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

Journal Article (Journal Article)


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.

Full Text

Duke Authors

Cited Authors

  • Remans, R; Pronyk, PM; Fanzo, JC; Chen, J; Palm, CA; Nemser, B; Muniz, M; Radunsky, A; Abay, AH; Coulibaly, M; Mensah-Homiah, J; Wagah, M; An, X; Mwaura, C; Quintana, E; Somers, M-A; Sanchez, PA; Sachs, SE; McArthur, JW; Sachs, JD; Millennium Villages Study Group,

Published Date

  • December 2011

Published In

Volume / Issue

  • 94 / 6

Start / End Page

  • 1632 - 1642

PubMed ID

  • 22030229

Electronic International Standard Serial Number (EISSN)

  • 1938-3207

International Standard Serial Number (ISSN)

  • 0002-9165

Digital Object Identifier (DOI)

  • 10.3945/ajcn.111.020099


  • eng