Background: Stunting has become a major nutritional problem for children under five in Indonesia. Since 2007 until now, the problem of stunting has been detected in Flobamora, including Rote Ndao Regency. The results of the weighing operation in 2023 reported that the prevalence of stunting in NTT province was 21.7%. Measurement data shows that in 2023 there will be 414 babies born, with 38 children experiencing stunting as measured using the baby's birth length. Mother's behavior regarding nutrition and culture of child eating patterns from the time the child is in the womb until the age of under five years plays an important role in shaping the quality of human resources, including preventing the problem of malnutrition, especially stunting. This study aimed to determine the relationship between maternal behavioral factors regarding nutrition and the eating culture of children under five in the stunting locus area, East Nusa Tenggara Province. Subjects and Method: This was a cross sectional study carried out in Mokdale Village, Lobalain District, Rote Ndao Regency, East Nusa Tenggara, Indonesia, from June to August 2023. A sample of 44 children aged 12 to 36 months, consisted of 22 stunted children and 22 normal height children was selected for this study. The dependent variable was stunting. The independent variables were maternal behavior, knowledge, attitude, and feeding practice, child’s eating behavior. The data were analyzed using Chi-square. Results: The incidence of stunting in children increased with maternal behavior regarding poor nutrition (OR = 2.72; 95% CI= 1.25 to 4.19; p= 0.001); maternal knowledge about poor nutrition (OR= 1.13; 95% CI= -1.06 to 2.37; p = 0.060); attitude = mother regarding poor nutrition (OR = 1.74; 95% CI=0.44 to 3.03; p =0.001); maternal actions regarding malnutrition (OR = 3.07; 95% CI = 1.50 to 4.64; p=0.001); and poor eating culture of children under five (OR= 3.03; 95% CI= 0.12 to 3.57; p= 0.001), and these result were statistically significant Conclusion: Maternal behavioral factors regarding good nutrition and good eating culture are closely related and can reduce the chances of problems with the nutritional status of toddlers in the stunting locus area, Lobalain District, Rote Ndao Regency, East Nusa Tenggara Province.
AbstractAnaemia and stunting are prevalent nutritional problems among children of low‐income countries that have profound effects on development, morbidity, and mortality. Many use a single conceptual framework to identify the basic determinants of these and other forms of malnutrition. One would expect that problems with matching underlying determinants should co‐occur in affected individuals to a greater degree than by chance. In 2 populations of children—ages 6–18 months in Bihar, India, (n = 5,664) and 6–36 months in Lambayeque, Peru (n = 688)—we measured the frequency of the co‐occurrence of anaemia and stunting. We compared this value with the value expected by chance, the product of the prevalence of anaemia and stunting, using a chi‐square test. We also built logistic regression models for each condition. The frequency of co‐occurrence in the Indian population was 21.5%, and in the Peruvian population, it was 30.4%, which are similar to frequencies expected by chance, 21.3% (p = .97) and 31.5% (p = .85). In Peru, anaemia was associated with age and consumption of treated water. Stunting was associated with age, sex, dietary diversity, hand washing, language spoken, and wealth. In India, anaemia was associated with age, sex, caste, dietary diversity, and household hunger. Stunting was associated with age, sex, caste, wealth, and maternal illiteracy. Despite some basic shared factors, anaemia and stunting are more independent than commonly assumed. Interventions that target children based on 1 condition may miss children with the other form of malnutrition.
Lucas Gosdin, Reynaldo Martorell, Rosario M. Bartolini et al.
AbstractWe evaluate the impacts of a $120 million project in Indonesia conducted between 2014 and 2018 that sought to reduce stunting through a combination of (1) community‐driven development grants targeted at health and education outcomes, (2) training for health providers on infant and young child feeding and growth monitoring and (3) training for sanitarians on a local variation of community‐led total sanitation. This cluster randomized controlled trial involved 95 treatment and 95 control subdistricts across South Sumatra, West Kalimantan, and Central Kalimantan provinces. Overall, we find no significant impacts on stunting, the study's primary outcome measure (0.5 pp; 95% confidence interval [CI]: −3.0 to 4.1 percentage points [pp]), or other longer‐term undernutrition outcomes about 1 year after the end of the project. The project had a modest impact on some secondary, more proximal outcomes related to maternal and child nutrition, including the percentage of mothers consuming the recommended number of iron‐folic acid pills during pregnancy (8.7 pp; 95% CI: 4.1–13.3 pp), 0–5‐month‐olds being exclusively breastfed (8.7 pp; 95% CI: 1.8–15.6 pp) and 6–23‐month‐olds receiving the number of recommended meals per day (8.5 pp; 95% CI: 3.8–13.2 pp). However, there were no significant impacts on other proximal outcomes like the number of pre‐natal and post‐natal checkups, child dietary diversity, child vitamin A receipt or the incidence of child diarrhoea. Our findings highlight that successfully implementing an integrated package of interventions to reduce child stunting may be challenging in practice. Project design needs to consider implementation reality along with best practice—for example, by piloting the synchronous implementation of multifaceted interventions or phasing them in more gradually over a longer timeframe.
ABSTRACTA large body of research investigates the determinants of stunting in young children, but few studies have considered which factors are the most important predictors of stunting. We examined the relative importance of predictors of height‐for‐age z‐scores (HAZ) and stunting among children under 5 years of age in seven of the most food‐insecure districts in South Africa using data from the Grow Great Community Stunting Survey of 2022. We used dominance analysis and variable importance measures from conditional random forest models to assess the relative importance of predictors. We found that intergenerational and socioeconomic factors—specifically maternal height (HAZ: Coef. 0.02, 95% CI 0.01–0.03; stunting: OR 0.96, 95% CI 0.94–0.98), birth weight (HAZ: Coef. 0.3, 95% CI 0.16–0.43; stunting: OR 0.5, 95% CI 0.35–0.72) and asset‐based measures of socioeconomic status (HAZ: Coef. 0.17, 95% CI 0.10–0.24; stunting: OR 0.77, 95% CI 0.67–0.89)—were the most important predictors of HAZ and stunting in these districts. We explored whether any other factors moderated (weakened) the relationship between these intergenerational factors and child height using conditional inference trees and moderation analysis. We found that being on track for vitamin A and deworming, adequate sanitation, a diverse diet and good maternal mental health moderated the effect of birth weight or mother's height. Though impacts are likely to be small relative to the impact of intergenerational risk factors, these moderating factors may provide promising avenues for helping to mitigate the intergenerational transmission of stunting risk in South Africa.
Kate Rich, Liezel Engelbrecht, Gabrielle Wills et al.
This study aims to evaluate household and individual level drivers of stunting among Filipino children aged 0-23 months in the 2003 National Nutrition Survey (NNS) and identified which factors pushed these same children to or out of stunting in middle childhood (8-9 years old) in 2011 Updating National Nutrition Survey (UNNS). All children aged 0-23 months in 2003 NNS were tracked if they're still in 2011 UNNS by matching identifiers: region, province, municipality/city, name, and birthdate. There are 290 children included in both surveys. Children were categorized as: stunted in 2003 but not in 2011 (catch-up); stunted in 2003 & 2011 (persistently stunted); stunted in 2011 but not in 2003 (stunted later). The prevalence of stunting increased from 17.2% in 2003 to 35.2% in 2011. About 22.1% became stunted later; persistently stunted (13.1%); catch-up (4.1%). The individual-level factors that contributed towards persistent stunting are older age onset of stunting, underweight, and a <2 years birth interval; while the household level factors are those with ≥ 5 dependents, and a higher number of under-fives in the family. Households usage of water-sealed toilets and availability of electricity decrease the odds of persistent stunting and stunting later. No significant factors were found on what moves a child out of stunting. Living in shanties (Huts) pushed a normal child to be stunted in 2011. This study reflects the strong influence of both individual and household factors on stunting. These results could be useful in crafting area and problem-specific interventions.
Imelda Angeles-Agdeppa, Patricia Isabel Gayya-Amita, Mario V. Capanzana
AbstractChild stunting in Vietnam has reduced substantially since the turn of the century but has remained relatively high for several years. We analysed data on children 6–59 months (n = 85,932) from the Vietnam Nutritional Surveillance System, a nationally representative cross‐sectional survey. Multivariable Poisson regression models were used to estimate relative risk (RR) of stunting, stratified by child age and ecological region. Covariates at the child, maternal, household, and environmental levels were included based on available data and the World Health Organization conceptual framework on child stunting. Among children 6–23 months, the strongest associations with child stunting were child age in years (RR: 2.49; 95% CI [2.26, 2.73]), maternal height < 145 cm compared with ≥150 cm (RR: 2.04; 95% CI [1.85, 2.26]), living in the Northeast compared with the Southeast (RR: 2.01; 95% CI [1.69, 2.39]), no maternal education compared with a graduate education (RR: 1.77; 95% CI, [1.44, 2.16]), and birthweight < 2,500 g (RR: 1.75; 95% CI [1.55, 1.98]). For children 24–59 months, the strongest associations with child stunting were no maternal education compared with a graduate education (RR: 2.07; 95% CI [1.79, 2.40]), living in the Northeast compared with the Southeast (RR: 1.94; 95% CI [1.74, 2.16]), and maternal height < 145 cm compared with ≥150 cm (RR: 1.81; 95% CI [1.69, 1.94]). Targeted approaches that address the strongest stunting determinants among vulnerable populations are needed and discussed. Multifaceted approaches outside the health sector are also needed to reduce inequalities in socioeconomic status.
AbstractHousehold food insecurity (HFI) plays an important role in child malnutrition in many low‐income countries. We determined the association between HFI and stunting and severe stunting among Rwandan children from the Gicumbi district, aged 6–59 months using a cross‐sectional study of 2,222 children. HFI factor was calculated by summing all seven HFI (access) frequency questions and was categorised into food security, mildly food insecurity, moderately food insecurity, and severe food insecurity. The association between stunting, severe stunting, and HFI was determined using the multiple logistic regression analyses that adjust for clustering and sampling weights. The odds of moderate and severe HFI were significantly higher among stunted children aged 6–59 months than those who were not stunted (adjusted odds ratio [AOR] = 1.43; 95% confidence interval [CI] [1.11, 1.84] and AOR = 1.35; 95% CI [1.08, 1.69], respectively). Children from households with moderate food insecurity were 2.47 times more likely to be severely stunted (AOR = 2.47; 95% CI [1.77, 3.46]), and those from households with severe food insecurity were more likely to be severely stunted (AOR = 1.82; 95% CI [1.34, 2.48]), compared with children aged 6–59 months from households with food security. Other factors included male children and children who did not attend monthly growth monitoring sessions. This study showed that moderate and severe HFI correlated with stunting and severe stunting. Interventions to improve stunting in Gicumbi children should also focus on male children, children who did not attend monthly growth monitoring sessions, and households with moderate and severe food insecurity.
Kingsley E. Agho, Christine Mukabutera, Monica Mukazi et al.
AbstractLow‐ and middle‐income countries shoulder the greatest burden of stunting and anaemia in children. This calls for prompt and effective intervention measures, while the contributing factors are not fully understood. This study evaluates determinants spanning from individual‐, household‐ and community levels including agroecology and antinutrients as unique sets of predictors. Primary data were collected from 660 rural households representing the midland (ML), highland, and upper highland (UHL) agroecological zones from northern Ethiopia. The study relates several predictors to stunting and anaemia in children aged 6–23 months. We found 49.1% and 49.7% of children were stunted and anaemic, respectively. Children living in the ML are approximately twice more likely to be stunted adjusted odds ratio (AOR: 1.869; 95% CI: 1.147–3.043) than in the UHL. The risk of stunting increases by 16.3% and 41.9% for every unit increase in phytate‐to‐zinc and phytate‐to‐iron molar ratios, respectively. A 10% increase in mean aggregated crop yield was observed to reduce the likelihood of stunting occurrence by 13.6%. Households lacking non‐farm income‐generating opportunities, travel longer time to access the marketplace and poor health service utilisation were associated with increased risk of stunting. Low diversity of child's diet, age of the child (18–23 months) and mothers at a younger age are significantly associated with stunting. Risk of anaemia in children is high amongst households with unimproved water, sanitation, and hygiene practices, younger age (6–11 months) and mostly occurs amongst boys. Children in the ML had a 55% reduced risk of being anaemic (AOR: 0.446; 95% CI: 0.273–0.728) as compared to the UHL. Therefore, the influence of these factors should be considered to tailor strategies for reducing undernutrition in children of 6–23 months in rural Ethiopia. Interventions should go beyond the administrative boundaries into targeting agroecological variation.
AbstractMalnutrition is a threat to optimal child development, with its occurrence during foetal and infancy stages associated with poor cognitive, motor and socio‐emotional skills. However, information on the effects of various types of malnutrition on early childhood development (ECD) is limited in Nepal. To assess the association of stunting, wasting and underweight (three prominent forms of malnutrition) with the four domains of the ECD index (literacy‐numeracy, physical, social‐emotional and learning development) among children 36–59 months of age, we conducted an adjusted logistic regression using Nepal's national household Multiple Indicator Cluster Survey (MICS) 2019 data set. The study sample consisted of children aged 36–59 months (n = 2871). Children were considered developmentally on track if they met criteria in each of the four ECD domains. Regarding ECD status of children 36–59 months old, 35% of children were not developmentally on track for the ECD index. The adjusted odds ratio indicated that stunting was associated with lower odds of not being developmentally on track according to the ECD index as well as the literacy‐numeracy, physical and learning domains of the ECD index. Likewise, underweight was associated with lower odds of not being developmentally on track according to the ECD index, primarily for ECD domains of literacy‐numeracy, physical and learning. Notably, no association between wasting and ECD indicators was observed. Children's nutrition status impacts child development outcomes. Adding ECD interventions, such as responsive and stimulating caregiving, within nutrition programmes among children who are stunted and underweight could improve child development outcomes.
Manisha L. Shrestha, Kelly E. Perry, Basant Thapa et al.
AbstractChild undernutrition is a public health and development problem in Myanmar that is jeopardizing children's physical and cognitive development and the country's social and economic progress. We identified key drivers of child stunting (low height‐for‐age) and wasting (low weight‐for‐height) in a nationally representative sample (n = 3,981) of children 0–59 months of age. The national prevalence of child stunting and wasting was 28% and 7%, respectively. Boys were more likely to be stunted or wasted than girls. Older children 24–35 months were at the highest risk of stunting compared with children under 6 months (risk ratios [RR] 10.34; 95% CI [6.42, 16.65]) whereas the youngest, under 6 months, were at the highest risk of wasting compared with children 36–59 months (RR 2.04; 95% CI [1.16, 3.57]). Maternal height <145 cm (RR 5.10; 95% CI [3.15, 8.23]), perceived small child size at birth (RR 2.08; 95% CI [1.62, 2.69]), and not benefiting from institutional delivery (RR 1.52; 95% CI [1.24, 1.87]) were associated with an increased risk of child stunting, as were maternal occupation, unimproved household drinking water, living in delta, coastal or upland areas, and poorer household wealth index quintile. Increased risk of child wasting was associated with maternal underweight (RR 1.64; 95% CI [1.11, 2.42]) and open defecation (RR 1.91; 95% CI [1.25, 2.92]) as well as maternal occupation and residence in a coastal area. Our findings indicate that the key drivers of child undernutrition in Myanmar are multifaceted and start in utero. Investing in scaling‐up multisectoral approaches that include nutrition‐specific and nutrition‐sensitive interventions with a focus on improving maternal nutrition is essential for reducing child undernutrition and contributing to further gains in the country's human and economic development.
Jessica L. Blankenship, Jennifer Cashin, Tuan T. Nguyen et al.
