Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries

• Published in: The American journal of clinical nutrition Vol. 94; no. 6; pp. 1632 - 1642
• Main Authors: Remans, Roseline, Pronyk, Paul M, Fanzo, Jessica C, Chen, Jiehua, Palm, Cheryl A, Nemser, Bennett, Muniz, Maria, Radunsky, Alex, Abay, Alem Hadera, Coulibaly, Mouctar, Mensah-Homiah, Joseph, Wagah, Margaret, An, Xiaoyi, Mwaura, Christine, Quintana, Eva, Somers, Marie-Andree, Sanchez, Pedro A, Sachs, Sonia E, McArthur, John W, Sachs, Jeffrey D
• Format: Journal Article
• Language: English
• Published: Bethesda, MD American Society for Nutrition 01.12.2011; American Society for Clinical Nutrition, Inc
• Subjects: Africa South of the Sahara - epidemiology; Africa, Sub-Saharan; Biological and medical sciences; Body Height; Child Care; Child Nutrition Disorders; Child Nutrition Disorders - diet therapy; Child Nutrition Disorders - epidemiology; Child, Preschool; childhood; children; Childrens health; complications; diet; Diet - standards; diet therapy; epidemiology; Family Characteristics; Feeding. Feeding behavior; food security; Food Supply; foods; Fundamental and applied biological sciences. Psychology; Growth Disorders; Growth Disorders - epidemiology; Growth Disorders - prevention & control; growth retardation; households; Human growth; Humans; Infant; Infection Control; Intervention; Malnutrition; Malnutrition - complications; Malnutrition - diet therapy; Observation; observational studies; Outcome Assessment, Health Care; Prevalence; prevention & control; Prospective Studies; Qualitative Research; Rural Population; sampling; surveys; Vertebrates: anatomy and physiology, studies on body, several organs or systems; villages; Africa South of the Sahara; Sub-Saharan Africa; Africa, Sub-Saharan; Human; Countries; Child; African
• ISSN: 0002-9165; 1938-3207; 1938-3207
• DOI: 10.3945/ajcn.111.020099

In sub-Saharan Africa, ~ 40% of children <5 y old are stunted, with levels that have remained largely unchanged over the past 2 decades. Although the complex determinants of undernutrition are well recognized, few studies have evaluated strategies that combine nutrition-specific, health-based approaches with food system- and livelihood-based interventions. We examined changes in childhood stunting and its determinants after 3 y of exposure to an integrated, multisector intervention and compared these changes with national trends. A prospective observational trial was conducted across rural sites in 9 sub-Saharan African countries with baseline levels of childhood stunting >20%. A stratified random sample of households and resident children <2 y old from villages exposed to the program were enrolled in the study. Main outcome measures included principal determinants of undernutrition and childhood stunting, which was defined as a height-for-age z score less than -2. National trends in stunting were generated from demographic and health surveys. Three years after the start of the program in 2005-2006, consistent improvements were observed in household food security and diet diversity, whereas coverage with child care and disease-control interventions improved for most outcomes. The prevalence of stunting in children <2 y old at year 3 of the program (2008-2009) was 43% lower (adjusted OR: 0.57; 95% CI: 0.38, 0.83) than at baseline. The average national stunting prevalence for the countries included in the study had remained largely unchanged over the past 2 decades. These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting.