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Open AccessArticle

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

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Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University, 9000 Ghent, Belgium
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Department of Population and Family Health, Institute of Health, Jimma University, P.O. Box 378, Jimma, Ethiopia
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Poverty, Health and Nutrition Division, International Food Policy Research Institute, Washington, DC 20005-3915, USA
*
Author to whom correspondence should be addressed.
Nutrients 2019, 11(10), 2485; https://doi.org/10.3390/nu11102485
Received: 5 September 2019 / Revised: 13 October 2019 / Accepted: 14 October 2019 / Published: 16 October 2019
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) stunting trend; children under-five years; low- and middle-income countries; determinants; Demographic and Health Survey (DHS)
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Argaw, A.; Hanley-Cook, G.; De Cock, N.; Kolsteren, P.; Huybregts, L.; Lachat, C. 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. Nutrients 2019, 11, 2485.

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