Despite steady gains over the past two decades, about a third of Cambodia’s children are still stunted—leaving them smaller, prone to illness and cognitively impaired—according to new research that suggests a more flexible approach is needed to continue progress.
Increased education among parents, better maternal care, improved sanitation and higher incomes were credited as the key drivers in reducing stunting from 51 percent of children in 2000 to 34 percent in 2014, according to a study released last week.
The researchers from the U.K. said that there seemed to be divergent causes for the drop in rural and urban areas.
The study, titled “What Explains Cambodia’s Success in Reducing Child Stunting: 2000-2014?,” also finds that programs focused exclusively on improving child nutrition had not shown sure signs of success.
“Maternal best practices and parental education appear to be the most promising areas for intervention in rural areas, whereas improvements in socio-demographic endowments like wealth may produce a larger impact in urban areas,” the study says.
“While targeted child nutrition interventions may be making larger contributions to reduction in stunting, there is very limited data at present on the coverage, quality and impacts of these programmes in most developing countries.”
Among the other major factors contributing to stunting were a lack of access to clean water and proper toilets, as increased exposure to fecal matter has been found to damage internal organs that process food, slowing physical and cognitive development even if a child is given a nutritious diet.
Geoff Revell, program director at sanitation NGO WaterSHED, said a concerted effort by the government, medical workers, families and communities was needed to convince people of all kinds of the importance of proper sanitation.
“If your neighbors don’t have toilets, then even children that have toilets and good nutrition might end up scoring lower on what’s called the height for age Z score, which is essentially the tool most used to understand stunting,” he said.
The effects, he added, could be irreversible.
“Every cohort that is malnourished or underfed, ultimately, they’re set back for life,” he said. “What’s most troubling, I think, for people in the health sector, are the long-term effects on the child’s wellbeing and quality of life…. They suffer health problems over the course of their life. They’re set back in terms of their cognitive abilities.”
Despite its gains, Cambodia’s children remain among the most affected in Southeast Asia when it comes to stunting, according to a March report from Unicef and the World Health Organization.
In May, researchers funded by France’s Institute for Development estimated an annual loss of $266 million as a result of health problems and lost productivity among those experiencing malnutrition. Their calculations, based on indicators of malnutrition identified in the 2014 Cambodian Demographic Health Survey, found stunting alone accounted for $120 million in lost costs due to resulting complications in children and adults.
Ly Sovann, spokesman for the Ministry of Health, declined to comment on the issue.