Critical roles of community health workers in combating stunting in low- and middle-income countries

Stunting continues to pose a considerable and persistent public health issue in low-and middle-income countries, especially in Sub-Saharan Africa and South Asia.Stunting, which reflects hindered growth and development in children under five years old, is an important marker of ongoing undernutrition and negative health outcomes during vital periods of growth and development. 1According to estimates from the World Health Organization (WHO), approximately 149 million children globally experience stunting, predominantly found in lowand middle-income countries (LMICs). 2 The outcomes of stunting reach well beyond mere limitations in physical growth; they contribute to lasting cognitive challenges, lower levels of educational achievement, and a decrease in economic productivity later in life.The primary factors contributing to this issue encompass low birth weight, inadequate sanitation and hygiene practices, less-than-ideal infant and young child feeding (IYCF) practices, food insecurity, and a lack of maternal nutrition knowledge shaped by cultural beliefs.In nations such as Indonesia with the prevalence of stunting at 24.4% 3 and in high-burden countries like Afghanistan and Ethiopia with rates at 30-40%, there exists a pressing necessity for thorough, culturally adjusted, and sustainable strategies to tackle this ongoing challenge. 4,5 mmunity Health Workers (CHWs) play a crucial role as frontline agents in addressing the issue of stunting, especially in settings with limited resources.Their distinctive roles within communities enable them to connect formal healthcare systems with underserved populations by employing culturally sensitive and trust-building methods. 6CHWs, equipped with specialized training, engage in essential activities such as monitoring growth, providing nutritional guidance, educating on maternal and child health, and advocating for disease prevention.Their responsibilities include clinical duties and initiatives to engage the community to promote behavioural changes.For example, Indonesia has engaged more than 1.5 million CHWs in its national strategy to reduce stunting.These workers provide services through Posyandu (integrated health posts) focused on monitoring growth, supplementing micronutrition t, and promoting hygiene practices. 3In societies characterized by conservative values, such as Afghanistan, female community health workers assume a vital role in addressing gender-related obstacles.They achieve this by performing home visits, educating mothers about proper nutrition, and assisting with referrals to healthcare facilities. 4ome research highlights significant roles of CHWs in implementing interventions that tackle not only immediate nutritional deficiencies but also wider factors contributing to malnutrition.Research through systematic reviews and meta-analyses indicates that well-trained community health workers can be crucial in enhancing feeding practices for infants and young children.This includes promoting exclusive breastfeeding and appropriate complementary