1. Drivers of stunting reduction in Ethiopia: a country case study
- Author
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Afrah Mohammedsanni, Muhammad Nazmul Islam, Hana Tasic, Jannah Wigle, Seifu Hagos Gebreyesus, Samanpreet Brar, Kaitlin Conway, Nadia Akseer, Zulfiqar A Bhutta, Erica Confreda, Emily C Keats, Bilal Shikur Endris, and Anushka Ataullahjan
- Subjects
Adult ,Male ,Rural Population ,medicine.medical_specialty ,mixed methods ,Sanitation ,Nutritional Status ,Medicine (miscellaneous) ,AcademicSubjects/MED00160 ,exemplar ,AcademicSubjects/MED00060 ,Young Adult ,children ,Environmental health ,Health care ,medicine ,Humans ,Open defecation ,Improved sanitation ,Child ,Poverty ,Growth Disorders ,Retrospective Studies ,linear growth ,Supplements and Symposia ,Nutrition and Dietetics ,Food security ,business.industry ,Public health ,stunting ,Infant ,Maternal Nutritional Physiological Phenomena ,East Africa ,nutrition ,Geography ,Food Security ,Child, Preschool ,Female ,Ethiopia ,business ,Qualitative research - Abstract
Background Chronic undernutrition in children continues to be a global public health concern. Ethiopia has documented a significant decline in the prevalence of childhood stunting, a measure of chronic undernutrition, over the last 20 y. Objectives The aim of this research was to conduct a systematic assessment of the determinants that have driven child stunting reduction in Ethiopia from 2000 to 2016, focused on the national, community, household, and individual level. Methods This study employed both quantitative and qualitative methods. Specifically, a systematic literature review, retrospective quantitative data analysis using Demographic and Health Surveys from 2000–2016, qualitative data collection and analysis, and analyses of key nutrition-specific and -sensitive policies and programs were undertaken. Results National stunting prevalence improved from 51% in 2000 to 32% in 2016. Regional variations exist, as do pro-rich, pro-urban, and pro-educated inequalities. Child height-for-age z score (HAZ) decomposition explained >100% of predicted change in mean HAZ between 2000 and 2016, with key factors including increases in total consumable crop yield (32% of change), increased number of health workers (28%), reduction in open defecation (13%), parental education (10%), maternal nutrition (5%), economic improvement (4%), and reduced diarrhea incidence (4%). Policies and programs that were key to stunting decline focused on promoting rural agriculture to improve food security; decentralization of the health system, incorporating health extension workers to improve rural access to health services and reduce open defecation; multisectoral poverty reduction strategies; and a commitment to improving girls’ education. Interviews with national and regional stakeholders and mothers in communities presented improvements in health service access, women and girls’ education, improved agricultural production, and improved sanitation and child care practices as drivers of stunting reduction. Conclusions Ethiopia's stunting decline was driven by both nutrition-specific and -sensitive sectors, with particular focus on the agriculture sector, health care access, sanitation, and education.
- Published
- 2020