The private school refused to admit 'Yazan' to enroll in the first grade, despite his reaching the school age and our willingness to pay all the tuition fees in advance. The teacher told me that I should enroll him in the kindergarten class due to his young age, despite my attempts to convince her that Yazan is six years old, but he looks younger because he is not growing normally. This treatment leaves an impression on my son's mind that he is unwanted and vulnerable to bullying and ridicule at any moment," says Yazan's mother to "Khuyut."
According to reports from the World Health Organization, nearly half of Yemeni children under the age of five suffer from stunted growth. This phenomenon is observable among children in the streets, schools, and public places. Experts attribute this primarily to malnutrition and inadequate healthcare, along with genetic factors, which play a lesser role. The ongoing war in Yemen since 2015 has exacerbated the severity of this issue.
In a related context, recent findings from the Multi-Indicator Cluster Survey, issued by the Central Statistical Organization in Yemen, revealed that 49% of children under the age of five suffer from stunting or chronic malnutrition, while 17% of children experience wasting or acute malnutrition.
These indicators, according to the organization, reflect the living conditions of approximately 75% of Yemeni households that have experienced a state of food insecurity.
“There are factors that affect children's appetite and their response to nutrition and various activities that stimulate their growth, ultimately leading them to severe or moderate malnutrition, which in turn affects their physical growth.”
Stunting and its Consequences
The World Health Organization defines stunting as "low height for age," attributing it to "chronic or recurrent malnutrition, often linked to poverty, poor maternal health and nutrition, frequent illness, or inadequate care and feeding in early life."
According to the organization, stunting prevents children from reaching their physical and cognitive potential, resulting in both immediate and long-term consequences. These consequences include increased rates of disease and mortality, as well as impaired growth and reduced learning ability. Additionally, stunting raises the risk of infection and non-communicable diseases.
Moreover, children who experience stunting and undergo rapid weight gain after two years are at a higher risk of developing overweight or obesity later in life.
In popular Yemeni culture, the phenomenon of stunting is referred to as 'Al-Sanfara,' a term associated with the widely known cartoon series 'The Smurfs.' The characters in this series are depicted as small blue creatures inhabiting a forest and being pursued by an evil character.
Nutrition and Violence
Yahya Saeed, a nutrition specialist at Al-Fawaris Medical Center in Sana'a, discusses the impact of malnutrition on children's health and physical well-being in his interview with "Khuyut." He explains, "Malnutrition affects both pregnant mothers and children, especially those under the age of five, compounded by the violence they may experience in their early years. This impacts the natural growth and the health of the child, as well as the angiotensin-converting enzyme, which turns into toxic stress, negatively affecting the overall health of the brain and the nervous system."
Likewise, Firdaus Al-Rubasi, a psychological specialist, agrees with him, stating to "Khuyut" that the violence and psychological traumas affect the child's peace and security, leading to disturbances in growth and behavior.
Al-Rubasi continues, saying, "Some may wonder about the connection between psychological peace and security and the physical growth of the child. Here, it's important to note that these influencing factors may vary in their impact from one child to another. However, overall, they affect children's appetite, their response to nutrition, and their engagement in various activities that stimulate their growth. Consequently, they may end up experiencing severe or moderate malnutrition, which in turn affects their physical growth. Therefore, addressing psychological aspects and avoiding traumatic experiences directly impact their natural growth."
“Growth hormone deficiency is a common cause of proportional stunting, occurring when the pituitary gland fails to produce sufficient amounts of the hormone due to genetic disorders, malnutrition, or other often unknown causes.”
The Importance of Visiting a Doctor
Many families with children suffering from stunted growth are unaware of how to deal with this phenomenon, especially when their economic circumstances hinder their access to various treatment options. Additionally, low health awareness often exacerbates the problem in many cases. As the children grow older, their bodies remain short and frail, with few exceptions for families who seek help from specialized doctors, who play a crucial role in improving the natural growth process for these children.
In this regard, Dr. Mona Jaber, a pediatrician, advises parents to monitor their children's growth closely. If they notice any delay compared to their peers, they should consult a specialist. She also emphasizes in her interview with "Khuyut": "Children's susceptibility to viral infections such as colds or diarrhea is an indicator of weakened immunity, which could significantly delay the child's natural growth process compared to his peers of the same age."
Regarding the importance of consulting nutritionists to prevent children from experiencing stunting, Nermeen Jameel, a resident of the capital Sana'a, recounts how a visit to the doctor changed her brother's life, who was suffering from stunted growth.
Nermeen says in an interview with "Khuyut": "My brother was exceedingly short, to the extent that his stunting affected his psyche and his interaction with his peers and surroundings. His short stature became a real problem for him, especially when he faced any form of bullying. Therefore, our family decided to visit a specialist doctor to support him and treat his condition. During the consultation, the doctor implemented several measures, including prescribing specific physical exercises, incorporating bone marrow into his diet, along with adhering to a specific dietary regimen and medication. Thank God, after a period of discipline and consistency, my brother returned to his natural growth."
Comprehensive Treatment
One of the important pieces of advice that doctors offer to families is not to rely solely on visits to nutritionists because they focus only on aspects related to this part. However, children affected by stunting need treatment for all underlying causes. Therefore, it is essential for the efforts of nutritionists to be combined with those of other doctors, such as internists, endocrinologists, and others, as there may be an organic cause unrelated to nutrition.
Dr. Yahya Saeed, a nutritionist, speaks to "Khuyut" about the nature of his specialty, saying: "As a nutritionist, I treat malnutrition in children aged 6 to 59 months. My treatment plans usually focus on prescribing specific supplements to stimulate the child's appetite and provide the necessary nutrients for optimal growth during this period. However, in many cases, it's necessary to refer the child to other doctors to determine if there are any organic issues affecting their growth process. Actually, these are routine procedures that all parents should pay attention to if their children suffer from stunting or if they feel their child is not growing normally compared to their peers."
On his part, Dr. Anas Al-Shaumi, a pediatric endocrinologist and diabetes consultant, says in a conversation with "Khuyut": "Growth hormone deficiency is a common cause of proportional stunting, occurring when the pituitary gland fails to produce sufficient amounts of the hormone due to genetic disorders, malnutrition, or other often unknown causes. To address this issue, parents may believe that doctors have a magic wand for a solution or a needle capable of miracles. However, the reality is that it requires patience, and improvement may not occur as expected. Nevertheless, medical interventions can work to mitigate the exacerbation of the problem or contribute somewhat to its treatment.
He summarizes the reasons for sudden growth cessation in children by stating: "This depends on the diagnosis. If it's due to malnutrition, the child first needs good nutrition. However, if it's due to malabsorption, then treatment for this problem is necessary."
