SynthesisThe American journal of clinical nutrition2020
Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline.
Synthesis in The American journal of clinical nutrition, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT05120427 (The Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia), which is not on this map. Cited by 116 papers, 9 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
The Impact of Growth Charts and Nutritional Supplements on Child Growth in Zambia: A Randomized Controlled Trial (ZamCharts)
Who cites it
116 citing papers in PubMed, 9 syntheses or guidelines pooled it, 350 citations in OpenAlex.
- Pooled it
- The role of household food insecurity in malnutrition among Indonesian children under 5 years of age: a systematic review and meta-analysis (2015-2025).Public health nutrition · 2026Pooled it
- The decline of child stunting in 122 countries: a systematic review of child growth studies since the 19th century.BMJ global health · 2026Pooled it
- Current trends in household food insecurity, dietary diversity, and stunting among children under five in Asia: a systematic review.Journal of global health · 2025Pooled it
- Prevalence of growth retardation among children and adolescents in China: a systematic review and meta-analysis.Frontiers in pediatrics · 2025Pooled it
- The health consequences of informal employment among female workers and their children: a systematic review.Globalization and health · 2023Pooled it
- Association Between Vitamin D Status and Undernutrition Indices in Children: A Systematic Review and Meta-Analysis of Observational Studies.Frontiers in pediatrics · 2021Pooled it
- How countries can reduce child stunting at scale: lessons from exemplar countries.The American journal of clinical nutrition · 2020Pooled it
- Understanding multifactorial drivers of child stunting reduction in Exemplar countries: a mixed-methods approach.The American journal of clinical nutrition · 2020Pooled it
- Nutrient Intake and Dietary Adequacy Among Rural Tanzanian Infants Enrolled in the Mycotoxin Mitigation Trial.Nutrients · 2024Trial
- Influence of vitamin D supplementation on growth, body composition, pubertal development and spirometry in South African schoolchildren: a randomised controlled trial (ViDiKids).BMJ paediatrics open · 2024Trial
- Effects of Cooking with Liquefied Petroleum Gas or Biomass on Stunting in Infants.The New England journal of medicine · 2024Trial
- Trial
- Neurodevelopment, vision and auditory outcomes at age 2 years in offspring of participants in the 'Women First' maternal preconception nutrition randomised controlled trial.Archives of disease in childhood · 2023Trial
- A Community Health Worker-Based Intervention on Anthropometric Outcomes of Children Aged 3 to 21 Months in Urban Pakistan, 2019-2021.American journal of public health · 2023Trial
- Impact of a package of health, nutrition, psychosocial support, and WaSH interventions delivered during preconception, pregnancy, and early childhood periods on birth outcomes and on linear growth at 24 months of age: factorial, individually randomised controlled trial.BMJ (Clinical research ed.) · 2022Trial
- Effectiveness of an integrated agriculture, nutrition-specific, and nutrition-sensitive program on child growth in Western Kenya: a cluster-randomized controlled trial.The American journal of clinical nutrition · 2022Trial
- Trial
- Impact of supplementation with milk-cereal mix during 6-12 months of age on growth at 12 months: a 3-arm randomized controlled trial in Delhi, India.The American journal of clinical nutrition · 2022Trial
- Human fecal transplantation from stunted children promotes metabolic dysfunction in mice fed with a high-fat and high-fructose corn syrup diet.Gut microbes · 2026Article
56 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundProgress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.
objectiveThis article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.
methodsWe conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time.
resultsAmong the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height.
conclusionsUnique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.