Children under 5 years who are stunted
Percent of stunted (moderate and severe) children aged 0–59 months (moderate = height-for-age below -2 standard deviations from the WHO Child Growth Standards median; severe = height-for-age below -3 standard deviations from the WHO Child Growth Standards median).
Number of children aged 0–59 months who are stunted.
Total number of children aged 0–59 months who were measured.
Age, place of residence, sex, socioeconomic status.
Percentage of children aged < 5 years stunted for age = (number of children aged 0–59 months whose z-score falls below -2 standard deviations from the median height-for-age of the WHO Child Growth Standards/total number of children aged 0–59 months who were measured) x 100.
Children’s weight and height are measured using standard equipment and methods (e.g. children younger than 24 months are measured lying down, while standing height is measured in children aged 24 months and older).
WHO maintains the Global Database on Child Growth and Malnutrition, which includes population-based surveys that fulfil a set of criteria. Data are checked for validity and consistency and raw data-sets are analysed according to a standard procedure to obtain comparable results. Prevalence below and above defined cut-off points for weight-for-age, height-for-age, weight-for-height and body mass index (BMI)-for-age in pre-school children are presented using z-scores based on the WHO Child Growth Standards.
Predominant type of statistics: adjusted.
Population-based household surveys.
Population-based health surveys with nutrition modules, national surveillance systems.
This indicator is used to measure nutritional imbalance resulting in undernutrition (i.e. stunting). Child growth is internationally recognized as an important indicator of nutritional status and health in populations.
The percentage of children with a low height for age (stunting) reflects the cumulative effects of undernutrition and infections since and even before birth. This measure can therefore be interpreted as an indication of poor environmental conditions or long-term restriction of a child's growth potential.
Children who suffer from growth retardation as a result of poor diets or recurrent infections tend to be at greater risk for illness and death. Stunting is the result of long-term nutritional deprivation and often results in delayed mental development, poor school performance and reduced intellectual capacity. This in turn affects economic productivity at the national level. Women of short stature are at greater risk for obstetric complications because of a smaller pelvis. Small women are at greater risk of delivering an infant with low birth weight, contributing to the inter-generational cycle of malnutrition, as infants of low birth weight or retarded intrauterine growth tend be smaller as adults.
Stunting is unaffected by seasonal variation and thus provides a better indication of trends than the wasting indicator (low weight-for-height), since it reflects long-term outcomes, such as frequent and high disease burden, limited access to food supply, poor feeding practices, and/or low household socioeconomic status, in the target population. Because stunting in children reflects socioeconomic conditions that are not conducive to good health and nutrition, this indicator is often used to target development programs. A decrease in the prevalence of stunting at the population level is a long-term indicator that social development is benefiting the poor as well as the relatively wealthy. Information on stunting for individual children is also useful clinically as an aid to diagnosis. Stunting based on height-for-age can be used for evaluation purposes but it is not recommended for monitoring as it does not change in the short term, such as 6-12 months.
The main limitation of this indicator is that length or height can be a difficult to obtain, thus leading to problems of validity. The most frequent problems in height measurement are inadequate
positioning of the child’s head and feet, a reading done in an oblique position, and not facing the reading point of the measuring board or height-measuring apparatus. If repeated measurements are different from each other, the measurements should be disregarded and the measuring should start again. Accuracy of measurement is achieved through good training and supervision.
Pediatric care, Nutrition, Child health, Morbidity
World Health Organization (WHO). 2015 Global Reference List of 100 Core Health Indicators.; 2015. http://apps.who.int/iris/bitstream/10665/173589/1/WHO_HIS_HSI_2015.3_eng.pdf
World Health Organization. Nutrition Landscape Information System (NLIS). Country Profile Indicators: Interpretation Guide. Geneva, Switzerland; 2010. http://apps.who.int/iris/bitstream/10665/44397/1/9789241599955_eng.pdf
WHO. WHO Global Database on Child Growth and Malnutrition. Department of Nutrition for Health and Development (NHD), Geneva, Switzerland. http://www.who.int/nutgrowthdb/en/
Gage AJ, Ali D, Suzuki C. A Guide for Monitoring and Evaluating Child Health Programs. MEASURE Evaluation. Carolina Population Center, University of North Carolina at Chapel Hill.; 2005. http://www.coregroup.org/storage/documents/Workingpapers/ms-05-15.pdf
Further information and related links
A draft framework for the global monitoring of the Comprehensive Implementation Plan on Maternal, Infant and Young Child Nutrition. Informal Consultation with Member States and UN Agencies on a Proposed Set of Indicators for the Global Monitoring Framework for Maternal, Infant and Young Child Nutrition, 30 September to 1 October 2013. Geneva: World Health Organization; 2013 (Retrieved from http://www.who.int/nutrition/events/2013_consultation_indicators_globalmonitoringframework_WHO_MIYCN.pdf).
Countdown to 2015 decade report (2000−2010): taking stock of maternal, newborn and child survival. Geneva and New York (NY): World Health Organization/United Nations Children’s Fund; 2010 (Retrieved from http://www.countdown2015mnch.org/reports-and-articles/previous-reports/2010-decadereport).
Countdown to 2015. Monitoring maternal, newborn and child health: understanding key progress indicators. Geneva: World Health Organization; 2011 (Retrieved from http://apps.who.int/iris/bitstream/10665/44770/1/9789241502818_eng.pdf).
Decision WHA67(9). Maternal, infant and young child nutrition. In: Sixty-seventh World Health Assembly, Geneva, 19-24 May 2014. Resolutions and decisions, annexes. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA67-REC1/A67_2014_REC1-en.pdf).
Document A67/15. Maternal, infant and young child nutrition. The Global Strategy and the Comprehensive Implementation Plan. Report by the Secretariat. Sixty-seventh World Health Assembly, Geneva, 19–24 May 2014. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/gb/ebwha/pdf_files/WHA67/A67_15-en.pdf).
Keeping promises, measuring results. Commission on information and accountability for Women’s and Children’s Health. Geneva: World Health Organization; 2011 (Retrieved from http://www.who.int/topics/millennium_development_goals/accountability_commission/Commission_Report_advance_copy.pdf).
Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee. Geneva: World Health Organization; 1995 (WHO Technical Report Series, No. 854).
WHO child growth standards: Length/height-for-age, weight-for-age, weight-for-length, weight-for-height and body mass index-for-age: Methods and development. Geneva: World Health Organization; 2006 (Retrieved from http://www.who.int/childgrowth/standards/technical_report/en/).
World health statistics 2014. Geneva: World Health Organization; 2014 (Retrieved from http://apps.who.int/iris/bitstream/10665/112738/1/9789240692671_eng.pdf?ua=1).
