Peer-reviewed article
Nutritional status and risk factors for stunting in preschool children in Bhutan
Yunhee Kang, Víctor M. Aguayo, Rebecca Kramer Campbell, Laigden Dzed, Vandana Joshi et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined nutritional status and stunting risk factors in 1,506 preschool children in Bhutan using data from the 2015 National Nutrition Survey. Stunting affected one in five children, with risk increasing significantly with age and decreasing with better maternal education. Wasting and overweight were relatively uncommon, suggesting that factors beyond acute malnutrition may be limiting children's linear growth in Bhutan.
Key points
- Stunting prevalence was 21.2% among children aged 0-59 months, compared to wasting at 2.6% and underweight at 7.4%
- Risk of stunting increased substantially with child age: 5.3% at <6 months, 16.8% at 6-23 months, and 25.0% at 24-59 months
- Maternal education showed a dose-response protective effect against stunting
- Distribution of weight-for-height scores was normal, suggesting acute malnutrition is not the primary driver of stunting
- Nutrient deficits other than acute caloric malnutrition or non-nutritional factors may be constraining linear growth
Limitations
This cross-sectional survey cannot establish causal relationships between risk factors and stunting. The study does not examine specific nutrient deficiencies or non-nutritional factors like infection or care practices that may explain why linear growth is compromised despite normal weight-for-height ratios.
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.