Multisector intervention to accelerate reductions in child stunting: an observational study from 9 sub-Saharan African countries
By Roseline Remans, Paul M Pronyk, Jessica C Fanzo, Jiehua Chen, Cheryl A Palm, Bennett Nemser, Maria Muniz, Alex Radunsky, Alem Hadera Abay, Mouctar Coulibaly, Joseph Mensah-Homiah, Margaret Wagah, Xiaoyi An, Christine Mwaura, Eva Quintana, Marie-Andree Somers, Pedro A Sanchez, Sonia E Sachs, John W McArthur, and Jeffrey D Sachs for the Millennium Villages Study Group
ABSTRACT
Background: 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 under- nutrition are well recognized, few studies have evaluated strategies that combine nutrition-specific, health-based approaches with food system– and livelihood-based interventions.
Objective: 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. Design: 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 house- holds and resident children ,2 y old from villages exposed to the program were enrolled in the study. Main outcome measures in- cluded principal determinants of undernutrition and childhood stunting, which was defined as a height-for-age z score less than 22. National trends in stunting were generated from demographic and health surveys.
Results: 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 coun- tries included in the study had remained largely unchanged over the past 2 decades.
Conclusion: These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting.