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

Introduction Child stunting, a measure of malnutrition, is a major global health challenge affecting 148.1 million children in 2022. Global stunting rates have declined from 47.2% in 1985 to 22.3% in 2022; however, 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 rates of child stunting.

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 2. 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 20th 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 20th century.

Conclusion The global child stunting rate was substantially higher in the early 20th 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.