Too short for age, maybe too short for dreams

//Too short for age, maybe too short for dreams

April 2nd, 2019

Esther Kagure

Ever wondered why some children are too short compared to others? Or why the shortest kid in the class was usually trailing last in academic performance?  This could be a result of stunting   defined by UNICEF as chronic undernutrition during the most critical periods of growth and development in early life.  The height and weight of children, their intellectual capabilities and subsequent development are greatly determined by nutrition between the conceptions to the age of 2 years.

Short stature could be due to a number of  reasons:

(Medical news todays 2017), advances three kinds of variant growths in children: Variant restricted growth influenced by genetics and hormones and sometimes a person is small but otherwise healthy, Disproportionate short stature; (DSS) which is Short stature is linked to a genetic mutation where the   individual with DSS will be small in height, and will have other unusual physical features; and Proportionate short stature (PSS) where the overall growth is restricted. This is because of undernutrition at the early stages of life one of the resultant conditions is stunting which this blog tries to explore;

In Kenya over one-quarter of children under five are stunted, or too short for their age. Stunting is more common in rural areas than urban areas (29% versus 20%) and ranges from 15% in Nyeri to 46% in Kitui and in West Pokot (KDHS 2014). The report further stipulates that 42% of mothers do not initiate breastfeeding within the first hour of delivery. 39% of mothers with infants 0-6 months do not exclusively breastfeed. On average, Kenyan children are breastfed for 21 months and exclusively breastfed for 4.3 months (KDHS 2014).61% of children 6-24 months do not receive optimal complementary feeding.  Nutrition holds the promise to avert malnutrition and its associated social and economic menace by embracing and leveraging on the first 1000 days window.

A 1000 DAYS

The 1000 days span between when the woman gets pregnant and her child’s second birthday which offer a critical window of opportunity to shape healthier and a more prosperous future for a child and the nation. Evidence shows that optimal nutrition during this time can have a lasting impact on a child’s growth, learning, and future productivity (USAID 2013) Good maternal nutrition is very important for a successful pregnancy, child delivery and lactation on to two years. Nutrition before a pregnancy influences a woman’s ability to conceive, it determines the fetal development and growth, size of the baby and its overall health and the health of the mother in general. Malnutrition before and during pregnancy makes the placenta fail to develop fully therefore it cannot optimally nourish the fetus. This leads to low birth weight. Low birth weight is a significant contributor to infant mortality,  and babies who survive are likely to suffer growth retardation and illness throughout their childhood, adolescence and into adulthood. Growth-retarded adult women are likely to carry on the vicious cycle of malnutrition by giving birth to low birth-weight babies. Underweight women experience more complication during pregnancy and delivery more than normal women.

After a child is born, appropriate infant and young child feeding practices should be practiced. That means exclusive breastfeeding for the first 6 months of life followed by gradual introduction of   complementary foods. Appropriate and optimal complementary feeding for the 6-24 months babies is critical in ensuring optimal growth and development. Food at this stage should meet the basic criteria of Frequency, Amount, Thickness, Variety, Adequacy, Active feeding and Hygiene (FATVAH) (Maternal, Infant and Young Child Nutrition National operational Guidelines for Health Workers 2013).

There are a number of factors that play a role in malnutrition and specifically stunting;

Poverty: Poverty limits availability of adequate amounts of nutritious food for the most vulnerable populations. Over 90 percent of malnourished people live in developing countries.

Lack of food; Most major food and nutrition crises do not occur because of a lack of food, but rather because people are too poor to obtain enough food. Non-availability of food in markets, difficult access to markets due to lack of transportation and insufficient financial resources are all factors contributing to the food insecurity of the most vulnerable populations.

Conflicts: Conflicts directly affect access to food, people uprooted by conflict lose access to their farms and businesses, or other means of local food production and markets. As a result, food supplies to distributors may be cut off, and the many populations dependent on them may be unable to obtain sufficient food.

Disease: Illnesses lead to poor intake of food and its absorption. To fight disease also, our bodies require more energy than usual. With a poor nutrition, the progress of diseases is fast than in an individual with a good nutrition status.

Inadequate nutrition knowledge: A big population does not have sufficient information on nutrient absorption and inhibitors of certain nutrients absorption for example the absorption of none-heme iron. In this case, the problem is not the access of food nor is it eating less diverse foods but having the nutrients in our meals yet our bodies are not in a position to access them.

KANCO has actively been involved in advocacy for nutrition sensitive actions. In its nutrition project in Mombasa County, KANCO has seen increased domestic resources for nutrition. There has also been enhancement in human and institutional capacity thus County health facilities and community units have recorded increased demand and uptake of nutrition services and commodities.

To eliminate malnutrition during 1000 days, a well detailed nutrition information should be included in our school curriculum. Nutrition Education on the Window of Opportunity should be included in our higher education institutions curriculum as a Common Unit.

During events like World Breastfeeding Week, it should be put in bold that even though Exclusive breastfeeding is optional left the consequences of not doing may have long lasting negative effects on the child.

Malnutrition has significant negative consequences for many developing countries, particularly in terms of poor human health, lost human capital, and decreased economic productivity. the Copenhagen Consensus in 2012  identified Investment in nutrition as a best investment for developing countries where  every dollar invested in nutrition yields a $30 return. To achieve this, there need to be increased domestic resources for health and to be more specific  resources for nutrition sensitive actions, there also need to increased nutrition education to the public.

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