TY - JOUR
T1 - Individual, household, and community level risk factors of stunting in children younger than 5 years
T2 - Findings from a national surveillance system in Nepal
AU - Dorsey, Jamie L.
AU - Manohar, Swetha
AU - Neupane, Sumanta
AU - Shrestha, Binod
AU - Klemm, Rolf D.W.
AU - West, Keith P.
N1 - Funding Information:
This work was undertaken as part of the Feed the Future Innovation Lab for Nutrition, managed by Tufts University's Friedman School of Nutrition Science and Policy and funded by the US Agency for International Development (USAID), Washington DC, under the Cooperative Agreement AID-OAA-L-10-00005. This study was designed by the Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University (JHU), and the authors gratefully acknowledge New ERA for their data collection efforts. We also acknowledge and thank the Child Health Division, Department of Health Services, and Ministry of Health and Population of Nepal as well as the district level offices of the 21 selected sites for their overall support of the study. We further acknowledge Dr. Patrick Webb, Dr. Shibani Ghosh and Diplav Sapkota of Tufts University's Friedman School of Nutrition Science and Policy, Dr. Devendra Gauchan of the Nepal Agricultural Research Council, and Dr. Ramesh K. Adhikari of the Institute of Medicine, Tribhuvan University for their supportive roles in conducting this research. We also acknowledge the Feed the Future Innovation Lab for Nutrition study team in Kathmandu-Dev Mandal Narayan, Hari Krishna Shah and especially Abhigyna Bhattarai for field and training supervision, and Ruchita Rajbhandary and Dev Raj Gautam for data analysis and data management support. Finally, we gratefully acknowledge the households, families, and communities who provided consent to be part of this study.
Publisher Copyright:
© 2017 John Wiley & Sons Ltd
PY - 2018/1
Y1 - 2018/1
N2 - Despite substantial reductions in recent years in Nepal, stunting prevalence in children younger than 5 years remains high and represents a leading public health concern. To identify factors contributing to the stunting burden, we report multilevel risk factors associated with stunting in 4,853 children aged 6–59 months in a nationally and agroecologically representative random sample from the first year of the Policy and Science for Health, Agriculture, and Nutrition Community Studies, a community-based observational, mixed-panel study. Mixed effects logistic regressions controlling for multilevel clustering in the study design were used to examine the association of individual-, household-, and community-level factors associated with stunting. Stunting prevalence was 38% in our sample. After adjustment for potential confounding variables, maternal factors, including maternal height and education, were generally the strongest individual-level risk factors for stunting, adjusted odds ratio (AOR) = 2.52, 95% CI [1.96, 3.25], short (<145 cm) versus not short mothers; AOR = 2.09, 95% CI [1.48, 2.96], uneducated mothers versus secondary school graduates. Among the household- and community-level factors, household expenditure and community infrastructure (presence of paved roads, markets, or hospitals) were strongly, inversely associated with increased stunting risk, AOR = 1.68, 95% CI [1.27, 2.24], lowest versus highest household expenditure quintile; AOR = 2.38, 95% CI [1.36, 4.14], less developed (lacking paved roads, markets, or hospitals) versus more developed communities. Although most factors associated with stunting are not rapidly modifiable, areas for future research and possible interventions emerged.
AB - Despite substantial reductions in recent years in Nepal, stunting prevalence in children younger than 5 years remains high and represents a leading public health concern. To identify factors contributing to the stunting burden, we report multilevel risk factors associated with stunting in 4,853 children aged 6–59 months in a nationally and agroecologically representative random sample from the first year of the Policy and Science for Health, Agriculture, and Nutrition Community Studies, a community-based observational, mixed-panel study. Mixed effects logistic regressions controlling for multilevel clustering in the study design were used to examine the association of individual-, household-, and community-level factors associated with stunting. Stunting prevalence was 38% in our sample. After adjustment for potential confounding variables, maternal factors, including maternal height and education, were generally the strongest individual-level risk factors for stunting, adjusted odds ratio (AOR) = 2.52, 95% CI [1.96, 3.25], short (<145 cm) versus not short mothers; AOR = 2.09, 95% CI [1.48, 2.96], uneducated mothers versus secondary school graduates. Among the household- and community-level factors, household expenditure and community infrastructure (presence of paved roads, markets, or hospitals) were strongly, inversely associated with increased stunting risk, AOR = 1.68, 95% CI [1.27, 2.24], lowest versus highest household expenditure quintile; AOR = 2.38, 95% CI [1.36, 4.14], less developed (lacking paved roads, markets, or hospitals) versus more developed communities. Although most factors associated with stunting are not rapidly modifiable, areas for future research and possible interventions emerged.
KW - Nepal
KW - children
KW - multilevel
KW - risk factors
KW - stunting
KW - younger than 5 years
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U2 - 10.1111/mcn.12434
DO - 10.1111/mcn.12434
M3 - Article
C2 - 28233455
AN - SCOPUS:85013637042
SN - 1740-8695
VL - 14
JO - Maternal and Child Nutrition
JF - Maternal and Child Nutrition
IS - 1
M1 - e12434
ER -