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How socioeconomic status moderates the stunting-age relationship in low-income and middle-income countries
  1. Christian Bommer1,
  2. Sebastian Vollmer1,
  3. S V Subramanian2
  1. 1 Department of Economics & Centre for Modern Indian Studies, University of Goettingen, Goettingen, Germany
  2. 2 Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr Christian Bommer; christian.bommer{at}


Introduction Reducing stunting is an important part of the global health agenda. Despite likely changes in risk factors as children age, determinants of stunting are typically analysed without taking into account age-related heterogeneity. We aim to fill this gap by providing an in-depth analysis of the role of socioeconomic status (SES) as a moderator for the stunting-age pattern.

Methods Epidemiological and socioeconomic data from 72 Demographic and Health Surveys (DHS) were used to calculate stunting-age patterns by SES quartiles, derived from an index of household assets. We further investigated how differences in age-specific stunting rates between children from rich and poor households are explained by determinants that could be modified by nutrition-specific versus nutrition-sensitive interventions.

Results While stunting prevalence in the pooled sample of 72 DHS is low in children up to the age of 5 months (maximum prevalence of 17.8% (95% CI 16.4;19.3)), stunting rates in older children tend to exceed those of younger ones in the age bracket of 6–20 months. This pattern is more pronounced in the poorest than in the richest quartile, with large differences in stunting prevalence at 20 months (stunting rates: 40.7% (95% CI 39.5 to 41.8) in the full sample, 50.3% (95% CI 48.2 to 52.4) in the poorest quartile and 29.2% (95% CI 26.8 to 31.5) in the richest quartile). When adjusting for determinants related to nutrition-specific interventions only, SES-related differences decrease by up to 30.1%. Much stronger effects (up to 59.2%) occur when determinants related to nutrition-sensitive interventions are additionally included.

Conclusion While differences between children from rich and poor households are small during the first 5 months of life, SES is an important moderator for age-specific stunting rates in older children. Determinants related to nutrition-specific interventions are not sufficient to explain these SES-related differences, which could imply that a multifactorial approach is needed to reduce age-specific stunting rates in the poorest children.

  • stunting
  • undernutrition
  • ses
  • socioeconomic status
  • wealth
  • age

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  • Handling editor Douglas James Noble

  • Contributors CB, SV and SVS jointly conceptualised the study. CB analysed the data and drafted the manuscript. CB, SV and SVS contributed to the interpretation of results and writing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval For this type of study ethics approval is not required as all analyses have been conducted with

    publically available secondary data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data are open access and can be obtained from