Preventing Childhood Stunting Through Integrated Life-Course Intervention Models: A Scoping Review
https://doi.org/10.53770/amhj.v6i2.1226
Keywords
Childhood Stunting Linear Growth Maternal Nutrition Complementary Feeding Nutrition-Sensitive InterventionsAbstract
Childhood stunting remains a major global public health challenge associated with chronic growth restriction beginning during pregnancy and continuing through early childhood. Its determinants include maternal nutrition, fetal growth, feeding practices, infections, caregiving, household resources, and environmental conditions. This scoping review aimed to map intervention models, delivery platforms, implementation approaches, and evidence gaps in stunting prevention across the life course, emphasizing intervention timing. The review followed established scoping review methodology and the PRISMA-ScR reporting guidelines. Literature was identified through PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library, supplemented by relevant World Health Organization reports. Eligibility criteria followed the Population Concept Context framework, focusing on children under five years, particularly during the first 1,000 days, and interventions targeting linear growth in vulnerable populations. Data were charted by intervention type, timing, delivery platform, outcomes, and implementation factors, then synthesized narratively. Twenty-nine sources met the inclusion criteria. Interventions included maternal nutrition, breastfeeding support, complementary feeding, fortified foods, water, sanitation and hygiene, social protection, and early childhood development. The evidence revealed substantial variation in intervention timing, delivery platforms, implementation strategies, and growth-related outcomes. Effectiveness appeared to depend on implementation quality, caregiver engagement, intervention intensity, and health-system and community support. The findings support coordinated nutrition-specific and nutrition-sensitive interventions beginning during pregnancy and continuing throughout the first 1,000 days. Future research should prioritize integrated delivery models, context-specific implementation strategies, and longitudinal evaluations to strengthen evidence on sustainable stunting prevention.
Downloads
References
Adu-Afarwuah, S., Lartey, A., Brown, K. H., Zlotkin, S., Briend, A., & Dewey, K. G. (2007). Randomized comparison of 3 types of micronutrient supplements for home fortification of complementary foods in Ghana: Effects on growth and motor development. The American Journal of Clinical Nutrition, 86(2), 412-420. https://doi.org/10.1093/ajcn/86.2.412
Arksey, H., & O'Malley, L. (2005). Scoping studies: towards a methodological framework. International Journal of Social Research Methodology, 8(1), 19-32. https://doi.org/10.1080/1364557032000119616
Ashorn, P., Alho, L., Ashorn, U., Cheung, Y. B., Dewey, K. G., Gondwe, A., Harjunmaa, U., Lartey, A., Phiri, N., Phiri, T. E., Vosti, S. A., & Zeilani, M. (2015). The impact of lipid-based nutrient supplement provision to pregnant women on newborn size in rural Malawi: A randomized controlled trial. The American Journal of Clinical Nutrition, 101(2), 387-397. https://doi.org/10.3945/ajcn.114.088617
Attanasio, O. P., Fernández, C., Fitzsimons, E. O. A., Grantham-McGregor, S. M., Meghir, C., & Rubio-Codina, M. (2014). Using the infrastructure of a conditional cash transfer program to deliver a scalable integrated early child development program in Colombia: Cluster randomised controlled trial. BMJ, 349, g5785. https://doi.org/10.1136/bmj.g5785
Bhutta, Z. A., Das, J. K., Rizvi, A., Gaffey, M. F., Walker, N., Horton, S., Webb, P., Lartey, A., & Black, R. E. (2013). Evidence-based interventions for improvement of maternal and child nutrition: What can be done and at what cost? The Lancet, 382(9890), 452-477. https://doi.org/10.1016/S0140-6736(13)60996-4
Black, R. E., Victora, C. G., Walker, S. P., Bhutta, Z. A., Christian, P., de Onis, M., Ezzati, M., Grantham-McGregor, S., Katz, J., Martorell, R., & Uauy, R. (2013). Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet, 382(9890), 427-451. https://doi.org/10.1016/S0140-6736(13)60937-X
Checkley, W., Buckley, G., Gilman, R. H., Assis, A. M. O., Guerrant, R. L., Morris, S. S., Mølbak, K., Valentiner-Branth, P., Lanata, C. F., & Black, R. E. (2008). Multi-country analysis of the effects of diarrhoea on childhood stunting. International Journal of Epidemiology, 37(4), 816-830. https://doi.org/10.1093/ije/dyn099
Christian, Lee, S. E., Donahue Angel, M., Adair, L. S., Arifeen, S. E., Ashorn, P., Barros, F. C., Fall, C. H. D., Fawzi, W. W., & Hao, W. (2013). Risk of childhood undernutrition related to small-for-gestational age and preterm birth in low- and middle-income countries. International Journal of Epidemiology, 42(5), 1340-1355. https://doi.org/10.1093/ije/dyt109
Clasen, T., Boisson, S., Routray, P., Torondel, B., Bell, M., Cumming, O., Ensink, J., Freeman, M., Jenkins, M., Odagiri, M., Ray, S., Sinha, A., Suar, M., & Schmidt, W.-P. (2014). Effectiveness of a rural sanitation programme on diarrhoea, soil-transmitted helminth infection, and child malnutrition in Odisha, India: A cluster-randomised trial. The Lancet Global Health, 2(11), e645-e653. https://doi.org/10.1016/S2214-109X(14)70307-9
Cumming, Arnold, B. F., Ban, R., Clasen, T., Esteves Mills, J., Freeman, M. C., Gordon, B., Guiteras, R., Howard, G., & Hunter, P. R. (2019). The implications of three major new trials for the effect of water, sanitation and hygiene on childhood diarrhea and stunting: A consensus statement. BMC Medicine, 17, 173. https://doi.org/10.1186/s12916-019-1410-x
de Onis, M., & Branca, F. (2016). Childhood stunting: A global perspective. Maternal & Child Nutrition, 12(Suppl 1), 12-26. https://doi.org/10.1111/mcn.12231
Dewey, K. G. (2016). Reducing stunting by improving maternal, infant and young child nutrition in regions such as South Asia: Evidence, challenges and opportunities. Maternal & Child Nutrition, 12(Suppl. 1), 27-38. https://doi.org/10.1111/mcn.12282
Dewey, K. G., & Adu-Afarwuah, S. (2008). Systematic review of the efficacy and effectiveness of complementary feeding interventions in developing countries. Maternal & Child Nutrition, 4(Suppl 1), 24-85. https://doi.org/10.1111/j.1740-8709.2007.00124.x
FAO. (2025). The State of Food Security and Nutrition in the World 2025: Addressing high food price inflation for food security and nutrition. https://www.fao.org/publications/sofi/2025/en/
Haider, B. A., & Bhutta, Z. A. (2017). Multiple-micronutrient supplementation for women during pregnancy. Cochrane Database of Systematic Reviews(4), CD004905. https://doi.org/10.1002/14651858.CD004905.pub5
Humphrey, J. H., Mbuya, M. N. N., Ntozini, R., Moulton, L. H., Stoltzfus, R. J., Tavengwa, N. V., Mutasa, K., Majo, F., Mutasa, B., & Mangwadu, G. (2019). Independent and combined effects of improved water, sanitation, and hygiene, and improved complementary feeding, on child stunting and anaemia in rural Zimbabwe: A cluster-randomised trial. The Lancet Global Health, 7(1), e132-e147. https://doi.org/10.1016/S2214-109X(18)30374-7
Iannotti;, Lutter, C. K., Stewart, C. P., Gallegos Riofrío, C. A., Malo, C., Reinhart, G., Palacios, A., Karp, C., Chapnick, M., & Cox, K. (2017). Eggs in early complementary feeding and child growth: A randomized controlled trial. Pediatrics, 140(1), e20163459. https://doi.org/10.1542/peds.2016-3459
Imdad, A., Yakoob, M. Y., & Bhutta, Z. A. (2011). Impact of maternal education about complementary feeding and provision of complementary foods on child growth in developing countries. BMC Public Health, 11(Suppl. 3), S25. https://doi.org/10.1186/1471-2458-11-S3-S25
Keats, E. C., Das, J. K., Salam, R. A., Lassi, Z. S., Imdad, A., Black, R. E., & Bhutta, Z. A. (2021). Effective interventions to address maternal and child malnutrition: An update of the evidence. The Lancet Child & Adolescent Health, 5(5), 367-384. https://doi.org/10.1016/S2352-4642(20)30274-1
Lassi, Z. S., Das, J. K., Zahid, G., Imdad, A., & Bhutta, Z. A. (2013). Impact of education and provision of complementary feeding on growth and morbidity in children less than 2 years of age in developing countries: A systematic review. BMC Public Health, 13(Suppl. 3), S13. https://doi.org/10.1186/1471-2458-13-S3-S13
Levac, D., Colquhoun, H., & O'Brien, K. K. (2010). Scoping studies: Advancing the methodology. Implementation Science, 5, 69. https://doi.org/10.1186/1748-5908-5-69
Luby, S. P., Rahman, M., Arnold, B. F., Unicomb, L., Ashraf, S., Winch, P. J., Stewart, C. P., Begum, F., Hussain, F., & Benjamin-Chung, J. (2018). Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Bangladesh: A cluster randomised controlled trial. The Lancet Global Health, 6(3), e302-e315. https://doi.org/10.1016/S2214-109X(17)30490-4
Mridha;, Matias, S. L., Chaparro, C. M., Paul, R. R., Hussain, S., Vosti, S. A., Harding, K. L., Cummins, J. R., Day, L. T., & Saha, S. E. A. (2016). Lipid-based nutrient supplements for pregnant women reduce newborn stunting in a cluster-randomized controlled effectiveness trial in Bangladesh. The American Journal of Clinical Nutrition, 103(1), 236-249. https://doi.org/10.3945/ajcn.115.111336
Null, C., Stewart, C. P., Pickering, A. J., Dentz, H. N., Arnold, B. F., Arnold, C. D., Benjamin-Chung, J., Clasen, T., Dewey, K. G., & Fernald, L. C. H. (2018). Effects of water quality, sanitation, handwashing, and nutritional interventions on diarrhoea and child growth in rural Kenya: A cluster-randomised controlled trial. The Lancet Global Health, 6(3), e316-e329. https://doi.org/10.1016/S2214-109X(18)30005-6
Olney, D. K., Pedehombga, A., Ruel, M. T., & Dillon, A. (2015). A 2-year integrated agriculture and nutrition and health behavior change communication program targeted to women in Burkina Faso reduces anemia, wasting, and diarrhea among children 3–12.9 months of age at baseline: A cluster-randomized controlled trial. The Journal of Nutrition, 145(6), 1317-1324. https://doi.org/10.3945/jn.114.203539
Patil, S. R., Arnold, B. F., Salvatore, A. L., Briceno, B., Ganguly, S., Colford, J. M., & Gertler, P. J. (2014). The effect of India's Total Sanitation Campaign on defecation behaviors and child health in rural Madhya Pradesh: A cluster randomized controlled trial. PLOS Medicine, 11(8), e1001709. https://doi.org/10.1371/journal.pmed.1001709
Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2024). Scoping reviews. In JBI Manual for Evidence Synthesis. JBI. https://doi.org/10.46658/jbimes-24-09
Pickering, A. J., Djebbari, H., Lopez, C., Coulibaly, M., & Alzua, M. L. (2015). Effect of a community-led sanitation intervention on child diarrhoea and child growth in rural Mali: A cluster-randomised controlled trial. The Lancet Global Health, 3(11), e701-e711. https://doi.org/10.1016/S2214-109X(15)00144-8
Prendergast, A. J., & Humphrey, J. H. (2014). The stunting syndrome in developing countries. Paediatrics and International Child Health, 34(4), 250-265. https://doi.org/10.1179/2046905514Y.0000000158
Rollins, N. C., Bhandari, N., Hajeebhoy, N., Horton, S., Lutter, C. K., Martines, J. C., Piwoz, E. G., Richter, L. M., & Victora, C. G. (2016). Why invest, and what it will take to improve breastfeeding practices? The Lancet, 387(10017), 491-504. https://doi.org/10.1016/S0140-6736(15)01044-2
Ruel, M. T., & Alderman, H. (2013). Nutrition-sensitive interventions and programmes: How can they help to accelerate progress in improving maternal and child nutrition? The Lancet, 382(9891), 536-551. https://doi.org/10.1016/S0140-6736(13)60843-0
Stewart, C. P., Iannotti, L., Dewey, K. G., Michaelsen, K. F., & Onyango, A. W. (2013). Contextualising complementary feeding in a broader framework for stunting prevention. Maternal & Child Nutrition, 9(Suppl. 2), 27-45. https://doi.org/10.1111/mcn.12088
Togatorop, V. E., Rahayuwati, L., Susanti, R. D., & Tan, J. Y. (2024). Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review. Rev Bras Enferm, 77(2), e20220625. https://doi.org/10.1590/0034-7167-2022-0625
Tricco, A. C., Lillie, E., Zarin, W., O'Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., & Garritty, C. (2018). PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Annals of Internal Medicine, 169(7), 467-473. https://doi.org/10.7326/M18-0850
UNICEF, World Health Organization, & World Bank Group. (2025). Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group Joint Child Malnutrition Estimates: Key findings of the 2025 edition. https://data.unicef.org/resources/jme-report-2025/
Victora, C. G., Bahl, R., Barros, A. J. D., França, G. V. A., Horton, S., Krasevec, J., Murch, S., Sankar, M. J., Walker, N., & Rollins, N. C. (2016). Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. The Lancet, 387(10017), 475-490. https://doi.org/10.1016/S0140-6736(15)01024-7
World Health Organization. (2023). Infant and young child feeding. https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding
Yousafzai, A. K., Rasheed, M. A., Rizvi, A., Armstrong, R., & Bhutta, Z. A. (2014). Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: A cluster-randomised factorial effectiveness trial. The Lancet, 384(9950), 1282-1293. https://doi.org/10.1016/S0140-6736(14)60455-4
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Ahmar Metastasis Health Journal
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
