it seems that the world is not on the right track, especially since malnutrition diseases are worsening and threatening the lives of millions. About 50% of deaths in children under the age of five are related to undernutrition, and most These deaths occur in low- and middle-income countries, according to World Health Organization data.

In view of the high economic and social costs resulting from stunting that undermine development plans and the future of countries, the Strategic Forum for Public Policy and Development Studies “Derayah” issues this research paper that addresses the concept of stunting and its indicators at the local, Arab and global levels, as well as the efforts of the Egyptian state to confront this disease. And a number of recommendations that would reduce the number of children with stunting in Egypt, through several axes, as follows:

First: the concept of stunting

Second: Indicators of stunting at Arab, regional and international levels

Third: The economic cost of child stunting

Fourth: Indicators of stunting in Egypt

Fifth: Causes of stunting in Egypt

Sixth: The Egyptian state’s efforts to confront stunting

Seventh: Recommendations to confront stunting

First: the concept of stunting

Stunting is a form of undernutrition that is the most common cause of malnutrition. Undernutrition results from lack of food intake and insufficient food intake to meet the body’s needs, and leads to vulnerability to disease and death, especially for children.

The World Health Organization indicates that stunting means short height for age, results from chronic or recurrent undernutrition, and is usually associated with poor socioeconomic conditions, poor maternal health and nutrition, frequent morbidity, and/or inadequate nutrition and care for infants and young children. In the early stages of life

Stunting is divided into two types:

1- Proportionate dwarfism: The body is disproportionately small, and body parts are smaller than normal but proportional.

2- Disproportionate dwarfism: The body size is disproportionate, making some parts of the body larger or smaller than normal.

It should be noted that the effects of this disease last a lifetime, as most stunted children usually develop anemia and low development of cognitive, social and emotional skills , and in later stages of their lives, they will be more susceptible to non-communicable diseases.

Second: Indicators of stunting at Arab, regional and global levels

The World Health Organization has confirmed that all countries of the world are affected by malnutrition in general and stunting in particular, while World Bank reports stated that the number of people – especially children – suffering from stunting confirms that it still constitutes the most serious challenges that stand as an obstacle to achieving development plans in various countries. Countries of the world.

Stunting at the Arab and regional levels

The World Bank warned in its report on the Middle East and North Africa region in April 2023 that inflation resulting from global conflicts and crises, most notably the Russian-Ukrainian war, caused food insecurity to rise to 17.6%, and increased the risk of expanding the cycle of stunting among children.

The report indicated that the increase in food prices between March and June of 2022 caused between 200,000 and 285,000 newborns to suffer from stunting in the Middle East and North Africa region, which means an increase in those risks between 17% and 24%.

The World Bank report also stated that Libya, Syria, and Yemen suffer from the highest rates of stunting, and that the Gulf Cooperation Council countries, represented by Bahrain, Kuwait, Oman, Qatar, and Saudi Arabia, recorded the lowest rates of stunting in the region.

In another report issued by the United Nations, the incidence of stunting in Syria has increased significantly due to malnutrition, as one in three children under the age of five in northwestern Syria suffer from stunting, in light of the suffering of more than 4.6 million children throughout the world. Syria is food insecure.
According to the data of the food and Agriculture Organization of the United Nations (FAO), the prevalence of stunting among children under the age of five in the Arab region reached 20.5% in 2020, compared to 28.7% in 2000.

Figure No. (1) shows the percentage prevalence of stunting among children under the age of five, according to the subclassification of Arab countries in terms of income:

Source: Joint estimates by UNICEF, WHO and the World Bank

Figure No. (2) shows the prevalence of stunting among children under five in Arab countries in 2020

Source: UNICEF, WHO and World Bank joint estimates

Although there has been a marked improvement in the past two decades in the number of stunted children, the current prevalence of stunting in the region remains high based on the World Health Organization’s classification of the severity of malnutrition as a public health problem, but the estimated current prevalence for the Arab region remains lower than the global average of 22.3%.

Global stunting

The joint estimates of child malnutrition (JME) issued by UNICEF, the World Health Organization and the World Bank in 2023 reveal insufficient progress to reach the Sustainable Development Goals, as only a third of countries are on track to halve the number of children affected by stunting by 2030, with progress so far impossible to assess for about a quarter of countries

These recent estimates reveal rates of stunting, as follows:

About 148 million children under the age of five worldwide are stunted in 2022, a rate of 22.3%.
There are about 52% of stunted children under the age of five in Asia, and 43% in Africa, as Figure 3 shows:

Source: UNICEF, WHO and World Bank

-The prevalence of stunting for children at the age of five decreased from about 33% in 2000, to 22.3% in 2022, that is, from 204.2 million children in 2000, to 148 million children in 2022.

-The number of stunted children has decreased over the past decade (2012-2022) in:

-Asia, where the numbers decreased from 106.8 million children to 76.6 million children.

-Latin America and the Caribbean, where numbers decreased from 6.8 million children to 5.7 million children.

-Europe, where the numbers decreased from 2.1 million children to 1.4 million children.

The number of stunted children in Africa increased from 61.3 million in 2012 to 63.1 million in 2022, as Figure No. (4) shows:

It is expected that the percentage of stunted children under five years old will reach 15.4% in 2025 and 12.8% in 2030.

It is clear from the numbers and percentages that the world is not on the right track in confronting stunting. Despite the decline in stunting rates in many countries, this decrease will not achieve the target in 2025 regarding reducing the incidence of stunting by about 40%, and the target in 2030 regarding reducing the incidence rate by about 50%.

Third: The economic cost of child stunting

Countries are suffering huge losses as a result of large numbers of children suffering from stunting, as per capita income decreases due to the failure to address this disease in the early years of a child’s life.

A report published on the World Bank website regarding the relationship between stunting rates and income losses for a worker who was stunted in childhood stated that the average per capita GDP in the country was 7% lower compared to it if none of the country’s current workers were affected by stunting in the past. Childhood, and in Africa and South Asia, average losses in per capita GDP rise to between 9-10%.

According to a study entitled “The Economic Costs of Child Stunting Beared by the Private Sector in Low- and Middle-Income Countries,” child stunting costs the private sector at least $135 billion in sales annually, and companies from Latin America, the Caribbean, and the East Asia and Pacific region incur greater losses. Losses.

The study also indicated that workers with stunting lose about 20% of their annual income, and that the sectors most affected by stunting are the manufacturing industries, clothing and food sectors.

Fourth: Indicators of stunting in Egypt

Stunting is one of the most important challenges facing the Egyptian state, and although it has achieved remarkable progress in reducing the number of people with stunting, the challenge is still great in terms of achieving the target according to Egypt’s Vision 2030 with regard to malnutrition in general and stunting in particular.

Based on the data of the Egyptian Household Health Survey 2022 conducted by the Central Agency for Public Mobilization and Statistics and statements by officials in the Ministry of Health, the indicators of stunting in Egypt can be summarized as follows:

The percentage of children under the age of five who are stunted decreased from 21% in 2014 to 13% in 2021, as Figure No. (5) shows:

Source: Central Agency for Public Mobilization and Statistics

-One in 3 children under the age of 5 suffers from stunting.

– About 4% of children in Egypt suffer from severe short stature, and compared to what was reported in the Population Health Survey for 2014, we find a significant decrease in this percentage, which had reached about 10%.

– With regard to the age pattern, we find that the stunting rate is high among children at the age of one month and then decreases to rise again to reach the highest stunting rates among children in the age group (12:17 months) by 19%.

Figure (6) shows the rates of stunting by age

Source: Egyptian Family Health Survey 2021

There are some differences according to different geographical regions, where the percentage of short stature relative to age in the rural tribal face reaches 16% and decreases in the urban sea face to less than 10%.

The highest rate of stunting was recorded in the age group of 12-17 months at a rate of 18.5%, and the lowest rate was in the age group of 48-59 months at a rate of 7.9%. At the governorate level, the governorates of “sharqia, Port Said, and Gharbia” recorded the lowest rates at 4%. 6.7% and 8%, respectively, while the governorates of “South Sinai, Sohag, and Assiut” recorded the highest rates at 26.8%, 21.9%, and 19.9%, respectively.

Fifth: Causes of stunting in Egypt

Several factors cause children to suffer from stunting in Egypt, and a team of researchers at UNICEF and the American University in Cairo highlighted the most prominent of these factors, which were as follows:

1-lack of health awareness among mothers and inappropriate feeding practices.

Lack of awareness among mothers of the importance of proper nutrition during pregnancy is a major cause of stunting in Egypt, as most of the irreversible damage caused by malnutrition in Egypt occurs during the period from pregnancy until the first twenty-four months of life.

2- Lack of dietary diversity and insufficient complementary feeding practices: The type of complementary foods that children receive after the age of 6 months lacks diversity and nutritious elements, and this appears more clearly in Upper Egypt compared to Lower Egypt.

3- inadequate health care services: the lack of required micronutrients in family health units is one of the important obstacles to improving maternal and Child Health, as well as the shortage of trained specialists in family health units and lack of knowledge about infant and young child nutrition are other factors contributing to the problem.

Sixth: The Egyptian state’s efforts to confront stunting

The Egyptian state cares about the health of citizens, and has set clear goals to promote healthy and safe nutrition policies, and sought to reduce the spread of stunting disease, and the most prominent actions of the state were as follows:

Article 81 of the 2014 Constitution gave people with dwarfism many rights
After long years of marginalization and neglect, it stipulates that: “The state is committed to guaranteeing the rights of persons with disabilities and dwarves, in terms of health, economic, social, cultural, recreational, sports, and educational levels, and providing them with job opportunities, allocating a percentage of them to them, and preparing public facilities and the environment surrounding them, and for them to exercise all rights.” political, and integrate them with other citizens, in implementation of the principles of equality, justice, and equal opportunities.

In January 2023, the Egyptian Food Bank launched the “First Chance” program to reduce the spread of stunting and address this problem, starting with pregnant mothers, newborn mothers, and their children up to two years of age.

The program is implemented under the axis of prevention, which has served more than 37,000 children across 10 governorates, by providing healthy and proper nutrition, for both the pregnant mother and the newborn child. The program ensures that the mother has sufficient food and awareness for a very delicate stage of her life and the age of Fetus.

The Ministry of Social Solidarity launched the “The First Thousand Days of a Child’s Life” program as one of the mechanisms to improve the nutritional status of pregnant and breastfeeding women and infants, in a way that works to enhance the cognitive and physical development of children and protect them from the effects of malnutrition, which includes stunting.

Especially since 85% of a person’s health throughout his life is formed during the golden 1000 days, and any shortcomings in this period cannot be compensated for after that.
The program is witnessing a major expansion at the level of all governorates for Takaful and Karama families who have children less than two years old, with a maximum of two children per family or one child for a pregnant mother, in line with family planning policies, which brought the total number of beneficiaries of the Thousand Days Program to 87,700 beneficiaries by the end of August 2022.

Seventh: Recommendations to confront stunting

1- Develop a national strategy to eliminate stunting that is consistent with the sustainable development goals and is implemented according to a specific timetable and a precise and binding plan.

2- Activating Constitutional Article No. 81 of the 2014 Constitution, which obligates the state to employ people with dwarfism and grant medically equipped cars exempt from taxes and customs and a social security pension, in addition to several services, so they are considered among the disability categories for which 5% of the number of workers in the state is available.

3- The need to increase the number of trained specialists in family health units, and the availability of micronutrients required to improve maternal and child health.

4- Providing companies and factories with the necessary needs of people with dwarfism, including appropriate tools, clothes, and other needs that guarantee them a decent, humane life.

5- The need for civil society organizations to contribute to helping dwarves live their lives normally, working to rehabilitate them, helping to care for them healthily, psychologically, and socially, and integrating them into society.

6- Launching a national media campaign aimed at raising awareness about the nature of malnutrition diseases, including stunting, how to confront them, and the importance of mothers and children receiving proper nutrition, especially in the first 1,000 days of a child’s life.