Peer-reviewed article
What explains the fall in child stunting in Sub-Saharan Africa?
Leander R. Buisman, Ellen Van de Poel, Owen O’Donnell, Eddy K.A. van Doorslaer ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzes why child stunting rates fell significantly in seven Sub-Saharan African countries between 2005 and 2014. Using demographic and health survey data, the researchers found that increases in child immunization, deworming, and maternal iron supplementation coincided with reduced stunting. Improved maternity care access emerged as the most important factor associated with both stunting reduction and better nutrition program coverage. The findings suggest that maternity care may be a key pathway for addressing childhood malnutrition.
Key points
- Stunting rates fell significantly in seven SSA countries during 2005-2014
- Increased coverage of child immunization, deworming, and maternal iron supplementation coincided with stunting reductions
- Improved utilization of maternity care was the strongest distal determinant associated with reduced stunting
- Age-appropriate feeding and diarrhea prevalence changes did not strongly explain stunting reductions
- Maternity care was also associated with increased coverage of iron supplementation and child immunization
Limitations
The analysis identifies correlations rather than causal effects; unmeasured factors such as vertical nutrition programs and other interventions may account for some of the observed improvements and are captured only as residuals.
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.