NextBillion - An Initiative of the William Davidson Institute at the University of Michigan

Wednesday, June 11, 2014

I’m certain that all readers on the site have heard of the Thousand Days concept. This is the notion that children are especially vulnerable to the effects of malnutrition and illness from conception up until they reach two years of age and that interventions targeted at this window have the best chance of improving child health worldwide. Over the last few years, the concept has served as a rallying point for major donors and has helped to shape the programs of numerous governments and nongovernmental and aid organizations. The primary success of the Thousand Days concept is that it provides a tangible, concrete tool for talking about nutrition programming, and as a result it has been crucial in galvanizing political will for combating child nutrition (1).

Equally importantly, it has shifted the focus of child nutrition work back towards very early childhood, a major step forward, especially in some countries (like Guatemala, where I primarily work), where most nutrition programming had, for decades, languished in the form of primary school-based programs (2). Furthermore, it has revived interest, research, and programming in primary prevention of malnutrition and, especially, the form of malnutrition known as stunting. Stunting is the most prevalent form of malnutrition in the world, with more than 150 million cases in children under 5 years of age globally (3). Stunting manifests as short height with relatively normal weight, and it presumed to be a proxy for brain development. Children who are stunted have delayed attainment of milestones and decreased cognitive potential. They also experience longer term effects, such as decreased rates of school completion and lower economic earning potential as adults (4). I don’t mean to reduce the entire focus of the Thousand Days approach to a focus on stunting, since it certainly covers many other things as well related to early child health. However, in high stunting areas like Guatemala the practical impact of the Thousand Days approach has been to reignite a the conversation about stunting.