Predictors of Stunting among School-Age Children in Northwestern Ethiopia

Prevalence and risk predictors of childhood stunting in Bangladesh

BACKGROUND

The child nutritional status of a country is a potential indicator of socioeconomic development. Child malnutrition is still the leading cause of severe health and welfare problems across Bangladesh. The most prevalent form of child malnutrition, stunting, is a serious public health issue in many low and middle-income countries. This study aimed to investigate the heterogeneous effect of some child, maternal, household, and health-related predictors, along with the quantiles of the conditional distribution of Z-score for height-for-age (HAZ) of under five children in Bangladesh.

METHODS AND MATERIALS

In this study, a sample of 8,321 children under five years of age was studied from BDHS-2017-18. The chi-square test was mainly used to identify the significant predictors of the HAZ score and sequential quantile regression was used to estimate the heterogeneous effect of the significant predictors at different quantiles of the conditional HAZ distribution.

RESULTS

The findings revealed that female children were significantly shorter than their male counterparts except at the 75th quantile. It was also discovered that children aged 7-47 months were disadvantaged, but children aged 48-59 months were advantaged in terms of height over children aged 6 months or younger. Moreover, children with a higher birth order had significantly lower HAZ scores than 1st birth order children. In addition, home delivery, the duration of breastfeeding, and the BCG vaccine and vitamin A received status were found to have varied significant negative associations with the HAZ score. As well, seven or fewer antenatal care visits was negatively associated with the HAZ score, but more than seven antenatal care visits was positively associated with the HAZ score. Additionally, children who lived in urban areas and whose mothers were over 18 years and either normal weight or overweight had a significant height advantage. Furthermore, parental secondary or higher education had a significant positive but varied effect across the conditional HAZ distribution, except for the mother's education, at the 50th quantile. Children from wealthier families were also around 0.30 standard deviations (SD) taller than those from the poorest families. Religion also had a significant relationship with the conditional HAZ distribution in favor of non-Muslim children.

CONCLUSIONS

To enhance children's nutritional levels, intervention measures should be designed considering the estimated heterogeneous effect of the risk factors. This would accelerate the progress towards achieving the targets of Sustainable Development Goals (SDGs) related to child and maternal health in Bangladesh by 2030.

Factors driving underweight, wasting, and stunting among urban school aged children: Evidence from Merawi town, Northwest Ethiopia

Prior research identified malnutrition as one of the most common causes of morbidity and mortality among children globally. Furthermore, research revealed that over two thirds of deaths associated with inappropriate feeding practices occurred during the early years of life. Improper feeding practices impact a child's health in many different ways. However, research on the possible factors driving underweight, wasting, and stunting among school aged children in developing countries is limited, hence warrant further attention. Against this backdrop, this research strives to identify and assess the determinants of underweight, wasting and stunting among school aged children of a developing country-Ethiopia. A community based cross-sectional study was conducted from April 1, 2018 to June 15, 2018 in Merawi town, Ethiopia. An interviewer-administered questionnaire was used to collect data from a sample of 422 children. Binary logistic regression technique was performed to examine the effect of each selected variable on the outcome measure. The prevalence of being underweight, wasting and stunting was found to be 5.7%, 9.8%, 10.4%, respectively. The age of the child [adjusted odds ratio (AOR) = 12.930 (2.350, 71.157)] and the number of children [AOR = 8.155 (1.312, 50.677)] were emerged as the key determinants for underweight, and the gender of the child was significantly associated with wasting [AOR = 0.455 (0.224, 0.927)]. Finally, the age of the child [AOR = 12.369 (2.522, 60.656)] was found to predict the risk of stunting. This study revealed the age, number of children and gender of the child to have a significant association with malnutrition. The findings of this research suggest that in improving the feeding practices of young school-aged children, special attention should be paid to female children and those coming from relatively large families.

Differences in nutritional status between rural and urban Yucatec Maya children: The importance of early life conditions

Early‐life conditions shape childhood growth and are affected by urbanization and the nutritional transition. To investigate how early‐life conditions (across the “first” and “second” 1000 days) are associated with rural and urban children's nutritional status, we analyzed anthropometric data from Maya children in Yucatan, Mexico. We collected weight, height and triceps skinfold measures, then computed body mass and fat mass indices (BMI/FMI), in a cross‐sectional sample of 6‐year‐olds (urban n = 72, rural n = 66). Demographic, socioeconomic and early‐life variables (birthweight/mode, rural/urban residence, household crowding) were collected by maternal interview. We statistically analyzed rural‐urban differences in demographic, socioeconomic, early‐life, and anthropometric variables, then created linear mixed models to evaluate associations between early‐life variables and child anthropometric outcomes. Two‐way interactions were tested between early‐life variables and child sex, and between early‐life variables and rural‐urban residence. Results showed that rural children were shorter‐statured, with lower overweight/obesity and cesarean delivery rates, compared to urban children. Household crowding was a negative predictor of anthropometric outcomes; the strongest effect was in boys and in urban children. Birthweight positively predicted anthropometric outcomes, especially weight/BMI. Birth mode was positively (not statistically) associated with any anthropometric outcome. Cesarean delivery was more common in boys than in girls, and predicted increased height in urban boys. In conclusion, urbanization and household crowding were the most powerful predictors of Maya 6‐year‐old anthropometry. The negative effects of crowding may disproportionately affect Maya boys versus girls and urban versus rural children. Early‐life conditions shape Maya children's nutritional status both in the “first” and “second” 1000 days.

Prevalence of Tungiasis and its risk factors of among children of Mettu woreda, southwest Ethiopia, 2020

Tungiasis is caused by the flea tunga penetrans and results in painful skin lesions, skin infections, and permanent disability. However, limited information is available that shows the magnitude of the problem and its risk factors that help for intervention in Ethiopia. The goal of this study was to determine the prevalence and risk factors of tungiasis in children aged 5 to 14 in Mettu woreda in 2020. A community based cross sectional study was conducted among randomly selected kebeles of Mettu woreda, in Southwest Ethiopia. To select study participants, multistage sampling was used. The data were collected through physical examination of the children, interview of parents/guardians of the children, and observation of the home environment using checklists and questionnaires. The descriptive analysis was done for socio-demographic characteristics, prevalence of tungiasis, and housing conditions. A logistic regression analysis was performed, and variables in multivariable regression reported odds ratios and their 95% confidence intervals once the variables were identified using a p-value of 0.05 as a risk factor of statistical significance. The prevalence of tungiasis among children 5–14 years of age in Mettu rural woreda was 52 percent (n = 821). As a risk factor, large family size (AOR: 2.9, 95% CI: 2.13, 4.40); school attendance (AOR: 1.5, 95% CI: 1.02, 2.18), floor inside the house (AOR: 3.8, 95% CI: 1.76, 8.43); having sleeping bed (AOR: 0.16, 95% CI: 0.03, 0.82); access to protected water sources (AOR: 0.24, 95% CI: 0.15, 0.39); access to improved toilet facilities(AOR: 0.63: 95% CI: 0.44, 0.89); access to electric services (AOR: 0.30, 95% CI: 0.15, 0.62); and lack of own farmland (AOR: 0.36, 95% CI: 0.26, 0.50) were found. Therefore, planning and implementation of interventions focus on those risk factors that are particularly important. Water, sanitation and hygiene interventions, and livelihood improvement interventions are required to solve the problem in the setting.

Nutritional Status and Associated Factors among Primary Schoolchildren from Pastoral Communities, Mieso-Mulu District, Sitti Zone, Somali Regional State, Eastern Ethiopia: Institution-Based Cross-Sectional Study

BACKGROUND

Child undernourishment is the disturbance of body function arising from a dietary imbalance between body demand and supply, which is the most serious public health problem in developing countries.

OBJECTIVE

This study aimed to assess the magnitude of nutritional status and associated factors among full-cycle primary schoolchildren in pastoral communities in the Mieso-Mulu district, Sitti Zone, Somali Regional State of Ethiopia.

METHODS

An institution-based cross-sectional study design was used. Study participants were selected using two-stage sampling procedures. Data were collected using structured, translated, pretested, and interviewer-administered questionnaires. The weight and height were measured using a calibrated digital scale and a Seca Rod stadiometer, respectively. Microscopic identification of intestinal parasites was done. Multicollinearity was checked for independent variables. Height for age z scores (HAZ) and body mass index for age z scores (BAZ) were used to determine the nutritional status of children. Logistic regression with both bivariate analysis and multivariate analysis was applied to identify associated factors with the nutritional status of children. Adjusted odds ratios were reported and the level of statistical significance was declared at a P value <0.05.

RESULTS

The magnitudes of thinness and stunting were 13.1% [95% CI: 10.6%, 15.7%] and 24.6% [95% CI: 21.3%, 27.9%], respectively. Being male, not using a bed net, and the presence of intestinal parasitic infection were among the factors associated with thinness. Family size of less than five, household food insecurity, and unavailability of the latrine were among the factors associated with stunting.

CONCLUSION

This study revealed that stunting and thinness are major health problems among schoolchildren. Household food insecurity, intestinal parasitic infection, bed net utilization, and the availability of latrine were some of the major factors significantly associated with undernutrition. Local policymakers, health programmers, nutritionists, health practitioners, and nongovernmental organizations should enhance the nutritional status of schoolchildren by using information dissemination interventions, particularly in improving waste disposal, sanitation/hygiene, latrine facilities, and school-based deworming. Furthermore, awareness creation using nutrition promotion and encouraging communities to attempt to diversify locally available and low-cost nutritionally effective food items to improve food consumption and distribution within a household is recommended to reduce the prevalence of undernutrition among schoolchildren.

The prevalence and associated factors of undernutrition among under-five children in South Sudan using the standardized monitoring and assessment of relief and transitions (SMART) methodology

Background

Conflict regions bear the heaviest brunt of food insecurity and undernutrition. South Sudan is one of the fragile countries following years of conflict that led to large displacements. Moderate to severe undernutrition among under-five children has been associated with elevated morbidity and mortality. This study, therefore, was conducted to assess the magnitude and factors influencing undernutrition (wasting, underweight and stunting) among children aged 6 to 59 months in Yambio County, South Sudan.

Methods

A cross-sectional study was conducted from 26 October to 6 November 2018 in Yambio County, South Sudan among 630 children aged 6–59 months from the 348 households surveyed in 39 clusters using two-stage cluster sampling design. Data were collected using questionnaires and nutritional anthropometric measurements. The Standardized Monitoring and Assessment of Relief and Transitions (SMART) Methodology was followed to obtain the prevalence of wasting, underweight and stunting based on respective z scores and according to the 2006 world health organization child growth standards. Data were exported to Stata version 16 for further analysis. Bivariate analysis of independent variables and undernutrition was done using binary logistic regression. Mixed effects logistic regression analysis was conducted to control for possible confounders and account for random effects at household and cluster levels. Unadjusted and adjusted odds ratios (cOR and aOR) with 95% confidence intervals (CI) and p-values were computed. P-values of ≤0.05 were considered statistically significant.

Results

The prevalence of undernutrition explained by wasting (weight-for-height Z-score (WHZ) < − 2), underweight (weight-for-age z-scores (WAZ) < − 2) and stunting (height-for-age z-scores (WHZ) < − 2) were 2.3% (1.3–4.1, 95% CI), 4.8% (3.1–7.5, 95% CI) and 23.8% (19.1–29.2, 95% CI). Male sex (aOR [95% CI], p-value: 5.6 [1.10–30.04], p = 0.038), older child’s age (aOR [95% CI], p-value: 30.4 [2.65–347.60], p = 0.006) and non-residents (cOR [95% CI], p-value: 4.2 [1.4–12.2] p = 0.009) were associated with increased risk of wasting. Household size (cOR [95% CI], p-value: 1.09 [1.01–1.18] p = 0.029) and younger child age (cOR [95% CI], p-value: 4.2 [1.34–13.23] p = 0.014) were significantly associated with underweight. Younger child age (aOR [95% CI], p-value: 5.4 [1.82–16.44] p = 0.003) and agricultural livelihood (aOR [95% CI], p-value: 3.4 [1.61–7.02] p = 0.001) were associated with stunting.

Conclusion

Based on a cut off of less than − 2 standard deviations for 2006 World Health Organization (WHO) child growth standards, the wasting prevalence was very low, underweight prevalence was low while stunting prevalence was high. The county lies in the only livelihood region in South Sudan with bimodal reliable rainfall pattern and it seems that the impact of the 2016 conflicts that lead to large displacements may not have greatly affected under-five undernutrition. Interventions targeted at improving food diversity, increasing nutrition knowledge and enhancing resilience in male children might reduce undernutrition. In the short-term, investment in continued surveillance of nutritional status should be a main focus.

Prevalence of stunting and associated factors among public primary school pupils of Bahir Dar city, Ethiopia: School-based cross-sectional study

Background

Stunting is a well-established child-health indicator of chronic malnutrition, which reliably gives a picture of the past nutritional history and the prevailing environmental and socioeconomic circumstances.

Objective

To investigate the prevalence of stunting and associated factors among public primary school children of the Bahir Dar city.

Method

A cross-sectional study was carried out from March to June 2019. Data were coded and entered into the Epi-Data and exported to SPSS version 23 software. The pupil was stunted if the height- for-age was ≤ -2 SDs from the median growth standards according to the WHO. A descriptive summary was computed using frequency, percent, mean, median and standard deviation. A simple logistic regression model was fitted to identify associated factors between the independent variables and the dependent variable at a 95% confidence interval (CI) and p-value <0.05.

Results

370 primary school pupils were included in the study with the mean age of 10.15 (± 2.23 SD) years. 51.6% of the pupils were females. The total prevalence of stunting was 15.13% (95%CI; 11%, 19%). The burden of stunting was higher in the age group of 11 years and older. Pupil’s age older than 11 years (AOR = 15. 6; 95%CI; 3.31, 73.45; p-value < 0. 001) and male sex (AOR = 7. 07; 95%CI: 2.51, 19.89; p-value < 0. 0002) were significantly associated with stunting.

Conclusion

The prevalence of stunting was relatively lower than the regional estimated stunting level. Older age and male sex were significantly associated with stunting.

Stunting and Combined Overweight with Stunting among Schoolchildren in Kuwait: Trends over a 13-Year Period

OBJECTIVES

This study aimed to investigate the sex- and age-specific trends of stunting and combined overweight with stunting among schoolchildren over a 13-year period in Kuwait.

SUBJECTS AND METHODS

The Kuwait Nutrition Surveillance System objectively measured the height of 172,573 schoolchildren (5-19 years) over a 13-year period (2007-2019). Data on gender and date of birth were extracted from school records. Stunting was defined as height 2 standard deviations (SD) below the World Health Organization growth reference median. Logistic regression models were used to examine the trends of stunting over the study period while stratifying by gender.

RESULTS

In males, the prevalence of stunting increased from 2.46% in 2007 to 4.18% in 2019 (p for trend <0.001). In females, the prevalence of stunting fluctuated but remained around 3.80% in both 2007 and 2019. The odds of stunting significantly increased in the period 2017-2019 compared to the period 2007-2010 among males, adjusted odds ratio (AOR) 1.04 (95% confidence interval [CI]: 1.14-1.76); p = 0.009, but not females, AOR 0.89 (95% CI: 0.73-1.07); p = 0.176. Although not statistically significant, there was a tendency for the odds of combined overweight with stunting to increase in males, AOR 1.65 (95% CI: 0.90-3.04); p = 0.087, but not females, AOR 1.13 (95% CI: 0.88-1.45); p = 0.248.

CONCLUSION

Although the prevalence of stunting and combined stunting with overweight is low, there is an emerging upward trend in schoolboys that warrants further investigation and monitoring. This highlights the need for gender-specific interventions to reduce nutritional abnormalities in high-income countries in the Middle East countries like Kuwait.

Child dietary diversity and food (in)security as a potential correlate of child anthropometric indices in the context of urban food system in the cases of north-central Ethiopia

OBJECTIVE

To investigate the relation of child dietary diversity and household food insecurity along with other socio-demographic with child anthropometric indices in north-central Ethiopia, an area with a high level of food insecurity and inadequate diet quality.

DESIGN

A community-based cross-sectional study was used.

SETTINGS

The study was conducted in Dessie and Combolcha towns of north-central Ethiopia from April to May 2018.

PARTICIPANTS

Randomly selected 512 mother-child pairs with child's age range of 6-59 months.

RESULTS

The mean (± SD) scores of weight-for-height/length, height/length-for-age, weight-for-age, and BMI-for-age Z-scores were 1.35 (± 2.03), - 1.89 (± 1.79), 0.05 (± 1.54), and 1.39 (± 2.06), respectively. From all anthropometric indicators, stunting and overweight/obesity remained the severe public issues hitting 43% and 42% of the children, respectively. In the model, mothers' age and education and child's age, sex, and dietary diversity were significantly related with child height-for-age Z-score while place of residence, sex of household head, child's age, and dietary diversity score were the predictors of child BMI-for-age Z-score in the urban contexts of the study area. Nevertheless, food insecurity was not related to any of the child anthropometric indices.

CONCLUSION

The double burden of malnutrition epidemics (stunting and obesity) coexisted as severe public health concerns in urban settings. Anthropometric statuses of children were affected by multidimensional factors and seek strong integration and immediate intervention of multiple sectors.

Prevalence and Determinants of Stunting and Thinness/Wasting Among Schoolchildren of Ethiopia: A Systematic Review and Meta-Analysis

BACKGROUND

Several studies have been carried out assessing the prevalence of undernutrition and possible determinants among schoolchildren in Ethiopia, but there is a lack of systematically gathered and analyzed information.

OBJECTIVE

This systematic review and meta-analysis aimed to summarize epidemiological data on undernutrition and possible determinants among schoolchildren in Ethiopia.

METHODS

We conducted a systematic review using open access articles that report the prevalence of stunting and wasting/thinness among schoolchildren from PubMed Central, Scopus, and Science direct. The pooled prevalence was determined using a random-effect model while heterogeneities between studies were evaluated by I ² test.

RESULTS

A total of 24 716 schoolchildren were included in the 39 eligible articles. The prevalence of stunting and wasting/thinness among schoolchildren in Ethiopia were 23.1% (95% CI: 19.0-27.0) and 22% (95% CI: 17-26), respectively. There was a marked difference in the prevalence of stunting and wasting/thinness across regions of Ethiopia. The risk of stunting was increased with meal frequency ≤3 times a day (odds ratio [OR] = 3.02, 95% CI: 1.90-4.14), age >10 years (OR = 2.16, 95% CI: 1.47-2.85), and family size ≥5 (OR = 1.88, 95% CI: 1.40-2.35). Similarly, the risk of wasting/thinness was increased with male sex (OR = 2.06, 95% CI: 1.54-2.58), low family income (OR = 2.16, 95% CI: 1.30-3.01), and age >10 years (OR = 1.78, 95% CI: 0.74-2.82).

CONCLUSION

This study revealed that more than one-fifth of schoolchildren are stunted or wasted/thin in Ethiopia. Large family size, male sex, and student age were consistently associated with stunting and wasting/thinness among schoolchildren. This study highlights the importance of an integrated effort to reduce undernutrition in Ethiopia.

Faktor Risiko Stunting pada anak di Negara Berkembang

Background: The problem of stunting occurs in developing countries including Indonesia. In Indonesia the prevalence of child stunting is 30.8%, still above the world prevalence, which is 22.2%. The prevalence of stunting in sub-Saharan Africa is 34.5%, in Ethiopia is 52.4%, and the prevalence of stunting in Congo is 40%. While WHO stipulates that nutrition problems should not exceed 20%. Stunting could inhibit linear growth, development and degenerative diseases later in adulthood.Objective: This review discussed the risk factors of child stunting in developing countries.Discusion: One of the causes of increased stunting in children was due to inadequate nutritional intake in a long period. Stunting was often not realized by parents and only visible after the age of 2 due to low stature. Based on the results of the literature review the likelihood of stunting in developing country were: 16.43 times morelikely due to low birth length, 3.27 times higher due to maternal education, 2.45 times higher if the children were living in rural area, 4.5 times higher due to low birth weight, no risk Antenatal Care increase the risk 3.4 times, 6.38 times higher due to no immunization, and no exclusive breastfeeding increase the risk of stunting 4.0 times.Conclusion: The risk factor for child stunting in developing countries are exclusive breastfeeding, socioeconomic, low birth weight, length of birth, low maternal education, infectious disease.ABSTRAKLatar Belakang: Masalah stunting (stunting) yang terjadi di Negara Berkembang seperti Indonesia masih tinggi yaitu 30,8% masih  di atas dunia yaitu 22,2%.  Stunting di sub sahara Afrika 34,5%, di Ethiopia  52,4%, prevalensi stunting di Congo 40%. Word Health Organization sudah menentukan bahwa terjadinya masalah gizi suatu negara sebaiknya kurang dari 20%. Stunting memiliki risiko gangguan pertumbuhan, perkembangan dan penyakit degeneratif pada usia dewasa nanti.Tujuan: Review ini bertujuan untuk mengidentifikasi faktor risikos apa saja yang dapat menentukan terjadinya stunting anak di Negara berkembang.Ulasan: Berdasarkan dari beberapa hasil penelitian menyebutkan bahwa salah satu penyebab stunting pada anak adalah karena tidak terpenuhinya gizi yang baik pada kurun waktu yang panjang dan sering kali tidak disadari oleh orang tuanya sehingga setelah anak usia di atas 2 tahun baru terlihat bahwa anaknya mengalami stunting. Berdasarkan hasil literatur review menunjukkan bahwa faktor risiko terjadinya stunting adalah panjang lahir berisiko 16,43 kali, pendidikan ibu yang rendah berisiko 3,27 kali, serta anak yang tinggal di desa berisiko 2,45 kali,  BBLR berisiko 4,5 kali, tidak ANC berisiko 3,4 kali, tidak imunisasi berisiko 6,38 kali, dan tidak ASI Eksklusif berisiko 4,0 kali  adalah merupakan faktor risiko  stunting anak di negara berkembang.Kesimpulan: Hasil sintesis ini secara konsisten yang menjadi faktor risikos terjadinya stunting pada anak di negara berkembang adalah tidak diberikan ASI eksklusif, sosial ekonomi, berat bayi lahir rendah, panjang lahir, pendidikan ibu rendah, penyakit infeksi.

Childhood Undernutrition and Its Predictors in a Rural Health and Demographic Surveillance System Site in South Africa

BACKGROUND

Overweight and obesity are increasing at an alarming rate in South Africa, while childhood undernutrition remains persistently high. This study determined the magnitude and predictors of stunting and underweight among schoolchildren in the Dikgale and Health Demographic Surveillance System Site, a rural site in South Africa.

METHODS

A cross sectional study using multistage sampling was conducted among 508 schoolchildren and their mothers. Anthropometric measurements were taken from children and their mothers, while sociodemographic information was obtained from mothers using a questionnaire. The World Health Organization Anthro Plus was used to generate height-for-age and weight-for-age z-scores to indicate stunting and underweight, respectively, among the children. Maternal overweight and obesity were assessed using body mass index. Bivariate and multivariate logistic regression analyses were used to evaluate the predictors of stunting and underweight among schoolchildren.

RESULTS

Twenty-two percent (22%) of children were stunted and 27% were underweight, while 27.4% of the mothers were overweight and 42.3% were obese. The odds of being stunted were lower in younger children, whereas having a mother who was overweight/obese and had a short stature increased the odds of stunting. Access to water, having a refrigerator, and having a young mother were protective against being underweight. Having a mother who was overweight/obese increased the odds of being underweight.

CONCLUSIONS

The study showed a high prevalence of stunting and underweight among children, and overweight and obesity among mothers, indicating a household double burden of malnutrition. The age of the child and maternal overweight/obesity and short stature were predictors of stunting and underweight, while having a younger mother and access to water and a refrigerator were protective against being underweight. The need for an evidence-based and feasible nutrition program for schoolchildren, especially those in rural schools, cannot be over-emphasized.