Peer-reviewed article
Child Growth Stunting: A Comprehensive Scientific Literature Review of Epidemiology, Etiology, Pathophysiology, and Evidence-Based Interventions
Engkus Kusnadi, Sri Ramdaniati, Bambang Budi Raharjo, Ari Yuniastuti ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This is a literature review that pulls together research on child growth stunting, a condition where children are too short for their age due to poor nutrition and health. It looked at 265 studies published mostly since 2010. The review finds that stunting has declined globally but remains high in places including sub-Saharan Africa. It explains that stunting is caused by many overlapping factors like poor diet, infections, unsafe water and sanitation, and poverty. It concludes that combining different types of interventions works better than tackling just one problem at a time.
Key points
- Global stunting prevalence fell from 33% in 2000 to 22% in 2020, but progress has stalled short of the 2030 target of a 40% reduction.
- Stunting affects about 149 million children under five worldwide, with sub-Saharan Africa among the regions most affected.
- Causes include poor diet, recurrent infections, poor water and sanitation, weak childcare practices, poverty, and low education.
- Environmental enteric dysfunction (a gut condition linked to poor sanitation) is an important biological mechanism behind stunted growth.
- Integrated approaches combining nutrition-specific and nutrition-sensitive interventions work better than single-sector programmes.
Limitations
This is a global literature synthesis, not a Africa-specific study, and does not report new primary data or evaluate a single named intervention with a study design.
Abstract
Background: Child growth stunting, defined as a height-for-age z-score (HAZ) below −2 SD based on World Health Organization standards, remains a major global public health challenge, affecting approximately 149 million children under five worldwide. Progress has stalled well short of the World Health Assembly target of a 40% reduction by 2030. Objective: This literature review synthesizes current evidence on the epidemiology, determinants, biological mechanisms, consequences, and interventions related to child stunting. Methods: A structured search of Scopus, PubMed, and Google Scholar covering 2010 to 2026 retrieved 3,412 records, of which 265 peer-reviewed studies and agency reports met the eligibility criteria and were thematically synthesized. Results: Global stunting prevalence declined from 33% in 2000 to 22% in 2020, although substantial disparities persist, particularly in South Asia and sub-Saharan Africa. Stunting is driven by multifactorial determinants, including inadequate dietary intake, recurrent infections, food insecurity, poor water, sanitation, and hygiene (WASH), inadequate childcare practices, poverty, and limited education. Environmental enteric dysfunction (EED) has emerged as an important mechanism linking poor sanitation to impaired growth. Conclusion: Evidence suggests that integrated multisectoral interventions combining nutrition-specific and nutrition-sensitive approaches are more effective than single-sector strategies. This review contributes an integrated synthesis linking cellular-level mechanisms to multisectoral policy design, explaining why single-sector programs may reach a ceiling. Acceleration requires sustained political commitment, adequate financing, and context-specific delivery.