Prevalence of stunting and environmental determinants among children under 5 years of age: A systematic review and meta-analysis

Abstract

Background: Stunting remains a major global public health issue, particularly in low- and middle-income countries. It is driven by inadequate nutrition and environmental factors, such as limited access to clean water, sanitation, and hygiene practices.

Objectives: This study aimed to estimate the prevalence of stunting among children under 5 years of age and to assess its correlation with environmental determinants.

Methods: This systematic review and meta-analysis followed PRISMA guidelines. Four international e-databases—Scopus, PubMed, ScienceDirect, and Springer—and reference lists were searched. In total, 20 studies involving 103,313 children met the inclusion criteria. A random-effects model was employed to estimate combined prevalence and associations; the I² statistic was used to assess heterogeneity.

Results: Stunting prevalence was 32.9% (95% CI: 28.6–37.8; I2 = 99.5%). Children from households with inadequate sources of drinking water were at a 1.2-times higher risk of stunting (adjusted odds ratio (AOR) = 1.2; 95% CI: 1.0–1.4; I2 = 78.5%). Inadequate toilet facilities increased the risk by 1.3 times (AOR = 1.3; 95% CI: 1.0–1.6; I2 = 86.5%), poor sanitation by 1.2 times (AOR = 1.2; 95% CI: 1.0–1.4; I2 = 75.0%), and poor handwashing practices by 2.3 times (AOR = 2.3; 95% CI: 1.0–5.5; I2 = 68.1%).

Conclusion: Stunting prevalence was significantly associated with environmental determinants. Integrating interventions for such factors with nutrition programs is essential to controlling stunting, particularly in rural areas. Policy efforts should prioritize improving access to safe drinking water, providing adequate sanitation facilities, conducting hygiene promotion programs, and community-based nutritional interventions to support child growth and development.