Background At present, South Asian Association for Regional Coorporation (SAARC) countries have tremendous pressure on child stunting along with the impact it is making on economic growth. World Health Organization (WHO), United Nations...
moreBackground At present, South Asian Association for Regional Coorporation (SAARC) countries have tremendous pressure on child stunting along with the impact it is making on economic growth. World Health Organization (WHO), United Nations International Children's Emergency Fund (UNICEF) and The World Bank (WB) have emphasized for this region to reduce stunting by 40%. The objective of this paper is to analyzed the impact of stunting on economic outcomes in SAARC countries so that to scale up policies and programs aiming to reduce child stunting. Methods The systematic review has assessed ve international databases; PubMed, JSTOR, Cochrane Library, Web of Science and CINAHL Plus for published, unpublished, and ongoing research till the year 2020. Grey literature is searched using Google Scholar and Google search engines. The systematic review registration number in PROSPERO is CRD42021230279. Result Thirty-three studies matched the criteria. Most quantitative studies link stunting with economic repercussions. Three investigations found no or a weak link between the two. Nutritional intervention synthesis predicts a 12 percent return, a 5:1-6:1 bene t-cost ratio, and a 14mm height gain. A 1 cm increase in height increases pay by 4% for men and 6% for women. Stunting caused a 5%-7% income penalty and lower lifetime pay. Studies show that a 10% increase in agricultural growth reduces stunting by 9.6%, while a 10% increase in non-agricultural growth reduces stunting by 8.4%. Conclusion To reduce stunting prevalence, policies should be scaled up, as well as targeted and structural interventions are needed. 1-Introduction According to the WHO (1), globally in 2020, 149 million children under the age of ve suffered from stunting, which causes them to be too short for their age and more than two standard deviations below the WHO's median (a value of a child's height in the middle of a frequency distribution of observed values of average child height, with an equal probability of falling above or below) (2). South Asia alone accounts for 53.8 million (31.8%) of the total (1). Stunting is caused by poverty, malnutrition, and chronic disease in the mother or child by birth. Stunting has immediate and intermediate causes, as well as underlying factors (3). Inadequate nutrition and repeated illnesses in the rst ve years of a child's life result in decreased IQ and physical development, reduced productivity, and poor health in general, which eventually cause chronic diseases including arthritis, asthma, cancer, and diabetes (3). Stunted children are less productive; mentally, physically, and physiologically (4), which results in lower wages and a likely contender for the next generation/s to be stunted. Stunting also reduces immunity, making people more susceptible to illnesses and affecting reproductive health (5, 6). Due to health concerns, stunted children suffer signi cant mental and physical effects in their early years, resulting in poor performance in school or in vocational training, poor job performance, lower wages and earnings due to lack of education and skills, which causes them to rely on other household members or society to sustain economic burden (5). Stunting has a lifelong impact (7). Height in childhood determines adulthood height (7), and height is an important determinant of wages (5, 8). As reported by (9-11) a child's rst 1000 days including enneadic months in the mother's womb impacts the future height. It is di cult to catch up on height later in adolescence due to a malnourished skeleton that takes time to grow taller than the usual non-stunted child (12, 13). Malnutrition is rampant in South Asia, as adequate food is out of reach for many poor people. They also lack the knowledge or education to make healthy food choices (14). According to World Bank's report, 62 million children out of 155 million are considered stunted, meaning they are too small for their age (15). According to the WHO, what sets South Asia apart from other developing countries where stunting is a problem is the persistence of chronic malnutrition notwithstanding rapid economic growth (16-22). This is due to poor transition mechanisms and weak supply side by countries in terms of inadequate and non-nutritious food, dirty water, poor sanitation, insu cient healthcare, to name a few examples. Due to poverty and its related reasons, the demand side is also weak; underinvesting in healthy food, education, old and traditional belief systems (like gender-based discrimination and the waste of colostrum), are a few of them. 2-Method This study assessed the economic consequences of stunting in SAARC, considering the impact of childhood stunting on adult economic outcomes. Terms like malnutrition, under-nutrition, and other such categories are used in this study as substitutes for stunting. The PICO questions were used to construct the protocol for this systematic review.