Changes in height-for-age of Egyptian children from 1995 to 2014: implications for improving child health outcomes

Stunting is a serious health problem in Egypt. Stunting rates and height-for-age z-score (HAZ) distributions changed notably in Egypt over time, yet the factors that led to these changes remain unknown. This study examines the factors associated with these changes and provides important considerations for designing interventions to achieve the Sustainable Development Goal (SDG) of ending all forms of malnutrition by 2030.

Leveraging data from Egypt's Demographic and Health Survey for the years 1995, 2003, and 2014, we employ a Recentered Influence Function (RIF) approach that goes beyond the conventional way of measuring stunting as a binary indicator to examine changes across the entire HAZ distribution. The RIF decomposes changes in the HAZ distribution over time into differences attributable to changes in the levels of the determinants of nutrition (covariate effects) and in the strength of the association between these determinants and HAZ (coefficient effects).

The stylized facts show a puzzling increase in stunting rates despite improvements in the level of the determinants of nutrition. Our RIF results attribute the change in stunting rates and other parts of the HAZ distribution primarily to changes in the association between the determinants of nutrition and HAZ (coefficient effects) rather than in the level of the determinants (covariate effects). The results also show that the determinants of nutrition could have heterogeneous impacts at different quantiles of the HAZ distribution.

To reduce stunting rates and achieve the SDG of ending malnutrition, our findings highlight the need for targeted interventions. Interventions should be geographically targeted, promote gender and income equality, improve maternal nutrition, and expand access to better sanitation facilities. This is in addition to wealth redistribution and reforming Egypt's subsidy program to focus on nutritious food.