Closing the rural-urban gap in child malnutrition: Evidence from Paraguay, 1997–2012

Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline

“…The included studies analyzed data on the determinants of child growth and drivers of stunting reduction from >70 countries worldwide. A total 11 of studies ( 29 , 30 , 33 , 40 , 46 , 48–51 , 55 , 99 ) contained data from national-level regression-decomposition analyses of change in HAZ and stunting prevalence in 14 countries (see Table 1 ). These studies best address our research question, and the following sections focus on synthesizing key findings from robust models across this set of studies, organized by groupings based on the basic, underlying, and immediate determinants of stunting.…”

“…In a majority of these regression-decomposition studies ( 33 , 40 , 46 , 48–51 ) multivariable regression and Oaxaca-Blinder decomposition methods were used to examine how different determinants predicted change in nutrition status. Multivariable linear regression and linear probability modeling were used to examine associations between HAZ and covariates of interest based on data collected regularly through DHS, the Multiple Indicator Cluster Survey (MICS), and other nationally representative surveys.…”

“…The presence of a piped water source in the yard of a house is associated with water-related safe hygiene practices in mothers ( 111 ) and represents a pathway associated with diarrhea reduction ( 112 ). Improved access to safe water source predicted 7% of the change in HAZ in rural Paraguay ( 40 ) and 6% in Senegal ( 50 ).…”

“…High childhood vaccination coverage is an indicator of a functional health system. Improved vaccination coverage predicted between 4% ( 51 ) and 6% ( 33 ) of HAZ change in Nepal and 3% in Paraguay ( 40 ). A total of 11 studies ( 14 , 22 , 33 , 40 , 48 , 51 , 59 , 68 , 93 , 99 , 102 ) analyzed the relation between vaccination coverage and stunting.…”

“…In addition to being an optimal nutrition source, exclusive breastfeeding for the first 6 mo of life followed by continued breastfeeding for 2 y has a protective effect against diarrhea-related morbidity and mortality by reducing exposure to water-borne pathogens ( 116 ). Being breastfed at birth predicted 3% of the change in HAZ in rural Paraguay ( 40 ). There were 14 studies ( 21 , 23 , 29 , 40 , 43 , 47 , 55 , 74 , 81 , 82 , 87 , 93 , 98 , 102 ) that explored the relation between improved breastfeeding practices and childhood stunting prevalence.…”