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Drivers of Under-Five Stunting Trend in 14 Low- and Middle-Income Countries since the Turn of the Millennium: A Multilevel Pooled Analysis of 50 Demographic and Health Surveys
Authors: Alemayehu Argaw, Giles Hanley-Cook, Nathalie De Cock, Patrick Kolsteren, Lieven Huybregts, and Carl Lachat
Source: Nutrients, 11(10): 2485; DOI:10.3390/nu11102485
Topic(s): Birth weight
Child health
Children under five
Water treatment
Women’s empowerment
Country: More than one region
  Multiple Regions
Published: OCT 2019
Abstract: Background: Understanding the drivers contributing to the decreasing trend in stunting is paramount to meeting the World Health Assembly’s global target of 40% stunting reduction by 2025. Methods: We pooled data from 50 Demographic and Health Surveys since 2000 in 14 countries to examine the relationships between the stunting trend and potential factors at distal, intermediate, and proximal levels. A multilevel pooled trend analysis was used to estimate the association between the change in potential drivers at a country level and stunting probability for an individual child while adjusting for time trends and child-level covariates. A four-level mixed-effects linear probability regression model was fitted, accounting for the clustering of data by sampling clusters, survey-rounds, and countries. Results: Stunting followed a decreasing trend in all countries at an average annual rate of 1.04 percentage points. Among the distal factors assessed, a decrease in the Gini coefficient, an improvement in women’s decision-making, and an increase in urbanization were significantly associated with a lower probability of stunting within a country. Improvements in households’ access to improved sanitation facilities and drinking water sources, and children’s access to basic vaccinations were the important intermediate service-related drivers, whereas improvements in early initiation of breastfeeding and a decrease in the prevalence of low birthweight were the important proximal drivers. Conclusions: The results reinforce the need for a combination of nutrition-sensitive and -specific interventions to tackle the problem of stunting. The identified drivers help to guide global efforts to further accelerate stunting reduction and monitor progress against chronic childhood undernutrition. View Full-Text Keywords: stunting trend; children under-five years; low- and middle-income countries; determinants; Demographic and Health Survey (DHS)