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


METHODS
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.


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 countries included in the study had remained largely unchanged over the past 2 decades.


CONCLUSIONS
These findings provide encouraging evidence that a package of multisector interventions has the potential to produce reductions in childhood stunting.
The Earth Institute, Columbia University, New York, NY, USA. rremans@ei.columbia.edu
Roseline
R
Remans
Paul M
PM
Pronyk
Jessica C
JC
Fanzo
Jiehua
J
Chen
Cheryl A
CA
Palm
Bennett
B
Nemser
Maria
M
Muniz
Alex
A
Radunsky
Alem Hadera
AH
Abay
Mouctar
M
Coulibaly
Joseph
J
Mensah-Homiah
Margaret
M
Wagah
Xiaoyi
X
An
Christine
C
Mwaura
Eva
E
Quintana
Marie-Andree
MA
Somers
Pedro A
PA
Sanchez
Sonia E
SE
Sachs
John W
JW
McArthur
Jeffrey D
JD
Sachs
D017954:Africa South of the Sahara / Q000453:epidemiology; D001827:Body Height; D002654:Child Care; D015362:Child Nutrition Disorders / Q000178:diet therapy* / Q000453:epidemiology; D002675:Child, Preschool; D004032:Diet / Q000592:standards*; D005191:Family Characteristics; D005523:Food Supply; D006130:Growth Disorders / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007223:Infant; D017053:Infection Control; D044342:Malnutrition / Q000150:complications / Q000178:diet therapy*; D019370:Observation; D017063:Outcome Assessment, Health Care; D015995:Prevalence; D011446:Prospective Studies; D036301:Qualitative Research; D012424:Rural Population