WHO child growth standards for Pygmies: one size fits all?

Abstract

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.

Efficacy of an iron‐fortified infant cereal to reduce the risk of iron deficiency anemia in young children in East Cameroon

“…In addition, the proportion of underweight children in the overall study population decreased from 25% to 11%, likely due to the energy content of the ICs. The high proportion of stunting observed in our population has been observed previously (Pondy, 2016) and is likely due to both poor growth resulting from low dietary diversity and the infrequent inclusion of meats and eggs as complementary foods, as well as overestimation based on the use of WHO growth charts, which are likely nonrepresentative standards for ethnic groups who reside in this area of Cameroon and who generally have a shorter stature (Funk et al, 2019). Growth charts specific for this population are not yet available.…”

Describing the growth and nutritional status of sickle cell disease children and adolescents with reference to WHO growth standards in Cameroon

“…The high prevalence of overweight/obese in high-income countries emphasizes the question of using foreign standards growth curves in normal children to identify impaired growth in children with sickle cell disease from Africa. A study evaluating the growth of pygmies using WHO curves reinforces the fact that ethnic-specific growth curves are better than using a one size fits all approach (WHO curves) that can give us erroneously wrong estimations of growth retardation [ 42 ]. However, the distribution curves of the weight-for-age, BMI-for-age, and height-for-age indices of children aged 5-19 clearly showed us a delay in stature and weight.…”