Harvard T.H. Chan School of Public Health researchers rank for the first time a range of risk factors associated with child stunting in developing countries, the greatest of which occurs before birth: poor fetal growth in the womb.

Based on their findings, they prescribe fundamental changes in approaches to remedy stunting, which today largely focus on children, calling for greater emphasis on interventions aimed at mothers and environmental factors such as poor water and sanitation and indoor biomass fuel use.

Funded by the Government of Canada through Grand Challenges Canada’s “Saving Brains” program, the study reports that in 2011 some 44 million (36 percent) of two-year-olds in 137 developing countries were stunted, defined as being two or more standard deviations shorter than the global median. About one quarter (10.8 million) of those stunting cases were attributable to full-term babies being born abnormally small.

The findings highlight a need for more emphasis on improving maternal health before and during pregnancy, according to the researchers at Harvard Chan School, who published their work Nov. 1, 2016 in PLOS Medicine.

The absence of optimal sanitation facilities that ensure the hygienic separation of human waste from human contact has the second largest impact overall, attributable to 7.2 million stunting cases (16.4 percent), followed in third place by childhood diarrhea, to which 5.8 million cases (13.2 percent) are attributed.

Child nutrition and infection risk factors accounted for six million (13.5 percent) of stunting cases overall.

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