Peer-reviewed article
How countries can reduce child stunting at scale: lessons from exemplar countries
Zulfiqar Ahmed Bhutta, Nadia Akseer, Emily Catherine Keats, Tyler Vaivada, Shawn K. Baker et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how five countries—Nepal, Ethiopia, Peru, Kyrgyz Republic, and Senegal—successfully reduced child stunting at scale. The research combined survey data analysis, interviews with national experts and mothers, and policy reviews to identify the factors driving progress. Both health sector interventions (40% of change) and broader social factors like maternal education and improved newborn care (50% of change) contributed to stunting reduction. The findings show that significant progress is possible even in diverse and challenging contexts.
Key points
- Multiple countries have dramatically reduced child stunting prevalence despite differences in context and geographical inequality
- About 40% of stunting reduction came from health and nutrition sectors, while 50% came from other sectors including improvements in maternal education and fertility reduction
- Improvements in maternal nutrition, maternal and newborn care, and reduced interpregnancy intervals were strong contributors to change
- Progress occurred through both direct nutrition interventions and indirect nutrition-sensitive strategies across health and non-health sectors
- A framework organizing interventions as direct/indirect and inside/outside the health sector can guide planning to accelerate stunting reduction
Limitations
The document does not provide specific prevalence numbers or effect sizes for individual interventions, making it difficult to assess the relative strength of different strategies. The synthesis draws on heterogeneous contexts and methodologies, so generalizing specific causal mechanisms to other countries may be limited.
Abstract
BACKGROUND: Child stunting and linear growth faltering have declined over the past few decades and several countries have made exemplary progress. OBJECTIVES: To synthesize findings from mixed methods studies of exemplar countries to provide guidance on how to accelerate reduction in child stunting. METHODS: We did a qualitative and quantitative synthesis of findings from existing literature and 5 exemplar country studies (Nepal, Ethiopia, Peru, Kyrgyz Republic, Senegal). Methodology included 4 broad research activities: 1) a series of descriptive analyses of cross-sectional data from demographic and health surveys and multiple indicator cluster surveys; 2) multivariable analysis of quantitative drivers of change in linear growth; 3) interviews and focus groups with national experts and community stakeholders and mothers; and 4) a review of policy and program evolution related to nutrition. RESULTS: Several countries have dramatically reduced child stunting prevalence, with or without closing geographical, economic, and other population inequalities. Countries made progress through interventions from within and outside the health sector, and despite significant heterogeneity and differences in context, contributions were comparable from health and nutrition sectors (40% of change) and other sectors (50%), previously called nutrition-specific and -sensitive strategies. Improvements in maternal education, maternal nutrition, maternal and newborn care, and reductions in fertility/reduced interpregnancy intervals were strong contributors to change. A roadmap to reducing child stunting at scale includes several steps related to diagnostics, stakeholder consultations, and implementing direct and indirect nutrition interventions related to the health sector and nonhealth sector . CONCLUSIONS: Our results show that child stunting reduction is possible even in diverse and challenging contexts. We propose that our framework of organizing nutrition interventions as direct/indirect and inside/outside the health sector should be considered when mapping causal pathways of child stunting and planning interventions and strategies to accelerate stunting reduction to achieve the 2030 Sustainable Development Goals.