Nutritional status and risk factors for stunting in preschool children in Bhutan

Abstract

Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z ‐scores of height‐for‐age [HAZ], weight‐for‐height [WHZ], and weight‐for‐age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.

The Forgotten Agenda of Wasting in Southeast Asia: Burden, Determinants and Overlap with Stunting: A Review of Nationally Representative Cross-Sectional Demographic and Health Surveys in Six Countries

“…Several maternal factors have consistently been identified as factors associated with increased risk of wasting in under-five children. Younger maternal age, height below 145 cm, low level of education and low BMI has been linked with increased risk of wasting in several studies [35,41,[58][59][60][61][62][63]. In our analysis, however, only BMI was associated with risk of wasting.…”

“…This is because the prevalence of wasting peaks in the 0-5 months age group in some Asian countries, compared to after infancy which is common in other settings [34,84]. The peak in prevalence of wasting in the 0 to 5 months group has recently emerged as a key indicator to decide whether the determinants of wasting in a given country are predominantly prenatal or postnatal [34,41,60]. In our analysis, the age distribution pattern across the different age groups was not consistent across all the countries.…”

Epidemiology of anaemia in children, adolescent girls, and women in Bhutan

“…An estimated 29% of non‐pregnant women and 43% of preschool‐age children worldwide have anaemia (Stevens et al, ), and iron‐deficiency anaemia is the single largest cause of years lived with disability in children and adolescents worldwide (Global Burden of Disease et al, ). Between 1990 and 2013, the global prevalence of anaemia declined by 21% (from 33.3% to 27.0%; Kassebaum, ), but progress has been uneven, with differences by region and greater improvements among men relative to women and among adults relative to children, widening previously observed disparities in anaemia prevalence among regions, sexes, and age groups (Kassebaum et al, ).…”

“…In children, anaemia is associated with impaired cognitive development and possibly with motor development as well (Balarajan, Ramakrishnan, Özaltin, Shankar, & Subramanian, ; Sachdev, Gera, & Nestel, ). Iron deficiency is the most common cause of anaemia (Kassebaum, ), but other causes include parasitic and other infections, chronic inflammatory conditions, deficiencies of micronutrients other than iron, and genetic causes (Bates, McKew, & Sarkinfada, ; Williams & Weatherall, ). The proportion of observed anaemia attributable to iron deficiency is estimated to be just over 60% worldwide but differs by geographic region and country and by demographic group (Kassebaum, ), as well as with the degree of economic development and prevalence of inflammation (Petry et al, ).…”

“…Iron deficiency is the most common cause of anaemia (Kassebaum, ), but other causes include parasitic and other infections, chronic inflammatory conditions, deficiencies of micronutrients other than iron, and genetic causes (Bates, McKew, & Sarkinfada, ; Williams & Weatherall, ). The proportion of observed anaemia attributable to iron deficiency is estimated to be just over 60% worldwide but differs by geographic region and country and by demographic group (Kassebaum, ), as well as with the degree of economic development and prevalence of inflammation (Petry et al, ). Recently reported prevalence of anaemia in South and Southeast Asia is 58% in preschool‐age children and 47% in non‐pregnant women, despite substantial reductions in the past 15 years (Stevens et al, ).…”