Maternal anemia and baby birth size mediate the association between short birth interval and under-five undernutrition in Ethiopia: a generalized structural equation modeling approach

Abstract

Background Studies assessing the association between short birth interval, a birth-to-birth interval of less than 33 months, and under-five undernutrition have produced inconclusive results. This study aimed to assess the relationship between short birth interval and outcomes of stunting, underweight, and wasting among children aged under-five in Ethiopia, and potential mediation of any associations by maternal anemia and baby birth size. Method Data from the 2016 Ethiopia Demographic and Health Survey (EDHS) was used. Stunting, wasting, and underweight among children aged under-five were outcome variables. Generalized Structural Equation Modeling (GSEM) was used to examine associations between short birth interval and outcomes, and to assess hypothesized mediation by maternal anemia and baby birth size. Results Significant associations between short birth interval and stunting (AOR = 1.49; 95% CI = 1.35, 1.66) and underweight (AOR = 1.43; 95% CI = 1.28, 1.61) were found. There was no observed association between short birth interval and wasting (AOR = 1.05; 95% CI = 0.90, 1.23). Maternal anemia and baby birth size had a significant partial mediation effect on the association between short birth interval and stunting (the coefficient reduced from β = 0.337, p < 0.001 to β = 0.286, p < 0.001) and underweight (the coefficient reduced from β = 0.449, p < 0.001 to β = 0.338, p < 0.001). Maternal anemia and baby birth size mediated 4.2% and 4.6% of the total effect of short birth interval on stunting and underweight, respectively. Conclusion Maternal anemia and baby birth size were identified as mediators of the association between short birth interval and under-five undernutrition status. Policies and programs targeting the reduction of under-five undernutrition should integrate strategies to reduce maternal anemia and small baby birth size in addition to short birth interval.

Investigating the direct and indirect associations between birth intervals and child growth and development: A cross-sectional analysis of 13 Demographic and Health Surveys

“…More research is needed to explore additional biological (e.g., birth weight, gestational weight gain) and behavioural (e.g., caregiver mental health, empowerment) mechanisms to better understand the associations between timing of birth intervals and child growth and development. A recent study using DHS data from Ethiopia showed that maternal anaemia and birth size mediated the associations between short birth intervals and child stunting and underweight ( Shifti et al, 2022 ). However, each of these two variables mediated only 4.2–4.5% of the total effect, indicating that other mechanisms are also at work.…”

“…We focused on linear growth (instead of ponderal growth) as a marker of chronic deprivation, which at least partially shares determinants with child development ( Prado et al, 2019 ). Most prior empirical literature on birth intervals has found stronger associations with linear growth ( Dewey & Cohen, 2007 ; Fink et al, 2014 ; Rutstein, 2005 ; Shifti et al, 2022 ) and therefore there was stronger evidence for examining mechanisms with respect to linear as opposed to ponderal growth. Because of the many limitations of stunting as an indicator of child health ( Leroy & Frongillo, 2019 ; Perumal et al, 2018 ) and the fact that nutrition interventions for children 36–59 months of age would likely result only in minor changes in child height ( Perumal et al, 2018 ), we focused on the continuous HAZ indictor in our analyses.…”

“…A growing number of studies in LLMICs have also shown that short birth intervals continue to compromise children's growth and development beyond infancy and throughout early childhood. Specifically, shorter birth intervals are associated with an increased risk of stunting and underweight in children under five years of age ( Dewey & Cohen, 2007 ; Fink et al, 2014 ; Rutstein, 2005 ; Shifti et al, 2022 ; Yaya et al, 2020 ). However, the relationship between birth intervals and child cognitive and socio-emotional development has received much less attention.…”

Multiple sclerosis risk among anti-tumor necrosis factor alpha users: A methodological review of observational studies based on real-world data

“…Mediators are variables that lie along the causal pathway between the exposure and the outcome [18]. Suppose we are interested in the total effect of smoking on MS progression.…”

Iron supplementation and deworming during pregnancy reduces the risk of anemia and stunting in infants less than 2 years of age: a study from Sub-Saharan Africa

“…Since then, daily iron supplementation and deworming treatment (DWM) have become an integral part of antenatal care (ANC) practices in sub-Saharan African countries [ 11 ]. Anemia in women during pregnancy has been reported to increase the risk of infant stunting, childhood anemia and low birth weight [ 12 , 13 ]. In Africa, stunting [ 14 ], childhood anemia [ 15 – 18 ], and low birth weight [ 19 , 20 ] remain a public health problem to this day.…”