Background: In 2017, Pakistan outsourced to a non-government organisation the management of its vaccination programme in 2 Sindh Province districts. Aim: To determine the impact on coverage of outsourcing vaccination programme in 2 districts of Sindh Province, Pakistan. Methods: Between August and October 2024, we interviewed parents or caregivers of 1600 children aged 12–24 months from 4 (2 outsourced and 2 non-outsourced) districts in Sindh Province, to collect sociodemographic and immunisation data. We analysed the data with STATA version 17, using chi-square test and Man-Whitney U test to compare the participants’ characteristics and immunisation status, and regression model to estimate the difference in immunisation rates between the 2 groups at 9 months. Results: Full immunisation coverage was slightly higher in the outsourced (78.8%) than the non-outsourced (75.8%) districts, but there was no statistically significant difference (P = 0.067). At 9 months, a significant difference (P = 0.036) was observed in immunisation rates: 15.0% decrease in compliance in the outsourced, compared to 19.7% in the nonoutsourced, districts. Conclusion: There was a partial improvement in vaccination coverage due to outsourcing: coverage was better only in one of the outsourced districts. There is a need for further research to understand the reasons for the slight differences in immunisation coverage between the outsourced and non-outsourced districts, and the cost-effectiveness of outsourcing.
Background: Vaccination is the most cost-effective intervention to improve health and reduce morbidity and mortality due to vaccine-preventable diseases in the child population. The South Asian region was home to 1.8 of the 6 million babies who died within twenty-eight days of birth in 2015. Objective: To describe the status and its determinants of immunisation coverage in three South Asian countries, India, Bangladesh and Nepal.Method: The study utilized data from the Demographic Health Surveys of India, Bangladesh and Nepal. We used the principal component analysis (PCA) to compute the wealth index. Descriptive statistics, bivariate analysis and multivariate logistic regression model were utilised to access the status and factors associated with immunisation coverage.Results:The study found increasing trends in immunisation coverage in India, Bangladesh and Nepal. More than 85% of children from Nepal and Bangladesh were fully immunised in contrast to 43.6% from India. There was a wide variation in child immunisation coverage in terms of socioeconomic and demographic factors. Multivariate logistic regression revealed that factors like mother’s age, residence, birth order and religion had minimal impact on complete immunisation coverage. However, mother’s education and wealth index appeared as the significant confounding factors of full immunization coverage. Children belonging to the higher educated and rich families were more likely to be fully immunised. Maximum impact of education (AOR=9.833; p<0.01) and wealth index (AOR=8.105; p<0.01) were observed in 2006 and 2011 respectively in Nepal.Conclusions: More than 85% of children from Nepal and Bangladesh were fully immunised in contrast to 43.6% from India. Mother’s education and wealth index appeared to have a significant impact on full immunization coverage.Sri Lanka Journal of Child Health, 2018; 47(1): 56-63
Background Child stunting remains a major public health issue in Pakistan, with structural and socioeconomic determinants driving outcomes. While maternal education and empowerment have been widely studied, the role of maternal occupation type (professional vs. non-professional) in shaping child nutritional status remains unclear. Methods This cross-sectional study analyzed data from 420 mother–child pairs (<5 years) attending two hospitals in Karachi. Maternal occupation was categorized as professional/technical/managerial vs. non-professional/unemployed. Child nutritional status was assessed using WHO criteria. Chi-square, t-tests, and logistic regression were employed to examine associations, adjusting for confounders (education, income, family structure, empowerment). Results Overall, 44.2% of children were stunted. Children of professionally employed mothers had significantly lower stunting prevalence (29.4%) compared to non-professional/unemployed mothers (47.1%; χ²=8.12, p=0.004). Adjusted logistic regression confirmed the protective effect of professional maternal occupation against stunting (aOR = 0.52; 95% CI: 0.31–0.87, p=0.012). Subgroup analyses revealed the protective effect was stronger in boys (aOR=0.44, CI: 0.23–0.83) than girls (aOR=0.61, CI: 0.33–1.15). Interaction models suggested maternal education amplified the occupation effect. Conclusions Professional maternal occupation independently reduces child stunting risk, even after adjusting for socioeconomic factors. Policies promoting women’s entry into professional sectors may provide downstream benefits for child nutrition.
<p><strong><em>Background: </em></strong><em>In Indonesia, socioeconomic disparities in childhood stunting is vast.</em><em></em></p><p><strong><em>Objectives: </em></strong><em>This study aimed to analyze the social determinants of stunting and severe stunting children in Indonesia.</em></p><p><strong><em>Methods: </em></strong><em>We analyzed data from cross-sectional surveys of Indonesia’s National Basic Health Research in 2013, the Central Bureau of Statistics, and the Ministry of Finance. Our samples were 3953 children aged 6-23 months and 10215 children aged 24-59 months. Dependent variables were the prevalence of child stunting and severe stunting. Independent variables covered factors at the social level while controlling structural and biological level-factors. Data were analyzed using multilevel analysis using generalized linear mixed models (GLMM).</em><em></em></p><p><strong><em>Results: </em></strong><em>Gross domestic product was associated with the reduced risk of stunting among children aged 6-23 months (ARRR= 0.99; 95%CI: 0.98-1.00) and 24-59 months (ARRR= 0.99; 95%CI: 0.97-0.99) as well as with the decreased risk of severe stunting among 6-23 months (ARRR= 0.99; 95%CI: 0.98-1.00) and 24-59 months (ARRR= 0.99; 95%CI: 0.97-0.99) old children. Tax ratio was a significant factor only for the severe stunting among 24-59 months old children (ARRR= 0.98; 95%CI: 0.96-0.99). There was also a geographical difference related to stunting and severe stunting.</em><em></em></p><p><strong><em>Conclusions: </em></strong><em>Equitable economic growth is an essential factor to improve the health and welfare of stunting and severe stunting children across the geographical setting in Indonesia.</em></p><p><em> </em></p>
Tri Siswati, Lukman Waris, Bunga Astria Paramashanti et al.
Abstract Stunting (length‐for‐age z score < −2) before 2 years of age has shown associations with poor child developmental indicators, but information at the population level is scarce in South Asia, the region with the highest burden of stunting. We examined associations between z scores (i.e., height for age [HAZ], weight for age [WAZ], and weight for height [WHZ]) and undernutrition (i.e., stunting [HAZ < −2], wasting [WHZ < −2], and underweight [WAZ < −2]) with learning/cognition and social–emotional development among children 36–59 months of age. Data from Multiple Indicator Cluster Surveys in Bangladesh ( n = 8,659), Bhutan ( n = 2,038), Nepal ( n = 2,253), and Pakistan (Punjab n = 11,369 and Sindh n = 6,718) were used. Children were considered developmentally “on‐track” in learning/cognition or social–emotional domains if they met specific early child development criteria. Meta‐analysis was conducted to examine regional associations, adjusting for socio‐economic status, early childhood education, and quality of care. In a pooled sample, on‐track learning/cognition development was positively associated with HAZ ( OR = 1.17, 95% CI [1.07, 1.27]) and WAZ ( OR = 1.18, 95% CI [1.07, 1.31]) and negatively associated with stunting ( OR = 0.72, 95% CI [0.60, 0.86]) and underweight ( OR = 0.75, 95% CI [0.66, 0.86]) but not associated with WHZ or wasting. On‐track development of social–emotional domain was not associated with any z scores or undernutrition indicators. Across several countries of South Asia, stunted children were less likely to be developmentally “on track” for learning/cognition. It is likely that interventions that prevent stunting may benefit child development, leading to significant individual and societal gains given the large burden of child stunting in regions like South Asia.
Yunhee Kang, Víctor M. Aguayo, Rebecca K. Campbell et al.
Background: The ability to access food according to needs is influenced by educational and knowledge factors, socio-cultural, geography, and economic factors. Overcoming stunting not only overcomes the problem of malnutrition but also must pay attention to the problem of affordability or access to nutritious food Objectives: To analyze access to nutritious food in the prevention system stunting in Lumajang Regency Methods: Qualitative research through a Case Study approach conducted in two villages in Lumajang Regency. The research informants consisted of key informants namely the Head of the Puskesmas, the main informants were mother with toddler Stunting and additional informants namely stakeholders related to stunting. Data processing and analysis using the Thematic Content Analysis method. Results: Access to nutritious food that is less than optimal is caused by economic factors that are lacking, lack of knowledge of mothers of toddlers, malnutrition in toddlers, children's eating arrangements are not meeting nutritional adequacy, children's consumption in a day is lacking, families do not take action to overcome children's nutritional problems and poor sanitation and environmental health Conclusions: Stunting in Lumajang Regency is the cause of which is access to nutritious food that is less than optimal so that it requires attention and cooperation from all parties to overcome it. The provision of education in the form of counseling needs to be carried out with multimethods and multi-media as well as integrated countermeasurements from all existing resources will accelerate the reduction of stunting cases in Lumajang Regency.
Child stunting in the Philippines remains a pressing health and education crisis, undermining children’s growth, learning capacity, and future productivity. Despite constitutional guarantees and laws such as the Kalusugan at Nutrisyon ng Mag Nanay Act, the Masustansyang Pagkain para sa Batang Pilipino Act, and the Early Childhood Care and Development Act, weak implementation has left millions of children vulnerable. Recent jurisprudence, including the consolidated cases of Pimentel III, Colmenares, and 1SAMBAYAN (2025), affirms that the right to health entails enforceable state obligations, situating stunting as a constitutional violation. Empirical evidence highlights maternal health and socio economic disparities as key drivers of malnutrition, while learning poverty remains alarmingly high. This paper argues that eradicating stunting requires decisive national action, stronger accountability, and sustained investment in maternal and child health programs to secure the country’s human capital.
AbstractIndia accounts for approximately one third of the world's total population of stunted preschoolers. Addressing global undernutrition, therefore, requires an understanding of the determinants of stunting across India's diverse states and districts. We created a district‐level aggregate data set from the recently released 2015–2016 National and Family Health Survey, which covered 601,509 households in 640 districts. We used mapping and descriptive analyses to understand spatial differences in distribution of stunting. We then used population‐weighted regressions to identify stunting determinants and regression‐based decompositions to explain differences between high‐ and low‐stunting districts across India. Stunting prevalence is high (38.4%) and varies considerably across districts (range: 12.4% to 65.1%), with 239 of the 640 districts have stunting levels above 40% and 202 have prevalence of 30–40%. High‐stunting districts are heavily clustered in the north and centre of the country. Differences in stunting prevalence between low and high burden districts were explained by differences in women's low body mass index (19% of the difference), education (12%), children's adequate diet (9%), assets (7%), open defecation (7%), age at marriage (7%), antenatal care (6%), and household size (5%). The decomposition models explained 71% of the observed difference in stunting prevalence. Our findings emphasize the variability in stunting across India, reinforce the multifactorial determinants of stunting, and highlight that interdistrict differences in stunting are strongly explained by a multitude of economic, health, hygiene, and demographic factors. A nationwide focus for stunting prevention is required, while addressing critical determinants district‐by‐district to reduce inequalities and prevalence of childhood stunting.
Background: Stunting is a significant global health issue, especially in Indonesia, where long-term malnutrition adversely affects children's growth and development, with prevalence rates still exceeding the WHO's recommended threshold. This study examines the contextual factors that influence the effectiveness of nutritional interventions and antenatal care (ANC) in combating stunting in Indonesia. Methods: A systematic review was conducted by the PRISMA guidelines. A comprehensive search across five major academic databases (Google Scholar, PubMed, ScienceDirect, Embase, and ProQuest) identified 3,690 articles. After a rigorous screening process, 13 studies published between 2019 and 2023 were included in the analysis, focusing on key contextual factors that impact stunting interventions in Indonesia. The quality appraisal utilized Joanna Briggs Institute checklists for analytical cross-sectional studies, cohort studies, quasi-experimental studies, qualitative research, systematic reviews, case reports, and text and opinion papers, each matched to the respective study design. Findings: The review identified four critical contextual factors shaping stunting interventions: (1) socioeconomic status, particularly household income and education, which significantly influence access to healthcare and nutrition; (2) cultural beliefs, including food taboos and misconceptions, which hinder optimal nutritional practices; (3) geographical disparities, with rural populations experiencing higher stunting rates due to limited access to healthcare and resources; and (4) government policies, highlighting the importance of strong political commitment, multisectoral collaboration, and localized programs. Conclusion: Nutritional interventions and ANC are more effective in reducing stunting among Indonesian children when tailored to local socioeconomic, cultural, and geographical contexts. These findings highlight the need for targeted, context-specific strategies to improve child growth outcomes in vulnerable populations.
Edward Kurnia Setiawan Limijadi, Katrin Setio Devi
ABSTRACT Childhood stunting remains a public health challenge in Thailand. While national surveys provide prevalence estimates, there is limited understanding of the multilevel influences shaping child feeding practices. This qualitative study aimed to explore individual, familial, and socioenvironmental determinants of child feeding practices among Thai female caregivers of young children with stunting. In‐depth interviews, guided by Social Cognitive Theory, were conducted with 40 female caregivers (primarily mothers) of children under 5 years old with stunting. Participants were purposively selected from nutrition clinics in four hospitals across four regions of Thailand (Chiang Mai, Bangkok, Satun, and Ubon Ratchathani). Trained local dietitians and nutritionists conducted interviews within the clinics. Transcripts were thematically analysed by two independent researchers, triangulated by input from local interviewers. Children's age ranged from 1.0 to 4.9 years old (mean 3.0 ± 1.1 years). Results showed that caregivers understood the importance of healthful feeding but faced barriers such as financial constraints, low self‐efficacy, limited food acceptance, and misconceptions about nutrition. Permissive feeding practices were common due to concerns over picky eating. Family dynamics, food access and availability, and limited engagement with government nutrition programmes further shaped child feeding practices. This study highlights the complex interplay of multilevel factors that influence child feeding practices among Thai caregivers of young children with stunting. Addressing these challenges effectively requires a multifaceted approach for caregivers, including nutrition education, behavioural support, and policies to improve food access and affordability.
Thanit Vinitchagoon, Yaowalak Rooppat, Pornpan Sukboon et al.
