Post-2015 Consensus: Nutrition Viewpoint, Owomugasho
Owomugasho makes the case for using underweight as a more appropriate indicator for nutritional assessment. Use of stunting, concentrating on the first 1,000 days of life, understates the influence of nutritional interventions from the second to fifth birthdays and also ignores the important period beyond the age of three, which is important to an infant’s growth and give an opportunity to make up for any early nutritional shortcomings.
In many rural communities, it is a common practice for mothers to conceive before or about the second birthday of a child, which implies the withdrawal of breastfeeding. This means a child may register a good score on the height-for-age nutritional indicator aged three, but at four or older may be stunted. The economic benefit-cost ratio may also not take account of other underlying factors such as family planning, primary health care, etc. For example, the rate of anaemia amongst mothers and macro- and micro-nutrient bioavailability prior, during and post pregnancy all critically affect the nutritional status of a child.
Stunting as a measure negates the genetic predisposition of communities as a result of primordial genetic makeup or by influences of the environment/adaptation or lifestyle. Also, in many rural African communities individuals may not have the height for age assumed by various scales for nutritional assessment but may have the right weight for height (Body Mass Index). This is a rapid nutritional status assessment tool that could address both issues of chronic and acute nutritional uptake.
In conclusion, underweight is the most appropriate indicator for nutritional assessment as it provides for both weight for age and height for age nutritional indicators that allowing for both acute and chronic nutrition status.