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Considering the use of ‘stunting’ as an indicator in nutrition projects

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This is a summary of the following report: USAID Advancing Nutrition (2020) Stunting: Considerations for use as an indicator in nutrition projects. Arlington, VA: USAID Advancing Nutrition. Available at: https://www.advancingnutrition.org/resources/stunting-considerations-use-indicator-nutrition-projects  

Background

Over the past decade, many national and donor-funded programmes have prioritised a reduction in stunting (low height-for-age) as their primary objective. However, improvements in linear growth are difficult to achieve over the short term in many contexts and often require long-term multi-sector investment to address various social, political and economic determinants. This has led to the apparent ‘failure’ of programmes despite their numerous other benefits for nutrition and human development. Based on literature from low- and middle-income countries published since 2013, this report discusses the use of stunting as an indicator and proposes the identification of a broader set of indicators to monitor and evaluate the United State Agency for International Development (USAID) (and other) nutrition programmes.

Interpreting stunting as an indicator

Stunting is an attractive indicator of programme performance since the data is relatively easy to collect and interpret. However, evidence suggests that stunting has been misused as an indicator of programme success for the following reasons:  

Use of stunting within USAID programmes

Despite its limitations as an indicator of programme performance, stunting prevalence remains a useful population measure that reflects overall living conditions and welfare. It is also useful to compare progress within the same population over time and to identify sub-groups of vulnerable children within a population who may benefit from nutrition programmes.

Selecting indicators for USAID activities

Overall, this report highlighted that, rather than relying on stunting to measure success, nutrition programmes should measure a broader set of lower-level indicators that can be more directly attributed to programme activities. Indicator selection should be informed by a logic model that reflects the full pathway between interventions and results, incorporating a range of nutrition, health and development outcomes. 

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Considering the use of ‘stunting’ as an indicator in nutrition projects. Field Exchange 67, April 2022. p94. www.ennonline.net/fex/67/usaidstuntingindicator

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