Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries
Remans, R.; Pronyk, P.M.; Fanzo, J.C.; Chen, J.; Palm, C.A.; Nemser, B.; Muniz, M.; Radunsky, A.; Abay, A.H.; Coulibaly, M.; Mensah-Homiah, J.; Wagah, M.; An, X.; Mwaura, C.; Quintana, E.; Somers, M.-A.; Sanchez, P.A.; Sachs, S.E.; McArthur, J.W.; Sachs, J.D.; Afram, S.; Kandji, S.; Kaya, B.; Masira, J.; Mutuo, P.; Mkumbira, J.; Ndahiro, D.; Nyadzi, G.; Onabanjo, N.; Siriri, D.; Teklu, G.; Yunusa, B.; Nziguheba, G.; Modi, V.; Sullivan, C.; Niang, A.; Africa, W.; Begashaw, B.
American Journal of Clinical Nutrition 94(6): 1632-1642
2011
ISSN/ISBN: 1938-3207 PMID: 22030229 DOI: 10.3945/ajcn.111.020099Document Number: 227920
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.