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

Abstract

Background Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development. Objective This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries. Methods We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time. Results Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height. Conclusions Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.

Modeling Enteropathy or Diarrhea with the Top Bacterial and Protozoal Pathogens: Differential Determinants of Outcomes

“…In addition, a “silent” pandemic of moderate to severe stunting still affects an estimated 144 million children worldwide in the first two critically formative years of their lives, mostly in impoverished communities. 2 , 3 This “silent pandemic” has potentially devastating consequences for children that do not die and may not be overtly symptomatic but who live through malnutrition and repeated or multiple enteric infections in early life. There has been a steady decline in the height-for-age Z (HAZ) scores of children in Asia, Africa, and Latin America over their first 2 years of life 4 While the causes of this early childhood stunting in poor areas is complex, it likely relates to combinations of reduced food security and repeated or even common multiple enteric infections, resulting in damage to the intestine referred to as “environmental enteropathy” (EE) or environmental enteric dysfunction (EED).…”

Stunting as a Synonym of Social Disadvantage and Poor Parental Education

“…The findings are in line with Jeong et al [44] who had summarized evidence that maternal and paternal education were independently associated with 0.37 (95% CI 0.33 to 0.41) and 0.20 (95% CI 0.16 to 0.24) higher height-for-age z-scores, and 0.31 (95% CI 0.29 to 0.34) and 0.16 (95% CI 0.14 to 0.18) higher Early Childhood Development Index z-scores, respectively (comparing secondary or higher to no education). The associations were stronger for maternal education than paternal education but comparable between child outcomes, whereas the factor household prosperity even though associated with parental education as shown by Vaivada et al [45], appeared to have no direct impact on height in the children of either school type.…”

Pendampingan Pemeriksaan Rutin dan Penyuluhan Kesehatan pada Siswa TK ABA se-Kecamatan Dau sebagai Usaha Pencegahan Bahaya Stunting

“…Khusus untuk masalah stunting, salah satu masalah yang mengemuka di Indonesia adalah angkanya masih termasuk kategori tinggi menurut standar WHO (Rahmadhita, 2020) meskipun prevalensi balita stunting turun dari 37,2% pada tahun 2013 menjadi 30,8% pada tahun 2018 tetapi masih dirasakan masih besarnya tantangan percepatan penurunan stunting tersebut dilihat dari data-data tentang proporsi berat badan lahir rendah (<2500 gram/BBLR) yang mengalami kenaikan tipis dari 5,7% menjadi 6,2%, panjang badan lahir kurang dari 48 cm yang mengalami kenaikan dari 20,2% menjadi 22,7%, serta proporsi imunisasi dasar lengkap pada anak usia 12-23 bulan mengalami penurunan dari 59,2% menjadi 57,9%. Kesemuanya untuk tahun 2013 dan 2018 dan secara umum Indonesia berada di posisi ke 108 dari 132 negara dalam masalah stunting (Vaivada et al, 2020) . Sebuah studi menemukan bahwa stunting terjadi akibat interaksi berbagai faktor yang kompleks, tidak hanya di tingkat individu, tetapi juga di tingkat rumah tangga dan masyarakat.…”