Evaluations of Programs to Prevent Childhood Stunting

Dear Colleagues,

Childhood stunting is the outcome of impaired linear growth, starting from conception through early postnatal life. Progress has been slow in reducing child undernutrition, with an estimated 149 million stunted children under five years of age. Beyond two years of age, it is hard for children to catch up on the lost growth. Thus, many programs aim to improve child growth during the 1000 days’ window of opportunity from conception to two years of age. Child stunting is the result of many factors, including inappropriate child feeding practices leading to inadequate nutrient intake, contaminated home environments, and frequent infections.

Impaired child growth is associated with many adverse consequences, including poor child cognitive development, lower academic attainment in school, increases in the risk of infectious diseases, and child death. It is causally associated with complicated births and poor birth outcomes in short-statured adult women. Stunted children are also more likely, in adulthood, to have lower incomes and an increase in the risk of noncommunicable diseases. High levels of stunting indicate an environment of deficiency for optimal child growth. Similar environments also lead to young children failing to reach their full cognitive and economic potential. Improving linear growth and reducing stunting alone may not be very effective in addressing some of the other outcomes associated with childhood stunting. For example, psychosocial stimulation in early childhood is a critical intervention for improving cognitive outcomes. To address different outcomes related to child stunting, multi-component interventions are required. Such programs will require elements which are directed at specific outcomes, for example, to improve both child growth and cognitive development interventions needed to combine both psychosocial stimulus and counselling for appropriate infant and young child feeding.

A further issue for programs to consider is that improvements in the determinants of stunting, such as complementary feeding practices or improved food security, are likely to occur before improvements in child growth. Evaluations of child stunting prevention programs need to include program impact pathways and assessments of the intermediary steps. A program may have a useful impact on, say, complementary feeding practices, but not have sufficient intensity or duration of exposure to clients to extend to an effect on child growth.

The implementation of child stunting prevention programs takes place in many different local contexts within and across countries. These contextual variations include the factors causing child stunting, the severity of the stunting, and the capability of health and other sectors to deliver programs. Program managers should not assume that interventions reported to be effective in carefully conducted randomized controlled trials will result in the same effects when implemented in a program setting, hence the importance of robustly designed impact evaluations when starting to deliver a new set of interventions. Stunting prevention program evaluations can enhance their usefulness for scale-up by collecting data about the fidelity and duration of service delivery, and implementation processes related to the causal pathway.

In this Special Issue, we aim to explore experiences with evaluations of child stunting prevention programs.  Potential topics include the following:

• Impact of child stunting prevention programs on the stunting and linear growth of children, infant and young child feeding practices and child nutrient intakes

• Impact of child stunting prevention programs on maternal dietary patterns and nutrient intake
• Impact of child stunting prevention programs on birth outcomes, especially low birth weight and small for gestational age births
• Intervention fidelity; users’ responses and implementation challenges through process evaluation of child stunting prevention programs
• Explorations of why child stunting prevention programs succeed or fail.

We look forward to your contributions to this critical area of global public health nutrition.

Prof. Dr. Michael J. Dibley
Guest Editor

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• Child stunting prevention programs
• Nutrition behaviour change communication
• Nutrition-based supplementation or fortification
• Impact evaluation
• Process evaluation
• Infant and young child feeding
• Maternal and child nutrient intake