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A multi‐level risk factor assessment for stunting: Evidence from a national sample in Nepal
Author(s) -
Dorsey Jamie,
Manohar Swetha,
Neupane Sumanta,
Shrestha Binod,
ThorneLyman Andrew,
Webb Patrick,
Klemm Rolf DW,
West Keith P
Publication year - 2017
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.31.1_supplement.639.17
Subject(s) - odds ratio , environmental health , odds , medicine , malnutrition , logistic regression , demography , confidence interval , nepali , cross sectional study , risk factor , art , literature , pathology , sociology
BACKGROUND Despite marked improvement in child undernutrition, especially stunting, in Nepal over the past decade, stunting prevalence remains high at 41% thus generating an urgent need to understand factors associated with childhood stunting. OBJECTIVE Identify individual, household and community level factors associated with stunting in Nepali children 6–59 months of age. METHODS The Policy and Science for Health, Agriculture, and Nutrition (PoSHAN) Community Studies has established a national agriculture‐to‐nutrition surveillance system in a representative sample of ~5500 households in 63 wards across 21 districts, 7 in each of the 3 agro‐ecological zones of the country. This study presents cross‐ sectional data collected in 2013 among a sample of 4853 children to determine factors associated with under‐five stunting, indicated by a height‐for‐age (HAZ) < −2. Using mixed effects logistic regressions to estimate adjusted odds ratios (AOR) with 95% confidence intervals (CI), we examined individual, household and community level risk factors associated with stunting, adjusting for the multi‐level clustering design. RESULTS The national prevalence of stunting among children < 5 years was 37.5%. Children living in less developed communities had a higher odds of stunting than those who lived in more developed communities [AOR (95% CI): 2.38 (1.36, 4.14)]. Female household headship was associated with lower odds of stunting [0.78 (0.64, 0.95)]. The presence of 3 or more under‐five year old children in a household was associated with an increased risk of stunting risk [1.19 (1.44, 2.52)] versus households with only one <5 year old. Monthly expenditure (below the 20 th vs above the 80 th %ile of household expenditure) was associated with an increased stunting risk [1.68 (1.27, 2.24)]. At the individual level, wasting of the child [1.52 (1.24, 1.86)], high fever in the last 30 days [1.28 (1.03, 1.59)], and maternal factors such as a lack of formal education [2.09 (1.48, 296)] and short stature [2.52 (1.96, 3.25)] were associated with an increased risk of stunting. CONCLUSION This study identifies risk factors at community, household and individual maternal and child levels associated with preschool child stunting that may assist in targeting programs to highest risk groups in the future. Support or Funding Information USAID, Feed the Future Lab for Nutrition