Service delivery strategies to reduce childhood stunting : a meta-analysis

Date of Award


Document Type


Degree Name

Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)


Community Health Sciences


Childhood stunting is a physical manifestation of profound mental and developmental delays in growth, measured against a reference growth curve (I). Stunting and wasting are responsible for 2.1 million deaths worldwide among children (1). Countries of Sub Africa and East Asia have concentrated burden, nearly 90% of the world's stunted children live in these regions (1). Beside in these two regions of the world, 159 million children (1) are stunted and 240 million (1) are at risk of developmental impairment. The causes are: impaired feeding practices, maternal malnutrition and poor sanitation. Good nutrition during the first 1000 days of life, from the beginning of a women's pregnancy until her child's 2nd birthday can reduce the prevalence of stunting (i). Strategies such as: promotion of exclusive breast feeding, timely initiation of complimentary feeding, food security, high value of agricultural crops and provision of adequate nutrition through integration of health services (I) are few strategies used so far to prevent childhood stunting. However, there is lack of evidence regarding health care service delivery as a means for improving stunting (I). Objectives: This study aims to understand the impact of health systems component- service delivery as a strategy to reduce childhood stunting in developing countries. Methodology: This review has used methodology according to Cochrane style methodology in preparation and maintaining of this study as mentioned in the steps below. The review includes RCT trials, Quasi experimental studies, pre-post studies which were available on Pubmed , Cochrane Library, Science Direct, CENTRAL and C1NAHL plus. The study has been divided into 5 stages: a) Setting pre determined criteria for identified studies and subsequent literature search b) Review of abstracts c) Review of full length articles d) Evaluating study quality and e) meta analysis. Results: Out of all the 3800 studies found, 185 abstracts were reviewed and 24 studies was included in this systematic review. The overall finding of this review indicates that different service delivery strategies such as integration of health services with public health programs, training of community health workers and provision of adequate resources and task shifting by selecting community volunteers and nutrition workers in LMIC's have improved the nutritional status of children, thereby reducing childhood stunting. The forest plots included are not significant as the combined point estimate lies on the line of null effect. The quality of included studies was also adequate. However, generalizability of studies included is limited due to the setting in which studies were conducted. Integrating health services as a service delivery strategy for appropriate delivery of health and nutrition services is imperative. Training CHW's and task shifting in public health models is a viable platform to enhance IYCF practices with other health service delivery options to reduce wasting and underweight. Therefore more effort is needed to effectively integrate and prioritize service delivery strategies in the health systems framework for reducing the prevalence of stunting in developing countries. Conclusion: The overall findings of this meta analysis of stunting in developing countries show the effectiveness of a few service delivery strategies for reduction of wasting in LMIC's. The care delivered through service delivery inputs for improving health outcome for children aged < 5 years. A clear focus on service delivery strategies to strengthen the health systems and subsequent stunting policy for low and middle income countries is not a deviation from child health priority but an enhanced way for tackling grave problems in LMIC's specially in Asia and Africa.

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