Priority interventions for reducing stunting in the complementary feeding age group in South Africa
1
Economics, Stellenbosch University, Stellenbosch, South Africa
2
Public Health and Community Nutrition, Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences,, Stellenbosch University, Cape Town, South Africa
3
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
4
Department of Planning, Monitoring and Evaluation, South African Government, Pretoria, South Africa
5
Children's Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):A2248
ABSTRACT
BACKGROUND:
Approximately one in four children under five in South Africa is stunted, with prevalence remaining largely unchanged for decades despite substantial social and health-sector investment. Stunting reflects cumulative nutritional and environmental deprivation during early life and has long-term consequences for cognitive development, educational attainment, and adult productivity. The complementary feeding period (6–24 months) is a critical window during which growth faltering most commonly emerges and beyond which recovery is limited. This paper synthesises international evidence to identify feasible short-term interventions that can accelerate reductions in stunting within South Africa’s fiscal, social, and institutional context.
METHODS:
We conducted a narrative review of high-quality international evidence on stunting interventions for children aged 6–24 months, drawing primarily on the 2013 and 2021 Lancet Maternal and Child Nutrition Series (see Bhutta et al., 2013; Black et al, 2013; Keats et al, 2021). This was complemented by an unstructured review of recent peer-reviewed studies, systematic reviews, and meta-analyses focused on causal evidence from low- and middle-income countries. Identified interventions were assessed for effectiveness, scalability, and contextual suitability for South Africa.
RESULTS:
Two interventions consistently demonstrated meaningful reductions in stunting risk. First, complementary feeding education and behaviour change interventions improved diet quality and reduced stunting, particularly when aligned with local food availability and affordability. Second, small-quantity lipid-based nutrient supplements reduced stunting risk by approximately 12% when provided preventively during the complementary feeding period. Evidence indicates these interventions are acceptable, scalable, and cost-effective, especially when delivered through primary health care and community-based platforms.
CONCLUSIONS:
Complementary feeding education and preventive small-quantity lipid-based nutrient supplementation represent the most promising short-term strategies for reducing stunting among young children in South Africa. Implemented alongside longer-term structural reforms, these interventions offer a practical pathway to achieve measurable gains in child growth during the critical first 1 000 days.
Approximately one in four children under five in South Africa is stunted, with prevalence remaining largely unchanged for decades despite substantial social and health-sector investment. Stunting reflects cumulative nutritional and environmental deprivation during early life and has long-term consequences for cognitive development, educational attainment, and adult productivity. The complementary feeding period (6–24 months) is a critical window during which growth faltering most commonly emerges and beyond which recovery is limited. This paper synthesises international evidence to identify feasible short-term interventions that can accelerate reductions in stunting within South Africa’s fiscal, social, and institutional context.
METHODS:
We conducted a narrative review of high-quality international evidence on stunting interventions for children aged 6–24 months, drawing primarily on the 2013 and 2021 Lancet Maternal and Child Nutrition Series (see Bhutta et al., 2013; Black et al, 2013; Keats et al, 2021). This was complemented by an unstructured review of recent peer-reviewed studies, systematic reviews, and meta-analyses focused on causal evidence from low- and middle-income countries. Identified interventions were assessed for effectiveness, scalability, and contextual suitability for South Africa.
RESULTS:
Two interventions consistently demonstrated meaningful reductions in stunting risk. First, complementary feeding education and behaviour change interventions improved diet quality and reduced stunting, particularly when aligned with local food availability and affordability. Second, small-quantity lipid-based nutrient supplements reduced stunting risk by approximately 12% when provided preventively during the complementary feeding period. Evidence indicates these interventions are acceptable, scalable, and cost-effective, especially when delivered through primary health care and community-based platforms.
CONCLUSIONS:
Complementary feeding education and preventive small-quantity lipid-based nutrient supplementation represent the most promising short-term strategies for reducing stunting among young children in South Africa. Implemented alongside longer-term structural reforms, these interventions offer a practical pathway to achieve measurable gains in child growth during the critical first 1 000 days.
| eISSN: | 2654-1459 |
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