A new study evaluates risk factors for childhood stunting in 137 developing countries.


The growth that occurs from conception until two years old impacts a child for the rest of his or her life.  Growth during this period influences a child’s long-term health, cognitive ability and economic potential.

Restricted growth, or stunting, is defined as a child having a height more than two standard deviations below the global standard median height for his or her age.  Although global childhood survival rates have improved over the past 50 years, it is estimated that 36% of children worldwide under the age of two are stunted in their growth. Over 14% of childhood deaths are attributable to stunting.

Earlier research has identified risk factors to stunting but did not clarify the relative influence of each factor. However, a recently published study in the Public Library of Science assessing the impact of stunting risk factors by country, region, and globally, may help to fill this knowledge gap.

The authors identified 18 key risk factors for stunting and grouped them into five clusters: (1) environmental factors; (2) maternal nutrition and infection; (3) teenage motherhood and short birth intervals; (4) child nutrition and infection; and (5) fetal growth restriction and preterm birth. Fetal growth restriction is defined as being born full-term but weighing less than the 10th percentile.

The study examined data from 137 developing countries for the prevalence of stunting by individual risks factor and clusters of risk factors and evaluated the respective influence of each by statistical analysis.

Results indicate that the most significant individual risk factors worldwide were fetal growth restriction, environmental factors, and childhood infection.

When risk factors were grouped into clusters, fetal growth restriction, and preterm births were similarly the leading cause of stunting in all regions. The second largest risk factor cluster varied by region.  Environmental factors such as poor water quality, poor sanitation and use of biomass fuel had the largest impact on stunting in South Asia, sub-Saharan Africa, and East Asia and Pacific.  Risk factors related to child nutrition and infection were the second largest leading risk cluster in all other regions.

In countries such as Niger, Burundi, Yemen, Ethiopia, Afghanistan, and Zambia where stunting reaches 50% of the population, all risk factor clusters were influential.

Some results were unexpected: individual risk factors such as discontinued breastfeeding and non-exclusive breastfeeding ranked high in Somalia and in middle-income countries such as Mexico, South Africa, Iran, Turkey, and Argentina.

The authors conclude that childhood stunting prevention programs should contain measures aimed at improving a woman’s nutrition status as well as improving her and her child’s living environment.


Written By:  Lynn Kim

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