Despite ample food supplies, child stunting remains a widespread problem, driven by poor sanitation and an imbalance in gut microbiota. Experts call for integrated solutions targeting nutrition, sanitation, and microbiome health to break this persistent cycle.
South Africa’s grocery stores may be well stocked, but that abundance has not prevented high rates of child stunting, a problem that reflects far more than a shortage of food. The broader global picture is no better: the World Health Organization says 150.2 million children under 5 were stunted in 2024, showing that the condition remains one of the world’s most persistent forms of child malnutrition.
Researchers writing in The Conversation argue that the issue starts early, when poor nutrition, repeated illness and unhealthy surroundings combine to slow both physical growth and brain development. They say the long-term effects can be severe, shaping children’s health, learning and future earnings. The challenge, they add, is that simply increasing calories is not enough.
A growing body of research points to the gut microbiome as a key part of the story. The trillions of organisms that live in and on the body help break down food and make nutrients available for growth. But in children exposed to poor sanitation, sewage and toxic dirt, the gut can become inflamed and damaged in ways that limit nutrient absorption. That condition, known as environmental enteric dysfunction, may leave stunting hidden until its effects are entrenched.
Studies cited by the authors suggest that children in low-income settings often fail to develop the stable, diverse gut communities seen in healthy early childhood. Work in Malawi found that microbes from malnourished children could induce growth problems in young animals, while microbes from healthy children helped restore growth. Other research has identified bacteria from the mouth colonising the wrong part of the gut in stunted children, potentially disrupting fat absorption.
The wider lesson, the authors say, is that food security on its own does not guarantee healthy growth. They call for integrated responses that combine better sanitation, infection control, nutrition, early childhood support and stronger monitoring at primary care level. They also argue that Africa needs more locally led research, since much of the microbiome evidence still comes from Asia, South Asia and a handful of sites in East Africa and Malawi.
For families and policymakers, the implication is practical as well as scientific: children may need more than meals to grow properly. Future progress, the researchers suggest, may come from tests that can identify gut dysfunction early and from treatments that restore the microbiome alongside improving diet.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
