1995年至2014年埃及儿童身高与年龄的变化：对改善儿童健康结果的影响

ReemHashad1*and Zeinab A.Hassan2 Abstract BackgroundStunting 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. Thisstudy examines the factors associated with these changes and provides important considerations for designinginterventions to achieve the Sustainable Development Goal (SDG) of ending all forms of malnutrition by 2030. MethodsLeveraging data from Egypt’s Demographic and Health Survey for the years 1995, 2003, and 2014, weemploy a Recentered Influence Function (RIF) approach that goes beyond the conventional way of measuringstunting as a binary indicator to examine changes across the entire HAZ distribution. The RIF decomposes changes inthe 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). ResultsThe stylized facts show a puzzling increase in stunting rates despite improvements in the level of thedeterminants of nutrition. Our RIF results attribute the change in stunting rates and other parts of the HAZdistribution primarily to changes in the association between the determinants of nutrition and HAZ (coefficienteffects) rather than in the level of the determinants (covariate effects). The results also show that the determinants ofnutrition could have heterogeneous impacts at different quantiles of the HAZ distribution. ConclusionTo reduce stunting rates and achieve the SDG of ending malnutrition, our findings highlight the needfor 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 redistributionand reforming Egypt’s subsidy program to focus on nutritious food. KeywordsStunting, Height-for-age, Re-centered Influence Function, Nutrition, Egypt JEL classification:D0, I1, J1, O1 © The Author(s) 2025.Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as yougive appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified thelicensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images orother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to thematerial. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation orexceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visithttp://creativecommons.org/licenses/by-nc-nd/4.0/. improvements in a child’s height, which also highlightsthe role of targeted interventions [6]. Introduction Stunting, a long-term outcome of malnutrition, is oneof the greatest threats to public health, according to theWorld Health Organization (WHO) [1]. Despite globalprogress in reducing stunting since the 1990s, the MiddleEast and North Africa (MENA) region has lagged behind[2]. Across MENA countries, the number and prevalenceof stunted children vary considerably. Egypt stands out asa particularly noteworthy case, with the highest numberof stunted children (2.1 million) in the MENA region in2014. In addition, the prevalence of stunting in Egypt ishigh—comparable to low-income countries and surpass-ing that of its low-middle-income peers. For example,despite similar Gross National Income (GNI), Egypt hadthree times the average stunting rate of Jordan (22.3%versus 7.8%) during 2012-2014 [3]. Egypt’s persistentstunting anomaly indicates that it is off-track to achievethe Sustainable Development Goal (SDG) 2.2 (end hun-ger and all forms of malnutrition by 2030), underscoringthe need for further research and policy interventions.Stunting is a serious health problem in Egypt, yet This paper addresses these research gaps and providesconsiderations for improving child health outcomes byanswering three research questions. First, we examinethe factors correlated with the changes in stunting ratesamong Egyptian children aged 2–4 from 1995 to 2014,focusing on the sharp decline in stunting from 35.6%in 1995 to 16.7% in 2003 and the surprising increase to20.5% in 2014. Second, we investigate the factors asso-ciated with marked changes in the entire HAZ distribu-tion over time, including concurrent increases in bothstunted and tall children. Third, we test for the presenceof socioeconomic inequalities in child malnutrition inEgyp