Childhood stunting is the most prevalent form of chronic malnutrition, affecting 149 million children under the age of five worldwide. As the determinants of stunting are complex and multicausal, it is important to look at area specific determinants and determine whether these are similar to the general determinants. This study investigated the prevalence and determinants of stunting in children under the age of five, visiting Bisho Hospital clinic in the Eastern Cape, South Africa. A cross-sectional, qualitative design was used. All children under the age of five, visiting Bisho Hospital’s clinic during the data collection period, and whose mothers provided consent, were included in the sample of 219 participants. An interview-administered questionnaire was used to determine possible factors that may play a role in stunting. Anthropometrical measurements (height, weight and mid-upper arm circumference) were used to calculate z-scores for the children. IBM SPSS Statistics 26 (version 24.0) was used for statistical analysis. Dietary diversity was calculated with a seven food group classification. The prevalence of stunting was 47.5 %, of which 57.7 % were classified as moderately stunted, and 42.3 % severely stunted. There was a significant correlation between the participants’ main form of sanitation and stunting in all age groups (p = 0.007; Cramer’s V = 0.413 and p = 0.04; Cramer’s V = 0.326, respectively). A statistical significance was found between the child support grant and stunting (p = 0.032) in children younger than six months, but not in the older group. No statistical significance was found between other determinants of stunting that were analysed. As stunting is multi-causal, it requires a combination of nutrition-specific and nutrition-sensitive interventions, together with strong political and financial commitment from stakeholders to eradicate stunting in children. Keywords: Stunting, Children, Sanitation, Infections, Breastfeeding
Renal biomarkers change rapidly in early childhood, but pediatric reference intervals used in African laboratories are often extrapolated from non-African populations and discrete age partitions. This study derived continuous age-dependent centile curves and preliminary reference intervals for body mass index (BMI), serum creatinine, urea, and electrolytes in healthy Kenyan children aged 0 to 60 months. In this cross-sectional study, 176 children (90 males, 86 females) were systematically recruited at Kitui County Referral Hospital between June 2024 and February 2025. Children underwent clinical screening, World Health Organization-standard anthropometry, and morning fasting venous blood sampling. Creatinine and urea were measured using isotope-dilution mass spectrometry-traceable enzymatic assays, and electrolytes by direct ion-selective electrode. Centiles (2.5th, 50th, 97.5th) were estimated non-parametrically with 90% bootstrap confidence intervals, and continuous age trends modeled using generalized additive models for location, scale, and shape or quantile regression. BMI showed modest age-related variation, with median values rising from 15.8 kg/m2 (2.5th-97.5th: 11.4-20.2) at 0 to 11 months to 16.5 kg/m2 (10.1-23.0) at 48 to 60 months, with dispersion narrowing after age 2. Median creatinine rose steeply in infancy and more gradually thereafter, from 17.4 to 31.2 µmol/L. Urea increased gradually from a median of 2.59 to 3.63 mmol/L, with overlapping centile limits across adjacent strata. Electrolytes were tightly regulated and largely age-invariant: sodium ranged from 135 to 147 mmol/L (median ~141), potassium 3.6 to 5.7 mmol/L (median declining from 4.9 to 4.5), and chloride 100 to 111 mmol/L (median ~105-106). Sex-specific partitions were supported only in early life (BMI in infancy, creatinine in toddlers); correlations between anthropometric z-scores and biomarkers were weak (|ρ| < 0.15; P > .10). These continuous centile curves provide the first preliminary age-dependent reference estimates for renal biomarkers in Kenyan children under 5, showing rapid early renal maturation alongside stable electrolyte homeostasis. As this cross-sectional design cannot capture within-subject variation, larger multicenter and longitudinal studies are needed to confirm these trajectories, refine intervals, and develop age-dependent z-score calculators for clinical use.
Background: Stunting remains a major public health challenge in Nigeria, affecting 40% of children according to the Nigeria Demographic and Health Survey (NDHS, 2024) amid persistent insecurity orchestrated by Boko Haram/ISWAP insurgency, farmer-herder conflicts, and banditry. However, much of the existing studies treat conflict exposure as a binary condition, overlooking important differences in event frequency and fatality intensity and their potentially distinct implications for child growth and development. Aims: We aimed to assess whether cumulative conflict exposure, captured by event frequency and fatality intensity, better explains childhood stunting in Nigeria than measures of conflict presence alone. Methods: This cross-sectional analysis used the 2024 NDHS dataset (children under 59 months = 9,410), ACLED events (2009-2025 = 73,147), and UCDP GED (1990-2025 = 8,255) as data sources. Conflict events were geocoded to NDHS clusters using 5 km, 10 km, and 50 km buffers. The frequency and intensity of conflict exposure were estimated separately and jointly using weighted cluster-robust logistic regression. Model performance for cumulative exposure versus binary presence/absence exposure was assessed using AIC, BIC, and McFadden's pseudo-R². Results: Weighted prevalence of stunting was 39.1%, with the highest rate observed in the North-West at 52.4% and the lowest in the South-South at 17.9% (p < .001). Conflict experience also differed significantly across geopolitical zones based on both ACLED and UCDP GED indicators (p < .001). The adjusted result showed a significant negative correlation between higher frequency of ACLED events and stunting (AOR = 0.85, 95% CI: 0.76–0.97, p = .012). Overall, the findings indicate that the relationship between armed insecurity and stunting varies by the frequency, intensity, and cumulative nature of conflict exposure. Conclusions: Insecurity involving conflict was correlated with childhood stunting, although this was context-specific, depending on how conflict was captured and what data were utilised. Frequency was a better indicator than fatality, and cumulative metrics were not superior to non-cumulative indicators of conflict. Based on this study’s results, we recommend that nutrition interventions focus on regions experiencing the highest levels of insecurity and childhood stunting.
BACKGROUND: Globally, 15 million children were born HIV-exposed uninfected (CHEU) from mothers living with HIV. CHEU have increased mortality, morbidity and stunting compared to children HIV-unexposed (CHU). Our objective was to compare body composition between CHEU and CHU, which may underlie this vulnerability. METHODS: In a substudy among 223 children (36 CHEU and 187 CHU) enrolled in the Sanitation Hygiene Infant Nutrition Efficacy (SHINE) trial in rural Zimbabwe, we measured height, knee-heel length, weight, calf circumference, skinfold thicknesses (triceps, subscapular and calf), and bio-electrical impedance at 2 years of age. Generalised estimating equations were used to compare body composition between CHEU and CHU, and interactions with linear growth and birthweight. RESULTS: CHEU had significantly lower length-for-age, knee-heel length, weight-for-age, mid-upper arm circumference and calf circumference compared to CHU. CHEU had a lower impedance index (adjusted mean difference -0.49, 95% CI -0.87, -0.11), reflecting less lean mass, and lower skinfold thicknesses (subscapular Z-score adjusted mean difference -0.49 (95% CI -0.97, -0.02); triceps Z-score -0.48 (95% CI -0.83, -0.13)), indicating reduced subcutaneous fat. In early-life, CHEU had lower birthweight. However, no significant interaction between stunting or birthweight and HIV exposure was observed for body composition outcomes. CONCLUSION: CHEU have a distinct pattern of body composition by 2 years of age, characterised by reduced lean and fat mass compared to CHU which was not explained by reduced linear growth or lower birthweight. This pattern of early-life growth may contribute to the increased vulnerability of CHEU to mortality, morbidity and reduced neurodevelopment.
Joseph D. Piper, Robert Ntozini, Idah Mapurisa et al.
Climatic variability affects many underlying determinants of child malnutrition, including food availability, access, and utilization. Evidence of the effects of changing temperatures and precipitation on children’s nutritional status nonetheless remains limited. Research addressing this knowledge gap is merited given the short- and long-run consequences of malnutrition. We address this issue by estimating the effects of temperature and precipitation anomalies on the weight and wasting status of children ages 0-59 months across 16 countries in sub-Saharan Africa. Linear regression models show that high temperatures and low precipitation are associated with reductions in child weight, and that high temperatures also lead to increased risk of wasting. We find little evidence of substantively meaningful differences in these effects across sub-populations of interest. Our results underscore the vulnerability of young children to climatic variability and its second-order economic and epidemiological effects. The study also highlights the corresponding need to design and assess interventions to effectively mitigate these impacts.
Abstract Climate change poses a growing threat to child health in Sub-Saharan Africa; however, the mechanisms linking extreme temperatures to child nutritional outcomes remain poorly understood. This study examined the effects of extreme heat exposure on child anthropometric outcomes across 33 Sub-Saharan African countries using data from 80 Demographic and Health Surveys (2006–2023/24) merged with satellite-derived climate measures. We found that extreme heat significantly impaired child growth: each additional 100 days with maximum temperature exceeding 100°F reduced height-for-age z-scores by 0.085 standard deviations and increased stunting probability by 1.8 percentage points. Notably, girls experienced significantly larger adverse effects than boys, with an additional 0.041 standard deviation reduction in height-for-age at the 100°F threshold. To investigate potential mechanisms, we examined the effects of heat exposure on dietary intake among children under 24 months of age. Extreme heat significantly reduces the consumption of nutrient-rich foods, including vitamin A- and iron-rich foods, and decreases dietary diversity. Furthermore, we found evidence of gender heterogeneity in dietary effects: households reduce dietary diversity for girls more than for boys during periods of temperature stress. These findings suggest that discriminatory feeding practices during environmental hardship may contribute to sex disparities in climate-nutrition effects. Our results highlight the need for nutrition-sensitive climate adaptation policies that explicitly focus on gender equity. JEL Classification : I15; J16; Q54; O15
This study addresses this evidence gap by investigating maternal determinants of child nutritional status in a predominantly rural district where no prior published study had examined these relationships. A community-based analytical cross-sectional study was conducted among 340 mother-child pairs. Systematic random sampling was employed at Child Welfare Clinics across five sub-districts of Mion District. Associations between maternal factors and nutritional outcomes were assessed via bivariate chi-square and Fisher's exact tests at p < 0.05. Prevalence of stunting (22.4%), wasting (15.8%), and underweight (18.3%) significantly exceeded national averages of 18.4%, 5.3%, and 10.4% respectively. Notably, wasting exceeded the WHO emergency threshold of 15%, indicating a critical public health situation. Significant associations were identified between household income and wasting (p = 0.03), maternal religious affiliation and underweight (p = 0.006), and maternal educational level and stunting (p < 0.001). Stunting prevalence unexpectedly increased with maternal education, likely attributable to small sample sizes in higher education tiers and uncontrolled confounding. Maternal age, marital status, and occupation were not significantly associated with any nutritional outcome. Undernutrition in Mion District has reached WHO-defined emergency levels, necessitating an immediate scale-up of Community-based Management of Acute Malnutrition (CMAM) services. Interventions must be culturally tailored, engaging religious and community leaders to address nutritional disparities linked to religious affiliation, while integrating social protection programmes, including targeted cash transfers, to mitigate the impact of low household income on acute malnutrition.
BACKGROUND: We evaluated growth outcomes in children and adolescents with HIV-1 initiating or switching to dolutegravir-based antiretroviral therapy (ART) in the single-arm trials IMPAACT P1093 (P1093) and IMPAACT 2019. METHODS: We performed descriptive post hoc analyses of body mass index-for-age (BAZ), weight-for-age (WAZ), and length/height-for-age z scores (L/HAZ) for each trial through Week 48. BAZ changes were assessed using a mixed model for repeated measures. RESULTS: We included data from 181 and 57 participants from P1093 and IMPAACT 2019, respectively (10% [23/238] were adolescents). Baseline mean BAZ was -0.1 in P1093 and - 0.7 in IMPAACT 2019. At Week 48, adjusted mean BAZ increased significantly in P1093 (0.3; 95% CI, 0.03, 0.49; p < 0.05) and non-significantly in IMPAACT 2019 (0.3; 95% CI, -0.03, 0.58; p = 0.074). Mean BAZ was in the normal range at Week 48 in both trials. Marked increases in BAZ were observed among subgroups with baseline BAZ < -2. By Week 48, 65% (117/181) of participants in P1093 and 74% (42/57) in IMPAACT 2019 remained in the same BAZ category. Improvements from severe or moderate malnutrition/thinness to normal weight occurred in 6% (10/181) and 7% (4/57) of participants in P1093 and IMPAACT 2019, respectively, while increases to overweight or obesity were observed in 9% (16/181) and 5% (3/57). Small changes were observed in overall mean WAZ and L/HAZ through Week 48 in both trials. CONCLUSIONS: Small overall increases in BAZ were observed over 1 year among pediatric participants on dolutegravir-based ART, with most participants remaining in their baseline BAZ category. CLINICAL TRIAL INFORMATION: ClinicalTrials.gov, NCT01302847 and NCT03760458.
Michael McKenna, Zrinka Lulic, Ann M. Buchanan et al.
ABSTRACT Sub‐Saharan Africa is off track in achieving the 2025 World Health Assembly nutrition targets. A robust health system is essential to deliver interventions that protect the nutrition of pregnant women and children under 5 years of age. This study aimed to examine health and nutrition service readiness, provision, and training in Côte d'Ivoire, the Democratic Republic of Congo (DRC), Guinea, Kenya, Mali, Niger and Nigeria. Two data sources were used: national‐level commodity data and health facility data. Interviews were conducted with Ministry of Health officials to gather information on the procurement of nutrition commodities. Health facility data were collected in a survey using a two‐stage random cluster design. This integrated approach assessed the availability of essential nutrition commodities, service provision and training of health personnel. Findings revealed significant variations in health system readiness and service provision. For pregnant women, the availability of iron–folic acid at facilities ranged from 73% in Guinea to 98% in Mali, with similar variability in service provision and health worker training. Multiple micronutrient and calcium supplements showed gaps in availability and provision. For children under five, oral rehydration solution availability ranged from 32% in Côte d'Ivoire to 89% in Niger, with corresponding differences in service provision and training. Newer interventions like micronutrient powders (24% in DRC–49% in Niger) and small‐quantity lipid‐based nutrient supplements showed low service provision (16% in Guinea–47% in Mali). This study highlights the need for targeted interventions to address supply chain challenges, enhance health worker training and improve service provision.
Romance Dissieka, Djeinam Toure, Akriti Singh et al.
Malnutrition among children is a serious health problem in Rwanda, with 33 percent of children under five being stunted. Limited dietary diversity, especially fruits and vegetables, contributes to micronutrient deficiencies and growth retardation. This research examined fruit and vegetable intake trends and relationships with the nutritional status of 6-59-month-old children in Nyamagabe District, Southern Province, Rwanda. Data collection occurred between November 2025 and February 2026 using a mixed-method convergent parallel design. The quantitative element included a community survey of 513 mother-child pairs through multistage cluster sampling. Anthropometric values were recorded per WHO protocol, and dietary intake was collected through 24-hour recalls, food questionnaires, and diversity scores. Food security was measured using the Food Insecurity Access Scale. The qualitative element included 17 focus groups and 20 in-depth interviews. The stunting, wasting, and underweight prevalence were 39.2, 3.5, and 12.1, respectively. Only 28.7 percent of children had minimum dietary diversity, with daily fruit and vegetable intake at 1.6 servings (SD = 1.3). Children consuming three or more servings were less likely to be stunted (AOR = 0.38; 95% CI: 0.24-0.61; p < 0.001) and underweight (AOR = 0.47; 95% CI: 0.27-0.83; p = 0.009). Household food insecurity was strongly associated with increased stunting risk (AOR = 3.45; 95% CI: 2.18–5.47; p < 0.001), indicating that food-insecure households had nearly 3.5 times greater odds of having a stunted child compared to food-secure households. Absence of formal maternal education (AOR = 2.67; 95% CI: 1.58–4.51; p < 0.001) and belonging to the lowest wealth quintile (AOR = 2.89; 95% CI: 1.72–4.86; p < 0.001) were additional independent risk factors for stunting. Barriers included seasonal deficits, high prices, weak nutrition education, and a preference for starchy staples. Solutions require nutrition-sensitive agriculture, year-round food production, behavior change, and food security programs.
Gisubizo Fabien, Irène Médémè Mitchodigni, Evode Habimana et al.
