Differences in socioeconomic conditions and health have been reported for African Pygmies and their sympatric populations of other ethnic groups. We collected anthropometric data in southern Cameroon from Baka and their Bantu neighbours, and also extracted data from the five available and representative Demographic and Health Surveys (DHS) in sub-Saharan African countries that have Pygmy populations..Our results show that the Baka exhibited a weak but significant decline of body mass index (BMI) with age (p = 0.003) without a sex difference. At a larger geographical scale, all five DHS surveys revealed flat or negative slopes for Pygmy BMI with age. Except for one non-Pygmy ethnic group, the slope was less than for all DHS- surveyed non-Pygmy African ethnicities. Pygmy populations were the least wealthy in all surveys, but no pattern for anaemia levels versus BMI emerged. We argue that the declining or stagnant trajectory of Pygmy BMI over age is most concerning, since this sets them apart not only from all other ethnic groups in the region, but from the general trend of increasing body weight over age. We suggest that our results do not reflect the influence of ethnicity per se, but the fact Pygmy populations are socially and materially deprived groups. These findings are fully aligned with the extraordinary high premature death rate among the Baka and need to be addressed for sustainable development initiatives to be effectively implemented.

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We determined stunting, wasting, and obesity frequencies in a total 1092 2-to-12 year old Baka Pygmy children from anthropometric and health data gathered in 34 villages in the Djoum-Mintom region in southeastern Cameroon in four health campaigns in 2010 and 2017-9. We compare these to the WHO Child Growth Standards, Amazonian Tsiname growth references for interpopulation comparisons and the study population itself. Population-specific growth charts were constructed using GAMLSS modelling. Our results show that Baka children have one of the highest global rates of stunting relative to the WHO child growth standard with 57.8% for 2-to-12 year olds and 64% and 73% for 2-to-4 year old girls and boys, respectively. Frequencies of wasting, overweight, and low BMI were low at 3.4%, 4.6% and 4.3%, respectively, for 2-to-12 year olds. Underweight was at 25.5%, in the upper range for sub-Saharan Africa. Edemas indicated rare severe malnutrition (0.3%). Uncertainties in age estimation had dramatic effects on the reliability of estimated individual z-scores but distributions of z-scores were robust at a population level. In the context of the recent evidence for genetic adaptation of the Pygmies' small stature to the tropical forest environment we argue that WHO child standards for weight and BMI are applicable. However, standards for height are clearly not adequate for Pygmy people. To achieve UN Sustainable Development Goals, we recommend that Pygmy specific growth standards are developed for the various, genetically differing Pygmy tribes. Keywords Indigenous peoples. Baka. Health. WHO child growth standards. Central Africa. Cameroon

Background African Pygmies exhibit a unique, genetically determined child growth dynamics and adult stature but the impact on assessing undernutrition remains unknown. Baka Pygmy health is highly compromised compared to sympatric populations. Evaluating child undernutrition is an important step to address this health quandry. We estimate stunting and wasting in Cameroon´s Baka children and investigate the applicability of the standards for Pygmy people.Methods Anthropometric and health data from 685 2-to12 year old children were collected at 25 health centres in southern Cameroon. Growth was analysed using both, WHO Child Growth Standards and the population itself as reference to define frequencies of stunting, wasting and obesity.Findings Baka children revealed with 68.4% the highest recorded level globally of stunting relative to the WHO child growth standard in 2-to-4 year olds. Wasting was at 8.2% in the upper third range in Sub-Saharan Africa.Obesity was with 6.5% similar to wasting, but no comparable data have been published for Sub-Saharan Africa. When referenced to the Baka population itself, values for stunting were dramatically lower at 1.0% and 2.9% for 2-to-4and 5-to-12 year olds, respectively. Wasting was also lower at 2.8% and 1.8% and was exceeded by obesity at 3.4% and 3.5%, respectively. Brachial perimeters and oedemas indicated rare severe malnutrition (< 2%) whilst moderate and severe anaemia were frequent (26.6% and 3.3%, respectively).Interpretation WHO child growth standards for stunting are clearly not applicable to Pygmies thus contradicting the widespread emphasis of their ethnicity-independent applicability. The inferred values for wasting and obesity are also difficult to interpret and are likely overestimated by the WHO criteria.To achieve UN Sustainable Development Goals and to fulfil our humanitarian responsibility for fellow man, we recommend that Pygmy specific growth standards are developed for the genetically differing Pygmy tribes.

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