The decline of child stunting in 122 countries : a systematic review of child growth studies since the 19th century

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Schneider, Eric B and Jaramillo Echeverri, Juliana and Purcell, Matthew and A’Hearn, Brian and Arthi, Vellore and Blum, Matthias and Brainerd, Elizabeth and Capuno, Joseph and Cermeño, Alexandra Lopez and Challú, Amílcar and Cho, Young-Jun and Cole, Tim and Corpuz, Jose and Depauw, Ewout and Droller, Federico and von Fintel, Dieter and Floris, Joël and Galofré-Vilà, Gregori and Harris, Bernard and Hatton, Tim and Heyberger, Laurent and Hurme, Tuuli and Inwood, Kris and Jaadla, Hanaliis and Kok, Jan and Kopczynśki, Michał and Lordemus, Samuel and Marein, Brian and Meisel-Roca, Adolfo and Morgan, Stephen and Öberg, Stefan and Ogasawara, Kota and Ortega, José Antonio and Palma, Nuno and Papadimitriou, Anastasios and Pistola, Renato and Quanjer, Björn and Rother, Helena and Saaritsa, Sakari and Salvatore, Ricardo and Staub, Kaspar and van der Eng, Pierre and Roberts, Evan (2026) The decline of child stunting in 122 countries : a systematic review of child growth studies since the 19th century. BMJ Global Health, 11 (2). e018607. ISSN 2059-7908 (https://doi.org/10.1136/bmjgh-2024-018607)

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Abstract

Introduction: Child stunting, a measure of malnutrition, is a major global health challenge affecting 148.1 million children in 2022. Global stunting rates have fallen from 47.2% in 1985 to 22.3% in 2022, but trends before the mid-1980s are unclear including whether child stunting was previously prevalent in current high-income countries (HICs). We conducted a systematic review of child growth studies before 1990 to reconstruct historical child stunting rates. Methods: We included reports of mean height by age and sex for children up to age 10.99 years. We excluded studies that were not representative of the targeted population and data for children under age two. Stunting rates were computed by converting the means and SDs of height to height-for-age Z-scores (HAZ) using the WHO standard/reference, combining the HAZ distributions for all ages, and measuring the share of the combined distribution below the stunting threshold. Results: We found 923 child growth studies at the community, regional and national level covering 122 countries from 1814 to 2016. We supplemented these historical studies with stunting estimates from the 1990s onward from the Joint Malnutrition Estimates database. Many current HICs had high levels of child stunting in the early twentieth century similar to low- and middle-income countries (LMICs) today. However, there was heterogeneity: stunting rates were low in Scandinavia, the European settler colonies and in the Caribbean, higher in Western Europe and exceptionally high in Japan and South Korea. Child stunting declined across the twentieth century. Conclusion: The global child stunting rate was substantially higher in the early twentieth century than in 1985, and the reduction of child stunting was a central feature of the health transition. The high stunting rates and subsequent reduction of stunting in HICs suggest that current HICs provide lessons for eradicating child stunting and that all LMICs can eliminate stunting.

ORCID iDs

Schneider, Eric B, Jaramillo Echeverri, Juliana, Purcell, Matthew, A’Hearn, Brian, Arthi, Vellore, Blum, Matthias, Brainerd, Elizabeth, Capuno, Joseph, Cermeño, Alexandra Lopez, Challú, Amílcar, Cho, Young-Jun, Cole, Tim, Corpuz, Jose, Depauw, Ewout, Droller, Federico, von Fintel, Dieter, Floris, Joël, Galofré-Vilà, Gregori, Harris, Bernard ORCID logoORCID: https://orcid.org/0000-0001-7118-1118, Hatton, Tim, Heyberger, Laurent, Hurme, Tuuli, Inwood, Kris, Jaadla, Hanaliis, Kok, Jan, Kopczynśki, Michał, Lordemus, Samuel, Marein, Brian, Meisel-Roca, Adolfo, Morgan, Stephen, Öberg, Stefan, Ogasawara, Kota, Ortega, José Antonio, Palma, Nuno, Papadimitriou, Anastasios, Pistola, Renato, Quanjer, Björn, Rother, Helena, Saaritsa, Sakari, Salvatore, Ricardo, Staub, Kaspar, van der Eng, Pierre and Roberts, Evan;
CORE (COnnecting REpositories)