BackgroundTanzania has made a significant improvement in wasting and underweight indicators. However, stunting has remained persistently higher and varying between regions. We analyzed Tanzania Demographic and Health Survey (TDHS) datasets to examine (i) the trend of stunting over the period of 25 years in Tanzania and (ii) the remaining challenges and factors associated with stunting in the country.MethodsThis secondary data analysis included six TDHS datasets with data of 37,409 under-five children spreading in 1991–1992(n = 6587), 1996(n = 5437), 1999(n = 2556), 2004–05(n = 7231), 2009–10(n = 6597), and 2015–16(n = 9001) conducted in all regions of Tanzania. Variables specific to children and their caregivers were analyzed using SPSS version 22. The variables considered include child anthropometric variables, caregiver’s demographic characteristics and household’s socio-economic factors. We used frequencies and percentages to compare stunting prevalence across the six surveys and chi-square test and three-level hierarchical logistic regression to examine the factors associated with stunting also applying sample weighting as advised by TDHS.ResultsThe prevalence of stunting has declined by 30% over the period of 25 years in Tanzania. However, one in three children aged below five years remains stunted with overweight and obesity more than doubled (from 11 to 25%) in the same period among women of reproductive age. The factors associated with stunting included children living in female-headed households (AOR = 1.16, P = 0.014), aged 24–35 months (AOR = 1.75, P = 0.019), born with low birth weight (AOR = 2.14, P < 0.001) and with inconsistent or without breastfeeding (AOR = 3.46, P < 0.001 and AOR = 4.29, P = 0.001) respectively. The risk of stunting among children living in urban area (AOR = 0.56, P < 0.001), with higher caregiver’s education (AOR = 0.56, P = 0.018), obese mother (AOR = 0.63, P < 0.001), households with highest wealth index (AOR = 0.42, P < 0.001), and among girls (AOR = 0.77, P < 0.001).ConclusionsThe burden of stunting in Tanzania has declined by 30% in the past 25 years, but still affecting one in every three children. Efforts are needed to increase the pace of stunting decline especially among boys, children in rural areas, from poor, uneducated, and female-headed households, and through improving infant and young feeding practices. Effective and tailored nutrition-sensitive and specific interventions using multisectoral approaches should be considered to address these important determinants.

The burden of child anemia is on the decline globally but remains prevalent in low- and middle-income countries, including Tanzania. Evidence suggests regional variation and a slow pace of decline even in areas with high food production. The factors behind such decline and remaining challenges behind child anemia remain understudied in Tanzania. This secondary data analysis utilized data including 7361 and 7828 children from the Tanzania Demographic and Health Surveys (TDHS) conducted in 2004–2005 and 2015–2016 separately to examine the decline of child anemia and regional variation thereof. We used a geographic information system (GIS) to visualize the changes and differences between regions and the two study periods, and used regression analyses to examine the recent determinants of child anemia. Anemia has declined among children under five in Tanzania by 42% over a one-decade period, but remained high in relatively high food-producing regions. The risk of anemia is still higher among boys compared to girls (AOR = 1.39, p = 0.005), 41% higher among children lived in households with more than three under-five children compared to those households with only one child (p = 0.002); lower among children whose mothers were educated (p < 0.001) or had first given birth when aged over 25 (p = 0.033); and 34% less among children in the wealthiest households (p < 0.001). Efforts are needed to address social determinants of health, especially targeting women’s empowerment through decreasing the number of children and encouraging child spacing, and poverty reduction, particularly in high food producing regions.

Our study aims to examine the disparity of under-5 child stunting prevalence between urban and rural areas of Tanzania in the past three decades, and to explore factors affecting the rural–urban disparity. Secondary analyses of Tanzania Demographic and Health Surveys (TDHS) data drawn from 1991–1992, 1996, 1999, 2004–2005, 2009–2010, and 2015–2016 surveys were conducted. Under-5 child stunting prevalence was calculated separately for rural and urban children and its decline trends were examined by chi-square tests. Descriptive analyses were used to present the individual-level, household-level, and societal-level characteristics of children, while multivariable logistic regression analyses were performed to examine determinants of stunting in rural and urban areas, respectively. Additive interaction effects were estimated between residence and other covariates. The results showed that total stunting prevalence was declining in Tanzania, but urban–rural disparity has widened since the decline was slower in the rural area. No interaction effect existed between residence and other determinants, and the urban–rural disparity was mainly caused by the discrepancy of the individual-level and household-level factors between rural and urban households. As various types of determinants exist, multisector nutritional intervention strategies are required to address the child stunting problem. Meanwhile, the intervention should focus on targeting vulnerable children, rather than implementing different policies in rural and urban areas.