Kim Drost^1,, Ben Sonneveld¹, Amani Alfarra²

Objective. The study formulates context-sensitive, evidenced-based policy recommendations that guide targeted interventions for reducing child stunting in Suriname. It identifies key variables associated with stunting, including child dietary adequacy, socioeconomic factors, ethnicity, and WASH conditions. Design. Explanatory sequential mixed-methods study in which quantitative analysis of nationally representative survey data preceded and informed semi-structured key-informant interviews. Quantitative and qualitative findings were integrated during interpretation to identify convergence, contextual explanations, and implications for policy. Setting. Suriname, using data from the 2018 UNICEF Multiple Indicator Cluster Survey (MICS) and key-informant interviews conducted in Paramaribo. Participants. Quantitative analyses included 1,212 children aged 0-23 months with complete anthropometric and feeding data from the MICS 2018 Suriname dataset. Qualitative data were obtained from 13 purposively selected stakeholders, including policymakers, researchers, health workers, and community leaders involved in food systems, nutrition, and child health. Results. Multivariate logistic regression analysis shows that male children and children living in households with unimproved sanitation had significantly higher odds of stunting. Children from Maroon backgrounds had significantly lower odds of stunting than Indigenous children, while children from Creole and Hindustani backgrounds showed a tendency toward lower odds of stunting compared with Indigenous children, although the associations did not reach conventional statistical significance. Treated drinking water also showed a suggestive inverse association with stunting. Qualitative findings highlighted economic constraints, geographic isolation, environmental threats, cultural feeding practices, and seasonal food shortages as important contributors to limited dietary diversity and growth faltering. Conclusions. Findings support an integrated approach to reducing child stunting in Suriname, combining improvements in WASH, child dietary adequacy, and access to nutritious foods. Multisectoral coordination and targeted support for geographically and socially vulnerable communities may help address the environmental, dietary, and structural factors identified in this study.

child stunting, child dietary adequacy, socioeconomic inequalities, water, sanitation and hygiene, infant and young child feeding, Small Island Developing States