Social sector drivers and stunting reduction in Pakistan: A subnational analysis

作者：Anushka Ataullahjan, Emily C Keats, Atif Habib, Muhammad Islam, Erica Confreda, Ahalya Somaskandan, Kimberly Charbonneau, Breagh Cheng, Rachel Jardine, Arjumand Rizvi, Imran Ahmed, Sajid Soofi, Baseer Achakzai Baseer Achakzai, Zulfiqar A Bhutta · 发表于：American Journal of Clinical Nutrition · 年份：2025 · DOI：10.1016/j.ajcnut.2024.09.025 · 被引用次数：7 · 研究领域：Child Nutrition and Water Access、Breastfeeding Practices and Influences、Global Maternal and Child Health

BACKGROUND: Poor nutrition remains a problem in Pakistan, and despite economic growth, stunting reduction is slow with subnational variations. Generally, stunting prevalence is lower in Khyber Pakhtunkhwa (KP) and Northern Punjab than in Sindh and Balochistan. OBJECTIVES: Our study aimed to identify and explore key drivers and barriers underlying subnational changes in stunting between 2011 and 2018. METHODS: We used a mixed-methods approach to determine the drivers of and barriers to change in stunting [height-for-age z-score (HAZ) < -2], including Oaxaca-Blinder decomposition and multivariable hierarchical modeling, using representative household nutrition surveys in 2011 and 2018. These findings were triangulated with a literature review, program and policy analysis, and primary qualitative research to generate a narrative of change. RESULTS: National decline in stunting prevalence was limited (2011: 42.3%, 2018: 40.2%); however, progress varied between provinces with significant stunting declines in KP and Northern and Southern Punjab [0.49 standard deviation (SD) gain in HAZ between 2011 and 2018 (43.0% to 38.3%)]. Factors driving HAZ increases were improvements in socioeconomic status (0.13 SD), coverage of Pakistan's income support program targeting females (0.05 SD), and a combination of other direct and indirect health and nutrition investments (0.1 SD). Our policy analysis and qualitative findings also supported these findings by identifying poverty and increased fo...