Peer-reviewed article
What works for reducing stunting in low-income and middle-income countries? Cumulative learnings from the Global Stunting Exemplars Project.
Zulfiqar A Bhutta, Muhammad Islam, Michelle F Gaffey, Cesar G Victora, Purnima Menon et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined what policies and programs help reduce stunting in children under 5 across 10 low- and middle-income countries that achieved average annual stunting reductions of 1.1%. The research found that rapid stunting reduction is possible through combined efforts across health and social sectors, including poverty reduction, water and sanitation improvements, girls' education, maternal nutrition support, family planning, malaria control, and disease prevention. The findings suggest that a systematic, evidence-based approach targeting these areas can accelerate improvements in child growth.
Key points
- Stunting reduction averaging 1.1% annually (range 0.4%-1.7%) was achieved across 10 exemplar countries
- Both indirect interventions (poverty alleviation, girls' education, water and sanitation) and direct interventions (maternal nutrition, disease prevention) contributed to improvements
- Maternal nutrition and family planning programs showed potential benefits for reducing stunting
- Malaria control programs were associated with improved childhood growth in endemic areas
- A systematic, evidence-informed approach to maternal and child health can accelerate reduction in linear growth faltering
Limitations
The study did not include robust serial assessment of dietary intake at individual level for children and mothers due to limited data availability. The analysis is retrospective and does not specify which individual interventions had the strongest independent effects on stunting reduction.
Abstract
BACKGROUND: Impaired linear growth and stunting in children under 5 y is a marker of multiple deprivations in low-income and middle-income countries. OBJECTIVES: We aimed to assess drivers and policies influencing improvements in linear growth and stunting reduction in 10 countries with annual rates of reduction in childhood stunting averaging 1.1% (range: 0.4%-1.7%) at national-level or subnational-level, and to improve a framework of action for other countries to follow. METHODS: We used mixed methods to assess trends and patterns of improvement in linear growth in children under 5 y using available household-level data and in-depth analysis of programs and their implementation. We assessed patterns of change with multivariate regression analyses of risk factors driving stunting and affecting change. We compared results from the Oaxaca-Blinder decomposition analyses using a hierarchical approach and retrospectively assessed the appropriateness of a previously proposed 10-step process for country-level planning and implementation processes. Limited data precluded robust serial assessment of dietary intake at individual level for children and mothers. RESULTS: Rapid reduction in childhood stunting is possible and findings across exemplar countries underscore the benefits of indirect and direct interventions in health and other social sectors. These include programs focusing on poverty alleviation; water, sanitation, and hygiene; promotion of girls' education and empowerment; and maternal nutrition. The potential benefits of family planning programs and factors contributing to gains in maternal nutrition were noted. In malarial endemic areas, malaria control programs were associated with improved childhood growth, and patterns of growth indicated continued benefits of childhood disease prevention and management strategies. CONCLUSIONS: A systematic, evidence-informed approach to improve maternal and child health and nutrition is feasible and, with targeting, can accelerate reduction in linear growth faltering in childhood.