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75 Reversal of stunting in holistic healthcare-education programme in Odisha state, India
  1. Abigail Nye,
  2. Catherine Morris,
  3. Mary Cusack
  1. UK


Background Stunted childhood growth is a global problem, and is a major cause of morbidity and mortality. Its causes are complex and multi-factorial, reflecting chronic undernutrition during crucial periods of growth and development in early life. Its consequences are evident at the individual, family and societal level, and can extend into future generations.

A child has stunting if their height-for-age z-score (HAZ) is below 2 standard deviations (SD) from the median of the World Health Organisation (WHO) Child Growth Standards. Until recently it was thought that children could not recover from stunting after the age of 2 years, but this has been refuted by several studies.

Objectives We aimed to investigate the impact on children’s height and weight, following enrolment in a free programme offering holistic healthcare, education and play, in Odisha state, India.

Methods We conducted a retrospective observational study analysing anthropometric data for children who are enrolled in the Love the One (LTO) programme in Odisha, India. LTO provides a holistic approach to education, healthcare and childcare for poor and deprived children. Children’s height and weight were collected at admission to the programme, and annually thereafter for 5 years, and converted to a centile for age according to the WHO Child Growth Standards. Mean height and weight centiles were calculated, and paired T-test used to compare measurements at admission and at yearly intervals.

Results 288 children were included, of which 137 (47.2% were male). The median age at admission was 3 years (range 0–12 years).

Mean centiles for height and weight on admission were 16.1 and 12.7 respectively. Height and weight centiles significantly increased after 1, 2 and 3 years in the programme. There was also a non-statistically significant increase at 4 to 5 years, explained by the smaller numbers of children who had been enrolled in the programme for longer periods of time. At admission, 41.8% of children were stunted. This fell to 23.9% after 1 year, 17.2% after 2 years, and 16.5% after 3 years. The greatest impact on reduction in stunting was seen in children who were admitted to the programme at age 3–4 years; and the least impact was seen in those admitted at more than 5 years old.

Conclusions Children admitted to the LTO programme show a significant increase in both height and weight centiles after 1, 2 and 3 years. Furthermore, 60.5% of children who had stunted growth on admission showed reversal of their stunting after 3 years. This reversal of stunting was most evident in children admitted before the age of 5 years, implying that interventions are most effective if they occur at an early age.

This study provides further evidence that stunting can be reversed, and that efforts should be made to improve the nutritional status of children of all ages. It demonstrates the impact that a holistic approach to education, healthcare and childcare, working within communities and families, can have on children’s growth.

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