Factors associated with stunting in healthy children aged 5 years and less living in Bangui (RCA)

Abstract

Stunting remains a major public health concern worldwide. Although its global prevalence is slowly decreasing, the actual number of affected children is still rising in Sub-Saharan Africa. In the Central African Republic (CAR), about one third of all children below the age of five are stunted. Stunting is correlated with many long-term consequences, including poor cognitive development and a higher rate of morbidity and mortality, making stunting a major contributor to poverty. In CAR, little is known about the factors that contribute to stunting. This study aimed at analysing, in a cross-sectional study, the main factors associated with stunting in a group of 414 children recruited between December 2011 and November 2013, aged five years or less and living in Bangui. For all children, demographic, socio-economic and anthropometric data were recorded and asymptomatic enteropathogen carriage was assessed in stool samples using classical microbiological assays. The study group had a mean age of 14.2±10 months. Fifty-eight percent (292/414) were boys, and 36 percent (148/414) exhibited stunted growth. Of the stunted children, 51% (75/148) showed a moderate delay in linear growth for their age group [height-for-age z-score (HAZ) between -2 and -3 SD] while 49% (73/148) presented a severe delay (HAZ < -3). Factors significantly associated with stunting included gender (aOR: 1.67; 95% CI: 1.07; 2.62 for boys compared to girls) and age (aOR of 3.98 (95% CI: 2.45; 6.46) for toddlers and aOR 4.42 (95% CI: 2.36; 8.28) for children compared to infants). Most importantly, we identified being overweight [weight-for-height z-score (WHZ) > 2 SD; aOR: 3.21; 95% CI: 1.50; 6.90 of overweight compared to normal weight] as also being significantly associated with stunting. This is the first study showing that even in the poorest countries of the world there is an association of stunting with being overweight.

Child malnutrition in Ifanadiana district, Madagascar: associated factors and timing of growth faltering ahead of a health system strengthening intervention

“…Taken together, these results suggest that of the factors measured, parental anthropometry and birth or gestational factors are most important in determining both linear growth faltering and wasting in Ifanadiana. These results are consistent with international literature showing that demographic factors, particularly child age, maternal weight, and birth size are important determinants of both stunting and wasting [13,14,17,19,21]. Paternal nutritional status is both less studied and less strongly predictive of malnutrition in international literature [17]; its importance in determining stunting may be a unique feature of our study, which included a large set of matched fathers, or of this population.…”

“…Paternal nutritional status is both less studied and less strongly predictive of malnutrition in international literature [17]; its importance in determining stunting may be a unique feature of our study, which included a large set of matched fathers, or of this population. This contrasts with previous studies in Madagascar which have attributed malnutrition to behavioral factors, poor maternal education, and male sex [25,27–29], and to international literature emphasizing parental education and behaviors [13,19] and male sex [13,17,21] as risk factors for malnutrition. The lack of association with vaccination and supplementation in our study provides evidence that these factors, which may mediate the relationships between parental education, work, and nutrition [18,20], are less important in this population.…”

“…Maternal and paternal education have been associated with lower odds of malnutrition [13,19]; in one study in Indonesia, health-promoting parental behaviors such as vaccination and supplementation appeared to mediate this relationship [20], and in one study in Tanzania, maternal farming work appeared to worsen child nutritional status [18]. However across international literature, the strongest and most consistent risk factors for malnutrition are demographic: male sex [13,17,21], increasing child age [13,14,21], smaller birth size [13,14,19], and poor maternal nutritional status [13,14,17,19] all predicted malnutrition, particularly stunting, in multiple studies and reviews, leading some authors to conclude that many relevant determinants of growth faltering are already established at birth [19]. …”

Factors affecting stunting among under-five children in Bangladesh

“…Besides this, household facilities such as safe water supply and access to a toilet and sanitation facility are among the factors that increase the risk of stunting [17,18]. While health care practic-es, services, dietary and food security issues are direct determinants of stunting, socio-economic determinants like household income, number of family members and educational level work as underlying factors responsible for stunting [19][20][21][22]. The influences of both direct and indirect factors have been reviewed by WHO in their Conceptual Framework on Childhood Stunting and were summarized by Dewey and Begum 2011 [23] as well.…”

Pengendalian Faktor Risiko Stunting Anak Baduta Di Sulawesi Tengah

“…Stunting merupakan perhatian utama kesehatan masyarakat di seluruh dunia (Bata et al, 2017). Prevalensi stunting didefinisikan sebagai proporsi anak-anak yang memiliki tinggi badan menurut umur <-2SD standar pertumbuhan anak WHO (Onis, Blo, & Borghi, 2011) Stunting pada anak-anak adalah hasil dari beberapa keadaan dan faktor penentu termasuk prahamil, intrauterus dan kekurangan gizi setelah lahir (Adair et al, 2013) Stunting pada kehidupan awal dikaitkan dengan konsekuensi fungsional yang merugikan, rendahnya kognisi dan kinerja pendidikan, pendapatan yang rendah pada saat dewasa, hilangnya produktivitas, meningkatnya risiko penyakit kronis yang berhubungan dengan masalah gizi (Black et al, 2013) Intervensi dini dapat mencegah hasil tersebut dan juga menurunkan resiko kematian ibu (de Onis, Blo ssner, & Borghi, 2012).…”