Prevalence of stunting and its determinants among children under five in 35 Sub-Saharan African countries (2011–2024): Insights from recent demographic health survey data using a generalized linear mixed-effects model with robust poisson regression

Background: Despite efforts by initiatives like the World Bank’s ‘All Hands-on Deck’ and UNICEF’s programs to address stunting through multisectoral approaches, the burden of stunting remains alarmingly high in sub-Saharan Africa. This study utilized recent large-scale survey data from 35 SSA countries (2011–2024) to estimate the pooled prevalence of stunting and its determinants among children under 5 years of age. Key variables such as antenatal care visits, postnatal care, and maternal nutritional indicators, which previous studies did not account for, are incorporated into the analysis. Methods: A secondary analysis was conducted using recent demographic and health survey data (2011–2024) from 35 sub-Saharan African (SSA) countries. A total weighted sample of 191,953 children under 5 years of age was included in the analysis. Descriptive and inferential analyses were performed using STATA 17. Forest plots were utilized to illustrate both pooled and country-specific stunting rates. Determinants of stunting were identified through a multilevel mixed-effects Poisson regression model with robust variance. The adjusted prevalence ratios and their 95% confidence intervals were used to assess the strength and statistical significance of associations. Result: The pooled prevalence of stunting among children under 5 years of age in 35 sub-Saharan African countries was 29.89% (95% CI: 26.63, 33.14%), with the lowest level in Gabon (13.91%) and the highest in Burundi (55.80%). Being male children (aPR = 1.24, 95% CI: 1.21–1.26), being aged 12 months or older (aPR: ≥ 1.81, p