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Evidence-based approaches to childhood stunting in low and middle income countries: a systematic review
  1. Muttaquina Hossain1,
  2. Nuzhat Choudhury1,
  3. Khaleda Adib Binte Abdullah1,
  4. Prasenjit Mondal1,
  5. Alan A Jackson2,
  6. Judd Walson3,
  7. Tahmeed Ahmed1
  1. 1 Stunting Research Platform, Nutrition and Clinical Services Division, ICDDR, Dhaka, Bangladesh
  2. 2 Southampton General Hospital, Southampton, UK
  3. 3 Department of Global Health, University of Washington, Seattle, USA
  1. Correspondence to Dr Muttaquina Hossain, Nutrition and Clinical Services Division, International Centre for Diarrhoeal Disease Research, 68 Shahid Tajuddin Ahmed Sarani, Mohakhali, Dhaka 1212, Bangladesh; muttaquina{at}


Objective We systematically evaluated health and nutrition programmes to identify context-specific interventional packages that might help to prioritise the implementation of programmes for reducing stunting in low and middle income countries (LMICs).

Methods Electronic databases were used to systematically review the literature published between 1980 and 2015. Additional articles were identified from the reference lists and grey literature. Programmes were identified in which nutrition-specific and nutrition-sensitive interventions had been implemented for children under 5 years of age in LMICs. The primary outcome was a change in stunting prevalence, estimated as the average annual rate of reduction (AARR). A realist approach was applied to identify mechanisms underpinning programme success in particular contexts and settings.

Findings Fourteen programmes, which demonstrated reductions in stunting, were identified from 19 LMICs. The AARR varied from 0.6 to 8.4. The interventions most commonly implemented were nutrition education and counselling, growth monitoring and promotion, immunisation, water, sanitation and hygiene, and social safety nets. A programme was considered to have effectively reduced stunting when AARR≥3%. Successful interventions were characterised by a combination of political commitment, multi-sectoral collaboration, community engagement, community-based service delivery platform, and wider programme coverage and compliance. Even for similar interventions the outcome could be compromised if the context differed.

Interpretation For all settings, a combination of interventions was associated with success when they included health and nutrition outcomes and social safety nets. An effective programme for stunting reduction embraced country-level commitment together with community engagement and programme context, reflecting the complex nature of exposures of relevance.

PROSPERO registration number CRD42016043772.

  • Stunting
  • programs
  • prevention strategies
  • systematic review
  • low and middle income countries

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  • Contributors MH and TA conceptualised the paper. MH contributed to overall coordination, collating of data sources, data analysis, tables and figures. TA and NC provided overall statistical and data analysis advice. MH, KABA and PM undertook the systematic review of published studies searches and abstraction. MH, TA, JW and AAJ provided input into the overall estimation process. All the authors reviewed and provided input to the manuscript. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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