Abstract

There have been steep falls in rates of child stunting in much of Sub-Saharan Africa (SSA). Using Demographic and Health Survey data, we document significant reductions in stunting in seven SSA countries in the period 2005–2014. For each country, we distinguish potential determinants that move in a direction consistent with having contributed to the reduction in stunting from those that do not. We then decompose the change in stunting and in proximal determinants into a part that can be explained by changes in distal determinants and a residual part that captures the impact of unmeasured factors, such as vertical nutrition programs. We show that increases in coverage of child immunization, deworming medication and maternal iron supplementation often coincide with a fall in stunting. The magnitudes and directions of changes in two other proximal determinants -- age-appropriate feeding and diarrhea prevalence -- suggest that these have not been strong contributors to the fall in stunting. Utilization of maternity care emerges from the decomposition analysis as the most important distal determinant associated with reduced stunting, and also with increased coverage of iron supplementation, and, to a lesser extent, with child immunization and deworming medication. This circumstantial evidence is strong enough to warrant more detailed investigation of the extent to which maternity care is an effective channel through which to target further attacks on the blight of undernourished children.

Highlights

  • The average rate of stunting fell between 2005 and 2015 (UNICEF-WHO-World Bank, 2017)

  • For each of the nine countries, we measure the change in each nutritional outcome (mean height-for-age z-score (HAZ) and rate of stunting) between the two Demographic Health Survey (DHS) surveys conducted in the period from 2005 to 2014

  • In seven countries (Ethiopia, Ghana, Kenya, Liberia, Namibia, Niger and Rwanda), there was a significant reduction in stunting, which, on average, was equal to 7.3 percentage points over 6.8 years

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Summary

Introduction

The average rate of stunting fell between 2005 and 2015 (UNICEF-WHO-World Bank, 2017). Much of Sub-Saharan Africa has experienced the improvement (Bredenkamp, Buisman, & Van de Poel, 2014; UNICEF-WHO-World Bank, 2017). Rates of stunting have remained stubbornly high, or have even risen, in Malawi, Mozambique and Sierra Leone (Bredenkamp et al, 2014; World Development Indicators, 2019). To avoid children in these countries being left too far behind, it is important to learn from the success stories about what contributes to improvements in nutritional status. This paper documents changes in stunting in nine Sub-Saharan African (SSA) countries. For the seven in which stunting fell significantly, it decomposes the reductions into changes in potential determinants, with the goal of distinguishing factors that plausibly could have contributed to these reductions from those that could not

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