Determinants of reduced child stunting in Cambodia: analysis of pooled data from three demographic and health surveys

The role of national nutrition programs on stunting reduction in Rwanda using machine learning classifiers: a retrospective study

BACKGROUND

In Rwanda, the prevalence of childhood stunting has slightly decreased over the past five years, from 38% in 2015 to about 33% in 2020. It is evident whether Rwanda's multi-sectorial approach to reducing child stunting is consistent with the available scientific knowledge. The study was to examine the benefits of national nutrition programs on stunting reduction under two years in Rwanda using machine learning classifiers.

METHODS

Data from the Rwanda DHS 2015-2020, MEIS and LODA household survey were used. By evaluating the best method for predicting the stunting reduction status of children under two years old, the five machine learning algorithms were modelled: Support Vector Machine, Logistic Regression, K-Near Neighbor, Random Forest, and Decision Tree. The study estimated the hazard ratio for the Cox Proportional Hazard Model and drew the Kaplan-Meier curve to compare the survivor risk of being stunted between program beneficiaries and non-beneficiaries. Logistic regression was used to identify the nutrition programs related to stunting reduction. Precision, recall, F1 score, accuracy, and Area under the Curve (AUC) are the metrics that were used to evaluate each classifier's performance to find the best one.

RESULTS

Based on the provided data, the study revealed that the early childhood development (ECD) program (p-value = 0.041), nutrition sensitive direct support (NSDS) program (p-value = 0.03), ubudehe category (p-value = 0.000), toilet facility (p-value = 0.000), antenatal care (ANC) 4 visits (p-value = 0.002), fortified blended food (FBF) program (p-value = 0.038) and vaccination (p-value = 0.04) were found to be significant predictors of stunting reduction among under two children in Rwanda. Additionally, beneficiaries of early childhood development (p  < .0001), nutrition sensitive direct support (p = 0.0055), antenatal care (p = 0.0343), Fortified Blended Food (p = 0.0136) and vaccination (p = 0.0355) had a lower risk of stunting than non-beneficiaries. Finally, Random Forest performed better than other classifiers, with precision scores of 83.7%, recall scores of 90.7%, F1 scores of 87.1%, accuracy scores of 83.9%, and AUC scores of 82.4%.

CONCLUSION

The early childhood development (ECD) program, receiving the nutrition sensitive direct support (NSDS) program, focusing on households with the lowest wealth quintile (ubudehe category), sanitation facilities, visiting health care providers four times, receiving fortified blended food (FBF), and receiving all necessary vaccines are what determine the stunting reduction under two among the 17 districts of Rwanda. Finally, when compared to other models, Random Forest was shown to be the best machine learning (ML) classifier. Random forest is the best classifier for predicting the stunting reduction status of children under two years old.

Effects of short birth interval on child malnutrition in the Asia-Pacific region: Evidence from a systematic review and meta-analysis

Child malnutrition remains a significant concern in the Asia-Pacific region, with short birth intervals recognised as a potential risk factor. However, evidence of this association is inconclusive. This study aimed to systematically review the existing evidence and assess the summary effects of short birth interval on child malnutrition in the Asia-Pacific region. Five electronic databases were searched in May 2023 to identify relevant studies reporting the association between short birth interval and child malnutrition, including stunting, wasting, underweight, anaemia and overall malnutrition, in Asia-Pacific region between September 2000 and May 2023. Fixed-effects or random-effects meta-analysis was performed to estimate the summary effects of short birth interval on child malnutrition. Out of 56 studies meeting the inclusion criteria, 48 were included in quantitative synthesis through meta-analysis. We found a slightly higher likelihood of stunting (n = 25, odds ratio [OR] = 1.13; 95% confidence interval [CI]: 0.97-1.32) and overall malnutrition (n = 3, OR = 2.42; 95% CI: 0.88-6.65) among children born in short birth intervals compared to those with nonshort intervals, although the effect was not statistically significant. However, caution is warranted due to identified heterogeneity across studies. Subgroup analysis demonstrated significant effects of short birth intervals on child malnutrition in national-level studies and studies with larger sample sizes. These findings underscore short birth intervals as a significant contributor to child malnutrition in the Asia-Pacific region. Implementing effective policies and programs is vital to alleviate this burden, ultimately reducing child malnutrition and associated adverse outcomes, including child mortality.

Determinants of stunting among under-five children: Evidence from Cambodian Demographic and Health Survey 2021-2022

BACKGROUND

Epidemiological and nutritional modifications are causing an increase in stunting in many low- and middle-income countries (LMIC), which will eventually result in juvenile diseases and mortality. Therefore, this study aimed to identify the influential factors contributing to stunting among under-five children in Cambodia.

METHODS

A secondary dataset consisting of 3268 under-five children was extracted from the latest Cambodian Demographic and Health Survey (CDHS)-2021/2022 dataset. The Chi-square test and Boruta algorithm were used for covariate selection, and logistic regression approaches were used to determine the influence of demographic, socioeconomic and other factors on the presence of stunting.

RESULTS

Findings revealed that about 21% of under-five children were stunted, and the prevalence of stunting was higher in rural areas than in urban areas. The prevalence of child stunting was lower in families with highly educated parents. A child whose father had a secondary education had 0.71 times lower (adjusted odds ratio [AOR]: 0.71, 95% CI: 0.520-0.969) chance of stunting than a child whose father had no education. Findings revealed that Ratnak Kiri, Mondul Kiri, Stung Treng, Pursat and Kampot had a greater prevalence of stunting than other places, ranging from 27.11% to 35.70%, whereas Banteay Meanchey, Phnom Penh and Kandal had the lowest rates, ranging from 12.80% to 16.00%. Results of the Boruta algorithm and logistic regression suggested that under-five stunting is significantly influenced by factors such as the child's age, size at birth, mother's age at first birth, mother's body mass index (BMI), father's educational status, cooking fuel, and wealth index.

CONCLUSIONS

It is necessary to take initiatives for reducing the prevalence of stunted children prioritising the identified factors that ultimately help to reduce the burden of child health. The authors believed that the findings of this study will be helpful for policymakers in designing the appropriate policies and actions to achieve the Sustainable Development Goals (SDGs) by reducing stunting among under-five children in Cambodia.

Prevalence of childhood stunting and determinants in low and lower-middle income African countries: Evidence from standard demographic and health survey

INTRODUCTION

Undernutrition poses a significant global public health challenge, adversely affecting childhood cognitive and physical development while increasing the risk of disease and mortality. Stunting, characterized by impaired growth and development in children due to insufficient psychological stimulation, frequent infections, and inadequate nutrition, remains a critical issue. Although economic growth alone cannot fully address the prevalence of stunting, there exists a robust correlation between a country's income level and childhood stunting rates. Countries with higher incomes tend to have lower rates of childhood stunting. Notably, while childhood stunting is declining worldwide, it remains persistent in Africa. Consequently, this study aims to assess the prevalence of childhood stunting and its determinants in low- and lower-middle-income African countries.

METHOD

This study conducted a secondary analysis of standard demographic and health surveys in low- and lower-middle-income African countries spanning the period from 2010 to 2022. The analysis included a total sample of 204,214 weighted children under the age of five years. To identify the determinants of stunting, we employed a multilevel mixed-effect model, considering the three levels of variables. The measures of association (fixed effect) were determined using the adjusted odds ratio at a 95% confidence interval. Significance was declared when the association between the outcome variable and the explanatory variable had a p-value less than 0.05.

RESULT

In low and lower-middle-income African countries, 31.28% of children under five years old experience stunting, with a 95% confidence interval ranging from 31.08% to 31.48%. The results from a multilevel mixed-effect analysis revealed that 24 months or more of age of child, male gender, low and high birth weight, low and high maternal BMI, no and low maternal education, low household wealth index, multiple (twin or triplet) births, rural residence, and low income of countries were significantly associated with childhood stunting.

CONCLUSION

Stunting among children under five years of age in low- and lower-middle-income African countries was relatively high. Individual, community, and country-level factors were statistically associated with childhood stunting. Equally importantly, with child, maternal, and community factors of stunting, the income of countries needs to be considered in providing nutritional interventions to mitigate childhood stunting in Africa.

Anthropometric failures and its predictors among under five children in Ethiopia: multilevel logistic regression model using 2019 Ethiopian demographic and health survey data

BACKGROUND

Composite Index of Anthropometric Failure (CIAF) combines all three forms of anthropometric failures to assess undernutrition status of children. There is no study on CIAF to identify the real and severe form of under nutrition among Ethiopian children that addressed community level factors. So, this study determined CIAF and identified important factors which helps to design appropriate intervention strategies by using multi-level advanced statistical model.

METHODS

The study included 5,530 under five children and utilized a secondary data (EMDHS 2019) which was collected through community-based and cross-sectionally from March 21 to June 28, 2019. Composite index of anthropometric failure among under five children was assessed and a two-stage sampling technique was used to select the study participants. Descriptive summary statistics was computed. A multi-level binary logistic regression model was employed to identify important predictors of CIAF in under five children. Adjusted odds ratio with its 95% CI was estimated and level of significance 0.05 was used to determine significant predictors of CIAF.

RESULTS

The prevalence of composite index of anthropometric failure (CIAF) was 40.69% (95% CI: 39.41, 42.00) in Ethiopia. Both individual and community level predictors were identified for CIAF in under five children. Among individual level predictors being male sex, older age, short birth interval, from mothers who have not formal education, and from poor household wealth quintile were associated with higher odds of CIAF among under five children. Low community women literacy and being from agriculturally based regions were the community level predictors that were associated with higher odds of CIAF in under five children in Ethiopia.

CONCLUSIONS

The burden of composite index of anthropometric failure in under five children was high in Ethiopia. Age of child, sex of child, preceding birth interval, mother's education, household wealth index, community women literacy and administrative regions of Ethiopia were identified as significant predictors of CIAF. Therefore, emphasis should be given for those factors to decrease the prevalence of CIAF in under five children in Ethiopia.

Multi-Level Mixed-Effects Analysis of Stunting Among 6 to 59 Months Children in Ethiopia: Evidenced from Analysis of Health and Demographic Survey, 2000 to 2019

Background. Stunting remains a major public health issue in developing countries like Ethiopia. It is termed as a chronic malnutrition which leads to morbidity and mortality among children. This study aimed to assess the prevalence and factors associated with stunting among 6 to 59 months children in Ethiopia. Methods. A total weighted sample of 34 930 children aged 6 to 59 months was included in this study. A Multilevel Mixed-Effect logistic regression was carried out. The Median Odds Ratio (MOR) and the Intra class Correlation Coefficient (ICC) were calculated. An adjusted odds ratio along with a 95% confidence interval was reported and statistical significance was declared at a P-value ≤ .05. Results. The weighted prevalence of stunting in Ethiopia was 48.3% (95% CI: 47.8%, 48.8%). Being male, increased in age, having multiple births (twin), having less than 2 years birth interval, history of diarrhea, anemia, lack of maternal and paternal formal education, having poor and middle-wealth status, and living in rural areas were significantly associated with stunting. Conclusions. The prevalence of stunting is high in Ethiopia. The risk factors mentioned above increase the likely hood of stunting among children. Therefore, we recommend that responsible bodies place a greater emphasis and priority on promoting parental education, awareness on the impact of the birth interval on child nutrition, the prevention of childhood diarrhea and anemia, improving household economic status, and reducing rural-urban disparities.

Prevalence and predictive factors associated with stunting in preschool children in a governorate of Iraq: a community-based cross-sectional study

Introduction

The prevalence and risk factors of stunting in various geographical regions have been well investigated. However, not enough data exists regarding the communities in Iraq. This study investigated the prevalence and risk factors of stunting in preschool children in Halabja governorate.

Methods

The required data for the study was collected through a structured questionnaire form from the children's parents. Then, the height and weight of the children were measured. According to the World Health Organization Child Growth Standards and using the WHO Anthro Survey Analyser software, children were classified as "stunted" when their height-for-age z-score was below two standard deviations.

Results

A total of 646 children were included, of which 310 (48%) were male and 336 (52%) were female. The gestational age of 556 (86%) children was 9 months, while 84 (13%) were born between 7-9 months, and 6 (1%) were born in 7 months. Regarding feeding during the first 2 years of life, 229 children (35.4%) were exclusively breastfed, 93 (14.4%) were bottle-fed, and 324 (50.2%) had mixed feeding. The prevalence of stunting was 7.9% in the sample pool, with 4.6% of females and 3.3% of males. Among stunted children, 6.35% were term babies, and 1.55% were preterm babies. None of the studied factors had a significant association with stunting.

Conclusion

The prevalence of stunting in the studied population was 7.9%. However, we could not find any significant association between the studied factors and stunting. Thus, the factors that may significantly affect stunting in our area of study, especially the historical chemical warfare side effects, need to be more extensively investigated in future studies.

Analysis of traditional feeding practices and stunting among children aged 6 to 59 months in Karanganyar District, Central Java Province, Indonesia

BACKGROUND

Traditional feeding practices are widespread in Indonesia. Therefore, using traditional feeding practices commonly used among mothers, this study examined the association between these practices and stunting along with other relevant factors (i.e., sociodemographic factors, feeding practices, vaccination status, and place of residence).

METHODS

This cross-sectional study was conducted in Karanganyar District, Central Java Province. Data from a total of 706 children aged 6 to 59 months (352 children with stunting and 354 children without stunting) were obtained from the medical records of 10 primary health care units (PHCUs) in 9 subdistricts. Descriptive analysis and binary logistic regression (BLR) were performed to explore the association between the dependent (stunting) and independent variables.

RESULTS

The BLR results from children 6 to 59 months indicated that children of mothers with food restrictions during pregnancy (AOR = 5.87, 95% CI: 3.03, 11.38), children with prelacteal feeding (AOR = 4.27, 95% CI: 2.16, 8.41) and children with food restrictions (AOR = 7.74, 95% CI: 1.22, 49.16) were more likely to experience stunting. Those from children 6 to 23 months revealed that food restrictions during pregnancy (AOR = 17.55, 95% CI: 2.86, 107.80) and prelacteal feeding (AOR = 10.58, 95% CI: 2.06, 54.41) were related to stunting. The reasons for traditional feeding practices were related to cultural beliefs. For example, mothers believed that red meat could cause high blood pressure; thus, the consumption of red meat could trigger miscarriage or bleeding during delivery. In addition, this study showed that low sociodemographic status, inappropriate feeding practices, incomplete vaccination, and residence in rural areas were related to stunting.

CONCLUSIONS

The findings reflect the importance of education for mothers to correct misconceptions of traditional feeding practices. The government should strengthen counseling services in PHCUs to improve mothers' knowledge of and attitudes toward appropriate feeding practices. Additionally, public relations practices through the mass media should continue for family members, especially senior members, as they influence mothers' autonomy in decision-making regarding feeding practices in Indonesia.

Levels of stunting associated factors among under-five children in Ethiopia: A multi-level ordinal logistic regression analysis

INTRODUCTION

Stunting is a major public health problem affecting more than one-third of under five year's old children in Ethiopia. It has short and long (irreversible) consequences, including stunted growth, never reaching physical and cognitive potential, struggles in school, and increased morbidity and mortality due to infections. Though stunting is the leading cause of child mortality in Ethiopia, evidence is scarce on the prevalence and predictors of stunting among under-five years old children in Ethiopia. Therefore, this study aimed to estimate the prevalence and predictors of stunting severity among under-5 children in Ethiopia.

MATERIALS AND METHODS

This study was based on 2019 Mini-Ethiopian Demographic and Health Survey (EDHS) data. A weighted total sample of 4972 under-five years old children was included in the study. Height measurement was collected for each child. Anthropometric indicator, height-for-age was determined for children using World Health Organization growth standards (Z-scores for Height-for-Age (HAZ)) to asses stunting level. Given the ordinal nature of stunting and the hierarchical nature of EDHS data, a multilevel ordinal logistic regression model was applied. Brant test was used to check the proportional odds assumption, which was satisfied (P-value ≥0.05). Moreover, deviance was used for model comparison. For the multivariable analysis, variables with a p-value ≤0.2 in the bivariable analysis were considered. The Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported as associated factor to the severity levels of stunting in the multivariable multilevel proportional odds model.

RESULTS

The overall prevalence of stunting among under-5 children in Ethiopia was 35.7% [95% CI: 34.4%, 37.1%]. Of these, 12.1% were severely stunted, and 24.9% were moderately stunted. Being male [AOR = 0.83, 95% CI: 0.74, 0.93], children aged 6-23 months [AOR = 2.38, 95% CI: 1.84, 3.07], ≥ 24 months [AOR = 4.15, 95% CI: 3.26, 5.28], children whose maternal age 15-24 years [AOR = 0.73, 95% CI: 0.58, 0.92], children from the poorest, poorer, middle, and richer household wealth were [AOR = 1.84, 95% CI: 1.32, 2.57], [AOR = 1.66, 95% CI: 1.20, 2.31], [AOR = 1.78, 95% CI: 1.29, 2.44], and [AOR = 1.62, 95% CI: 1.20, 2.17], children whose maternal educational status of no formal education and primary education had [AOR = 1.90, 95% CI: 1.28, 2.82], [AOR = 1.78, 95% CI: 1.22, 2.60], Tigray [AOR = 2.95, 95% CI: 1.78, 4.86], Afar [AOR = 1.85, 95% CI: 1.11, 3.10], Amhara [AOR = 1.90, 95% CI: 1.14, 3.14] and Harari [AOR = 1.97, 95% CI: 1.20, 3.25]regions, low community maternal education [AOR = 0.76, 95% CI: 0.62, 0.92] were significantly associated with stunting severity levelling.

CONCLUSION

Stunting among children under five years of old in Ethiopia remains a major public health issue. Improving access to maternal education is related to appropriate child feeding practices and health, particularly in younger and uneducated mothers. Strengthening the family's wealth status is also recommended to reduce stunting. In addition, it is better to support strategies of preconception care for mothers during pregnancy to reduce stunting in the long term.

The intergenerational effect of tuition-free lower-secondary education on children's nutritional outcomes in Africa

One in five child deaths under age 5 are a result of severe wasting. Malnutrition at early ages is linked to lifelong consequences, such as reduced cognitive skills, reduced earnings in adulthood and chronic health conditions. Countries worldwide have committed to addressing child undernutrition, and ending hunger is foundational to the Millennium Development Goals. In this paper, we study the intergenerational effect of providing free tuition in secondary school on future children's nutrition. We combined a novel longitudinal dataset that captures educational policies for 40 African countries from 1990 to 2019 with the Demographic and Health Survey (DHS). We identified three countries that introduced free secondary education several years after implementing free primary education. Exploiting this variation in timing we estimate the additional impact of providing free secondary education over free primary education. Using a difference-in-difference approach, we find that introducing free secondary education significantly reduced wasting. Cohorts exposed to free secondary had an 18% relative decrease in wasting. The impact on cohorts exposed only to free primary was smaller and not statistically significant. Expanding free secondary education has long-term, intergenerational benefits and is an effective path to reducing malnutrition. Results are robust to different specifications.

Bayesian multilevel modelling of the association between socio-economic status and stunting among under-five-year children in Tanzania

BACKGROUND

Stunting is associated with socioeconomic status (SES) which is multidimensional. This study aimed to compare different SES indices in predicting stunting.

METHODS

This was the secondary data analysis using Tanzania Demographics and Health Surveys (TDHS). The study used 7492, 6668, and 8790 under-five-year children from TDHS 2004/5, 2010, and 2015/16, respectively. The Household Wealth Index (HWI); Water and Sanitation, Assets, Maternal education and Income (WAMI); Wealth Assets, Education, and Occupation (WEO); and the Multidimensional Poverty Index (MPI) indices were compared. The summated scores, principal component analysis (PCA), and random forest (RF) approaches were used to construct indices. The Bayesian and maximum likelihood multilevel generalized linear mixed models (MGLMM) were constructed to determine the association between each SES index and stunting.

RESULTS

The study revealed that 42.3%, 38.4%, and 32.4% of the studied under-five-year children were stunted in 2004/5, 2010, and 2015/16, respectively. Compared to other indicators of SES, the MPI had a better prediction of stunting for the TDHS 2004/5 and 2015/16, while the WAMI had a better prediction in 2010. For each score increase in WAMI, the odds of stunting were 64% [BPOR = 0.36; 95% CCI 0.3, 0.4] lower in 2010, while for each score increase in MPI there was 1 [BPOR = 1.1; 95% CCI 1.1, 1.2] times higher odds of stunting in 2015/16.

CONCLUSION

The MPI and WAMI under PCA were the best measures of SES that predict stunting. Because MPI was the best predictor of stunting for two surveys (TDHS 2004/5 and 2015/16), studies dealing with stunting should use MPI as a proxy measure of SES. Use of BE-MGLMM in modelling stunting is encouraged. Strengthened availability of items forming MPI is inevitable for child growth potentials. Further studies should investigate the determinants of stunting using Bayesian spatial models to take into account spatial heterogeneity.

Socio-economic and agricultural factors associated with stunting of under 5-year children: findings from surveys in mountains, dry zone and delta regions of rural Myanmar (2016-2017)

OBJECTIVE

The study's objective was to investigate multiple underlying social, economic and agricultural determinants of stunting among under-five children in three distinct ecological areas in rural Myanmar.

DESIGN

Repeated cross-sectional surveys in three states of Myanmar.

SETTING

Rural households in Chin (mountainous), Magway (plains) and Ayeyarwady (delta).

PARTICIPANTS

From two purposively selected adjacent townships in each state, we randomly selected twenty villages and, in each village, thirty households with under-five children. Households in the first survey in 2016 were revisited in late 2017 to capture seasonal variations.

RESULTS

Stunting increased from 40·4 % to 42·0 %, with the highest stunting prevalence in Chin state (62·4%). Univariate Poisson regression showed factors contributing to child stunting varied across the regions. Adjusted Poisson regression models showed that child's age and short maternal stature (aRR = 1·14 for Chin, aRR = 1·89 for Magway and aRR = 1·86 for Ayeyarwady) were consistently associated with child stunting across three areas. For Chin, village-level indicators such as crop consumption (aRR = 1·18), crop diversity (aRR = 0·82) and land ownership (aRR = 0·89) were significantly associated with stunting. In Magway, the number of household members (aRR = 1·92), wealth status (aRR = 0·46), food security status (aRR = 1·14), land ownership (aRR = 0·85) and in Ayeyarwady, women's decision-making (aRR = 0·67) and indicators related to hygiene (aRR = 1·13) and sanitation (aRR = 1·45) were associated with stunting.

CONCLUSIONS

Area-specific factors were associated with stunting. Maternal short stature and child age were consistent determinants of stunting. A multi-sectoral local approach, including improvements in transport, is needed to address the intergenerational malnutrition problem.

Child Stunting Reduction in Aceh Province: Challenges and a Way Ahead

INTRODUCTION

Indonesia ranks the fifth highest in child stunting among Asian countries. Aceh, a westernmost province in Indonesia recorded the highest prevalence of stunting in children under two years old in the nation. Our study investigated the current government efforts on child stunting reduction activities since the introduction of Governor Regulation No. 14/2019.

METHODS

The study investigated the current efforts of Aceh governments and relevant actors on child stunting reduction using in-depth interviews, document reviews and focus group discussions.

RESULTS

Thirty-five (35) respondents including policy makers were interviewed, four focus group discussions (15 each group) were conducted, and various official documents were reviewed. Various challenges for reducing child stunting in Aceh were identified: inadequate knowledge and skills of Posyandu cadres on child stunting; reluctance to consume iron and folic acid (IFA), and supplementary foods (PMT Bumil) by many pregnant women due to perceived annoying effects and unappetizing taste; work engagement, insufficient breast milk production and inadequate support from husbands failing to achieve exclusive breastfeeding among nursing women; inadequate provision of complementary fortified foods for children 6-23 months; lack of clean water, waste management and WASH practices.

CONCLUSION

The intervention on both nutrition-specific and nutrition-sensitive factors was found to be insufficient in Aceh. Although WASH (water, sanitation and hygiene) practices are the most important contributors to child stunting, only the health agency plays a singular role in reduction efforts by focussing on specific factors. Coordination between relevant agencies to address both factors is required to achieve the effectiveness of child stunting reduction and prevention in Aceh.

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.

Risk Factors for Stunting among Children under Five Years in the Province of East Nusa Tenggara (NTT), Indonesia

In East Nusa Tenggara Province, Indonesia, 42.6% of children under five had stunted growth in 2018, which affects both individual and communal levels. The first step in creating effective interventions is identifying the risk factors for stunting. This study aims to pinpoint the stunting risk factors in East Nusa Tenggara Province, Indonesia, by incorporating secondary data from the 2018 Indonesia Basic Health Research (RISKESDAS). This study implemented a cross-sectional design by utilizing the data of individuals who were successfully visited during the survey. Initial data screening in East Nusa Tenggara Province based on the criteria for children aged 0−59 months and stunting showed as many as 1643. Multivariate logistic regression analysis was performed to evaluate the relationship between children’s characteristics and stunting. There was a significant relationship between age group variables for younger children (aged 12−23, 24−35, and 36−47 months), mothers with low education, and children living in rural areas with the incidence of stunting in children (p-value < 0.05). The dominant factors that caused stunting in this study were the children’s age of 24−35 months (OR = 2.08, 95% CI: 1.12−3.86), mothers with low education (OR = 1.57, 95% CI: 1.18−2.08), and children living in rural areas (OR = 1.39, 95% CI: 1.01−1.91). The highest prevalence of stunting was in the group of children aged 12−23 months (45.2%). To prevent child stunting, the government must intervene for mothers with low education and those living in rural areas. Intervention includes intensive socialization about improving nutritional status during pregnancy and practicing complementary feeding and breastfeeding habits until the child is 24 months old.

Optimum birth interval (36-48 months) may reduce the risk of undernutrition in children: A meta-analysis

Background

Although some studies have highlighted short birth interval as a risk factor for adverse child nutrition outcomes, the question of whether and to what extent long birth interval affects better nutritional outcomes in children remains unclear.

Methods

In this quantitative meta-analysis, we evaluate the relationship between different birth interval groups and child nutrition outcomes, including underweight, wasting, and stunting.

Results

Forty-six studies with a total of 898,860 children were included in the study. Compared with a short birth interval of <24 months, birth interval of ≥24 months and risk of being underweight showed a U-shape that the optimum birth interval group of 36-48 months yielded the most protective effect (OR = 0.54, 95% CI = 0.32-0.89). Moreover, a birth interval of ≥24 months was significantly associated with decreased risk of stunting (OR = 0.61, 95% CI = 0.55-0.67) and wasting (OR = 0.63, 95%CI = 0.50-0.79) when compared with the birth interval of <24 months.

Conclusion

The findings of this study show that longer birth intervals (≥24 months) are significantly associated with decreased risk of childhood undernutrition and that an optimum birth interval of 36-48 months might be appropriate to reduce the prevalence of poor nutritional outcomes in children, especially underweight. This information would be useful to government policymakers and development partners in maternal and child health programs, especially those involved in family planning and childhood nutritional programs.

Nutritional status of under-five aged children of ready-made garment workers in Bangladesh: A cross-sectional study

BACKGROUND

The ready-made garment (RMG) sector is a significant contributor to the economic growth of Bangladesh, accounting for 10% of the country's GDP and more than 80% of its foreign exchange earnings. The workforce in this sector is predominantly made up of women, with 2.5 million women working in the industry. However, these women face numerous challenges in carrying out their culturally-expected household responsibilities, including childcare, due to severe resource constraints. As a result, the children of these working women have a higher incidence of malnutrition, particularly stunted growth. This study aims to identify the factors that contribute to stunting in children under the age of five whose mothers work in the RMG sector in Bangladesh.

METHODS

The study collected data from 267 female RMG workers in the Gazipur district of Bangladesh using a simple random sampling technique. Chi-square tests were used to determine the associations between the factors influencing child stunting, and Multinomial Logit Models were used to estimate the prevalence of these factors.

RESULTS

The study found that the prevalence of moderate and severe stunting among the children of RMG workers living in the Gazipur RMG hub was 19% and 20%, respectively. The study identified several significant predictors of child stunting, including the mother's education level, nutritional knowledge, control over resources, receipt of antenatal care, household size, sanitation facilities, and childbirth weight. The study found that improving the mother's education level, increasing household size, and receiving antenatal care during pregnancy were important factors in reducing the likelihood of child stunting. For example, if a mother's education level increased from no education to primary or secondary level, the child would be 0.211 (0.071-0.627) and 0.384 (0.138-1.065) times more likely to have a normal weight and height, respectively, than to be moderately stunted.

CONCLUSION

The study highlights the challenges faced by working women in the RMG sector, who often receive minimal wages and have limited access to antenatal care services. To address these challenges, the study recommends policies that support antenatal care for working-class mothers, provide daycare facilities for their children, and implement a comprehensive social safety net program that targets child nutrition. Improving the socioeconomic status of mothers is also critical to reducing child malnutrition in this population.

High prevalence of chronic malnutrition in indigenous children under 5 years of age in Chimborazo-Ecuador: multicausal analysis of its determinants

Background

Despite the multiple initiatives implemented to reduce stunting in Ecuador, it continues to be a public health problem with a significant prevalence. One of the most affected groups is the rural indigenous population. This study aimed to analyze the prevalence of chronic malnutrition in indigenous children under 5 years of age and its association with health determinants, focusing on one of the territories with the highest prevalence of stunting.

Methods

A cross-sectional study in 1,204 Kichwa indigenous children under the age of five, residing in rural areas of the counties with the highest presence of indigenous in the province of Chimborazo-Ecuador. A questionnaire on health determinants was applied and anthropometric measurements were taken on the child and the mother. Stunting was determined by the height-for-age z-score of less than 2 standard deviations, according to the World Health Organization´s parameters. Data were analyzed using bivariate and multivariate Poisson regression.

Results

51.6% (n = 646) of the children are stunted. Height-for-age z-scores were significantly better for girls, children under 12 months, families without overcrowding, and families with higher family income. The variables that were significantly and independently associated with stunting were: overcrowding (PR 1.20, 95% CI 1–1.44), the mother required that the father give her money to buy medicine (PR 1.33, 95% CI 1.04–1.71), the father did not give her money to support herself in the last 12 months (1.58, 95% CI 1.15–2.17), mother’s height less than 150 cm (PR 1.42, 95% CI 1.19–1.69) and the child was very small at birth (PR 1.75, 95% CI 1.22–2.5).

Conclusion

One out of every two rural indigenous children included in this study is stunted. The high prevalence of stunting in the indigenous and rural population is multicausal, and requires an intersectoral and multidisciplinary approach. This study identified three fundamental elements on which public policy could focus: (a) reduce overcrowding conditions, improving economic income in the rural sector (for example, through the strengthening of agriculture), (b) provide prenatal care and comprehensive postnatal care, and (c) promote strategies aimed at strengthening the empowerment of women.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14327-x.

The Effectiveness of Baby Massage in Stunting Prevention: Study Based on Body Length Gain in Infants aged 0–3 Months

Baby massage is a gentle massage for infants aged 0-3 months that is believed to improve the baby's body length. The purpose of this study was to determine the impact of baby massage on the increase in body length and weight of infants aged 0-3 months. This type of research was quasi-experimental. The samples were mothers and infants 0-3 months, divided into the treatment and control groups. The number of samples for each group was 35 respondents. Baby massage was carried out by the mother twice a day, in the morning and evening after bathing, for one month. The enumerators collected data on length and weight before and after 1 month in both groups and statistically tested by unpaired t-test. The reduction in stunting prevalence in the treatment group was 22.8%, while the control group was 8.6%. The prevalence of underweight in the treatment group did not significantly change (2.9%), while the control group experienced an increase of 11.7%. The increase in body length of the treatment group was 4.49 cm, and the control group was 3.23 cm; the baby massage significantly affected body length for infants 0-3 months (ρ=0.000). The average weight gain of infants in the treatment group was 825.7 g, and the control group was 702.9 g; the baby massage was not significantly affected the body weight (ρ=0.224). Thus, the baby massage can be an alternative in boosting the length and weight of babies aged 0-3 months

Risk factors for early childhood growth faltering in rural Cambodia: a cross-sectional study

OBJECTIVE

This study aimed to determine risk factors of growth faltering by assessing childhood nutrition and household water, sanitation, and hygiene (WASH) variables and their association with nutritional status of children under 24 months in rural Cambodia.

DESIGN

We conducted surveys in 491 villages (clusters) randomised across 55 rural communes in Cambodia in September 2016 to measure associations between child, household and community-level risk factors for stunting and length-for-age z-score (LAZ). We measured 4036 children under 24 months of age from 3877 households (491 clusters). We analysed associations between nutrition/WASH practices and child growth (LAZ, stunting) using generalised estimating equations (GEEs) to fit linear regression models with robust SEs in a pooled analysis and in age-stratified analyses; child-level and household-level variables were modelled separately from community-level variables.

RESULTS

After adjustment for potential confounding, we found household-level and community-level water, sanitation and hygiene factors to be associated with child growth among children under 24 months: presence of water and soap at a household's handwashing station was positively associated with child growth (adjusted mean difference in LAZ +0.10, 95% CI 0.03 to 0.16); household-level use of an improved drinking water source and adequate child stool disposal practices were protective against stunting (adjusted prevalence ratio (aPR) 0.80, 95% CI 0.67 to 0.97; aPR 0.82, 95% CI 0.64 to 1.03). In our age-stratified analysis, we found associations between child growth and community-level factors among children 1-6 months of age: shared sanitation was negatively associated with growth (-0.47 LAZ, 95% CI -0.90 to -0.05 compared with children in communities with no shared facilities); improved sanitation facilities were protective against stunting (aPR 0.43, 95% CI 0.21 to 0.88 compared with children in communities with no improved sanitation facilities); and open defecation was associated with more stunting (aPR 2.13, 95% CI 1.10 to 4.11 compared with children in communities with no open defecation). These sanitation risk factors were only measured in the youngest age strata (1-6 months). Presence of water and soap at the household level were associated with taller children in the 1-6 month and 6-12 month age strata (+0.10 LAZ, 95% CI -0.02 to 0.22 among children 1-6 months of age; +0.11 LAZ, 95% CI -0.02 to 0.25 among children 6-12 months of age compared with children in households with no water and soap). Household use of improved drinking water source was positively associated with growth among older children (+0.13 LAZ, 95% CI -0.01 to 0.28 among children 12-24 months of age).

CONCLUSION

In rural Cambodia, water, sanitation and hygiene behaviours were associated with growth faltering among children under 24 months of age. Community-level sanitation factors were positively associated with growth, particularly for infants under 6 months of age. We should continue to make effort to: investigate the relationships between water, sanitation, hygiene and human health and expand WASH access for young children.

Prevalence and correlates of severe under-5 child anthropometric failure measured by the composite index of severe anthropometric failure in Bangladesh

BACKGROUND

Although Bangladesh has made noticeable progress in reducing the prevalence of stunting, wasting, and being underweight among under-5 children, it has not been very successful in reducing overall severe anthropometric failure (SAF) among them. Therefore, the study aims to identify the prevalence and risk factors of SAF measured by the Composite Index of Severe Anthropometric Failure (CISAF) among under-5 children in Bangladesh.

METHODS

Data was drawn from a cross-sectional Bangladesh Demographic Health Survey (BDHS) conducted in 2017-2018. A bivariate analysis (Chi-square test) and logistic regression analysis were used to estimate the unadjusted, and age and sex-adjusted prevalence of SAF. Odds ratio (OR) and confidence interval (CI) were assessed using logistic regression analysis to identify the various risk factor of SAF.

RESULTS

The overall adjusted prevalence of under-5 child SAF was 11.3% (95% CI: 10.6-12.0) and it was highly prevalent among children of uneducated mothers (adjusted, 22%, 95% CI: 17.3-26.8). The key factors associated with SAF were children in the age group 24-35 months (OR: 2.43, 95% CI: 1.83-3.23), children born with low birth weight (OR: 3.14, 95% CI: 2.24-4.97), children of underweight mothers (OR: 1.82, 95% CI: 1.44-2.29), children of parents with no formal education (OR: 2.28, 95% CI: 1.56-3.31) and children from lower socio-economic status (OR: 2.25, 95% CI: 1.55-3.26).

CONCLUSION

Prioritizing and ensuring context-specific interventions addressing individual, community, public policy, and environment level risk factors from policy level to implementation to reduce structural and intermediary determinants of under-5 SAF.

The effect of convergent action on reducing stunting prevalence in under-five children in Banggai District, Central Sulawesi, Indonesia

OBJECTIVE

This study aimed to assess the amount of changes in prevalence of stunting after one-year convergence intervention.

METHODS

This was an evaluation study of national program that implemented in Banggai District beginning 2018. There were ten villages (n=532) that included in the program based on severity of stunting prevalence. Data were analyzed using chi-square and independent t-test using SPSS.

RESULT

After a year program, stunting reduced to 38.91% or 2.18% from the baseline (41.09%). The highest reduction was in at 0-5 mo (8.59%) and 6-11 mo (8.46%). There was no difference using height for age z-score in all ages (-1.64±1.19 to -1.59±1.38, p=0.506). However, the reduction was significant at 0-11 months (-1.20±1.23 to 0.78±1.58, p=0.020) but no in other age categories (p>0.05).

CONCLUSION

The convergence action for one year intervention reduced significantly stunting in 0-11 months of children but not in other age categories of under five children.

Acute malnutrition and its determinants of preschool children in Bangladesh: gender differentiation

Background

Children acute malnutrition (AM) is a global public health concern, especially in low and middle income countries. AM is associated with multiple physiological vulnerabilities, including immune dysfunction, enteric barrier disruption, gut microbiome dysbiosis, and essential nutrient deficits. This study aimed to determine the prevalence of AM and its associated factors among preschool children in Rajshahi district, Bangladesh.

Methods

This cross-sectional study was conducted from October to December, 2016. Children acute malnutrition was assessed using mid-upper arm circumference. Multiple binary logistic regression analyses were employed to determine the associated factors after adjusting the effect of independent factors of children AM.

Result

The prevalence of AM amongst preschool children was 8.7%, among them 2.2 and 6.5% were severe acute malnutrition and moderate acute malnutrition, respectively. Z-proportional test demonstrated that the difference in AM between girls (11.6) and boys (5.9%) was significant (p < 0.05). Children AM was associated with being: (i) children aged 6–23 months (aOR = 2.29, 95% CI: 1.20–4.37; p < 0.05), (ii) early childbearing mothers’ (age < 20 years) children (aOR = 3.06, 95% CI: 1.08–8.66; p < 0.05), (iii) children living in poor family (aOR = 3.08, 95% CI: 1.11–8.12; p < 0.05), (iv) children living in unhygienic latrine households (aOR = 2.81, 95% CI: 1.52–5.09; p < 0.01), (v) Hindu or other religion children (aOR = 0.42, 95% CI: 0.19–0.92; p < 0.05).

Conclusion

The prevalence of AM was high among these preschool children. Some modifiable factors were associated with AM of preschool children. Interventions addressing social mobilization and food security could be an effective way to prevent acute malnutrition among children in Bangladesh.

Urban-rural differences in the associated factors of severe under-5 child undernutrition based on the composite index of severe anthropometric failure (CISAF) in Bangladesh

Introduction

Severe undernutrition among under-5 children is usually assessed using single or conventional indicators (i.e., severe stunting, severe wasting, and/or severe underweight). But these conventional indicators partly overlap, thus not providing a comprehensive estimate of the proportion of malnourished children in the population. Incorporating all these conventional nutritional indicators, the Composite Index of Severe Anthropometric Failure (CSIAF) provides six different undernutrition measurements and estimates the overall burden of severe undernutrition with a more comprehensive view. This study applied the CISAF indicators to investigate the prevalence of severe under-5 child undernutrition in Bangladesh and its associated socioeconomic factors in the rural-urban context.

Methods

This study extracted the children dataset from the 2017–18 Bangladesh Demographic Health Survey (BDHS), and the data of 7661 children aged under-5 were used for further analyses. CISAF was used to define severe undernutrition by aggregating conventional nutritional indicators. Bivariate analysis was applied to examine the proportional differences of variables between non-severe undernutrition and severe undernutrition group. The potential associated socioeconomic factors for severe undernutrition were identified using the adjusted model of logistic regression analysis.

Results

The overall prevalence of severe undernutrition measured by CISAF among the children under-5 was 11.0% in Bangladesh (rural 11.5% vs urban 9.6%). The significant associated socioeconomic factors of severe undernutrition in rural areas were children born with small birth weight (AOR: 2.84), children from poorest households (AOR: 2.44), and children aged < 36 months, and children of uneducated mothers (AOR: 2.15). Similarly, in urban areas, factors like- children with small birth weight (AOR: 3.99), children of uneducated parents (AOR: 2.34), poorest households (APR: 2.40), underweight mothers (AOR: 1.58), mothers without postnatal care (AOR: 2.13), and children’s birth order ≥4 (AOR: 1.75), showed positive and significant association with severe under-5 undernutrition.

Conclusion

Severe undernutrition among the under-5 children dominates in Bangladesh, especially in rural areas and the poorest urban families. More research should be conducted using such composite indices (like- CISAF) to depict the comprehensive scenario of severe undernutrition among the under-5 children and to address multi-sectoral intervening programs for eradicating severe child undernutrition.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-12038-3.

Exploring behavioural factors affecting nutritional supplement use among children in Honduras

OBJECTIVE

This study explored social and behavioural factors associated with a home fortification of complementary foods program among families of undernourished children in 14 rural communities in Honduras.

DESIGN

We collected and analysed survey data from a convenience sample of 196 households participating in a nutritional program using home fortification of complementary foods in 2017. The program supplied families with a soy-based atole powder fortified with micronutrients. A research team completed a face-to-face survey exploring social and behavioural factors associated with nutritional supplement use. Anthropometric measurements for participating children were abstracted from health clinic records of previous quarterly appointments.

SETTING

The study took place in San Jose del Negrito, Honduras.

PARTICIPANTS

Participants were parents or guardians of children enrolled in the nutrition program.

RESULTS

Nearly half of participant families shared the nutritional supplement with other family members besides the index child, while 10 % reported using the supplement as a meal replacement for the child. Low education level of mothers was associated with improper use of the supplement (P = 0·005). Poorer families were more likely to share the supplement (P = 0·013).

CONCLUSIONS

These results highlight the challenges of programs using home fortification of complementary foods in the context of food scarcity. Findings highlight the importance of increasing rural children's overall caloric intake, perhaps by increasing access to locally available protein sources. Results also suggest transitioning nutritional programs to family-based interventions to increase overall intended compliance to nutrition programming.

The psychological distress of parents is associated with reduced linear growth of children: Evidence from a nationwide population survey

Background

Stunting, an indicator of restricted linear growth, has become a primary measure of childhood undernutrition due to its persistent high prevalence globally, and importance for health and development. Although the etiology is recognized as complex, most analyses have focused on social and biomedical determinants, with limited attention on psychological factors affecting care and nurturing in the home. We assessed whether the psychological distress of parents is related to child linear growth and stunting, and documented the associated risk factors, and examined the relationship between parental distress and behavioral and other risk factors for stunting.

Methods

We used data from the Indonesia National Health Survey 2013, including 46,315 children 6–59 months of age. Multivariate linear, logistic, and multilevel multinomial logistic regression, using survey weights, were used to assess the relationship between parental distress, as assessed by the WHO Self Reporting Questionnaire (SRQ20), with height-for-age z score (HAZ), stunting, and behavioral and other risk factors for stunting.

Results

Maternal, paternal and parental distress (i.e. both maternal and paternal distress) were associated with reduced linear growth of the children by 0.086 (95% CI -0.17, -0.00), 0.11 (95% CI -0.24, -0.02) and 0.19 (95% CI -0.37, -0.00) HAZ-scores, respectively. Maternal and paternal distress increased the risk of mild stunting (HAZ <-1) by 33% (95% CI 1.17,1.50) and 37% (95% CI 1.18,1.60), and the risk of moderate stunting (HAZ <-2) by 25% (95% CI 1.10,1.43) and 28% (95% CI 1.08,1.51]), respectively. Parental stress increased the risk of moderate stunting by 40% (95% CI 1.06,1.85). Amongst specific groups of risk factors, the proportion of HAZ-score lost was associated with socioeconomic factors (30.3%) including, low wealth, low maternal occupational status, low maternal education, rural residence, and low paternal occupational status; physiological factors (15.5%) including low maternal height, low maternal mid-upper arm circumference, being male, low paternal height; behavioral factors (8.9%) including open garbage disposal, paternal smoking, not using iodized salt; and experiencing at least one infectious diseases episode (1.1%).

Conclusions

Maternal, paternal and parental stress were associated with reduced linear growth of children. These findings highlight the complex etiology of stunting and suggest nutritional and other biomedical interventions are insufficient, and that promotion of mental and behavioral health programs for parents must be pursued as part of a comprehensive strategy to enhance child growth and development, i.e. improved caretaker capacity, integrated community development, improved parenting skills, as well as reduced gender discrimination, and domestic violence.

Severe stunting and its associated factors among children aged 6-59 months in Ethiopia; multilevel ordinal logistic regression model

BACKGROUND

In Ethiopia, stunting is the most common form of undernutriton. Identifying the determinants of severe stunting among children is crucial for public health interventions to improve child health. Therefore, this study aimed to identify the determinants of severe stunting among under-five children in Ethiopia.

METHODS

A community-based cross-sectional study design was employed. A two stage stratified cluster sampling technique was used. A multilevel ordinal logistic regression model was fitted to identify independent determinants. Adjusted odds ratio (AOR) and median odds ratio (MOR) with its 95% confidence interval at p-value< 0.05 were used to declare statistical significance.

RESULTS

The result of this study showed that about 18% of the children were severely stunted. Being male increased the severity of stunting in children by 26% adjusted odds ratio (AOR): 1.26 (95% CI: 1.09-1.46), compared to female sex; over-weight mothers increased the severity of stunting in their children AOR: 3.43 (95% CI: 2.21-5.33) compared to normal BMI mothers; and children from middle, poorer, and poorest wealth index households were 1.84 (95% CI:1.27-2.67), 2.13 (95% CI, CI:1.45-3.14) and 2.52 (95% CI,1.72-3.68). In contrast, severe stunting was reduced by 62% (AOR: 0.38, 95% CI: 0.20-0.74) and 48% (AOR = 0.52, 95% CI: 0.37-0.72) in children of educated mothers compared to children of uneducated mothers and children of underweight mothers compared with those children of normal BMI mothers respectively. For each one-unit increase in maternal height, there is a 5% significant reduction in the child's odds of being severely stunted. After controlling for other factors, the effect of predictors on the likelihood of stunting in high risk clusters increased by a median odds ratio (MOR) of 1.83 (95% CI: 1.69-2.00).

CONCLUSIONS

The magnitude of severe childhood stunting was still high with regional variation in Ethiopia. Child age, sex, maternal height, age, education and household wealth index as well as administrative regions were significantly associated factors with severe stunting. Significant interventions shall be implemented at the individual, household and community levels in order to reduce the problem.

The determinants of under-5 age children malnutrition and the differences in the distribution of stunting-A study from Armenia

Stunting undermines economic growth by perpetuating the vicious cycle of poverty and labour market performance. Studies have captured the trend in stunting and present distributional evidence of policy effects in the country contexts. We identify the determinants of U5 (under 5 years of age) malnutrition for the poor and the Nonpoor and compare the distribution of stunting at four time points (2000, 2005, 2010 and 2015) over a 15-year period between different groups of population. Further, we decompose the gap in malnutrition into causes of differences in stunting between worse-off and better-off socioeconomic groups of the population and estimate the magnitude of distributional differences in stunting between two socioeconomic groups. We also present the inequality trend over time that provides insights into the dynamicity of the effect of different determinants on stunting at different time points. Using 35,490 observations from Armenian Demographic and Health Survey Data [four waves: Year2015,9533; Year2010,8644; Year2005,8919; Year2000,8334], we apply regression-based decomposition method and inequality measures to identify the determinants of malnutrition and distribution of stunting between and within socioeconomic groups. Although the proportional difference in prevalence of stunting between worse-off and better-off children of 13 months and above are reduced by 9.5% in 2015 compared to 2000, the association between socioeconomic position and stunting is statistically significant among children aged 13 months and above in 2000, as well as among children of 36 months and above in 2015. This study demonstrates that the less of socioeconomic distribution of the population, but rather more of the effect from in-country region and settlement of residence are significantly associated with stunting. The approach of our analysis is potentially also a useful tool to generate evidence for decision making towards achieving SDGs 2.2. We conclude that development in childhood is not independent from the distributional effect of region specific development initiatives. Understanding the regional characteristics and resources allocated for the maternal and child health is the necessity to address stunting.

Socio-economic status and the double burden of malnutrition in Cambodia between 2000 and 2014: overweight mothers and stunted children

OBJECTIVE

The Cambodian population has experienced an increase in the proportion of stunted children who have overweight mothers during a period of rapid social and economic growth. We aimed to identify socio-economic factors associated with this household-level double burden over time.

DESIGN

We used data from four Cambodia Demographic and Health Surveys from 2000 to 2014 to study the impact of socio-economic status (SES) on the link between child stunting and overweight mothers in two periods 2000-2005 v. 2010-2014. We hypothesised that SES would be a primary factor associated with this phenomenon.

PARTICIPANTS

We included 14 988 children under the age of 5 years, among non-pregnant mothers aged 15-49 years of age and conducted analysis on a subsample of 1572 children with overweight mothers.

SETTING

Nationally representative household survey across all regions.

RESULTS

SES factors, specifically household wealth and maternal employment in service or manual occupations (in 2010-2014), are the main drivers of stunting among children of overweight mothers. Children with overweight mothers in the poorest households are more than twice as likely to be stunted than in the richest in both periods (2000-2005: adjusted OR (aOR) = 2·53, 95 % CI: 1·25, 5·13; 2010-2014: aOR = 2·61, 95 % CI: 1·43, 4·77), adjusting for other SES factors, indicating that despite decreasing income inequality, the poorest continue to bear excess risk of a double burden of malnutrition. Maternal short stature also doubled the likelihood of child stunting in both periods, which suggests intergenerational transmission of adversity and physical underdevelopment.

CONCLUSIONS

Socio-economic inequalities should be addressed to reduce disparities in the household-level double burden of malnutrition.

Predictors of stunting among children age 6-59 months in Ethiopia using Bayesian multi-level analysis

In developing countries including Ethiopia stunting remained a major public health burden. It is associated with adverse health consequences, thus, investigating predictors of childhood stunting is crucial to design appropriate strategies to intervene the problem stunting. The study uses data from the Ethiopian Demographic and Health Survey (EDHS) conducted from January 18 to June 27, 2016 in Ethiopia. A total of 8117 children aged 6-59 months were included in the study with a stratified two stage cluster sampling technique. A Bayesian multilevel logistic regression was fitted using Win BUGS version 1.4.3 software to identify predictors of stunting among children age 6-59 months. Adjusted odds ratio (AOR) with 95% credible intervals was used to ascertain the strength and direction of association. In this study, increasing child's age (AOR = 1.022; 95% CrI 1.018-1.026), being a male child (AOR = 1.16; 95%CrI 1.05-1.29), a twin (AOR = 2.55; 95% CrI 1.78-3.56), having fever (AOR = 1.23; 95%CrI 1.02-1.46), having no formal education (AOR = 1.99; 95%CrI 1.28-2.96) and primary education (AOR = 83; 95%CrI 1.19-2.73), birth interval less than 24 months (AOR = 1.40; 95% CrI 1.20-1.61), increasing maternal BMI (AOR = 0.95; 95% CrI 0.93-0.97), and poorest household wealth status (AOR = 1.78; 95% CrI 1.35-2.30) were predictors of childhood stunting at individual level. Similarly, region and type of toilet facility were predictors of childhood stunting at community level. The current study revealed that both individual and community level factors were predictors of childhood stunting in Ethiopia. Thus, more emphasize should be given by the concerned bodies to intervene the problem stunting by improving maternal education, promotion of girl education, improving the economic status of households, promotion of context-specific child feeding practices, improving maternal nutrition education and counseling, and improving sanitation and hygiene practices.

Stunting Malnutrition Associated with Severe Tooth Decay in Cambodian Toddlers

Background: The persistently high prevalence of undernutrition in Cambodia, in particular stunting or chronic malnutrition, calls for innovative investigation into the risk factors that affect children’s growth during critical phases of development. Methods: Secondary data analysis was performed on a subgroup of children who were present at two time points within the Cambodian Health and Nutrition Monitoring Study (CAHENMS) and who were less than 24 months of age at the nominated baseline. Data consisted of parent interviews on sociodemographic characteristics and feeding practices, and clinical measures for anthropometric measures and dental status. Logistic regression modelling was used to examine the associations between severe dental caries (tooth decay)—as indicated by the Significant Caries Index—and the presence of new cases of stunting malnutrition at follow-up. Results: There were 1595 children who met the inclusion criteria and 1307 (81.9%) were followed after one year. At baseline, 14.4% of the children had severe dental caries, 25.6% presented with stunted growth. 17.6% of the children transitioned from healthy status to a low height-for-age over the observation period. Children with severe dental caries had nearly double the risk (OR = 1.8; CI 1.0–3.0) of making that transition. Conclusion: Severe caries experience was associated with poorer childhood growth and, as such, could be an underinvestigated contributor to stunting.

A success story of reduction in childhood stunting and underweight in India: analysis of pooled data from three rounds of Indian Demographic and Health Surveys (1998-2016)

This study used a series of individual-level datasets from National Family Health Surveys conducted in 1998-99, 2005-06 and 2015-16 to assess the factors behind the reduction in childhood stunting and underweight in India between the years 1998-99 and 2015-16. A multivariable decomposition regression analysis was performed. Results showed that the prevalence of childhood stunting declined from 49.4% in 1998-99 to 34.9% in 2015-16. Over the same period, the prevalence of childhood underweight declined from 41.9% in 1998-99 to 33.1% in 2015-16. The reduction in the prevalence of stunting was found to be contributed largely by a reduction in the combined prevalence of stunting and underweight (60%), followed by stunted only (21%) and the combined prevalence of stunting, underweight and wasting (19%). Likewise, the reduction in the prevalence of underweight was contributed by a reduction in the combined prevalence of stunting and underweight and the combined prevalence of stunting, underweight and wasting. Results of the decomposition analysis showed that over the period 1998-99 to 2015-16, improvement in wealth status and maternal education led to 13% and 12% declines, respectively, in childhood stunting and to 31% and 19% declines, respectively, in childhood underweight. Furthermore, reductions in childhood stunting and underweight were due to an increased average number of antenatal care visits, lower average birth order, decreased share of children with below-average birth size, increased use of clean fuel for cooking and a reduction in the practice of open defecation. These findings suggest that further reduction in the prevalence of childhood stunting and underweight could be attained through more equitable household economic growth, investment in girl's education, greater access to improved toilet facilities, more widespread use of clean fuel for cooking, reduction in average birth order, increased antenatal care visits and greater consumption of IFA tablets by pregnant women. Policymakers need to prioritize these measures to further reduce malnutrition among Indian children.

Spatial heterogeneity and factors influencing stunting and severe stunting among under-5 children in Ethiopia: spatial and multilevel analysis

Stunting remains a major public health concern in Ethiopia. Government needs to reshape and redesign new interventions to reduce stunting among under-five children. Hence, this study identified the problem according to location and risk factor. This study is a secondary data analysis of the 2016 Ethiopian Demographic and Health Survey. A total of 9588 children aged 0-59 months were included in the study. The spatial and multilevel logistic regression analyses were used to explore spatial heterogeneity and identify individual- and household-level factors associated with stunting and severe stunting. Spatial heterogeneity of stunting and severe stunting was seen across the study setting. Male children (AOR = 1.51, CI 1.16, 1.96); multiple births (AOR = 27.6, CI 10.73, 71.18); older children (AOR = 1.04, CI 1.01, 1.05) and anemic children (AOR = 3.21, CI 2.3, 4.49) were severely stunted at individual-level factors. Children from educated and malnourished mothers (respectively, AOR = 0.18, CI 0.05, 0.71; AOR = 5.35, CI 3.45, 8.32), and from less wealthier mothers (AOR = 5.95, CI 2.58, 13.69) were severely stunted at household-level factors. Giving priority to the hotspot areas of stunting and older and anemic children, multiple births, and maternal undernutrition is important to reduce stunting. Studies are recommended to fill the gaps of this study.

Reducing malnutrition in Cambodia. A modeling exercise to prioritize multisectoral interventions

Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6-23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north-eastern provinces and the capital and used as cross-sectional. Socio-demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low-household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north-eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity-focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.

Stunting in childhood: an overview of global burden, trends, determinants, and drivers of decline

BACKGROUND

Progress has been made worldwide in reducing chronic undernutrition and rates of linear growth stunting in children under 5 y of age, although rates still remain high in many regions. Policies, programs, and interventions supporting maternal and child health and nutrition have the potential to improve child growth and development.

OBJECTIVE

This article synthesizes the available global evidence on the drivers of national declines in stunting prevalence and compares the relative effect of major drivers of stunting decline between countries.

METHODS

We conducted a systematic review of published peer-reviewed and gray literature analyzing the relation between changes in key determinants of child linear growth and contemporaneous changes in linear growth outcomes over time.

RESULTS

Among the basic determinants of stunting assessed within regression-decomposition analyses, improvement in asset index score was a consistent and strong driver of improved linear growth outcomes. Increased parental education was also a strong predictor of improved child growth. Of the underlying determinants of stunting, reduced rates of open defecation, improved sanitation infrastructure, and improved access to key maternal health services, including optimal antenatal care and delivery in a health facility or with a skilled birth attendant, all accounted for substantially improved child growth, although the magnitude of variation explained by each differed substantially between countries. At the immediate level, changes in several maternal characteristics predicted modest stunting reductions, including parity, interpregnancy interval, and maternal height.

CONCLUSIONS

Unique sets of stunting determinants predicted stunting reduction within countries that have reduced stunting. Several common drivers emerge at the basic, underlying, and immediate levels, including improvements in maternal and paternal education, household socioeconomic status, sanitation conditions, maternal health services access, and family planning. Further data collection and in-depth mixed-methods research are required to strengthen recommendations for those countries where the stunting burden remains unacceptably high.

Maternal mid-upper arm circumference during pregnancy and linear growth among Cambodian infants during the first months of life

Stunting prevalence among children under 5 years remains high in Cambodia, affecting about one-third of children. In most low- and middle-income countries, linear growth faltering of young children starts in the womb. The 1,000-days window of opportunity to improve child nutritional status includes pregnancy, as maternal nutritional status is an important determinant of birthweight and child development. In Cambodia, nutritional status of pregnant women is poor, with some studies reporting >20% of pregnant women having a low mid-upper arm circumference (MUAC < 23 cm). Few studies have investigated associations between maternal nutritional status during pregnancy and neonatal growth. Using data from a Cambodian cohort study conducted from 2016 through 2018 in selected districts of Phnom Penh, Kratie, and Ratanakiri provinces, we investigated associations between maternal MUAC during pregnancy as indicator of maternal nutritional status and their offspring linear growth during early life. Multivariate regression models were used to assess the associations between maternal MUAC during the last trimester of pregnancy and infant's length-for-age z-scores during the first 3.5 months of life. Maternal MUAC was significantly associated with infant's length-for-age z-scores (regression coefficient 0.06, 95% CI [0.03, 0.09]). Infants born from mothers with a low MUAC during pregnancy had a 1.6 times higher risk (odds ratio 1.621, 95% CI [0.998, 2.636]) of being stunted during the first 3.5 months of life compared with infants born from mothers with a MUAC >23 cm. This study underlines the importance of optimum maternal MUAC during pregnancy for optimal infant growth. Interventions that aim to tackle stunting in infants should integrate improving maternal MUAC during pregnancy.

Improving children's nutritional status in Cambodia: Multidimensional poverty and early integrated interventions

One in three Cambodian children under 5 years of age are stunted. This study adopted a multidimensional approach to understand the influence of a series of contextual factors on the nutritional status of Cambodian children. In this study, we use a multidimensional poverty framework to identify a combination of interventions likely to achieve reductions in child stunting, in Cambodia. We used the UNICEF Multiple Overlapping Deprivation Analysis tool and data from the Cambodia Demographic and Health Survey 2014 to assess children's multidimensional poverty across nutrition, health, early childhood development, water, sanitation, and housing dimensions. We found that 80% of children under age five were deprived in at least two poverty dimensions. Multivariate logistic regression analysis revealed that reducing the likelihood of being deprived in three or more poverty dimensions was associated with a significant reduction of the probability of being stunted, after controlling for potential confounders. The combined probability of nondeprivation in nutrition, sanitation, and health dimensions had the largest effect on reducing the probability of stunting. The results of this study highlight the multiple, intersecting needs of children and their associated explanatory factors. Targeted and integrated cross-sectoral policies that reinforce comprehensive early childhood interventions are needed for improving nutritional status as part of a wider set of child poverty reduction measures in Cambodia.

Extent of and trends in inequalities in child stunting in Sierra-Leone from 2005 to 2013: evidence from demographic and health surveys and multiple indicator cluster surveys

BACKGROUND

Comprehensive assessment of stunting disparity in Sierra-Leone has not been done so far. We aimed to document extent and over time dynamics of inequality in stunting in Sierra-Leone using approaches that facilitate implementation of interventions aim to eliminate non-justified stunting disparity in the country.

METHODS

The data for the study were derived from two rounds of the Sierra Leone Demographic and Health Survey conducted in 2008 and 2013, and two rounds of the Sierra Leone Multiple Indicator Cluster Survey done in 2005 and 2010. We used the 2019 update WHO Health Equity Assessment Toolkit (HEAT) to do the analysis. The toolkit makes use of data stored in the WHO Health Equity Monitor database. We analyzed stunting inequality using summary measures: Population Attributable Risk, Population Attributable Fraction, Difference and Ratio. The summary measures were computed for five equity stratifers: wealth, education, child's sex, place of residence and subnational region. We computed 95% Confidence Interval (CI) for each point estimate to show whether or not observed stunting inequalities are statistically significant, and whether or not the disparity changed over time statistically significantly.

RESULTS

The findings demonstrated stark inequalities in stunting in all the studied dimensions of inequality. While residence and subnational regional related inequalities remain unchanged over time, wealth and educational inequality had seen slight improvement during the same time period. Large sex related stunting inequality remained during the first three surveys time points, but it disappeared in 2013.

CONCLUSIONS

Huge stunting disparities occurred in Sierra Leone, and the disparity disproportionately affects disadvantaged subpopulations and male children. Nutrition interventions that specifically target the subgroups which suffer more from the burden of stunting are required.

Stunting Among Under 5-Year-Olds in Nepal: Trends and Risk Factors

Introduction

The nutritional status in the first 5 years of life has lifelong and inter-generational impacts on individual’s potential and development. This study described the trend of stunting and its risk factors in children under 5 years of age between 2001 and 2016 in Nepal.

Methods

The study used datasets from the 2001, 2006, 2011 and 2016 Nepal Demographic Health Surveys to describe the trend of stunting in under 5-year children. Multiple logistic regression analysis was carried out to assess the risk factors for stunting at the time of the four surveys.

Results

The nutritional status of under 5-year children improved between 2001 and 2016. Babies born into poorer families had a higher risk of stunting than those born into wealthier families (AOR 1.51, CI 95% 1.23–1.87). Families residing in hill districts had less risk of stunting than those in the Terai plains (AOR 0.75, CI 95% 0.61–0.94). Babies born to uneducated women had a higher risk of stunting than those born to educated women (AOR 1.57, CI 95% 1.28–1.92).

Discussion

Stunting among under-5-year children decreased in the years spanning 2001–2016. This study demonstrated multiple factors that can be addressed to decrease the risk of stunting, which has important implications for neurodevelopment later in life. We add literature on risk factors for stunting in under-5-year children.

Determinants of stunting among children aged 6 to 59 months in pastoral community, Afar region, North East Ethiopia: unmatched case control study

Background

Stunting is defined as a child with a height for-age Z-score less than minus two standard deviations. Globally, 162 million less than 5 years were stunted. In Ethiopia, Nationally the prevalence of stunting among under five children was 38.4% and in Afar it is above the national average (41.1%). This study was aimed to identify determinants of stunting among children aged 6 to 59 months in rural Dubti district, Afar region, North East Ethiopia, 2017.

Methods

Community based unmatched case-control study design was conducted among 322 (161 cases and 161 controls) children aged 6 to 59 months from March 2-30/ 2017. Simple random method was used to select 5 kebelles from 13 kebelles. Training was given for data collectors and supervisors. Data were entered to EPI data version 3.02 and exported to SPSS version 20 for analysis. Binary logistic regression analysis was used and variables with p-value < 0.25 on univariable binary logistic regression analysis were further analyzed on multivariable binary logistic regression analysis and statistical significance was declared at 95% CI.

Results

Being from a mother with no education (AOR = 4.92, 95%CI (1.94, 12.4), preceding birth interval less than 24 months (AOR = 4.94, 95% (2.17, 11.2), no ANC follow-up (AOR = 2.81, 95% (1.1.46, 5.38), no access to latrine (AOR =3.26, 95% CI (1.54-6.94), children born from short mother < 150 cm (AOR = 3.75, 95%CI (1.54, 9.18), not fed colostrum (AOR = 4.45, 95% CI (1.68, 11.8), breast fed for less than 24 months (AOR = 3.14, 95% CI (1.7, 5.79) and non-exclusive breast feeding (AOR = 6.68, 95% (3.1, 14.52) were determinants of stunting at 95% CI.

Conclusion

No maternal education, preceding birth interval less than 24 months, no ANC follow-up, no access to latrine, short maternal height, not feeding colostrum, duration of breast feed less than 24 months and non- exclusive breast feeding were determinants of stunting at 95% CI.

Risk factors for undernutrition among children 0-59 months of age in Myanmar

The prevalence of childhood stunting in Myanmar is one of the highest among the countries of Southeast Asia. Cross-sectional data from the Myanmar Demographic Health Survey 2015-2016 were used to examine risk factors for stunting, wasting, and underweight among children aged 0-59 months. The prevalence of stunting, wasting, and underweight was 29.0%, 7.3%, and 19.2%, respectively. Accounting for sampling design and weights, multivariable logistic regression was conducted with 35 household, maternal, and child characteristics. Current pregnancy and maternal height <145 cm, home delivery, child's small birth size recalled by mother, and older age (ref: 0-5 months) predicted both stunting and underweight. Larger than average birth size was protective for all stunting, wasting, and underweight. Maternal body mass index <18.5 kg m-2 was a common risk factor for wasting and underweight. Lower wealth quintiles, maternal engagement in nonagricultural occupation, and male child predicted stunting only. Younger child age and not receiving vitamin A supplementation in the previous 6 months were risk factors for wasting only. Regional variation was also seen, with a higher odds of stunting in the West-South Region, North-East States, and West States, compared with the Central Regions. In Myanmar, socio-economic and demographic factors, poor maternal nutritional status, and living in certain geographical locations are affecting children's undernutrition. It is recommended that interventions for growth faltering focus on the first 1,000 days of life; optimum maternal nutrition be ensured during and before pregnancy and at adolescence; societal support be provided for mothers in poverty or engaged in nonagriculture; and region-specific undernutrition pathways be understood.

Child stunting is associated with child, maternal, and environmental factors in Vietnam

Child stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6-59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross-sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6-23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24-59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.

Trends and inequalities in stunting in Nepal: a secondary data analysis of four Nepal demographic health surveys from 2001 to 2016

Background

The rate of stunting in Nepal is among the highest in the world, which is a major public health problem. The objective of this study was to present data on stunting prevalence according to socio-demographic and geographical circumstances and to determine the impact of those circumstances on the risk of stunting.

Methods

Data from Nepal Demographic and Health Surveys were used with the study population of children under 5 years old. The prevalence of stunting was determined by descriptive analysis and logistic regression analysis was used to determine risk factors for stunting.

Results

The prevalence of stunting has declined in overall as well as in all groups and subgroups analysed. The percentage of stunted children from 2001 to 2016 decreased by 18 and 10.7% in the rural and urban areas respectively. The unadjusted analysis depicted association between stunting and children living in rural areas since children living in rural areas had higher odds of being stunted compared to their urban counterparts. However, the association was no longer observed when adjusted for other variables included in this study. Children born to mothers without any education had 2.27 (95% CI 1.70-3.05), 5.222 (95% CI 2.54-10.74), 1.81 (95% CI 0.92-3.55) and 1.92 (95% CI 1.28-2.89) odds of being stunted than those born to mothers with higher education for the year 2001, 2006, 2011 and 2016 respectively in the adjusted analysis. Similarly, children belonging to the poorest wealth quintile had 1.90 (95% CI 1.55-2.33), 1.87 (95% CI 1.36-2.58), 2.47 (95% CI 1.51-4.02) and 4.18 (95% CI 2.60-6.71) odds of being stunted than those belonging to the richest quintile in 2001, 2006, 2011 and 2016 respectively. The association between stunting and wealth quintile depicting children belonging to the poorest and poorer wealth quintile having higher odds of being stunted remain the same in both unadjusted and adjusted analysis.

Conclusion

At national level, stunting is decreasing in Nepal; however, the prevalence of stunting is different between groups and subgroups analysed. The substantial inequalities in stunting have been preserved. Therefore, special emphasis should be given to vulnerable groups such as children belonging to the poorest and poorer wealth quintile instead of using blanket approach for delivering nutrition interventions. A balanced approach to nutritional inequalities prevalent across different regions and subgroups is required.

Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey

BACKGROUND

Child growth stunting remains a challenge in sub-Saharan Africa, where 34% of children under 5 years are stunted, and causing detrimental impact at individual and societal levels. Identifying risk factors to stunting is key to developing proper interventions. This study aimed at identifying risk factors of stunting in Rwanda.

METHODS

We used data from the Rwanda Demographic and Health Survey (DHS) 2014-2015. Association between children's characteristics and stunting was assessed using logistic regression analysis.

RESULTS

A total of 3594 under 5 years were included; where 51% of them were boys. The prevalence of stunting was 38% (95% CI: 35.92-39.52) for all children. In adjusted analysis, the following factors were significant: boys (OR 1.51; 95% CI 1.25-1.82), children ages 6-23 months (OR 4.91; 95% CI 3.16-7.62) and children ages 24-59 months (OR 6.34; 95% CI 4.07-9.89) compared to ages 0-6 months, low birth weight (OR 2.12; 95% CI 1.39-3.23), low maternal height (OR 3.27; 95% CI 1.89-5.64), primary education for mothers (OR 1.71; 95% CI 1.25-2.34), illiterate mothers (OR 2.00; 95% CI 1.37-2.92), history of not taking deworming medicine during pregnancy (OR 1.29; 95%CI 1.09-1.53), poorest households (OR 1.45; 95% CI 1.12-1.86; and OR 1.82; 95%CI 1.45-2.29 respectively).

CONCLUSION

Family-level factors are major drivers of children's growth stunting in Rwanda. Interventions to improve the nutrition of pregnant and lactating women so as to prevent low birth weight babies, reduce poverty, promote girls' education and intervene early in cases of malnutrition are needed.

Associations between contraception and stunting in Guatemala: secondary analysis of the 2014-2015 Demographic and Health Survey

BACKGROUND

There has been limited research on the relationship between contraception and child growth in low-income and middle-income countries (LMICs). This study examines the association between contraception and child linear growth in Guatemala, an LMIC with a very high prevalence of child stunting. We hypothesise that contraceptive use is associated with better child linear growth and less stunting in Guatemala.

METHODS

Using representative national data on 12 440 children 0-59 months of age from the 2014-2015 Demographic and Health Survey in Guatemala, we constructed multivariable linear and Poisson regression models to assess whether child linear growth and stunting were associated with contraception variables. All models were adjusted for a comprehensive set of prespecified confounding variables.

RESULTS

Contraceptive use was generally associated with modest, statistically significant greater height-for-age z-score. Current use of a modern method for at least 15 months was associated with a prevalence ratio of stunting of 0.87 (95% CI 0.81 to 0.94; p<0.001), and prior use of a modern method was associated with a prevalence ratio of stunting of 0.93 (95% CI 0.87 to 0.98; p<0.05). The severe stunting models found generally similar associations with modern contraceptive use as the stunting models. There was no significant association between use of a modern method for less than 15 months and the prevalence ratio of stunting or severe stunting.

CONCLUSIONS

Contraceptive use was associated with better child linear growth and less child stunting in Guatemala. In addition to the human rights imperative to expand contraceptive access and choice, family planning merits further study as a strategy to improve child growth in Guatemala and other countries with high prevalence of stunting.

Factors associated with stunting among children below five years of age in Zambia: evidence from the 2014 Zambia demographic and health survey

Background

Stunting continues to be a major public health problem globally. Stunting is a manifestation of many factors including inadequate food intake and poor health conditions. However, poor quality nutritional diets during pregnancy, infancy and early childhood lead to inadequate nutrient intake. The prevalence of stunting in Zambia has been over 40% and remains unacceptably high. There is limited information on factors associated with stunting in Zambia. Thus to better understand factors contributing to the high stunting levels, the 2013/14 Zambia Demographic and Health Survey (ZDHS) data was analysed.

Methods

Data was extracted using a data extraction tool and analysed using Stata version 13. Sample data of 12, 328 children aged 0-59 months was analysed. The analysis involved simple and multiple logistic regression to find associations between independent variables and stunting.

Results

The prevalence of stunting among under five children in Zambia is 40%. From the 4937 children who were stunted, stunting was higher among male children as compared to female children (42.4 and 37.6% respectively). Additional analysis revealed that children whose source of drinking water was improved (33.7%) were less likely to be stunted compared to children whose source of drinking water was poor (47.7%). Stunting was associated with sex and age of a child; mother's age and education; residence; wealth and duration of breastfeeding. For instance, children whose mothers had higher education showed a 75% reduction of odds compared to children whose mothers had no education (AOR = 0.35, 95%CI: 0.22, 0.54; p < 0.05). Similarly, wealth status showed an inverse relationship. Children who came from rich households showed a 32% reduction of odds compared to children who came from poor households (AOR = 0.68, 95%CI: 0.57, 0.82; p < 0.05).

Conclusion

The study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; mother's age and level of education; wealth status; improved source of drinking water; duration of breastfeeding and residence. Therefore, multiple measures targeted at reducing child stunting should be taken in a bid to influence policy and conceiving of programmes.

Environmental Risk Factors Associated with Child Stunting: A Systematic Review of the Literature

BACKGROUND

Stunting, a form of malnutrition characterized by impaired linear growth in the first two years of life, affects one quarter of children globally. While nutritional status remains the key cause of stunting, there is evidence that environmental risk factors are associated with stunting.

OBJECTIVE

The objective of this review is to explore the current literature and compile the environmental risk factors that have been associated with stunting. Further, we seek to discover which risk factors act independently of nutritional intake.

METHODS

A systematic search of the literature was performed using PubMed, EMBASE, Scopus, TOXNET, and CINAHL. A search of the grey literature was conducted. Papers were included in this review if they examined an association between childhood stunting and exposure to environmental risk factors.

FINDINGS

We included 71 reports in the final analysis. The included studies showed that foodborne mycotoxins, a lack of adequate sanitation, dirt floors in the home, poor quality cooking fuels, and inadequate local waste disposal are associated with an increased risk of childhood stunting. Access to safe water sources was studied in a large number of studies, but the results remain inconclusive due to inconsistent study findings. Limited studies were available for arsenic, mercury, and environmental tobacco, and thus their role in stunting remains inconclusive. The identified research did not control for nutritional intake. A causal model identified solid fuel use and foodborne mycotoxins as being environmental risk factors with the potential to have direct effects on childhood growth.

CONCLUSIONS

A diverse range of environmental risk factors are, to varying degrees, associated with stunting, demonstrating the importance of considering how the environment interacts with nutrition. Health promotion activities may be more effective if they consider environmental factors alongside nutritional interventions.

Environmental Risk Factors Associated with Child Stunting: A Systematic Review of the Literature

BACKGROUND

Stunting, a form of malnutrition characterized by impaired linear growth in the first two years of life, affects one quarter of children globally. While nutritional status remains the key cause of stunting, there is evidence that environmental risk factors are associated with stunting.

OBJECTIVE

The objective of this review is to explore the current literature and compile the environmental risk factors that have been associated with stunting. Further, we seek to discover which risk factors act independently of nutritional intake.

METHODS

A systematic search of the literature was performed using PubMed, EMBASE, Scopus, TOXNET, and CINAHL. A search of the grey literature was conducted. Papers were included in this review if they examined an association between childhood stunting and exposure to environmental risk factors.

FINDINGS

We included 71 reports in the final analysis. The included studies showed that foodborne mycotoxins, a lack of adequate sanitation, dirt floors in the home, poor quality cooking fuels, and inadequate local waste disposal are associated with an increased risk of childhood stunting. Access to safe water sources was studied in a large number of studies, but the results remain inconclusive due to inconsistent study findings. Limited studies were available for arsenic, mercury, and environmental tobacco, and thus their role in stunting remains inconclusive. The identified research did not control for nutritional intake. A causal model identified solid fuel use and foodborne mycotoxins as being environmental risk factors with the potential to have direct effects on childhood growth.

CONCLUSIONS

A diverse range of environmental risk factors are, to varying degrees, associated with stunting, demonstrating the importance of considering how the environment interacts with nutrition. Health promotion activities may be more effective if they consider environmental factors alongside nutritional interventions.