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[NAIROBI] Children living in high altitude areas are at greater risk of stunting, highlighting the need for health policies that are tailored to life in the world’s mountain regions, a study says.
According to estimates from the United Nations Children's Fund, the World Health Organization and the World Bank, in 2019, about 52 million children below five years of age were stunted in Sub-Saharan Africa.
Stunting affects about 155 million children — 23 per cent of children — younger than five years globally and is associated with an increased risk of mortality, cognitive deficits and developmental impairments that make them more vulnerable to chronic diseases in later life, researchers say.

“Policymakers and public health practitioners should give attention to pregnancies and child growth at higher altitudes.”

Kaleab Baye, Addis Ababa University

The study, published in the Journal of the American Medical Association last month (24 August), offers new insights into the connection between altitude and undernutrition, making the case for policy tailored to high altitude contexts.
“The study found that children residing at higher altitudes were, on average, born shorter and remained on a lower growth trajectory than children residing at lower altitudes,” Kaleab Baye, the study’s lead author and an associate professor at Addis Ababa University, tells SciDev.Net.

The study suggests that specific attention and health care guidance are needed to manage pregnancies and early childhood development in high-altitude settings.

“Failing to address altitude-mediated growth deficits may result in a significant proportion of the world population not meeting the Sustainable Development Goals and World Health Assembly nutrition targets,” the study says.

Baye says that children residing in ‘ideal home environments’ grew at the same rate as the average child in the 2006 WHO growth standard but their growth changed from about 500 metres above sea level.

An ideal home environment includes access to safe water and sanitation, parents owning a television or car, mothers being educated and babies being born in a hospital, according to the study.
“After 500 metres above sea level, the average child height-for-age significantly deviated from the growth curve of the median child in the 2006 WHO reference population,” he explains.

Baye says that the study identified the weeks immediately before and after birth as the most vulnerable period for children living at altitude, as pregnancies are complicated by chronic suboptimal supply of oxygen, putting the foetus at risk of limited growth.

Causes of stunting in Ethiopia and across Sub-Saharan Africa include poor diets, poor water, sanitation and hygiene conditions, poverty, food insecurity, and inadequate health and care services, according to Baye.
Researchers analysed 133 national demographic and health surveys from 59 low- and middle-income countries, conducted between 1992 and 2018. This represented close to one million height measurements in 96,552 clusters at altitudes ranging from 372 metres below sea level to almost 6000 metres above sea level.
Baye tells SciDev.Net that about 288 million people in Africa live at altitudes higher than 1500 metres above sea level.
“From Sub-Saharan Africa, Ethiopia, Kenya, South Africa, Tanzania and Uganda are among the countries that have the highest number of their population living above 1500 metres above sea level,” he says.
Policymakers and public health practitioners should give attention to pregnancies and child growth at higher altitudes.”

Mercy Lung’aho, a nutrition specialist with the Alliance of Bioversity International and the International Center for Tropical Agriculture, says that stunting negatively impacts cognitive development, which ultimately affects adult income potential and the economy. “For instance, the cost of malnutrition in Ethiopia is equivalent to 16.1 per cent of the country’s gross domestic product,” she says.

Nutrition interventions from health and other sectors, such as agriculture, social protection, and education need to work together to address malnutrition in Africa, Lung’aho adds.

The study findings, she explains, point to the need to improve the targeting of child health and nutrition programmes, considering the specific vulnerabilities of populations and addressing child health inequities in all settings, especially where altitude is a consideration.
This piece was produced by SciDev.Net’s Sub-Saharan Africa English desk.


Kaleab Baye and others Evaluation of linear growth at higher altitudes (Journal of the American Medical Association, August 24, 2020)

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