WASTING ... WASTING 12-23 MONTHS(% ) NO DATA 0-5 5.1 -10 10.1-20 20.1-30 MORE THAN 30 0 This map and the one on the next page are both scaled to express the total population of children under five years of age in each country, thus providing an idea of the worldwide distribution of children in this age group. The colour shading on the first map shows the preva- lence of wasting, or acute under-nutrition. The second map shows the prevalence of stunting, which is a sign of chronic under-nutrition. In both cases, the statistical data used to prepare the maps refer to children between 12 and 23 months of age, the time when these two nutri- tional problems are particularly severe. The countries seen to have the largest surface area and most intense colour are those where the greatest number of children are affected. Together the two maps give a fairly good idea of the prevalence of malnutrition of deficiency and show where corrective action is most urgently needed. What are wasting and stunting? Wasting means that children - at a critical period in their development- are not forming sufficient muscle or depositing enough fat, while stunting means that they are not growing as tall as they could. Wasting is identified by comparing children's weight with their height, and stunting is identified by com- 10 0 paring their height with their age. The two conditions may occur independently or in combination, but because each has a different meaning and causes, both need to be properly identified so that health workers are able to WORLD HEALTH , May 1988 WORLD HEALTH, May 1988 The growth chart: simple and appro- priate technology for monitoring young children's growth and development. Photo WHO/J. Schytte 0 0 0 take the right corrective action. Viewed together, wasting and stunting in preschool children provide a good idea of a population's overall health status. In the past, the indicator most widely used to assess nutritional status - because it was simple and readily un- derstood - was weight attained at a given age, known as weight-for-age. But this does not describe nutritional sta- tus with sufficient accuracy because it fails to distinguish between wasting and stunting. From a socioeconomic and public health angle, the differences between preva- lences of wasting and stunting are significant. Wasting is a symptom of acute under-nutrition, and is usually a combined consequence of insufficient food in- take and a high incidence of infectious diseases, espe- cially diarrhoea. Stunting, on the other hand, is a conse- quence of chronic under-nutrition arising from insufficient food intake and exposure to infections· over a long period. Given the cumulative effect of these conditions, the longer they prevail the more likely a child is to be stunted. In many developing countries, wasting most severely affects children during the second year of life, when they 11 STUNTING 12-23 M ONTH S (% ) NO DATA 0-5 5. 1-10 10.1 -20 20.1-30 M ORE THAN 30 D 0 0 0 0 are no longer breast-fed. The missing benefits of breast milk are often not compensated by nutritious weaning foods. And in the absence of breast milk, children lose their protection against infection at just the time when they are becoming increasingly mobile and coming into direct and frequent contact with an often unhealthy environment. A common characteristic of families living in poverty and squalor, stunting has sometimes been used as an indicator of the social and economic level of specific populations groups. As it is a more widespread condition than wasting, and as many ch ildren seem to adapt to it and to function at or near normal levels, there is some debate about how severe stunting really is. In the long term, however, th is condition has a number of serious consequences. For example, women who themselves were stunted during childhood are more likely to deve- lop complications when they have their own babies and to give birth to low-birth-weight children. Is there a way of finding out about the types of malnu- trition and their extent within a country or different re- gions of the same country? Yes. This can be done by 12 0 Breast milk gives young children the best start in life, and protects them against infection. Photo WHO/J. Schytte W oRLD HEALTH, May 1988 I using anthropometry-assessing growth performance and body mass-to measure weight-for-height for wast- ing and height-for-age for stunting. Growth charts are a simple appropriate technology that wHo is actively promoting for use in interpreting such measurements in the community. These charts are de- vised in a way that not only makes it easy for health work- ers to record measurements but also to assess at a glance the nutritional status of each child . Some of them show horizontally the age of the child from birth up to 5 years of age, and vertically the child's weight or height recorded at regular intervals. Other charts such as the one shown on page ll, used in Mauritania, allow a simul- taneous measurement of height and weight. They also display a "safety zone "-orange in our drawing-which is the area between two ascending statistical curves. Chil- dren whose measurements-red dots on the drawing- fall outside this zone possibly have growth problems that suggest something is wrong with their nutritional situation -either a shortage or, in some cases, an over-supply of nutrients. The baby drawn in red in the drawing is a typi- cal case of wasting. Health workers need to be alert both W ORLD HEALTH, May 1988 ... STUNTING 0 D • 0 to the positioning of the dots and to the direction of growth over time, in order to ensure that children grow and develop correctly. Nutritional deficiency is not always obvious. Only rarely associated with a sensation of hunger, this type of malnu- trition is a silent disease in the majority of cases. Its visible signs - apathetic behaviour, for instance, or even more obvious physical disabilities-may well pass unnoticed in societies where more pressing problems stemming from poverty are the rule. Yet, in the long run, this form of mal- nutrition endangers health more than most other dis- eases. lt leaves marks that last for a lifetime by inhibiting growth, hindering mental. physical and social develop- ment, and increasing the probability of serious and pro- longed bouts of infectious disease. lt follows that studies of growth and development patterns, together with posi- tive health measures to overcome the problems thus un- covered, are among the most important tools for healthy development. 0 13
WASTING ... WASTING 12-23 MONTHS(% ) NO DATA 0-5 5.1 -10 10.1-20 20.1-30 MORE THAN 30 0 This map and the one on the next page are both scaled to express the total population of children under five years of age in each country, thus providing an idea of the worldwide distribution of children in this age group. The colour shading on the first map shows the preva- lence of wasting, or acute under-nutrition. The second map shows the prevalence of stunting, which is a sign of chronic under-nutrition. In both cases, the statistical data used to prepare the maps refer to children between 12 and 23 months of age, the time when these two nutri- tional problems are particularly severe. The countries seen to have the largest surface area and most intense colour are those where the greatest number of children are affected. Together the two maps give a fairly good idea of the prevalence of malnutrition of deficiency and show where corrective action is most urgently needed. What are wasting and stunting? Wasting means that children - at a critical period in their development- are not forming sufficient muscle or depositing enough fat, while stunting means that they are not growing as tall as they could. Wasting is identified by comparing children's weight with their height, and stunting is identified by com- 10 0 paring their height with their age. The two conditions may occur independently or in combination, but because each has a different meaning and causes, both need to be properly identified so that health workers are able to WORLD HEALTH , May 1988 WORLD HEALTH, May 1988 The growth chart: simple and appro- priate technology for monitoring young children's growth and development. Photo WHO/J. Schytte 0 0 0 take the right corrective action. Viewed together, wasting and stunting in preschool children provide a good idea of a population's overall health status. In the past, the indicator most widely used to assess nutritional status - because it was simple and readily un- derstood - was weight attained at a given age, known as weight-for-age. But this does not describe nutritional sta- tus with sufficient accuracy because it fails to distinguish between wasting and stunting. From a socioeconomic and public health angle, the differences between preva- lences of wasting and stunting are significant. Wasting is a symptom of acute under-nutrition, and is usually a combined consequence of insufficient food in- take and a high incidence of infectious diseases, espe- cially diarrhoea. Stunting, on the other hand, is a conse- quence of chronic under-nutrition arising from insufficient food intake and exposure to infections· over a long period. Given the cumulative effect of these conditions, the longer they prevail the more likely a child is to be stunted. In many developing countries, wasting most severely affects children during the second year of life, when they 11 STUNTING 12-23 M ONTH S (% ) NO DATA 0-5 5. 1-10 10.1 -20 20.1-30 M ORE THAN 30 D 0 0 0 0 are no longer breast-fed. The missing benefits of breast milk are often not compensated by nutritious weaning foods. And in the absence of breast milk, children lose their protection against infection at just the time when they are becoming increasingly mobile and coming into direct and frequent contact with an often unhealthy environment. A common characteristic of families living in poverty and squalor, stunting has sometimes been used as an indicator of the social and economic level of specific populations groups. As it is a more widespread condition than wasting, and as many ch ildren seem to adapt to it and to function at or near normal levels, there is some debate about how severe stunting really is. In the long term, however, th is condition has a number of serious consequences. For example, women who themselves were stunted during childhood are more likely to deve- lop complications when they have their own babies and to give birth to low-birth-weight children. Is there a way of finding out about the types of malnu- trition and their extent within a country or different re- gions of the same country? Yes. This can be done by 12 0 Breast milk gives young children the best start in life, and protects them against infection. Photo WHO/J. Schytte W oRLD HEALTH, May 1988 I using anthropometry-assessing growth performance and body mass-to measure weight-for-height for wast- ing and height-for-age for stunting. Growth charts are a simple appropriate technology that wHo is actively promoting for use in interpreting such measurements in the community. These charts are de- vised in a way that not only makes it easy for health work- ers to record measurements but also to assess at a glance the nutritional status of each child . Some of them show horizontally the age of the child from birth up to 5 years of age, and vertically the child's weight or height recorded at regular intervals. Other charts such as the one shown on page ll, used in Mauritania, allow a simul- taneous measurement of height and weight. They also display a "safety zone "-orange in our drawing-which is the area between two ascending statistical curves. Chil- dren whose measurements-red dots on the drawing- fall outside this zone possibly have growth problems that suggest something is wrong with their nutritional situation -either a shortage or, in some cases, an over-supply of nutrients. The baby drawn in red in the drawing is a typi- cal case of wasting. Health workers need to be alert both W ORLD HEALTH, May 1988 ... STUNTING 0 D • 0 to the positioning of the dots and to the direction of growth over time, in order to ensure that children grow and develop correctly. Nutritional deficiency is not always obvious. Only rarely associated with a sensation of hunger, this type of malnu- trition is a silent disease in the majority of cases. Its visible signs - apathetic behaviour, for instance, or even more obvious physical disabilities-may well pass unnoticed in societies where more pressing problems stemming from poverty are the rule. Yet, in the long run, this form of mal- nutrition endangers health more than most other dis- eases. lt leaves marks that last for a lifetime by inhibiting growth, hindering mental. physical and social develop- ment, and increasing the probability of serious and pro- longed bouts of infectious disease. lt follows that studies of growth and development patterns, together with posi- tive health measures to overcome the problems thus un- covered, are among the most important tools for healthy development. 0 13