BY ASSOC PROF DR ROSLINA ABDUL RAHIM

THE World Health Organisation ( WHO ) has defined stunting as an impairment in linear growth ( length / height for age ) below two standard deviations ( SD ) of the WHO Child Growth Standards median in children under the age of five .

WHO has also estimated that one in four children below the age of five will fail to grow along the trajectory optimum , resulting in stunting . This problem affects one-quarter of children globally , particularly in African and Asian countries .

PREVALENCE IN MALAYSIA

According to World Bank Data ( 2018 ), Malaysia ’ s stunting rate among children under five in 2016 ( 20.7 per cent ) was higher compared to Gaza and the West Bank in 2014 ( 7.4 per cent ). The prevalence of stunting in Malaysia was also higher compared to other middle-income countries such as Ghana ( 18.8 per cent ), Mexico ( 12.4 per cent ), Kazakhstan ( eight per cent ), and Macedonia ( 4.9 per cent ).

The rate of stunting cases in Malaysia has seen an increasing trend since 2010 . According to the National Health and Morbidity Survey ( NHMS , 2019 ), 21.8 per cent of children in Malaysia are stunted , one in five children below the age of five . The prevalence of stunting in Malaysia is the highest in Kelantan ( 34 per cent ), Terengganu ( 26.1 per cent ), Pahang ( 25.7 per cent ) and the lowest in Kuala

The above image ' s red arrow shows an 11-year-old girl with her friends . This girl is undergoing follow-up treatment with a Sultan Ahmad Shah Medical Centre ( SASMEC ) paediatrician . The image obtained was consented to by her parent .

Lumpur ( 10.5 per cent ).

The NHMS 2019 data reported that stunting was prevalent in poorer households and affected children from households with a monthly income greater than RM10,000 . Stunting affects all ethnicities and the Chinese race recorded the lowest stunting rate .

Mothers with a lack of tertiary education had a higher rate of stunting children . The stunting rate declined as maternal education improved . Other than that , a mother ’ s employment status seems to influence stunting rates , where 38.3 per cent of children are stunted when the mother is unemployed ; mothers who work in the government sector it is 21.7 per cent and private sector , 19.4 per cent .

FACTORS AFFECTING THE GROWTH RATE OF STUNTED CHILDREN

The first 1,000 days is a golden period of life for children , which begins in the womb till the first two years . According to John Hopkins Medicine , pregnant women , and nursing mothers should consume a balanced healthy diet with vitamins and minerals supplements for their babies .

Later , after the baby is born till they reach two years of age , it is also crucial to nourish them with nutritious food that contains macronutrients and micronutrients for their growth and mental development .

Macronutrients consist of carbohydrates , proteins , fats , fibre and water , while micronutrients consist of vitamins [ Vitamin A , D , E , K ( lipid soluble ) and Vitamin B and C ], and minerals ( sodium , chloride , potassium , magnesium , phosphorus etc .), trace minerals ( such as iron , manganese , copper , iodine , zinc , fluoride etc .).

Therefore , when the child is undernourished , it can lead to stunted growth . According to Dr Muhd Alwi Muhd Helmy , a pediatrician from Sultan Ahmad Shah Medical Centre ( SASMEC ), kids nowadays are picky eaters and don ’ t prefer vegetables . This attitude was observed in stunted children . Therefore , being a picky eater is also a risk factor for stunting children .

The Covid-19 pandemic lockdown also contributed to stunting children , as it affected the socio-economy of the parents . Some parents lost their job , forcing them to use their savings . They couldn ’ t afford to buy nutritious food for their children . Children who live in rural areas with poor sanitisation and water supply also contributed to stunted children .

THE IMPACT OF STUNTING ON CHILDREN

Stunted children exhibit lower cognitive function and delays in their growth and mental development milestones . Cognitive function

includes learning , thinking , reasoning , remembering , problem-solving , decision-making , and attention .

Besides that , studies have shown that these children perform poorly in reading , vocabulary , and mathematics . Scientific studies have shown that stunted kids suffer low immunity and are more vulnerable to simple infection and illness .

Stunting is an irreversible condition , where children cannot recover their height in the same way they can recuperate their weight . Albeit these stunted children grow up , they will be obese stunted adults who are more predisposed to Type 2 diabetes , hypertension , and even cardiovascular disease .

According to studies conducted by Ozaltin et al . ( 2010 ), children born to women who are stunted are at greater risk of dying than children of mothers of normal height . Kewey and Begum ( 2011 ) also reported that a short stature impacts lower economic productivity . WHO ( 2021 ) reported that malnutrition increased healthcare cost , reduced productivity , and slowed down economic growth .

WHAT CAN WE DO ?

Agreeing with WHO , if this problem is not identified and corrected before age two ( within the first 1,000 days of life ), a child may have to spend an entire life dealing with the consequences of stunting . As a parent , what can we do to prevent stunting in our children ?

We know this problem occurs because of undernourishment . It sounds simple but as parents , how do we educate ourselves to provide our kids with nutritious food for their growth and mental development ?

We need to ensure our children eat a healthy , balanced diet that includes all the macronutrients and micronutrients vital for their growth and mental development . We need to educate ourselves about the benefits of eating vegetables and fruits .

For example , carrots promote eye health and lower the cholesterol level . Broccoli helps to boost immunity and reduce inflammation , promoting a healthy heart and bowels . We also need to be creative in our cooking methods making it interesting and attractive for children to eat .

Colours also attract kids to eat . Also , as a parent , we need to take the first step to eat vegetables and fruits and eat together with our kids so they will also follow our steps . Hence , parents become prominent role models for their kids .

We must also educate our children on the cons of eating junk , processed , and fast foods as they contain high calories , salt , and sugar levels . All these can lead to being overweight , predispose them to diabetes , fatigue , weakness , memory , and learning problems , increased risk of cancer , heart , liver , and kidney disease , and also affect brain function .

We hope this article provides insight and creates awareness of stunting among readers and parents . With the understanding of stunting in children , we will have a good idea to reduce the rate of stunted children in Malaysia . – The Health

Assoc Prof Dr Roslina Abdul Rahim is a Physiologist at the Department of Basic Medical Science , Kulliyyah of Medicine , International Islamic University Malaysia ( IIUM ).