Drivers of stunting reduction in Senegal: a country case study

Abstract

Background Senegal has been an exemplar country in the West African region, reducing child stunting prevalence by 17.9% from 1992 to 2017. Objectives In this study, we aimed to conduct a systematic in-depth assessment of factors at the national, community, household, and individual levels to determine the key enablers of Senegal's success in reducing stunting in children <5 y old between 1992/93 and 2017. Methods A mixed methods approach was implemented, comprising quantitative data analysis, a systematic literature review, creation of a timeline of nutrition-related programs, and qualitative interviews with national and regional stakeholders and mothers in communities. Demographic and Health Surveys and Multiple Indicator Cluster Surveys were used to explore stunting inequalities and factors related to the change in height-for-age z-score (HAZ) using difference-in-difference linear regression and the Oaxaca-Blinder decomposition method. Results Population-wide gains in average child HAZ and stunting prevalence have occurred from 1992/93 to 2017. Stunting prevalence reduction varied by geographical region and prevalence gaps were reduced slightly between wealth quintiles, maternal education groups, and urban compared with rural residence. Statistical determinants of change included improvements in maternal and newborn health (27.8%), economic improvement (19.5%), increases in parental education (14.9%), and better piped water access (8.1%). Key effective nutrition programs used a community-based approach, including the Community Nutrition Program and the Nutrition Enhancement Program. Stakeholders felt sustained political will and multisectoral collaboration along with improvements in poverty, women's education, hygiene practices, and accessibility to health services at the community level reduced the burden of stunting. Conclusions Senegal's success in the stunting decline is largely attributed to the country's political stability, the government's prioritization of nutrition and execution of nutrition efforts using a multisectoral approach, improvements in the availability of health services and maternal education, access to piped water and sanitation facilities, and poverty reduction. Further efforts in the health, water and sanitation, and agriculture sectors will support continued success.

The risk to child nutrition during and after COVID-19 pandemic: what to expect and how to respond

“…It is also advised to purchase nutritious foods and avoid low-cost non-nutritious snack foods and sugary drinks that contribute to overweight and obesity, as well as tooth decay, metabolic and cardiovascular disease. These programs have been effective in countries affected by the Ebola virus (17,18) . Governments should establish effective programs and policies that reduce risk factors, such as access to clean water, hygiene practices, and healthy sanitation to avoid infectious diseases such as diarrhea, which are, in turn, contributing factors to wasting.…”

“…Empowering and strengthening family planning and recommended birth spacing of 3-5 years Strengthening the promotion of exclusive breast-feeding, complementary feeding nutrition during pregnancy through nutrition education, counseling and promotion programmes at community centres Availing the production and consumption of nutritional supplements to the undernourished children Financial investment in infrastructure and agricultural food production Establishing a strong mutual partnership with international funding bodies to invest enough money in community nutritional programmes Establishing community employment and forming incoming generating activities such as cooperatives for unemployed and poor families Forming the incentives such as safety-net programmes benefiting the groups under the poverty line to improve their nutrition status Strengthening the agricultural projects and producing enough production of diverse nutritional products at a large scale in all regions of the country Investing in educational, counseling and promotion programmes related to mother and child nutrition Building enough nutrition-based facilities like community nutrition centres Supportive investment to the food industries to increase the production of fortified foods enriched with micronutrients Investing in the construction of infrastructures such as transportation, health network for better provision of nutrition services Developing technology-based systems to speed up nutrition services to the communities especially in the period of outbreaks like the COVID-19 pandemic COVID-19, it is also advised to purchase nutritious foods and avoid low-cost non-nutritious snack foods and sugary drinks that contribute to overweight and obesity, as well as tooth decay, metabolic and CVD. These programmes have been effective in countries affected by the Ebola virus (17,18) .…”

Reducing childhood stunting in India: Insights from four subnational success cases

“…Recent evidence from various geographies indicates changes in a combination of these determinants contributed to improvements in height-for-age Z scores (HAZ). For example, improvements to maternal and newborn health had contributed to 28% change in HAZ in Senegal (Brar et al, 2020 ) and in Peru (Huicho et al, 2020 ) but only 11.5% in Nepal (Conway et al, 2020 ). Improved maternal nutrition contributed to 26% change in HAZ in Peru (Huicho et al, 2020 ), but only 5% in Ethiopia (Tasic et al, 2020 ), and parental education contributed to 25% change in HAZ in Nepal (Conway et al, 2020 ), 20% in Peru (Huicho et al, 2020 ), and only 15% in Senegal (Brar et al, 2020 ).…”

Political Commitment of Local Government in Handling Stunting During the Covid-19 Pandemic: A Case Study of Enrekang District

“…Beal T et.al, reviewing the determinants of stunting in children in Indonesia, revealed that children from households with poor latrines and untreated drinking water were at higher risk of stunting. 26 The commitment of the district government of Enrekang is in line with experiences in several other countries in creating a healthy environment by reducing open defecation and encouraging hygienic practices and has been linked to reducing stunting in Senegal 25 and Ethiopia 21 focusing on change. the behavior to create a village free of open defecation.…”