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report
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HMH Professional; ★
Discover the Best of Priority areas for reducing stunting in South Africa: Examining the implications of recent international evidence
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This working paper summarises and discusses the most recent and best available international evidence on stunting. Our aim is to inform and guide the public debate, the advocacy of non-profit organisations (NPOs), and the policymaking responses of the government as they grapple with South Africa's deepening food insecurity and stunting crisis. We first discuss the underlying causes of stunting, namely nadequate dietar y intake, repeated infections, social and cognitive under-stimulation, and air pollution. Then through a review of the evidence, we focus on short to medium term inter ventions to reduce stunting targeted at children of the complementar y feeding age of 6 to 24 months. This age group falls within the crucial and highly sensitive first 1000-day period and is a challenging feeding transition because breastmilk alone is no longer enough to sustain the child from six months onwards. A stock-take of the evidence, weighed against local contextual needs, leads us to two key recommended inter ventions for this complementar y feeding age group: first, nutrition education for the community and caregivers with a focus on appropriate complementar y feeding practices, and, second, the prescription and promotion of Lipid Nutrient Supplements in Small Quantities (LNS-SQ)-a high-energy fortified food for at-risk young children. We also highlight the importance of supporting policies and regulations to curtail the advertising of unhealthy food choices, promote the wider availability of healthy foods and develop better routine data on child nutrition and grow th outcomes. While primar y health care clinics are the most suitable nodes to reach mothers and ver y young children with inter ventions, we note that early childhood care or educational (ECCE) programmes have an important role to play in supporting such policies-both directly, through social and cognitive stimulation and better feeding, and potentially indirectly, by ser ving as champions, promoters and community-based contact points for complementar y feeding education and nutritional supplements. Improved ser vice deliver y-with a focus on water, sanitation and hygiene (WASH), environmental management and health care reform-are also vital in tackling underlying causes of stunting. Routine data on breastfeeding, vitamin deficiencies, wasting, under weight and stunting is urgently needed to assess whether the recommended nutrition strategies are working and having the envisaged widespread impact on child grow th and development. Beyond nutrition-specific inter ventions, more research is needed on how inter ventions to limit repeated infections, social and cognitive under-stimulation, and air pollution could alleviate stunting issues.. 1 We thank Tafwirapo Chichana and Tankiso Lefeta for their excellent research assistance.
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