What Explains Cambodia's Success in Reducing Child Stunting-2000-2014?

PLoS One. 2016 Sep 20;11(9):e0162668. doi: 10.1371/journal.pone.0162668. eCollection 2016.


In many developing countries, high levels of child undernutrition persist alongside rapid economic growth. There is considerable interest in the study of countries that have made rapid progress in child nutrition to uncover the driving forces behind these improvements. Cambodia is often cited as a success case having reduced the incidence of child stunting from 51% to 34% over the period 2000 to 2014. To what extent is this success driven by improvements in the underlying determinants of nutrition, such as wealth and education, ("covariate effects") and to what extent by changes in the strengths of association between these determinants and nutrition outcomes ("coefficient effects")? Using determinants derived from the widely-applied UNICEF framework for the analysis of child nutrition and data from four Demographic and Health Surveys datasets, we apply quantile regression based decomposition methods to quantify the covariate and coefficient effect contributions to this improvement in child nutrition. The method used in the study allows the covariate and coefficient effects to vary across the entire distribution of child nutrition outcomes. There are important differences in the drivers of improvements in child nutrition between severely stunted and moderately stunted children and between rural and urban areas. The translation of improvements in household endowments, characteristics and practices into improvements in child nutrition (the coefficient effects) may be influenced by macroeconomic shocks or other events such as natural calamities or civil disturbance and may vary substantially over different time periods. Our analysis also highlights the need to explicitly examine the contribution of targeted child health and nutrition interventions to improvements in child nutrition in developing countries.

MeSH terms

  • Analysis of Variance
  • Cambodia / epidemiology
  • Child
  • Child Nutrition Disorders / epidemiology
  • Child Nutrition Disorders / prevention & control*
  • Child Nutritional Physiological Phenomena*
  • Child, Preschool
  • Comorbidity
  • Economic Development / statistics & numerical data
  • Female
  • Growth Disorders / epidemiology
  • Growth Disorders / prevention & control*
  • Health Surveys / methods*
  • Health Surveys / statistics & numerical data
  • Health Surveys / trends
  • Humans
  • Incidence
  • Infant
  • Male
  • Nutritional Status
  • Rural Health / statistics & numerical data
  • Socioeconomic Factors
  • Urban Health / statistics & numerical data

Grants and funding

The authors received no specific funding for this work.