Prevalence of stunting and its determinants among children under five in 35 Sub-Saharan African countries (2011-2024): Insights from recent demographic health survey data using a generalized linear mixed-effects model with robust poisson regression.

backgroundDespite efforts by initiatives like the World Bank's 'All Hands-on Deck' and UNICEF's programs to address stunting through multisectoral approaches, the burden of stunting remains alarmingly high in sub-Saharan Africa. This study utilized recent large-scale survey data from 35 SSA countries (2011-2024) to estimate the pooled prevalence of stunting and its determinants among children under 5 years of age. Key variables such as antenatal care visits, postnatal care, and maternal nutritional indicators, which previous studies did not account for, are incorporated into the analysis.

methodsA secondary analysis was conducted using recent demographic and health survey data (2011-2024) from 35 sub-Saharan African (SSA) countries. A total weighted sample of 191,953 children under 5 years of age was included in the analysis. Descriptive and inferential analyses were performed using STATA 17. Forest plots were utilized to illustrate both pooled and country-specific stunting rates. Determinants of stunting were identified through a multilevel mixed-effects Poisson regression model with robust variance. The adjusted prevalence ratios and their 95% confidence intervals were used to assess the strength and statistical significance of associations.

resultThe pooled prevalence of stunting among children under 5 years of age in 35 sub-Saharan African countries was 29.89% (95% CI: 26.63, 33.14%), with the lowest level in Gabon (13.91%) and the highest in Burundi (55.80%). Being male children (aPR = 1.24, 95% CI: 1.21-1.26), being aged 12 months or older (aPR: ≥ 1.81, p < 0.01), insufficient antenatal care (ANC) visits (aPR: ≥ 1.17, p < 0.01), lack of postnatal visits(aPR = 1.03, 95% CI: 1.07, 1.05), children perceived as small or average at birth (aPR: ≥ 1.16, p < 0.01), mother without a higher education (aPR: ≥ 1.94, p < 0.01), living in a poor or average wealth household (aPR: ≥ 1.23, p < 0.01) were significant predictors of stunting. Conversely, maternal overweight (aPR = 0.81, 95% CI: 0.77-0.84) and obese mothers (aPR = 0.88, 95% CI: 0.85-0.90) were associated lower prevalence of stunting.

conclusionStudy revealed significant country-level variations and rates exceeding 30% in 15 countries, signaling a major public health concern. The key individual, household and contextual factors associated with stunting in this study suggest the need for immediate actions expanding antenatal and postnatal care, promoting facility-based deliveries, enhancing maternal education, and media outreach. Long term strategies must tackle poverty, food systems, and equitable nutrition access, supported by governance and stability. A multisectoral approach integrating health, education, agriculture, WASH, and social protection ensures substantiable child growth, complemented by longitudinal research for policy coherence.