Socioeconomic and demographic correlates of child nutritional status in Nepal: an investigation of heterogeneous effects using quantile regression

Abstract

Background Child undernutrition continues to be a major public health problem in many countries, including Nepal. The repercussions of undernutrition are not only limited to the affected children and families but also transcend to the national and global economy. Earlier studies from Nepal have predominantly used either ordinary least squares (OLS) regression or binary regression to analyse the socioeconomic and demographic correlates of the nutritional outcome. In this study, quantile regression was used to understand a complete and more precise estimate of the effects of the covariates on the child nutritional status. Methods This study was based on the most recent nationally representative Nepal Multiple Indicator Cluster Survey (MICS) 2019. Height-for-age z scores (HAZ) were used as an indicator for assessing the nutritional status of under-five children. Quantile regression was used to examine the heterogeneous association of covariates with conditional HAZ distribution across the different quantiles (0.10, 0.30, 0.50, 0.85). As a comparison, the effects of covariates at conditional mean of HAZ using OLS regression was also analysed. The graphs were plotted to visualize the changes in the coefficients for each regressor across the entire conditional HAZ distribution. Results Age of children, sex of children, province and wealth had a consistent and statistically significant association with HAZ in both OLS and quantile regression. Improved toilet facility was positively correlated with HAZ at the lower tails (tenth and thirtieth percentiles). Ethnicity (Janajati and Newer) was positively correlated with HAZ at the lower tail (thirtieth percentile) and mean (OLS regression). Maternal education was a significant predictor of improved height-for-age across conditional quantiles, except at the tenth percentile. Maternal age, number of under-five children in household, number of household members, and improved source of drinking water showed heterogeneous effects across different quantiles of conditional HAZ distribution. Conclusion Use of quantile regression approach showed that the effect of different factors differed across the conditional distribution of HAZ. Policymakers should consider the heterogeneous effect of different factors on HAZ so that the targeted intervention could be implemented to maximize the nutritional benefits to children.

A cross-sectional study evaluating the prevalence and predictors of malnutrition among children and adolescents visiting an urban academic hospital in Nepal

“…Further, KCH is a regional referral centre for children with the most serious conditions. Our study found that children from the lowest wealth index were at risk for stunting, which is aligned with the findings of other studies in Nepal (26,27) . Children with a chronic condition were at risk for stunting, which may be due to continuous challenges with dietary intake due to the chronic disease itself or alterations in nutrient metabolism as a result of the medical condition.…”

“…Children with a chronic condition were at risk for stunting, which may be due to continuous challenges with dietary intake due to the chronic disease itself or alterations in nutrient metabolism as a result of the medical condition. Similar to studies utilising national data (26) , we found that older age was predictive of stunting, which may be due to a limited number of nutrition rehabilitation programmes in previous years. Children from select ethnicities were at higher risk of stunting and Nepalese children tended to be shorter than norms set by the WHO, possibly due to malnutrition or genetics.…”

Nutritional Status of Under Five Year Children Residing in Selected Wards of Barahachhetra Municipality, Sunsari, Nepal: a Cross-sectional Study

“…There The findings of our study are very close to the similar studies conducted in India and Bangladesh where 17% to 21% of children under five years were wasted, 30% to 41% were stunted and 29% to 39% were underweight [6,12]. The main contributing factors for under five malnutrition in those studies included child's age, mother's education, father's education, father's occupation, family wealth index, current breastfeeding, and place of delivery which were significantly associated with malnutrition in our study too [6,12]. Our findings are also comparable with the national data where wasting, stunting, and underweight are 10%, 35.8%, and 27% respectively [5].…”

Relationship between Family Factors, Food Consumption Behaviors, and Nutritional Status among Muslim School-Age Students in Nakhon Si Thammarat Province, Thailand

“…On the other hand, families with 1 or 2 siblings may be more inclined to provide larger quantities of food, potentially leading to excessive nutritional intake and subsequent overweight or obesity. This finding contradicted previous studies that had indicated that the number of siblings was related to the likelihood of malnutrition [12,32,33]. In Nepal, Muslim children under 5 years old with 3 or more siblings were found to be more prone to stunting compared to those with 1 sibling [33].…”