Research Article | | Peer-Reviewed

Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data

Received: 16 October 2025     Accepted: 5 November 2025     Published: 15 January 2026
Views:       Downloads:
Abstract

Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of undernutrition is decreasing in many parts of the developing world, but challenges remain in many countries. For instance,the prevalence of stunting is 30.7% in Africa - higher than the global average of 22.0%. In Kenya, more than a quarter of children under the age of five, or two million children, have stunted growth. Stunting is the most frequent form of under-nutrition among young children. If not addressed, it has devastating long-term effects, including diminished mental and physical development.Child under-nutrition in Kenya has decreased in recent years. Levels of child stunting fell from 35.2% in 2009 to 26% in 2014 and wasting from 7% in 2009 to 4% in 2015. In Kenya, Coast Province has the highest stunting rate with (30.8%) and the lowest in Nairobi Province (17.2%). Despite this advancement, the world is still unlikely to achieve that goal in the global nutrition targets. Our study intends to investigate on crucial prognostic factors influencing child stunting in Coast, Kenya. The principal objective of this paper is to determine the effect of socioeconomic and demographic variables on child stunting in presence of dependencies in clusters and households. The study then uses variable selection technique, which is an artificial intelligence techniques to select covariates with the highest predictive power from the robust KDHS 2022 data. Additionally, a proportional hazards assumption test was carried out for the chosen covariates. Those covariates that satisfied the proportionality assumption were finally included in the frailty model to takes care of the presence of dependencies within the households. Data used were based on the Kenya Demographic and Health Survey (KDHS 2022), which were collected by use of questionnaires. Child stunting from the, KDHS 2022 data, was analyzed in an age period : stunting from the age of 12 months to the age of 60 months, referred to as “child stunting”.

Published in World Journal of Public Health (Volume 11, Issue 1)
DOI 10.11648/j.wjph.20261101.11
Page(s) 1-10
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2026. Published by Science Publishing Group

Keywords

Stunting, Mixed Effects Models, Correlated Data, Function in R Statistical Software, Random Effects, Fixed Effects, Best Linear Unbiased Predictors (BLUP)

References
[1] Beal, T., Tumilowicz, A., Sutrisna, A., Izwardy, D., & Neufeld, L. M. (2018). A review of child stunting determinants in Indonesia. Maternal & child nutrition, 14(4), e12617.
[2] Hoffman, D., Cacciola, T., Barrios, P., & Simon, J.(2017). Temporal changes and determinants of childhood nutritional status in Kenya and Zambia. Journal of Health, Population and Nutrition, 36(1), 1-13.
[3] Global Nutrition report:
[4] Unicef report:
[5] Kenya National Bureau for Statistics report : KNBS. Kenya National Bureau for Statistics (KNBS) (2015) Demographic and health Survey 2014. Nairobi, Kenya: KNBS, Ministry of Health, NACC, KEMRI, NCPD, 2015.
[6] Soliman, A., De Sanctis, V., Alaaraj, N., Ahmed, S., Alyafei, F., Hamed, N., & Soliman, N. (2021). Early and long-term consequences of nutritional stunting: from childhood to adulthood. Acta Bio Medica: Atenei Parmensis, 92(1).
[7] Kramer, C. V., & Allen, S. (2015). Malnutrition in developing countries. Paediatrics and child health, 25(9), 422-427.
[8] Prendergast, A. J., & Humphrey, J. H. (2014). The stunting syndrome in developing countries. Paediatrics and international child health, 34(4), 250-265.
[9] Dewey, K. G., & Begum, K. (2011). Long-term consequences of stunting in early life. Maternal & child nutrition, 7, 5-18.
[10] Wanjiru, W. H. (2021). Improved balanced random survival forest for the analysis of right censored data: application in determining under five child mortality (Doctoral dissertation, Moi University).
[11] Takele, K., Zewotir, T., & Ndanguza, D. (2019). Understanding correlates of child stunting in Ethiopia using generalized linear mixed models. BMC Public Health, 19(1), 1-8.
[12] Hougaard, P. (1995). Frailty models for survival data. Lifetime data analysis, 1(3), 255-273.
[13] Corsi, D. J., Neuman, M., Finlay, J. E., & Subramanian,S. V. (2012). Demographic and health surveys: a profile. International journal of epidemiology, 41(6), 1602-1613.
[14] Keino, S., Plasqui, G., Ettyang, G., & van den Borne, B.(2014). Determinants of stunting and overweight among young children and adolescents in sub-Saharan Africa. Food and nutrition bulletin, 35(2), 167-178.
[15] UNICEF. (2016). The under-five mortality rate: The indispensable gauge of child health.
[16] Black, R. E., Levin, C., Walker, N., Chou, D., Liu, L., Temmerman, M., & Group, D. R. A. (2016). Reproductive, maternal, newborn, and child health: key messages from disease control priorities 3rd edition. The Lancet, 388(10061), 2811-2824.
[17] McGuire, J. W. (2006). Basic health care provision and under-5 mortality: a cross-national study of developing countries. World Development, 34(3), 405-425.
[18] Child Mortality. (2022, January 20). UNICEF DATA.
[19] Nations, U. (2016). The Sustainable Development Goals 2016. eSocialSciences.
[20] Wanjiru, W. H. (2021). Improved balanced random survival forest for the analysis of right censored data: application in determining under five child mortality (Doctoral dissertation, Moi University).
[21] Bereka, S. G., Habtewold, F. G., & Nebi, T. D. (2017). Under-five mortality of children and its determinants in Ethiopian Somali regional state, Eastern Ethiopia. Health Science Journal, 11(3), 1.
[22] Khan, J. R., & Awan, N. (2017). A comprehensive analysis on child mortality and its determinants in Bangladesh using frailty models. Archives of Public Health, 75(1), 1-10.
[23] Sharma, A. K., & Dutta, R. (2020). Determinants of child survival at the household level: An insight of the method of factor analysis. In Contemporary Issues in Sustainable Development (pp. 253-271). Routledge India.
[24] Corsi, D. J., Neuman, M., Finlay, J. E., & Subramanian,S. V. (2012). Demographic and health surveys: a profile. International journal of epidemiology, 41(6), 1602-1613.
[25] Burnham, K. P. (2000). Model selection and multimodel inference. A practical information-theoretic approach.
[26] Nelson Owuor Onyango (2009). On the Linear Mixed Effects Regression (lmer) R Function for Nested Animal Breeding Data. CS-BIGS 4(1): 44-58.
[27] Searle, S. R., Casella, G., & McCulloch, C. E. (2009). Variance components. John Wiley & Sons.
[28] Patterson, H. D. (1971). Thompson R. Recovery of inter-block information when block sizes are unequal. Biometrika, 58, 545-554.
[29] Duchateau, L., Janssen, P., & Rowlands, J. (1998). Linear mixed models. An introduction with applications in veterinary research. ILRI (aka ILCA and ILRAD).
[30] Ayiko, R., Antai, D., & Kulane, A. (2009). Trends and determinants of under-five mortality in Uganda. East African journal of public health, 6(2), 136-140.
[31] Nasejje, J. B., Mwambi, H. G., & Achia, T. N.(2015). Understanding the determinants of under-five child mortality in Uganda including the estimation of unobserved household and community effects using both frequentist and Bayesian survival analysis approaches. BMC public health, 15(1), 1003.
[32] Sreeramareddy, C. T., Kumar, H. N., & Sathian, B.(2013). Time Trends and Inequalities of Under-Five Mortality in Nepal: A Secondary Data Analysis of Four Demographic and Health Surveys between 1996 and 2011. PLoS ONE, 8(11): e79818.
[33] Verweij, P. J., & van Houwelingen, H. C. (1995). Time-dependent effects of fixed covariates in Cox regression. Biometrics, 1550-1556.
[34] Cox, D. R., & Oakes, D. (1984). Analysis of survival data. Chapman and Hall/CRC.
[35] Lee, E. T., & Wang, J. (2003). Statistical methods for survival data analysis. (vol. 476). John Wiley & Sons.
[36] Ratnaningsih, D. J., Saefuddin, A., Kurnia, A., & Mangku, I. W. (2019, July). Stratified-extended cox model in survival modeling of non-proportional hazard. In IOP Conference Series: Earth and Environmental Science (vol. 299, No. 1, p. 012023). IOP Publishing.
[37] Vaupel, J. W., Manton, K. G., & Stallard, E. (1979). The impact of heterogeneity in individual frailty on the dynamics of mortality. Demography, 16(3), 439-454.
[38] Weathers, B. (2017). Comparision of Survival Curves Between Cox Proportional Hazards, Random Forests, and Conditional Inference Forests in Survival Analysis.
[39] Muriithi, D. M., & Muriithi, D. K. (2015). Determination of infant and child mortality in Kenya using cox-proportional hazard model. American Journal of Theoretical and Applied Statistics, 4(5), 404-413.
[40] Otieno, F., & Omolo, C. (2003). Infant and child mortality. Kenya demographic and health survey, 114-122.
Cite This Article
  • APA Style

    Ogolla, O., Simwa, R., Kipkoech, C. (2026). Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data. World Journal of Public Health, 11(1), 1-10. https://doi.org/10.11648/j.wjph.20261101.11

    Copy | Download

    ACS Style

    Ogolla, O.; Simwa, R.; Kipkoech, C. Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data. World J. Public Health 2026, 11(1), 1-10. doi: 10.11648/j.wjph.20261101.11

    Copy | Download

    AMA Style

    Ogolla O, Simwa R, Kipkoech C. Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data. World J Public Health. 2026;11(1):1-10. doi: 10.11648/j.wjph.20261101.11

    Copy | Download

  • @article{10.11648/j.wjph.20261101.11,
      author = {Ombaka Ogolla and Richard Simwa and Cheruiyot Kipkoech},
      title = {Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data
    },
      journal = {World Journal of Public Health},
      volume = {11},
      number = {1},
      pages = {1-10},
      doi = {10.11648/j.wjph.20261101.11},
      url = {https://doi.org/10.11648/j.wjph.20261101.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.wjph.20261101.11},
      abstract = {Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of undernutrition is decreasing in many parts of the developing world, but challenges remain in many countries. For instance,the prevalence of stunting is 30.7% in Africa - higher than the global average of 22.0%. In Kenya, more than a quarter of children under the age of five, or two million children, have stunted growth. Stunting is the most frequent form of under-nutrition among young children. If not addressed, it has devastating long-term effects, including diminished mental and physical development.Child under-nutrition in Kenya has decreased in recent years. Levels of child stunting fell from 35.2% in 2009 to 26% in 2014 and wasting from 7% in 2009 to 4% in 2015. In Kenya, Coast Province has the highest stunting rate with (30.8%) and the lowest in Nairobi Province (17.2%). Despite this advancement, the world is still unlikely to achieve that goal in the global nutrition targets. Our study intends to investigate on crucial prognostic factors influencing child stunting in Coast, Kenya. The principal objective of this paper is to determine the effect of socioeconomic and demographic variables on child stunting in presence of dependencies in clusters and households. The study then uses variable selection technique, which is an artificial intelligence techniques to select covariates with the highest predictive power from the robust KDHS 2022 data. Additionally, a proportional hazards assumption test was carried out for the chosen covariates. Those covariates that satisfied the proportionality assumption were finally included in the frailty model to takes care of the presence of dependencies within the households. Data used were based on the Kenya Demographic and Health Survey (KDHS 2022), which were collected by use of questionnaires. Child stunting from the, KDHS 2022 data, was analyzed in an age period : stunting from the age of 12 months to the age of 60 months, referred to as “child stunting”.
    },
     year = {2026}
    }
    

    Copy | Download

  • TY  - JOUR
    T1  - Hierarchical Modeling of Child Stunting Using Kenya Demographic Health Survey Data
    
    AU  - Ombaka Ogolla
    AU  - Richard Simwa
    AU  - Cheruiyot Kipkoech
    Y1  - 2026/01/15
    PY  - 2026
    N1  - https://doi.org/10.11648/j.wjph.20261101.11
    DO  - 10.11648/j.wjph.20261101.11
    T2  - World Journal of Public Health
    JF  - World Journal of Public Health
    JO  - World Journal of Public Health
    SP  - 1
    EP  - 10
    PB  - Science Publishing Group
    SN  - 2637-6059
    UR  - https://doi.org/10.11648/j.wjph.20261101.11
    AB  - Child stunting reduction is the first of 6 goals in the Global Nutrition Targets for 2025 and a key indicator in the second Sustainable Development Goal of Zero Hunger. The prevalence of undernutrition is decreasing in many parts of the developing world, but challenges remain in many countries. For instance,the prevalence of stunting is 30.7% in Africa - higher than the global average of 22.0%. In Kenya, more than a quarter of children under the age of five, or two million children, have stunted growth. Stunting is the most frequent form of under-nutrition among young children. If not addressed, it has devastating long-term effects, including diminished mental and physical development.Child under-nutrition in Kenya has decreased in recent years. Levels of child stunting fell from 35.2% in 2009 to 26% in 2014 and wasting from 7% in 2009 to 4% in 2015. In Kenya, Coast Province has the highest stunting rate with (30.8%) and the lowest in Nairobi Province (17.2%). Despite this advancement, the world is still unlikely to achieve that goal in the global nutrition targets. Our study intends to investigate on crucial prognostic factors influencing child stunting in Coast, Kenya. The principal objective of this paper is to determine the effect of socioeconomic and demographic variables on child stunting in presence of dependencies in clusters and households. The study then uses variable selection technique, which is an artificial intelligence techniques to select covariates with the highest predictive power from the robust KDHS 2022 data. Additionally, a proportional hazards assumption test was carried out for the chosen covariates. Those covariates that satisfied the proportionality assumption were finally included in the frailty model to takes care of the presence of dependencies within the households. Data used were based on the Kenya Demographic and Health Survey (KDHS 2022), which were collected by use of questionnaires. Child stunting from the, KDHS 2022 data, was analyzed in an age period : stunting from the age of 12 months to the age of 60 months, referred to as “child stunting”.
    
    VL  - 11
    IS  - 1
    ER  - 

    Copy | Download

Author Information
  • Sections