The Impact of Changes in Nutritional Policy on the Determinants of Child Stunting: Evidence From the 2010 and 2022 Living Conditions Monitoring Surveys in Zambia

Abstract

This study extends earlier work on the determinants of child stunting in Zambia by incorporating 2022 Living Conditions Monitoring Survey data, enabling assessment of nutritional change over a longer post-policy period. It supplements the earlier paper by using 2022 LCMS data as opposed to 2015, thereby giving a longer period between the policy change and evaluation. We analyze changes in child height-for-age z-scores (HAZ) in Zambia between 2010 and 2022, aligned with the 2011–2015 and 2017–2021 National Food and Nutrition Strategic Plans. National HAZ improved (Δ ≈ −0.92 SD), with gains in improved water (+26 pp), sanitation (+18.7 pp), dietary diversity (+0.78), and maternal schooling (+0.79); however, crowding (+0.08), the child-to-adult ratio (+0.13), and the food budget share (+9 pp) rose. Blinder—Oaxaca results indicate both endowments and returns contributed nationally. Rural areas achieved a smaller gain (Δ ≈ −0.60 SD), driven mainly by stronger returns—especially a steeper HDDS-HAZ gradient—while endowments changed little. Urban-dominant areas saw a larger gain (Δ ≈ −1.56 SD) due to both endowments (household structure, food spending) and returns, with the housing-space coefficient partially offsetting progress. Overall, Zambia's multisectoral approach likely supported broad improvements, but sanitation gaps and urban environmental risks constrained impacts. Priorities: accelerate rural sanitation with hygiene SBC; protect diet quality via food-system actions and social protection; and strengthen urban environmental health.