Individual, household, and community level risk factors of stunting in children younger than 5 years: Findings from a national surveillance system in Nepal

Abstract

Despite substantial reductions in recent years in Nepal, stunting prevalence in children younger than 5 years remains high and represents a leading public health concern. To identify factors contributing to the stunting burden, we report multilevel risk factors associated with stunting in 4,853 children aged 6-59 months in a nationally and agroecologically representative random sample from the first year of the Policy and Science for Health, Agriculture, and Nutrition Community Studies, a community-based observational, mixed-panel study. Mixed effects logistic regressions controlling for multilevel clustering in the study design were used to examine the association of individual-, household-, and community-level factors associated with stunting.Stunting prevalence was 38% in our sample. After adjustment for potential confounding variables, maternal factors, including maternal height and education, were generally the strongest individ- Although most factors associated with stunting are not rapidly modifiable, areas for future research and possible interventions emerged.

The co‐occurrence of anaemia and stunting in young children

“…In India, maternal education was associated with stunting and household hunger was associated with anaemia. This is consistent with previous studies (Dorsey et al, 2017;Eicher-Miller, Mason, Weaver, McCabe, & Boushey, 2009). In Peru, caregivers' hand washing behaviour was associated with stunting, in line with evidence that sanitation and hygiene can help reduce the burden of stunting (Cumming & Cairncross, 2016).…”

Why under five children are stunted in Pakistan? Multilevel analysis of Punjab Multiple Indicator Cluster Survey (MICS-2014)

“…Mother and Fathers' higher education status is associated significantly with the less likelihood of child of less than five years being stunted (moderate and severe) in Punjab, Pakistan. This result is in line with other studies from Asia and Africa [57,34,58,59,28]. Although the channels through which education of parents can affect child health outcomes are debated as it hypothesized that higher educated parents are relatively better endowed with (health care) knowledge and resources, relatively rich and better able to provide childcare [60,28,61].…”

Water, sanitation and hygiene practices associated with improved height-for-age, weight-for-height and weight-for-age z-scores among under-five children in Nepal

“…Another important WASH variable is access to safe drinking water but the methods for how the safe drinking water variable is defined and included in existing nutritional studies vary markedly. They mainly differ on either use of a protected water source [24,32], piped water source [11,33] or household water treatment methods [34][35][36]. In resource constraint settings where a water pipeline system is unreliable and not well maintained, the risk of water contamination in the supply chain remains high [16,37] potentially diluting the effect measure and strength of association.…”

“…The relative contribution of WASH interventions on childhood undernutrition is still unresolved in the current literature [21,22] with some studies providing conflicting results depending upon study design, nutritional outcomes and geographical settings where studies were conducted [11,[21][22][23]. Despite this, a majority of cross-sectional studies have consistently demonstrated a crucial role of improved WASH practices on childhood nutrition outcomes [6,11,24,25]. However, wide spread variation in methodological approaches and study settings have often posed a considerable challenge for interpretation and synthesis of study findings, limiting the prospect of providing definitive policy recommendations.…”