Peer-reviewed article
Assessing the relative significance of key risk factors for child undernutrition in Punjab, Pakistan.
Abid Aman Burki ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed data from 38,495 children under five in Punjab, Pakistan to identify the most important risk factors for undernutrition. The researchers found that poverty, low maternal education, short birth intervals, young maternal age, and low birth weight were the strongest predictors of stunting and underweight. The risk factors differed by age: for infants, exclusive breastfeeding and assisted delivery were protective, while for older children, dietary diversity mattered more.
Key points
- Five key predictors consistently associated with stunting and underweight: household poverty, low maternal education, short birth intervals, underage motherhood, and low birth weight
- For wasting, significant determinants were low birth weight, low maternal education, incomplete vaccination, and recent fever
- Inadequate dietary diversity was a major contributor to undernutrition among children aged 6-35 months
- Infants aged 0-5 months benefit from protective factors such as exclusive breastfeeding and neonatal care
- Older children face higher and more variable undernutrition risks than infants
Limitations
This is a cross-sectional analysis of observational data, so it cannot determine causality or the direction of associations between risk factors and undernutrition. The study identifies correlations but cannot establish which interventions would most effectively reduce undernutrition.
Abstract
BACKGROUND: Child undernutrition remains a pressing global concern, with Pakistan among the most affected countries in South Asia. Despite recognition of its multifaceted causes, the relative importance of key risk factors remains insufficiently understood. This study investigates the relative significance of associated risk factors among preschool-age children in Punjab, Pakistan's most populous province. METHODS: Using data from the 2018 Punjab Multiple Indicator Cluster Survey (MICS), this study analyses 38,495 children aged 0-59 months. Binary logistic regression models were employed to estimate the effects of 25 risk factors on stunting, underweight, and wasting, selected through a review of literature. The analysis was conducted for the full sample (children aged 0-59 months) and two age sub-groups: infants aged 0-5 months and children aged 6-35 months, selected to reflect key developmental stages. Environmentally modifiable risk factors were ranked by effect size to identify high-priority intervention areas. RESULTS: Five key predictors were consistently associated with stunting and underweight: household poverty, low maternal education, short birth intervals, underage motherhood, and low birth weight (LBW). For wasting, significant determinants included LBW, low maternal education, incomplete vaccination, and recent fever. Among children aged 6-35 months, inadequate dietary diversity was a major contributor, while in infants (0-5 months), lack of exclusive breastfeeding and unassisted delivery were most influential. Box plot analysis revealed that older children face higher and more variable undernutrition risks, whereas infants benefit from protective factors such as breastfeeding and neonatal care-highlighting the importance of age-specific interventions. CONCLUSIONS: The findings underscore the urgent need for integrated, age-adapted strategies that address both structural and behavioural determinants of child undernutrition. Effective interventions must combine poverty reduction, maternal education, and healthcare access with targeted nutrition programs for infants and toddlers. These insights offer a critical evidence base to inform policies aimed at improving child nutrition and health in Punjab and similar contexts.