What explains the fall in child stunting in Sub-Saharan Africa?

Abstract

There have been steep falls in rates of child stunting in much of Sub-Saharan Africa (SSA). Using Demographic and Health Survey data, we document significant reductions in stunting in seven SSA countries in the period 2005–2014. For each country, we distinguish potential determinants that move in a direction consistent with having contributed to the reduction in stunting from those that do not. We then decompose the change in stunting and in proximal determinants into a part that can be explained by changes in distal determinants and a residual part that captures the impact of unmeasured factors, such as vertical nutrition programs. We show that increases in coverage of child immunization, deworming medication and maternal iron supplementation often coincide with a fall in stunting. The magnitudes and directions of changes in two other proximal determinants -- age-appropriate feeding and diarrhea prevalence -- suggest that these have not been strong contributors to the fall in stunting. Utilization of maternity care emerges from the decomposition analysis as the most important distal determinant associated with reduced stunting, and also with increased coverage of iron supplementation, and, to a lesser extent, with child immunization and deworming medication. This circumstantial evidence is strong enough to warrant more detailed investigation of the extent to which maternity care is an effective channel through which to target further attacks on the blight of undernourished children.

Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline

“…The included studies analyzed data on the determinants of child growth and drivers of stunting reduction from >70 countries worldwide. A total 11 of studies ( 29 , 30 , 33 , 40 , 46 , 48–51 , 55 , 99 ) contained data from national-level regression-decomposition analyses of change in HAZ and stunting prevalence in 14 countries (see Table 1 ). These studies best address our research question, and the following sections focus on synthesizing key findings from robust models across this set of studies, organized by groupings based on the basic, underlying, and immediate determinants of stunting.…”

Extent of and trends in inequalities in child stunting in Sierra-Leone from 2005 to 2013: evidence from demographic and health surveys and multiple indicator cluster surveys

“…However, there is no in-depth evaluation of stunting inequality in Sierra Leone so far. We located few studies done on stunting in the country [20][21][22][23][24][25]. However, our study substantially updates the existing knowledge in many aspects.…”

A multilevel analysis of individual, household and community level factors on stunting among children aged 6–59 months in Eswatini: A secondary analysis of the Eswatini 2010 and 2014 Multiple Indicator Cluster Surveys

“…Developing countries such as Eswatini recorded a reduction of child stunting of 5% from 2010 to 2014, from a prevalence of 30.9% in 2010 to 25.3% in 2014 among children under two years [ 7 , 8 ]. Previous studies established in developing countries that some of the factors associated with child stunting include: the age of the child; sex of the child; maternal age; maternal education; the number of children under five years in the household; the source of drinking water; the household wealth index; the place of residence; and the region of residence [ 9 – 11 ]. Even though studies investigating factors associated with child stunting have been conducted in other developing countries such as Zambia, Ghana, Tanzania, and Ethiopia [ 12 – 15 ] in Eswatini, only descriptive reports serve as a source of information for stunting [ 7 , 8 ].…”