A startling reality: nearly one million young children die each year because they fail to grow as healthy and strong as they should. Across the globe, growth failure in early childhood accounts for an enormous burden, ranking as the third leading risk factor for death and disability among children under five. These findings come from the Global Burden of Disease 2023 study, published today in The Lancet Child & Adolescent Health.
Although the estimated number of deaths linked to child growth failure (CGF) fell from about 2.75 million in 2000 to around 880,000 in 2023, the health impact remains severe. The majority of CGF-related deaths occur in sub-Saharan Africa (approximately 618,000) and in South Asia (about 165,000).
When breaking CGF down by indicator, underweight carries the heaviest burden, responsible for about 12% of all deaths in children under five. Wasting accounts for roughly 9%, and stunting about 8%. Importantly, researchers found that more children are affected by stunting than previously thought.
CGF raises the risk of death and long-term disability from a range of diseases. Nearly 800,000 children under five died from lower respiratory infections, diarrheal diseases, malaria, and measles in 2023, with CGF contributing to the majority of diarrheal and respiratory infection deaths in sub-Saharan Africa (77% and 65%, respectively). In South Asia, CGF accounted for about 79% of diarrheal deaths and 53% of respiratory infection deaths in this age group. By comparison, the high-income regions, which reported the fewest CGF-related deaths, still show substantial shares—around 33% for diarrheal deaths and 35% for respiratory infections.
Dr. Bobby Reiner, co-author and a professor at the Institute for Health Metrics and Evaluation (IHME) at the University of Washington School of Medicine, notes that the drivers of CGF are intricate and accumulate over time. “Causes range from feeding problems and food insecurity to climate change, sanitation gaps, and conflict,” he explains. “Because no single approach will fix health outcomes across all regions, multifaceted strategies are necessary.”
A key takeaway is that most cases of stunting become apparent in the first three months of life, highlighting the critical need for interventions before and during pregnancy. The interplay between wasting and stunting forms a destructive cycle: stunting heightens the risk of future wasting, and wasting exacerbates stunting, a loop that worsens as children grow. Early-life growth failure often points to newborns who are small for gestational age or born prematurely, while growth issues in later infancy and early childhood may reflect ongoing nutritional deficits, repeated infections, or other contributing factors.
Dr. Reiner adds, “Because reversing stunting is challenging, these latest estimates should guide efforts to pinpoint high-prevalence areas and prioritize early detection and timely intervention.”
