Urban-Rural Disparities in the Magnitude and Determinants of Stunting among Children under Five in Tanzania: Based on Tanzania Demographic and Health Surveys 1991-2016

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.

Utilizing a multi-stage transition model for analysing child stunting in two urban slum settlements of Nairobi: A longitudinal analysis, 2011-2014

INTRODUCTION

Stunting is common among children in many low and middle income countries, particularly in rural and urban slum settings. Few studies have described child stunting transitions and the associated factors in urban slum settlements. We describe transitions between stunting states and associated factors among children living in Nairobi slum settlements.

METHODS

This study used data collected between 2010 and 2014 from the Nairobi Urban and Demographic Surveillance System (NUHDSS) and a vaccination study nested within the surveillance system. A subset of 692 children aged 0 to 3 years, with complete anthropometric data, and household socio-demographic data was used for the analysis. Height-for-age Z-scores (HAZ) was used to define stunting: normal (HAZ ≥ 1), marginally stunted (-2 ≤ HAZ < -1), moderately stunted (-3 ≤ HAZ < -2), and severely stunted (HAZ < -3). Transitions from one stunting level to another and in the reverse direction were computed. The associations between explanatory factors and the transitions between four child stunting states were modeled using a continuous-time multi-state model.

RESULTS

We observed that 48%, 39%, 41%, and 52% of children remained in the normal, marginally stunted, moderately stunted, and severely stunted states, respectively. About 29% transitioned from normal to marginally stunted state, 15% to the moderately stunted state, and 8% to the severely stunted state. Also, 8%, 12%, and 29% back transitioned from severely stunted, moderately stunted, and marginally stunted states, to the normal state, respectively. The shared common factors associated with all transitions to a more severe state include: male gender, ethnicity (only for mild and severe transition states), child's age, and household food insecurity. In Korogocho, children whose parents were married and those whose mothers had attained primary or post-primary education were associated with a transition from a mild state into a moderately stunted state. Children who were breastfed exclusively were less likely to transition from moderate to severe stunting state.

CONCLUSION

These findings reveal a high burden of stunting and transitions in urban slums. Context-specific interventions targeting the groups of children identified by the socio-demographic factors are needed. Improving food security and exclusive breastfeeding could potentially reduce stunting in the slums.

Associated factors of malnutrition status among children and adolescents living with HIV in Tanzania: Individual-level analysis and marginal effect estimation

OBJECTIVES

This study aimed to identify individual-level factors that affect malnutrition outcomes among children and adolescents living with HIV/AIDS in Tanzania.

METHODS

We used data from the National AIDS Control Programme. 70,102 participants aged 5 to 19 years attending care and treatment clinics between January to December 2021 were included. Nutritional assessments were performed by anthropometric measurement. Logistic regression models were used to evaluate risk factors. We further estimated marginal prevalence and adjusted predictions by marginal effects. Supplementary analysis assessed the accuracy of the final fitted model.

RESULTS

Prevalence of malnutrition for stunting, underweight, wasting, and anthropometric failure (CIAF) were 36.0%, 28.9%, 13.0%, and 48.0%, respectively. Several individual-level factors were significant determinants of malnutrition. Boys, participants aged 15-19 years, those switched to second- or third-line antiretroviral therapy (ART), initiated ART at ages of 5-14 years, ART duration less than 3 years, and were in advanced stages of WHO HIV clinical status had increased adjusted odds ratios and marginal prevalence. The larger AUC values for all models implied importance of identified factors accounted for malnutrition.

CONCLUSIONS

On long-term ART, nutritional interventions should be context-specific guidelines to improve growth, especially at ART initiation, ART regimen, and ART duration reckoning with age and sex.

Early life exposure to cold weather shocks and growth stunting: Evidence from Tanzania

This study examines the effects of early life and in utero exposure to cold weather shocks on the incidence of growth stunting for children under age five in Tanzania. We find that an increase of 10 percentage points in the proportion of days with temperatures below 15 degrees Celsius (one standard deviation below the long-term average) is associated with an increase in the probability of stunting and severe stunting by 2.0 and 1.4 percentage points (equivalent to 5.5 and 9.7 percent of the mean stunting and severe stunting), respectively. The results also show strong effects of in utero exposure during the second trimester of pregnancy on child stunting and wasting. In terms of the mechanisms, we find that the effects on disease environment, food insecurity, and reduced agricultural productivity are the possible channels driving the results.

Geospatial Overlap of Undernutrition and Tuberculosis in Ethiopia

Undernutrition is a key driver of the global tuberculosis (TB) epidemic, yet there is limited understanding regarding the spatial overlap of both diseases. This study aimed to determine the geographical co-distribution and socio-climatic factors of undernutrition and TB in Ethiopia. Data on undernutrition were found from the Ethiopian Demographic and Health Survey (EDHS). Data on TB were obtained from the Ethiopia national TB prevalence survey. We applied a geostatistical model using a Bayesian framework to predict the prevalence of undernutrition and TB. Spatial overlap of undernutrition and TB prevalence was detected in the Afar and Somali regions. Population density was associated with the spatial distribution of TB [β: 0.008; 95% CrI: 0.001, 0.014], wasting [β: -0.017; 95% CrI: -0.032, -0.004], underweight [β: -0.02; 95% CrI: -0.031, -0.011], stunting [β: -0.012; 95% CrI: -0.017, -0.006], and adult undernutrition [β: -0.007; 95% CrI: -0.01, -0.005]. Distance to a health facility was associated with the spatial distribution of stunting [β: 0.269; 95% CrI: 0.08, 0.46] and adult undernutrition [β: 0.176; 95% CrI: 0.044, 0.308]. Healthcare access and demographic factors were associated with the spatial distribution of TB and undernutrition. Therefore, geographically targeted service integration may be more effective than nationwide service integration.

Analysis of the Determinants of Stunting among Children Aged below Five Years in Stunting Locus Villages in Indonesia

Determinants of stunting are a concern in stunting locus villages, especially in East Nusa Tenggara, the province with the highest prevalence of stunting in Indonesia. This study aims to analyze the determinants of stunting in such villages. A cross-sectional research design was conducted on a sample of 166 mothers of children aged 24–59 months selected using a proportional random sampling method in four stunting locus villages in East Nusa Tenggara province, from January to March 2022. Chi-square and binary logistic regression were used to analyze the determinants of stunting with a significance level of p < 0.05. The prevalence of stunting among children aged below five years in the villages was 22.3%. Lack of maternal knowledge (AOR: 5.310; 95% CI: 0.671–41.997) and negative parenting (AOR: 3.026; 95% CI: 1.191–7.871) were associated with higher risk of stunting. Meanwhile, children aged below five years with close birth spacing (AOR: 0.304; 95% CI: 0.087–1.063) had a low risk of stunting. The prevalence of stunting in stunting locus villages needs special attention from the Indonesian government. Maternal knowledge should be enhanced by distributing information related to stunting through formal and non-formal education and teaching good parenting to reduce the prevalence of stunting among children aged below five years in stunting locus villages.

Sociodemographic and Healthcare Factors Associated with Stunting in Children Aged 6-59 Months in the Urban Area of Bali Province, Indonesia 2018

Stunting is a worldwide public health concern, including in Indonesia. Even when living in an urban area with urban characteristics, it is still possible for children to be at risk of stunting. The aim of this study was to determine the sociodemographic and healthcare factors associated with stunting in a province experiencing tourism growth, namely, Bali. Cross-sectional data on Bali Province from the Indonesian Basic Health Research Survey (Riskesdas, 2018) were used as the basis for the research analysis. A total of 846 respondents under five years of age were analyzed, indicating a stunting prevalence of 19.0%. Multivariate logistic regression demonstrated low maternal educational attainment (adjustedOR = 1.92; 95% Confidence Interval = 1.24-2.97), the inadequate consumption of iron tablets during pregnancy (adjustedOR = 1.56; 95% Confidence Interval = 1.08-2.24), and no extended family (adjustedOR = 1.55; 95% Confidence Interval = 1.07-2.26) as being significantly associated with stunting. According to these findings, sociodemographic and healthcare factors are associated with stunting in urban Bali. Improving women's education, ensuring sufficient iron tablets are consumed during pregnancy, and encouraging the involvement of the extended family in childcare are recommended.

Urban-rural differences in the relationship between stunting, preschool attendance, home learning support, and school readiness: A study in Côte d'Ivoire

Background

Stunted physical growth during early childhood is a marker of chronic undernutrition, and the adverse life circumstances that underlie it. These have the potential to disrupt normal brain development and the acquisition of foundational cognitive, language, social and motor skills. Stunting is prevalent in most low-and middle-income countries. Because the prevention of stunting requires large-scale structural and attitudinal changes, several psycho-educational interventions have been developed to mitigate the adverse association between early stunting and skill development. However, the resource-intensive nature of custom-designed interventions limit their sustainability and scalability in resource-limited settings. This study explored the possibility that available resources that promote positive development (existing preschool education programs, and no- or low-cost home-based learning activities and resources) may protect against any negative association between stunting and the acquisition of foundational skills required for academic learning and adaptation at school.

Method

Data for 36-to 59-month-old children (n = 3,522; M = 46.7 months; 51.2% male; 74.1% rural) were drawn from the most recent Multiple Indicator Cluster Survey conducted in Côte d'Ivoire (MICS5, 2016). Stunting was assessed using the WHO Child Growth Standards. Preschool attendance and home learning activities and resources were assessed by maternal report. School readiness was assessed using the 8-item form of the Early Child Development Index (ECDI).

Results

A high percentage of children met the criteria for stunting (28.5%; 19.7% moderate; 8.8% severe). There were marked urban-rural differences in the prevalence of stunting, rates of preschool attendance, home learning activities and resources, children's school readiness scores, and the relationships between stunting, the protective factors and school readiness scores. These urban-rural differences in ECDI scores could be fully explained by differences between these settings in stunting and the protective factors. However, only two protective factors (access to books and home-based activities that promote learning) made independent contributions to variance in ECDI scores. There was tentative evidence that stunted children whose homes provided highly diverse learning activities and multiple types of learning resources were more likely than those who did not to have a high level of school readiness.

Conclusion

Capitalizing on the existing practices of families that show positive deviance in caregiving may provide a basis for culturally appropriate, low-cost interventions to improve school readiness among children in low- and middle-income countries, including children with stunted growth.

Drivers of Stunting Reduction in Yogyakarta, Indonesia: A Case Study

BACKGROUND

Chronic malnutrition in children is a severe global health concern. In Yogyakarta, the number of children who are too short for their age has dropped dramatically over the past few decades.

OBJECTIVE

To perform an analysis of trends, policies, and programs; and an assessment of government, community, household, and individual drivers of the stunting reduction in Yogyakarta, Indonesia.

METHOD

Using a mixed-methods approach, there were three types of research: (1) analysis of quantitative data, (2) evaluation of stunting policy, and (3) focus group discussions and in-depth interviews to collect qualitative data.

RESULTS

The prevalence of stunting has decreased from year to year. Mean height-for-age z-scores (HAZ) improved by 0.22 SDs from 2013 to 2021. Male and female toddlers aged <20 months have relatively the same body length as the WHO median, but it is lower for children >20 months old. The COVID-19 pandemic has contributed to an increase in stunting-concurrent wasting. Nutrition-specific and -sensitive interventions have been carried out with coverage that continues to increase from year to year, although in 2020, or at the beginning of the COVID-19 pandemic, the coverage of specific interventions decreased. The government has committed to tackling stunting by implementing the five pillars of stunting prevention and the eight convergent stunting actions. As the drivers of stunting reduction, national and community stakeholders and mothers, at the village level, cited a combination of poverty reduction, years of formal education, prevention of early marriage, access to food, enhanced knowledge and perception, and increased access to sanitation and hygiene.

CONCLUSIONS

Nutrition-specific and -sensitive sector improvements have been crucial for decreasing stunting in Yogyakarta, particularly in the areas of poverty reduction, food access, preventing child marriage, sanitation, education, and increasing knowledge and perception.

Analysis of Factors that affect Events and Interventions of Stunting through the E-Stunting Android Application

Background: Based on the Indonesian Toddler Nutrition Status Survey in 2021, it was found that the stunting rate in Indonesia reached 24.4%, which means there were 5.33 million indicated stunting. Objective: The purpose of this study was to detect the causative factors and effectiveness of stunting interventions in the E stunting application. Methods: The type of the research is quantitative analytic with cross sectional approach using double linear regression analytic test with p = 0.05. The difference test used an unpaired sample test analytic by looking at the difference in mean in the control and treatment groups. The population uses totality sampling with the rule of thumb technique. This research instrument uses a minimum diet diversity questionnaire, diet diversity, parenting model, as well as a questionnaire with a Likert scale and has been through validity and reliability tests. Results: The results of the determinant coefficient test have a relationship between the independent and dependent variables, while Adjusted R2 = 0.803 which means 80.3% of all variables affect the z score in children, while the difference test result obtained a result of sig 2 tailed = 0.001 and the value of Sig Levene's test for equality variance of 0.44 > 0.001 Conclusion: There is an effect of frequency of eating, number of types of food, eating culture, history of breastfeeding, complementary feeding, perception, knowledge of the z score (stunting events). And E stunting is effective in assessing the causative factors and treatment in cases of infants with stunting

Inequalities in the prevalence of stunting, anemia and exclusive breastfeeding among African children

Background

Childhood stunting and anemia are on the increase in many resource-constrained settings, without a counter increase in proper feeding practices such as exclusive breastfeeding. The objective of this study was to explore the prevalence of stunting, anemia and exclusive breastfeeding across African countries.

Methods

Demographic and Health Survey (DHS) data from 39 African countries was analyzed. Data from under 5 children were analyzed. Forest plot was used to determine inequalities in the prevalence of the outcome variables.

Results

The prevalence of stunting was highest in Burundi (56%), Madagascar (50%) and Niger (44%). In addition, Burkina Faso (88%), Mali (82%), Cote d’Ivoire and Guinea (75% each) and Niger (73%) had the highest prevalence of anemia. Furthermore, Burundi (83%), Rwanda (81%) and Zambia (70%) had the highest exclusive breastfeeding. We found statistical significant difference in the prevalence of stunting, anemia and exclusive breastfeeding (p < 0.001). Higher prevalence of stunting and anemia were estimated among the male, rural residents, those having mothers with low education and from poor household wealth.

Conclusion

Concerted efforts are required to improve childhood health, survival and proper feeding practice. Reduced stunting and anemia could be achieved through sustained socioeconomic improvement that is shared in equity and equality among the population. Interventions aimed at increasing food availability can also aid in the reduction of hunger, particularly in impoverished communities.

Rural and Urban Correlates of Stunting Among Under-Five Children in Sierra Leone: A 2019 Nationwide Cross-Sectional Survey

BACKGROUND

Undernutrition accounts for at least 50% of the annual global under-five mortality burden. Although disparities in the childhood stunting between urban and rural areas in Sierra Leone have been documented, information on factors associated with these differences is lacking. We aimed to determine rural-urban correlates of stunting among children under the age of 5 in Sierra Leone.

METHODS

We analyzed data from 2019 Sierra Leone demographic and health survey (SLDHS) focusing on under-five children. We conducted multivariable logistic regression to examine rural-urban factors associated with childhood stunting.

RESULTS

Prevalence of stunting was 31.6% (95% CI 29.8-33.2) in rural areas and 24.0% (95% CI 21.6-26.1) in urban areas. Within the rural areas, children of stunted mothers (aOR = 2.37; 95% CI 1.07-5.24, P < .05), younger mothers aged 15 to 19 years (aOR = 2.08; 95% CI 1.17-3.69, P < .05), uneducated mothers (aOR = 1.87; 95% CI 1.28-2.71, P < .01), as well as older children (24-59 months) (aOR = 1.83; 95% CI 1.48-2.27, P < .001), and boys (aOR = 1.37; 95% CI 1.12-1.66, P < .01) were more likely to be stunted compared to those of non-stunted, older, post-primary education mothers and those who were less than 24 months and girls respectively. While urban children whose fathers had lower education (aOR = 1.94; 95% CI 1.10-3.42, P < .05), whose mothers were more parous (para 2-4) (aOR = 1.74; 95% CI 1.03-2.95, P < .05), and boys (aOR = 1.48; 95% CI 1.06-2.08, P < .05) were more likely to be stunted compared to their counterparts with fathers that had tertiary education, mothers of low parity and girls, respectively.

CONCLUSIONS

Stunting is more prevalent in the rural areas compared to the urban areas. Sex of the child was the only significant factor in both rural and urban areas. Our study findings suggest that programs designed to reduce stunting should aim for integrated yet context specific interventions in rural and urban areas.