Abstract The study describes the patterns of concurrent wasting and stunting (WaSt) among children age 6–59 months living in the 1980s in Niakhar, a rural area of Senegal under demographic surveillance. Wasting and stunting were defined by z scores lower than −2 in weight for height and height for age. Both conditions were found to be highly prevalent, wasting more so before age 30 months, stunting more so after age 30 months. As a result, concurrent WaSt peaked around age 18 months and its prevalence (6.2%) was primarily the product of the two conditions, with an interaction term of 1.57 ( p < 10 −6 ). The interaction was due to the correlation between both conditions (more stunting if wasted, more wasting if stunted). Before age 30 months, boys were more likely to be concurrently wasted and stunted than girls (RR = 1.61), but the sex difference disappeared after 30 months of age. The excess susceptibility of younger boys could not be explained by muscle mass or fat mass measured by arm or muscle circumference, triceps, or subscapular skinfold. Concurrent WaSt was a strong risk factor for child mortality, and its effect was the product of the independent effect of each component, with no significant interaction.
Abstract Gender disparities in child undernutrition and mortality in India have been a topic of interest for a long time, but little is known on trends or geographic variability in recent periods. We examined the degree to which historic patterns in gender disparities in child undernutrition and mortality in India have persisted given recent progress in health and nutrition. Using two nationally representative datasets from India between 2006 and 2016, we estimated mortality rates and stunting by gender and by birth order among children under 5 years old. We then tested for differences between boys and girls within each survey round for both national and state levels using bootstrapped standard errors, controlling for cluster and sampling weights. We found striking progress in child mortality and stunting in India between 2006 and 2016 for both boys and girls. Boys were more likely to die than girls during the first year of life. Girls had a higher risk of mortality between age 1 and 5 years than boys in 2006, but the improvements in survival eliminated this gender gap in 2016. For stunting, we found no gender difference in 2006, but girls had higher height‐for‐age Z ‐scores (HAZ) and lower stunting than boys in 2016. Trends in gender gaps in mortality and stunting vary substantially by birth order and between states. Our findings indicate that improvements in mortality and nutritional status among girls have started to close gender disparities. Policy efforts to close gaps must stay the course in states that have made progress and be accelerated in states where disparities are still prominent.
Harold Alderman, Phuong Hong Nguyen, Lan Mai Tran et al.
AbstractChild stunting prevalence is primarily used as an indicator of impeded physical growth due to undernutrition and infections, which also increases the risk of mortality, morbidity and cognitive problems, particularly when occurring during the 1000 days from conception to age 2 years. This paper estimated the relationship between stunting prevalence and age for children 0–59 months old in 94 low‐ and middle‐income countries. The overall stunting prevalence was 32%. We found higher stunting prevalence among older children until around 28 months of age—presumably from longer exposure times and accumulation of adverse exposures to undernutrition and infections. In most countries, the stunting prevalence was lower for older children after around 28 months—presumably mostly due to further adverse exposures being less detrimental for older children, and catch‐up growth. The age for which stunting prevalence was the highest was fairly consistent across countries. Stunting prevalence and gradient of the rise in stunting prevalence by age varied across world regions, countries, living standards and sex. Poorer countries and households had a higher prevalence at all ages and a sharper positive age gradient before age 2. Boys had higher stunting prevalence but had peak stunting prevalence at lower ages than girls. Stunting prevalence was similar for boys and girls after around age 45 months. These results suggest that programmes to prevent undernutrition and infections should focus on younger children to optimise impact in reducing stunting prevalence. Importantly, however, since some catch‐up growth may be achieved after age 2, screening around this time can be beneficial.
Omar Karlsson, Rockli Kim, Grainne M. Moloney et al.
AbstractMicronutrient supplementation is widely used to prevent stunting in children under 5 years in low‐ and middle‐income countries (LMIC), but the impact of treatment has been disappointing, possibly due to non‐compliance. Our aim was to deliver long‐term micronutrient supplementation via a novel, culturally acceptable liquid food to improve linear growth in a high stunting prevalence region.In a randomised control trial, 971 children aged 6–72 months received either ‘Chispuditos®’ (n = 681), a hot drink (atole) fortified with micronutrients (atole + MN) (9 mg/zinc, 12.5 mg/iron), or lactose‐free milk (n = 290) for 18 months. Primary outcomes were changes in length/height‐for‐age (HAZ) score and the prevalence of stunting at 18‐month follow‐up. Adherence was monitored monthly, and 73% children in atole + MN group consumed at least half their daily zinc and iron requirement. At 18 months, there was no difference between the treatments in growth [mean change in HAZ −0.02 (95% CI −0.12, 0.08)] or stunting [atole + MN 41%, milk 41%; RR 0.99 (95% CI 0.84, 1.19)]. There were no differences in haemoglobin (HB), ferritin or zinc. No children had iron deficiency anaemia (IDA) at outcome, but zinc deficiency remained equally prevalent in both groups: atole + MN 35%, milk 35% [RR 1.02 (95% CI 0.83, 1.24)]. There was no difference in morbidity between the groups, and micronutrient status was unrelated to HAZ. Long‐term micronutrient supplementation via a culturally acceptable food had no impact on stunting or morbidity, raising the question of whether large‐scale micronutrient supplementation is worthwhile.
Victor Alfonso Mayén, Abimbola Ogunlusi, Charlotte Margaret Wright et al.
ABSTRACT Child stunting affects 38.3% of children under five in Ethiopia as of 2016. Women's empowerment, defined through both fundamental capabilities and household decision‐making authority, has emerged as a critical determinant of child nutritional outcomes. Drawing on Sen's capability approach and Kabeer's empowerment framework, we examined the associations between two distinct dimensions of women's empowerment and child stunting across Ethiopia's diverse regions. We analyzed 18,466 mother–child pairs from the 2011 and 2016 Ethiopia Demographic and Health Surveys. Validated empowerment indices were constructed using factor analysis. We employed hierarchical multilevel models as our primary specification to examine the associations between women's empowerment and child stunting across Ethiopia's 11 administrative regions. Between 2011 and 2016, stunting declined from 42.3% to 36.4%. Women's decision‐making authority increased (mean score: 0.70–0.78), while capabilities remained stable (0.17– 0.16). Higher capabilities were significantly associated with lower odds of stunting ( β = −0.141, aOR = 0.87, 95% CI: 0.83, 0.91), whereas decision‐making showed no association ( β = 0.013, aOR = 1.01, 95% CI: 0.98, 1.05). A significant interaction between capabilities and decision‐making was observed ( β = 0.050, aOR = 1.05, 95% CI: 1.01, 1.09). Regional heterogeneity was substantial: Amhara maintained high stunting rates despite empowerment gains, while Somali saw improvements with low capabilities but increased decision‐making. The study findings suggest that interventions should prioritize capability development through region‐specific strategies reflecting diverse pastoral, agrarian, and urban contexts; promote multi‐sectoral programs linking education and nutrition services; and develop monitoring frameworks to track both dimensions of empowerment at the regional level.
Seyoum Teffera Mengesha, Eva Berde, Amare Zerihun Yohannes et al.
Background: Infant and child nutrition in Zambia remains a pressing public health problem. The Zambia Demographic and Health Survey (ZDHS) indicates that 35% of children under-five and 36 % among those aged 6-23 months are stunted. This study set out to assess the influence of Infant and Child Feeding (IYCF) practices on child stunting (6-23 months) in Zambia. Methods: The 2008 ZDHS children’s data were analysed to measure stunting among infants aged 6-23 months. We fitted a bivariate logistic regression to measure association between feeding practices and stunting in children. Pearson’s Chisquare test of proportions and adjusted odd ratios (AOR) with confidence intervals at 95% are reported. Results: Findings indicate that 36% of children 6-23 months old were stunted. IYCF practices indicators remain relatively poor in Zambia with only 13% of children age 6-23 months having received minimum acceptable diet, 23% received minimum dietary diversity and 42% received minimum meal frequency. Breastfeeding and receipt of a minimum dietary diversity reduced the odds of stunting among children age 6-23 months by 38% and 33% respectively. A child’s perceived low birth size, being male, maternal anaemia status and mother’s use of the internet were significant predictors of stunting. Conclusion: The study shows that IYCF practices have an influence on stunting in Zambia and that socio-economic and demographic factors are likewise associated with stunting although the main determinants are amendable to intervention. Promoting the recommended WHO IYCF practices; breastfeeding, minimum meal frequency, receiving foods with diverse dietary content and accelerated investment in nutrition programs is recommended.
Background: Child nutrition and growth are often framed as the responsibility of mothers. Global programs on infant and young child feeding (IYCF) emphasize maternal education, breastfeeding practices, and household food preparation. However, recent evidence suggests that fathers play a significant but under-recognized role in shaping dietary practices, health-seeking behaviors, and growth outcomes. Fathers influence family income allocation, food purchasing decisions, and the overall household environment. Their attitudes toward nutrition and health services can affect maternal practices and children’s access to adequate diets. In many low- and middle-income countries (LMICs), including Indonesia, cultural norms may limit paternal involvement in caregiving, leaving gaps in nutrition promotion and child health. As stunting continues to affect one in five Indonesian children under five (SSGI 2024), exploring fathers’ role in child nutrition may offer new insights for public health interventions. Objective: To review recent literature (2015–2024) on the role of fathers in child nutrition and growth, with a focus on implications for stunting prevention strategies in LMICs. Method: A narrative mini-review was conducted using PubMed, Google Scholar, and UNICEF/WHO reports. Keywords included father involvement, child nutrition, infant and young child feeding, growth, stunting. Inclusion criteria: studies published between 2015 and 2024 that assessed paternal knowledge, attitudes, or practices related to child feeding and growth outcomes. Results: Father involvement in IYCF: Studies from South Asia and Africa show that paternal support improves breastfeeding initiation and reduces early introduction of formula or complementary foods. Dietary diversity: Children with fathers engaged in meal planning or food purchasing were more likely to receive diverse diets. Knowledge gaps: Surveys reveal that fathers generally have lower awareness of nutrition guidelines compared to mothers, particularly regarding sugar-sweetened beverages, portion sizes, and micronutrient supplementation. Impact on growth outcomes: Limited but growing evidence links paternal involvement with reduced risk of stunting and underweight, suggesting indirect pathways through maternal support and household food security. Cultural barriers: In many LMICs, caregiving is socially framed as a maternal duty, leading fathers to underestimate their role in nutrition. Discussion: The literature indicates that fathers’ engagement is a missing link in stunting prevention efforts. While mothers remain primary caregivers, fathers strongly shape the food environment and resource allocation. Addressing paternal knowledge gaps and cultural barriers could enhance the effectiveness of child nutrition programs. Community-based interventions that include fathers have shown promising results in improving IYCF practices. Conclusion: Fathers play a crucial yet under-recognized role in child nutrition and growth. Integrating paternal involvement into public health strategies may improve dietary practices, support maternal caregiving, and reduce stunting risk. More research is needed in Indonesia and other LMICs to quantify this impact and design culturally appropriate interventions.
ABSTRACT Stunting, largely established during the first 1000 days of life, remains a major public health challenge in sub‐Saharan Africa, contributing to early‐life deficits and perpetuating intergenerational disadvantage. Children born to stunted mothers are at increased risk of experiencing stunting themselves, reflecting the persistence of nutritional vulnerability across generations. This study examines the association between maternal and child stunting across 19 sub‐Saharan African countries using recent Demographic and Health Survey (DHS) data. A cross‐sectional analysis was conducted using pooled DHS data from 91,840 children aged 6–59 months and their mothers, collected between 2013 and 2024. Child stunting was defined as a height‐for‐age Z‐score (HAZ) below −2 standard deviations. Multivariable logistic regression models were used to assess the association between maternal and child stunting, adjusting for key sociodemographic and household characteristics. The overall prevalence of child stunting was 31.5%. Stunting prevalence was substantially higher among children of stunted mothers (66.6%) compared to those of non‐stunted mothers (32.3%). Maternal stunting was associated with significantly increased odds of child stunting (adjusted odds ratio [AOR]: 3.79; 95% CI: 3.25–4.43). Additional determinants included maternal education, household wealth, and place of residence. Marked regional disparities were observed, with the highest prevalence in Central Africa (37.8%) and the lowest in Western Africa (26.6%). Maternal stunting emerges as a strong and independent predictor of child stunting, underscoring the importance of life‐course approaches to nutrition. Interventions targeting maternal nutrition, female education, and structural socioeconomic inequalities are essential to disrupt the intergenerational transmission of stunting in sub‐Saharan Africa.
AbstractMany interventions focus on preventing stunting in the first 1,000 days of life. We take a broader perspective on childhood growth to assess the proportions of children who suffer persistent stunting, recover, and falter and become newly stunted between birth and adolescence. We use longitudinal data collected on 7,128 children in Ethiopia, India, Peru, and Vietnam. Data were collected in five survey waves between the ages of 1 to 15 years. We use descriptive and graphical approaches to compare the trajectories of children first stunted by age 1, first stunted by age 5, and those remained not stunted until age 5. On average, 29.6% of children were first stunted by age 1, 12.9% of children were first stunted by the age 5, and 68.7% of children were not stunted at either age 1 or age 5. A larger percentage of children stunted by age 1 remained stunted at age 15 (40.7%) compared with those who were first stunted by age 5 (32.3%); 33.7% of children first stunted by age 1 and 31.1% of children first stunted by age 5 go on to recover, but then falter during later childhood. 13.1% of children who were not stunted at age 1 or age 5 become newly stunted between the ages of 8 and 15. Our results show that children both become stunted and recover from stunting into adolescence. More attention should be paid to interventions to support healthy growth throughout childhood.
Abstract Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of child stunting in Indonesia has remained high over the past decade, and at the national level is approximately 37%. It is unclear whether current approaches to reduce child stunting align with the scientific evidence in Indonesia. We use the World Health Organization conceptual framework on child stunting to review the available literature and identify what has been studied and can be concluded about the determinants of child stunting in Indonesia and where data gaps remain. Consistent evidence suggests nonexclusive breastfeeding for the first 6 months, low household socio‐economic status, premature birth, short birth length, and low maternal height and education are particularly important child stunting determinants in Indonesia. Children from households with both unimproved latrines and untreated drinking water are also at increased risk. Community and societal factors—particularly, poor access to health care and living in rural areas—have been repeatedly associated with child stunting. Published studies are lacking on how education; society and culture; agriculture and food systems; and water, sanitation, and the environment contribute to child stunting. This comprehensive synthesis of the available evidence on child stunting determinants in Indonesia outlines who are the most vulnerable to stunting, which interventions have been most successful, and what new research is needed to fill knowledge gaps.
