Reducing malnutrition in Cambodia. A modeling exercise to prioritize multisectoral interventions

Abstract

Undernutrition is a major contributor to child morbidity and mortality and poses a large burden to the economy, in Cambodia. This study explored factors contributing to child stunting and wasting and their regional inequalities among 1,938 Cambodian children aged 6–23.9 months. Data were drawn from a longitudinal study (year 2017) conducted in six districts of two north‐eastern provinces and the capital and used as cross‐sectional. Socio‐demographic and household characteristics, children's feeding practices during the previous 24 hr, and children's length and weight measurements were collected. Gradient boosting models were used to calculate the contribution of determinants to child undernutrition whereas concentration index was used to assess the impact of those determinants on stunting and wasting inequalities among socioeconomic groups. It was found that low‐household wealth could predict 21% to 45% of child stunting and 23% to 36% of wasting across regions. After wealth, source and treatment of drinking water were found the second major predictor for stunting (15%) and wasting (21%). Combining child nutrition and household water, sanitation and hygiene indicators predicted around 30% of child undernutrition, either in the form of stunting or wasting. Mothers' education predicted >30% of stunting in the north‐eastern region. Results highlight that a complex interplay of factors contributes to child stunting and wasting. An integrated, intersectoral, equity‐focused approach that addresses children's dietary quality, household's water, sanitation and hygiene conditions, mother's education, and poverty is likely to yield the highest impact in achieving further gains in nutritional status among Cambodian children.

Implementation Outcomes of National Convergence Action Policy to Accelerate Stunting Prevention and Reduction at the Local Level in Indonesia: A Qualitative Study

“…The existence of clear responsibilities in resources, leadership, and governance between sectors in nutrition-specific and -sensitive interventions has a strong potential to support the acceleration of stunting reduction [ 33 ]. The developed strategy is carried out through collaborations and coordination across sectors at the central and regional levels, as well as through the provision of sustainable food, health, water, and nutrition [ 34 ]. Multisectoral action plans at various levels have been proven to reduce stunting [ 33 , 35 , 36 ].…”

Water quality for young children in Cambodia—High contamination at collection and consumption level

“…That limited evidence of effectiveness stressed the need to focus on household water practices (Clasen et al, ). Source of drinking water has shown to be a key contributor to child wasting in the north‐eastern provinces (Laillou et al, ) supporting the importance of water hygiene promotion in households and communities as part of a comprehensive approach for ensuring good child nutritional status.…”

Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review

“…Of the two predictors classified in this factor, low micronutrient quality is the predictor that appears to provide the greatest increased risk of causing stunting, which is equal to 13% ( 33 ) . Although few studies have reported it, it was identified that vitamin D ( 19 ) , iodine ( 33 ) , iron ( 28 ) , and vitamin A ( 31 , 33 ) are micronutrients associated with stunting in Southeast Asia. This finding is also the same as that of another study on stunting in other middleand low-income countries ( 48 ) .…”