Schistosomiasis and childhood stunting

Linear growth stunting increases a child's risk for mortality and lifelong morbidities. Understanding and preventing the causes of childhood stunting is a global health priority. The leading contributors to stunting are undernutrition and infection. Schistosomiasis, a neglected tropical disease, has long been associated with childhood stunting, but there are limited reviews summarizing the evidence. This narrative review examines cross-sectional associations between infection and linear growth, longitudinal impacts of schistosomiasis treatment on growth and the influence of schistosomiasis on the endocrine system, specifically the growth hormone (GH) and insulin-like growth factor 1 (IGF-1) axis. After reviewing more than 60 years of research, there is evidence for an association between schistosomiasis infection and linear growth measures but mixed results relating to stunting, a categorical outcome based on low height-for-age measures. This may be due to limitations in study design or the length of time required to induce stunting. The reports also support the theory that schistosomiasis disrupts the GH/IGF-1 axis, resulting in reduced IGF-1 and impaired linear growth. These findings reinforce the need for early treatment interventions for children living in schistosomiasis-endemic regions and encourage research to include stunting risk factors and endocrine measures in future schistosomiasis study designs. This article is part of the theme issue 'Biological, biomedical and environmental drivers of stunting'.