Peer-reviewed article

Exploring the multifactorial predictors of stunting in children under five: A systematic review of the literature, 2015-2024.

Ayue HI, Nurdiana N, Wardhani V, Astuti AB, Prayitno H et al. · 1 Oct 2025

Abstract

Background Stunting is a global health challenge with high prevalence in Asia and Africa. Although many studies have discussed its determinants, fragmented evidence and regional differences still hinder the formulation of effective policies. Objective This study aims to identify and map predictors of stunting in children under 5 years of age, focusing on socio-demographic, prenatal, natal, and postnatal factors, as well as distinguishing universal and contextual determinants across regions. Design and methods This systematic review followed the PROSPERO protocol (CRD42025633321) and the PRISMA 2020 guidelines. Literature searches were conducted in databases (Scopus, Web of Science, PubMed, ProQuest, ScienceDirect, Taylor & Francis, and Emerald). Included articles were original English-language studies published between 2015 and 2024 that examined predictors of stunting in children aged 0-59 months. Methodological quality was assessed by two independent reviewers using the JBI Critical Appraisal Tools. Data were then extracted, narratively synthesized, and mapped according to UNICEF regional classifications. Results Of the 5094 initial records, 92 studies met the inclusion criteria. Maternal education, socioeconomic status, sanitation, maternal age, maternal height, birth weight, and exclusive breastfeeding and complementary feeding practices emerged as the most consistent and universal predictors. Other factors were more contextual, depending on the region. Cross-regional analysis confirmed the existence of universal determinants as well as specific regional risk factors. Conclusion Stunting is a multifactorial problem across life phases. Regional mapping enriches theoretical understanding and provides a scientific basis for context-based policies. These findings emphasize the need for multi-level interventions and cross-regional longitudinal research with uniform measurement standards.