Determinants of Child Stunting, Wasting, and Underweight: Evidence from 2017 to 2018 Pakistan Demographic and Health Survey

Abstract

Child malnutrition persists in low-resource countries such as Pakistan, indicating an urgent need for interventions and policies aimed to address this critical population health issue. The World Health Organization Global Target 2025 includes the reduction of malnourishment in the form of stunting, wasting, and low weight. This study aims to examine the prevalence of factors associated with three measures of child malnutrition, i.e., stunting, wasting, and low weight in Pakistan. This study uses a secondary data analysis design based on data from Pakistan Demographic and Health Survey (2017-18) that used a two-stage cluster sampling approach. National level data covering urban and rural areas were used for this study consisting of 4,226 children less than 5 years of age. Univariate and multivariable analyses using logistic regression models were conducted. Over 23% of the children were underweight, 8.0% suffered wasting, and 37.7% were stunted. Children with small size at birth (<45.7 cm), those who were average in size (45.7 to 60 cm) at birth were less likely to be stunted (AOR, 0.4890) and underweight (AOR, 0.538). Children with large size at birth (>60 cm) were also less likely to be stunted (AOR, 0.288) and underweight (AOR, 0.538). Children who consumed fresh milk were less likely to be classified as wasted (AOR, 0.524) than those children who did not consume fresh milk. The children in high- and middle-economic status families were less likely to be stunted, underweight, or wasted. Children of mothers who had secondary and higher education were less likely to be stunted (AOR, 0.584) and were less likely to be underweight (AOR, 0.668) than illiterate mothers’ children. Children of working mothers were less likely to be wasted compared to children of nonworking mothers (AOR, 0.287). Maternal BMI is also inversely associated with being underweight because overweight and obese mothers were less likely to have underweight children (AOR, 0.585). Our findings reflect a need to design targeted public health policies and community-based education that emphasize the mother’s education on nutrition health and provide socioeconomic resources that enable mothers to provide dietary needs that prevent malnutrition.

Determinants of aggregate anthropometric failure among children under-five years in Ethiopia: Application of multilevel mixed-effects negative binomial regression modeling

“…The observed gender differences in anthropometric failure have been reported in earlier studies and is consistent with previous findings from Nigeria [48], Rwanda [49], and Senegal [50]. Similarly, studies from Asian countries, like India [51], Pakistan [52], and Indonesia [53] also reported related findings. A systematic review and metaanalysis by Thurstans et al also found that boys had a higher risk of stunting, wasting, and being underweight than girls [54].…”

The Role of Social Factors in Childhood Stunting in Pakistan with Special Focus on Parental Aspects

“…Furthermore, the previous literature confirms that child malnutrition is associated with child stunting growth. The study recommended that the World Health Organization Global Target 2025 could be achieved if Pakistan controlled children's stunting growth (Siddiqa et al, 2023). The present study results were linked to the current results, such as the study found that child malnutrition and no food diversity were associated with children stunting.…”

Maternal Health Services in Pakistan

“…Pakistan Demographic and Health Survey findings show that 57% of married or engaged women have never attended school. This research is particularly instructive to empowerment studies because previous research in Pakistan found a positive relationship between educational attainment and maternal healthcare use in particular, with Pakistani women who lived in areas with high levels of secondary education being 74% more likely to give birth in a health facility than Pakistani women who lived in areas with lower levels of community education attainment 14 . Moreover, cultural restrictions on male-female relations are linked to maternal mortality; women who encounter issues during labour and delivery might not be able to seek medical help unless a male family member is present 15 .…”

“…For instance, education is frequently used as a stand-in for empowerment; yet, access to school is restricted by societal conventions, family socioeconomic status, and access across regions, in addition to gender 17 . Although wealth and income have also been investigated as potential indicators of empowerment, these studies indicated that multidimensional empowerment does not always follow gains in economic productivity 14 .…”

“…Three significant programs with significant foreign funding-the Women's Health Project (2000)(2001)(2002)(2003)(2004)(2005)(2006), Pakistan Initiatives for Mothers and Newborns (PAIMAN, 2004-20108), and the Norway-Pakistan Partnership Initiativehelped to improve MCH and provided about PKR 24 billion (US$225 million, at 2015 prices) (NPPI, 2009(NPPI, -2014. Between 2000 and 2014, these programs jointly intervened in the MCH delivery system of 44 districts (out of 113 total), which account for over 40% of the country's population and are mostly situated in rural areas 27,28 .…”