The challenge
Height-for-age Z-scores (HAZ) are a core measure of child growth, predicting mortality, cognitive development, schooling, and adult earnings, with large societal and economic consequences. Traditional analyses focus on average effects and may miss how determinants differ across the nutritional distribution, limiting the design of effective policies for the most vulnerable children. Timor-Leste, one of the world’s youngest nations and still facing major post-conflict development challenges, has extremely high stunting rates, with nearly half of children under five affected. Yet evidence on which factors matter most for severely stunted children remains scarce.
The research
This project investigates which factors are associated with child Height-for-age Z-scores (HAZ) in Timor-Leste and whether these determinants differ for severely stunted children compared with those who are moderately stunted or better nourished. Using lasso-quantile regression, we examine how influences vary across the full HAZ distribution, focusing on clinically meaningful thresholds such as –3 and –2 standard deviations. Our analysis draws on a new 2023 stratified two-stage clustered survey conducted in nine municipalities, covering 3,191 households with children aged 0–59 months. The dataset includes detailed information across more than 300 variables, enabling a comprehensive assessment of determinants of child growth.
The impact
Improving child nutrition in Timor-Leste requires both national action and targeted interventions based on children’s nutritional status and location. National priorities include reducing severe food insecurity and ensuring universal use of health facilities at birth. For severely stunted children, policies should focus on maternal nutrition, basic infrastructure such as improved flooring and clean cooking fuel, and access to nutrient-rich foods, especially in remote areas. For stunted children, interventions should emphasise environmental improvements—including clean cooking fuel and ventilation—along with stronger infection control through better sanitation, hygiene, and timely treatment, supported by continued investment in local infrastructure.
Our researchers
Diana Contreras Suarez and Silvia Espinosa - Melbourne Institute
Our partners
The Asia Foundation Timor-Leste
Publications
Coming soon.