In recent years, many developing countries have seen significant reductions in chronic childhood malnutrition. Understanding what is driving these reductions is key in scaling up effective nutrition policies and strategies and reaching the nutrition goals set out in the Sustainable Development Goals (SDGs). A recent paper in Global Food Security, written by researchers from IFPRI and Cornell University, explores possible explanations for reduced child malnutrition in Bangladesh, Nepal, Ethiopia, Senegal, Zambia, and the state of Odisha (India) in order to identify best practices that can be used in other developing regions.

The authors utilize a quantitative, comparative, and dynamic statistical analysis model applied to multiple rounds of Demographic Health Surveys (DHS) from each country in order to better understand the factors driving nutritional changes over time across multiple contexts. The study focuses on linear growth, as a poor height-for-age z-score (HAZ) has been causally linked in the literature to adverse life outcomes and is therefore a strong indicator of overall nutrition. The exploratory approach into linear growth offers plausible explanations of nutritional change that can be further evaluated through experimental studies in local contexts.

The study examines multiple variables, including household economic status (using a robust household asset index compared to GDP per capita), parental education, maternal height, fertility (total number of children born), sanitation, and access to clean water and healthcare. In the majority of the study countries (with the exception of Zambia), household asset accumulation and parental education (specifically mothers’ education) are the key drivers of good childhood nutrition. Antenatal healthcare also appears to be an important indicator of nutritional improvements in Nepal, Senegal, and Odisha. Improved sanitation was only found to have a significant impact in South Asia; the authors suggest that this may be the case because the growth impacts of sanitation are conditional on population density, which is higher in South Asia than in Africa south of the Sahara.

In Zambia, where malaria is endemic, the growing use of bednets was the strongest factor in the improvement of childhood nutrition. They note that research into the links between the treatment of widespread diseases and nutrition is needed.

The authors do acknowledge several limitations of the study. First, the data used were observational and were only used to assess how accurately changes in potential determinants of nutrition account for nutritional change over time; according to the authors, it is not certain how close this accounting process is to a causal process. In addition, other potential drivers, such as women’s empowerment or the consumption of animal products (which have key nutritional elements necessary for children’s growth) are not captured in the data. Despite these limitations, however, the results are robust to a variety of checks and consistently identify several common and plausible drivers of nutritional change.

The study reiterates the fact that a broad range of factors impact child nutrition and calls for multidimensional nutritional strategies, including education, WASH, and healthcare.

By: Jenn Campus

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