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.
Stunted children will have normal cognitive ability if nutrition is improved. The rapid brain growth in the first 1,000 days of life means that children should not be malnourished. Stunting is generally caused by a lack of macronutrients (carbohydrates, protein, and fat) and micronutrients (calcium and zinc). The mobile application called stunting child nutrition (GiAS) has features that can detect stunting, monitor toddler growth, recommend daily menus for toddlers, nutritional adequacy rate (RDA) in 2019, and others. The purpose of this study was to make it easier to distinguish macronutrients, zinc, and calcium from stunting and non-stunting children aged 12–24 months using the GiAS android application. It is conducted at the Citeureup Community Health Center, Cimahi city, for June–July 2020. The sampling technique was a simple random sampling of 88 respondents. This type of research is an observational analytic with a statistical test is a cross-sectional design. The results of the study using the Mann-Whitney test showed differences in carbohydrates (84.99±26.31 vs 151.16±68.43, p=0.001), protein (30.81±11.03 vs 60.55±38.43, p=0.001), fat (32.80±15.39 vs 64.84±47.81, p=0.001), and calcium (0.55±0.40 vs 1.43±1.16, p=0.001) and there is similarity of zinc (0.005±0.004 vs 0.010±0.016, p=0.084) after 7 days of using the GiAS application between stunting and non-stunting children. The probability value <0.05 means that the application can compare macronutrients, zinc, and calcium between stunted and non-stunted children on the 7th day. Chi-square analysis showed an increase in children's weight and height under five at two weeks and one month (p=0.001). In conclusion, the comparison of macronutrients, zinc, calcium in stunting and non-stunting children aged 12–24 months can be differentiated using the GiAS application. APLIKASI GIZI ANAK STUNTING (GIAS) BERBASIS ANDROID UNTUK MENILAI ZAT GIZI MAKRO, ZINC, DAN KALSIUM PADA ANAK STUNTING DAN NON-STUNTINGAnak stunting akan memiliki kognitif yang normal jika dilakukan perbaikan gizi yang optimal. Pertumbuhan otak yang pesat di 1.000 hari pertama kehidupan menjadikan anak tidak boleh kekurangan nutrisi. Stunting umumnya kekurangan zat gizi makro (karbohidrat, protein, dan lemak) serta zat gizi mikro (kalsium dan zinc). Aplikasi mobile bernama gizi anak stunting (GiAS) memiliki fitur yang dapat mendeteksi stunting, memantau pertumbuhan balita, merekomendasikan menu harian untuk balita, angka kecukupan gizi (AKG) tahun 2019, dan lainnya. Tujuan penelitian ini adalah kemudahan membedakan zat gizi makro, zinc, dan kalsium anak stunting dengan non-stunting usia 12–24 bulan menggunakan aplikasi android GiAS di Puskesmas Citeureup Kota Cimahi periode Juni–Juli 2020. Teknik pengambilan sampel adalah simpel random sampling sebanyak 88 responden. Jenis penelitian ini adalah analitik observasional dengan uji statistik adalah desain cross-sectional (α=0,05). Hasil penelitian menggunakan Uji Mann-Whitney terdapat perbedaan karbohidrat (84,99±26,31 vs 151,16±68,43; p=0,001), protein (30,81±11,03 vs 60,55±38,43; p=0,001), lemak (32,80±15,39 vs 64,84±47,81; p=0,001), dan kalsium (0,55±0,40 vs 1,43±1,16; p=0,001) serta ada persamaan zinc (0,005±0,004 vs 0,010±0,016; p=0,084) sesudah 7 hari penggunaan aplikasi GiAS antara anak stunting dan non-stunting. Nilai probabilitas <0,05 berarti aplikasi dapat membandingkan zat gizi makro, zinc, dan kalsium antara anak stunting dan non-stunting pada hari ke-7. Analisis chi-square terlihat peningkatan berat badan dan tinggi badan balita pada 2 minggu dan 1 bulan (p=0,001). Simpulan, komparasi zat gizi makro, zinc, kalsium anak stunting dan non-stunting usia 12–24 bulan dapat dibedakan menggunakan aplikasi GiAS.
Fajarini Putri Hidayat, Ma'mun Sutisna, Roni Rowawi et al.
ABSTRACT Despite socio‐economic progress, prevalence of childhood stunting remains high in South Asia—a phenomenon often referred to as the “Asian Enigma.” This paradox stems from suppressed women's empowerment, poor water, sanitation, and hygiene (WaSH) conditions and inadequate child‐feeding. Evidence shows that women's empowerment improves these underlying factors associated with improved stunting. We examined how domains of women's empowerment relate to the risk of childhood stunting in South Asia directly and indirectly in interaction with household improved WaSH facility and age‐appropriate food consumption. Using recent Demographic and Health Survey data from Bangladesh, India, Nepal, and Pakistan, we analyzed a sample of 37,620 married women, aged 15–49 years, currently cohabiting with husbands and having an under‐five child. We constructed three domains of survey‐based women's empowerment index‐global: social independence, intrinsic agency, and instrumental agency, by confirmatory factor analysis, using generalized structural equation modelling. We developed three different models by using generalized linear mixed‐effects models with robust error variance to estimate the relative risk (RR) of stunting with 95% confidence interval (CI). We found social independence [RR: 0.86, 95% CI: 0.83, 0.90], intrinsic agency [0.98 (0.97, 0.99)] and instrumental agency [0.99 (0.98, 0.99)] were associated with reduced risk of stunting in South Asia. Though interaction between social independence and WaSH was associated with reduced risk [0.92 (0.86, 0.99)], interaction between social independence [1.12 (1.07, 1.17)] and instrumental agency [1.03 (1.01, 1.05)] and food consumption increased risk of stunting in South Asia. Interactions between women's empowerment and WaSH and food consumption reveal complex effects including both synergy and trade‐offs, highlighting the need for integrated strategies combining women's empowerment, WaSH improvements, and targeted nutrition specific interventions in South Asia.
Saira Parveen Jolly, Regien Biesma, Robert Lensink et al.
AbstractGrowing evidence suggests that household sanitation is associated with child nutritional status in low‐ and middle‐income countries. This paper examined whether household access to improved sanitation facilities and sources of drinking water was associated with stunting and anaemia amongst children aged 6–35 months of age in Indonesia. The sample for the analysis comprised 1,450 children aged 6–35 months who participated in the end‐line survey of the maternal and young child nutrition security project in Asia, conducted in three selected districts in Indonesia. Logistic regression models were used to determine the association between household sanitation and water source, and stunting and anaemia. Approximately 26% and 56% of children 6–35 months of age were stunted and anaemic, respectively. Children living in a household with improved sanitation facilities had 29% reduced odds of being stunted compared with those in a household with unimproved sanitation facilities, after adjusting for potential confounders including child's age and gender, maternal education, and iron–folic acid supplementation, as well as household wealth status and source of drinking water (OR = 0.68, 95% CI:0.48–0.96). No association between household sanitation and childhood anaemia was observed. Source of drinking water was not associated with stunting or anaemia amongst children. There were no synergistic effects of household sanitation and water supply on stunting and anaemia. This suggests that efforts to improve household sanitation condition may need to be considered an essential, integral part of the programmatic responses by governments and development partners for the prevention of childhood nutritional status. Further randomised research is necessary to determine the causal link.
<em>The purpose of this research is to describe the Regent Regulation No. 77 of 2021 Implementation of the Stunting ReductionProgram Policy in Ayula Tilango Village, Bone Bolango Regency. Based on the following indicators; (a) Policy Standards and Targets, (b) Resources, (c) Inter – Agency Communication, (d) Implementer Characteristics, (e) Economic, Social, and Political Environment, and (f) Implementer Attitudes. This study utilized a qualitative research method with a case study approach. Data was collected through in – depth interviews with various stakeholders, observation, and analysis of policy documents related to stunting program, The research results indicated that the implementation of the stunting program in Ayula Tilango Village faces several challenges, such as budget misalignment and difficulties in creating land for a clean water source. Despite these challenges, the program has achieved some positive impacts, including increased awareness of importance of balanced nutrition, improved acces to healthcare services, and healthier eating habits. However. These impacts still need further enchancement to address stunting issue in Ayula Tilango Village effectively. In conclusion, this research finds that the implementation of the stunting program in Ayula Tilango Village has encountered various obstacles affecting its effectiveness, therefore, greater efforts are needed to improve human resources and allocate budget moe effectively</em>
Mohamad Rifki Dimas, Fenti Prihatini Dance Tui, Sri Yulianti Mozin
