Grant: Doctoral Award - Frederick Banting and Charles Best Canada Graduate Scholarships

Stunting is a form of chronic undernutrition leading to poor growth in children. It is a major risk factor for child mortality and is responsible for up to 17% of child deaths worldwide. Stunting is also associated with reduced physical and cognitive capacity, poor school achievement and reduced income potential in adult life. In Cambodia, stunting prevalence is high, affecting about 40% of children. We have little information on the causes of stunting in this population. Speculated contributors include micronutrient deficiencies, inflammation and other genetic factors (hemoglobin disorders), but it is not known to what extent. These genetic hemoglobin disorders affect about 55% of the Cambodian population and result in a defective structure of hemoglobin, the protein found in red blood cells that carries oxygen. These disorders can both cause anemia and confound the diagnosis of nutritional anemia. It is important to distinguish between nutritional anemia (that is treatable) and anemia of other causes (i.e. genetic disorders) in order to advise appropriate public health interventions and thereby prevent child undernutrition. This retrospective cohort study aims to: 1) define the cumulative incidence of stunting (height-for-age) in Cambodian children 6-59 months of age; 2) investigate correlates between stunting and risk factors including micronutrient deficiencies, inflammation and genetic hemoglobin disorders; and 3) determine if anemia is more related to nutrition (micronutrient deficiencies) or other causes (genetic disorders). This research is highly relevant to policy makers in regions with high rates of stunting, anemia and hemoglobin disorders, namely South East Asia; and globally to all countries with high rates of stunting given the sheer magnitude of this global health problem. In Canada, this research is relevant to understanding the diagnosis of anemia and for guiding policy on the treatment of anemia and prenatal genetic counseling in this population.