Breaking the Cycle: Intergenerational Transmission of Stunting in Sub-Saharan Africa-Evidence From 19 Countries

Stunting, largely established during the first 1000 days of life, remains a major public health challenge in sub-Saharan Africa, contributing to early-life deficits and perpetuating intergenerational disadvantage. Children born to stunted mothers are at increased risk of experiencing stunting themselves, reflecting the persistence of nutritional vulnerability across generations. This study examines the association between maternal and child stunting across 19 sub-Saharan African countries using recent Demographic and Health Survey (DHS) data. A cross-sectional analysis was conducted using pooled DHS data from 91,840 children aged 6-59 months and their mothers, collected between 2013 and 2024. Child stunting was defined as a height-for-age Z-score (HAZ) below -2 standard deviations. Multivariable logistic regression models were used to assess the association between maternal and child stunting, adjusting for key sociodemographic and household characteristics. The overall prevalence of child stunting was 31.5%. Stunting prevalence was substantially higher among children of stunted mothers (66.6%) compared to those of non-stunted mothers (32.3%). Maternal stunting was associated with significantly increased odds of child stunting (adjusted odds ratio [AOR]: 3.79; 95% CI: 3.25-4.43). Additional determinants included maternal education, household wealth, and place of residence. Marked regional disparities were observed, with the highest prevalence in Central Africa (37.8%) and the lowest in Western Africa (26.6%). Maternal stunting emerges as a strong and independent predictor of child stunting, underscoring the importance of life-course approaches to nutrition. Interventions targeting maternal nutrition, female education, and structural socioeconomic inequalities are essential to disrupt the intergenerational transmission of stunting in sub-Saharan Africa.