Drivers of stunting reduction in Peru: a country case study

Abstract

Background Peru reduced its under-5 child stunting prevalence notably from 31.3% in 2000 to 13.1% in 2016. Objectives We aimed to study factors and key enablers of child stunting reduction in Peru from 2000–2016. Methods Demographic and Health Surveys were used to conduct descriptive analyses [height-for-age z scores (HAZ) means and distributions, equity analysis, predicted child growth curves through polynomial regressions] and advanced regression analyses. An ecological (at department level) multilevel regression analysis was conducted to identify the major predictors of stunting decline from 2000 to 2016, and Oaxaca–Blinder decomposition was conducted to identify the relative contribution of each factor to child HAZ change. A systematic literature review, policy and program analysis, and interviews with relevant stakeholders were conducted to understand key drivers of stunting decline in Peru. Results The distribution of HAZ scores showed a slight rightward shift from 2000 to 2007/2008, and a greater shift from 2007/2008 to 2016. Stunting reduction was higher in the lowest wealth quintile, in rural areas, and among children with the least educated mothers. Decomposing predicted changes showed that the most important factors were increased maternal BMI and maternal height, improved maternal and newborn health care, increased parental education, migration to urban areas, and reduced fertility. Key drivers included the advocacy role of civil society and political leadership around poverty and stunting reduction since the early 2000s. Key enablers included the economic growth and the consolidation of democracy since the early 2000s, and the acknowledgement that stunting reduction needs much more than food supplementation. Conclusions Peru reduced child stunting owing to improved socioeconomic determinants, sustained implementation of out-of-health-sector and within-health-sector changes, and implementation of health interventions. These efforts were driven through a multisectoral approach, strong civil society advocacy, and keen political leadership. Peru's experience offers useful lessons on how to tackle the problem of stunting under differing scenarios, with the participation of multiple sectors.

National and subnational trends of birthweight in Peru: Pooled analysis of 2,927,761 births between 2012 and 2019 from the national birth registry

“…These results are in line with previous studies showing that remote rural areas of the Amazon and the Highlands lagged behind in terms of progress achieved overtime by Peru for various neonatal and child health indicators. [53] , [54] , [55] , [56] Also, our findings mirror those retrieved at the individual-level. Altitude above sea level has been found to have a negative correlation with birthweight.…”

Projecting the impact of nutrition policy to improve child stunting: A case study in Guatemala using the Lives Saved Tool

“…43,44 In Peru, for example, large improvements in child stunting observed from 2000-2013 were likely attributable to economic growth, increased societal participation, poverty-reduction strategies, and increased health spending. 45,46 Furthermore, a retrospective review of five exemplar countries that made significant improvements in stunting found that nutrition-sensitive strategies accounted for 50% of the total stunting reduction. 41 Despite compelling ecological evidence, nutrition-sensitive interventions have not consistently shown improvements in linear growth in randomized controlled trials.…”

A framework for identifying and learning from countries that demonstrated exemplary performance in improving health outcomes and systems

“…[28][29][30] The EGH framework builds on and consolidates lessons from these efforts, positing one common systematic approach that can be used across diverse topics and research groups. [31][32][33][34][35] Each of the framework elements aims to complement one another and strengthen emergent themes. We assemble topical technical advisors at the outset of each project.…”