Trends and determinants of stunting among under-5s: evidence from the 1995, 2001, 2006 and 2011 Uganda Demographic and Health Surveys

AbstractObjectiveTo describe trends of childhood stunting among under-5s in Uganda and to assess the impact of maternal education, wealth and residence on stunting.DesignSerial and pooled cross-sectional analyses of data from Uganda Demographic and Health Surveys (UDHS) of 1995, 2001, 2006 and 2011. Prevalence of stunting and mean height-for-age Z-score were computed by maternal education, wealth index, region and other sociodemographic characteristics. Multivariable logistic and linear regression models were fitted to survey-specific and pooled data to estimate independent associations between covariates and stunting or Z-score. Sampling weights were applied in all analyses.SettingUganda.SubjectsChildren aged <5 years.ResultsWeighted sample size was 14 747 children. Stunting prevalence decreased from 44·8% in 1995 to 33·2% in 2011. UDHS reported stunting as 38% in 1995, underestimating the decline because of transitioning from National Center for Health Statistics/Centers for Disease Control and Prevention standards to WHO standards. Nevertheless, one in three Ugandan children was still stunted by 2011. South Western, Mid Western, Kampala and East Central regions had highest odds of stunting. Being born in a poor or middle-income household, of a teen mother, without secondary education were associated with stunting. Other persistent stunting predictors included small birth size, male gender and age 2–3 years.ConclusionsSustained decrease in stunting suggests that child nutrition interventions have been successful; however, current prevalence does not meet Millennium Development Goals. Stunting remains a public health concern and must be addressed. Customizing established measures such as female education and wealth creation while targeting the most vulnerable groups may further reduce childhood stunting.

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Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18094578 ◽

2021 ◽

Vol 18 (9) ◽

pp. 4578

Author(s):

Nidhi Wali ◽

Kingsley E. E. Agho ◽

Andre M. N. Renzaho

Keyword(s):

South Asia ◽

South Asian ◽

Health Surveys ◽

Associated Factors ◽

Common Factor ◽

Household Wealth ◽

Health Concern ◽

Demographic And Health Surveys ◽

Asian Countries ◽

Sampling Weights

Child wasting continues to be a major public health concern in South Asia, having a prevalence above the emergency threshold. This paper aimed to identify factors associated with wasting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent demographic and health surveys (2014–2018) of five countries in South Asia was combined. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. Wasting prevalence was higher for children aged 0–23 months (25%) as compared to 24–59 months (18%), with variations in prevalence across the South Asian countries. The most common factor associated with child wasting was maternal BMI [adjusted odds ratio (AOR) for 0–23 months = 2.02; 95% CI: (1.52, 2.68); AOR for 24–59 months = 2.54; 95% CI: (1.83, 3.54); AOR for 0–59 months = 2.18; 95% CI: (1.72, 2.77)]. Other factors included maternal height and age, household wealth index, birth interval and order, children born at home, and access to antenatal visits. Study findings suggest need for nutrition specific and sensitive interventions focused on women, as well as adolescents and children under 2 years of age.

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Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980014000275 ◽

2014 ◽

Vol 17 (11) ◽

pp. 2407-2418 ◽

Cited By ~ 16

Author(s):

Helga Bjørnøy Urke ◽

Maurice B Mittelmark ◽

Martín Valdivia

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Cross Sectional ◽

Growth Standards ◽

Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v2 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Elias Malamala ◽

Sia E Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Child Survival ◽

Wealth Index ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021. Objectives This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. To get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although its contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities. To significantly reduce the larder burden of stunting among the disadvantaged groups, initiatives should be embarked on the distribution of social services like water, health infrastructures, and education.

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Inequalities in stunting among under-five children in Tanzania: decomposing the concentration indexes using demographic health surveys from 2004/5 to 2015/6

International Journal for Equity in Health ◽

10.1186/s12939-021-01389-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Edwin Musheiguza ◽

Michael J. Mahande ◽

Elias Malamala ◽

Sia E. Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Wealth Index ◽

Reproductive Age ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania from from 50% in 1991/92 to 34% in 2016 although the prevalence is still high (34%)Stunting varyies across socioeconomic determinants with a larger burden among the socioeconomic disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.This study aimed at determining the trend, contributing factors and changes of inequalities in stunting among children aged 3–59 months from 2004 to 2016. Methods Data were drawn from the Tanzania Demographic and Health Surveys. The concentration index (CIX) was used to quantify the magnitude of inequalities in stunting. The pooled Poisson regression model was used to determine the factors for stunting, decision criterion for significant determinants was at 5% level of significance. The CIX was decomposed using the Wagstaff and Watanabe decomposition methods., the percentage contribution of each factor to the toal concentration index was used to rank the factors for socioeconomic inequalities in stutning. Results Inequalities in stunting were significantly concentrated among the poor; evidenced by CIX = − 0.019 (p < 0.001) in 2004, − 0.018 (p < 0.001) in 2010 and − 0.0096 (p < 0.001) in 2015. There was insignificant decline in inequalities in stunting; the difference in CIX from 2004 to 2010 was 0.0015 (p = 0.7658), from 2010 to 2015/6 was − 0.0081 (p = 0.1145). The overall change in CIX from 2004 to 2015/6 was 0.00965 (p = 0.0538). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) had positive impacts on the levels of inequalities in stunting for all surveyed years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. Reducing stunting among the disadvantaged groups requires initiatives which should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in remote areas.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v3 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Elias Malamala ◽

Sia E Msuya ◽

Festo Charles ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Wealth Index ◽

Reproductive Age ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background: Child stunting is a global health concern. Stunting leads to several consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. The reduction of inequalities in stunting is very crucial as we aim to reduce stunting to 28% by 2021 and hence attain zero malnutrition by 2030 under Sustainable Development Goal 2.2.. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. To get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results: Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although the contribution changed over time. Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution to the levels of inequalities in stunting. To significantly reduce the larger burden of stunting among the disadvantaged groups, initiatives should be embarked on the distribution of social services including maternal and reproductive education among women of reproductive age, water and health infrastructures in local areas.

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A success story of reduction in childhood stunting and underweight in India: analysis of pooled data from three rounds of Indian Demographic and Health Surveys (1998–2016)

Journal of Biosocial Science ◽

10.1017/s002193202000070x ◽

2020 ◽

pp. 1-18

Author(s):

Swati Srivastava ◽

Ashish Kumar Upadhyay

Keyword(s):

Antenatal Care ◽

Birth Order ◽

Health Surveys ◽

Maternal Education ◽

Decomposition Analysis ◽

Demographic And Health Surveys ◽

Wealth Status ◽

Indian Children ◽

Clean Fuel ◽

Childhood Stunting

Abstract This study used a series of individual-level datasets from National Family Health Surveys conducted in 1998–99, 2005–06 and 2015–16 to assess the factors behind the reduction in childhood stunting and underweight in India between the years 1998–99 and 2015–16. A multivariable decomposition regression analysis was performed. Results showed that the prevalence of childhood stunting declined from 49.4% in 1998–99 to 34.9% in 2015–16. Over the same period, the prevalence of childhood underweight declined from 41.9% in 1998–99 to 33.1% in 2015–16. The reduction in the prevalence of stunting was found to be contributed largely by a reduction in the combined prevalence of stunting and underweight (60%), followed by stunted only (21%) and the combined prevalence of stunting, underweight and wasting (19%). Likewise, the reduction in the prevalence of underweight was contributed by a reduction in the combined prevalence of stunting and underweight and the combined prevalence of stunting, underweight and wasting. Results of the decomposition analysis showed that over the period 1998–99 to 2015–16, improvement in wealth status and maternal education led to 13% and 12% declines, respectively, in childhood stunting and to 31% and 19% declines, respectively, in childhood underweight. Furthermore, reductions in childhood stunting and underweight were due to an increased average number of antenatal care visits, lower average birth order, decreased share of children with below-average birth size, increased use of clean fuel for cooking and a reduction in the practice of open defecation. These findings suggest that further reduction in the prevalence of childhood stunting and underweight could be attained through more equitable household economic growth, investment in girl’s education, greater access to improved toilet facilities, more widespread use of clean fuel for cooking, reduction in average birth order, increased antenatal care visits and greater consumption of IFA tablets by pregnant women. Policymakers need to prioritize these measures to further reduce malnutrition among Indian children.

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Inequalities in stunting among under-five children in Tanzania: Decomposing the Concentration Indexes using Demographic Health Surveys from 2004/5 to 2015/6

10.21203/rs.3.rs-24183/v1 ◽

2020 ◽

Author(s):

Edwin Musheiguza ◽

Michael Johnson Mahande ◽

Sia E Msuya ◽

Elias Malamala ◽

Rune Philemon ◽

...

Keyword(s):

Social Services ◽

Health Surveys ◽

Concentration Index ◽

Maternal Education ◽

Child Survival ◽

Wealth Index ◽

Health Concern ◽

Demographic And Health Surveys ◽

Contributing Factors ◽

Absolute Level

Abstract Background: Child stunting is a global health concern. It has consequences on child survival, growth, and development. The absolute level of stunting has been decreasing in Tanzania although the prevalence is still high (34%), varying across socioeconomic determinants with a larger burden among the disadvantaged group. Reduction of inequalities in stunting are very crucial as we aim to reduce stunting to 28% by 2021. Objectives: This study aimed to determine the trend, contributing factors and changes of inequalities in stunting among children aged 3 – 59 months from 2004 to 2016 Methodology: Data were drawn from the Tanzania Demographic and Health Surveys. The dependent variable was stunting. The concentration index was used to quantify the magnitude of inequalities in stunting for each year. In order to get the contribution of each determinant on the inequality in stunting, the concentration index was decomposed by using the Wagstaff and Watanabe decomposition methods of the concentration index. Results: Inequalities in stunting insignificantly declined from -0.019 (p<0.001) in 2004 to -0.018 (p<0.001) in 2010 and then to -0.0096 (p<0.001). Disparities in the distribution of wealth index (mean contribution > 84.7%) and maternal years of schooling (mean contribution > 22.4%) increased the levels of inequalities in stunting in all survey years. Rural-urban differences reduced inequalities in stunting although its contribution changed over time. Conclusion: Inequalities in stunting declined, differentials in wealth index and maternal education had increased contribution on the levels of inequalities. To significantly reduce the larder burden of stunting among the disadvantaged groups, initiatives should be embarked on distribution of social services like water, health infrastructures and education.

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Contextual and Compositional Risk Factors of Overweight and Obesity in India over Two Decades: An Analysis of National Demographic and Health Surveys

Current Developments in Nutrition ◽

10.1093/cdn/nzaa063_005 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1607-1607

Author(s):

Jeswin Baby ◽

Jithin Sam Varghese ◽

Tinku Thomas ◽

Shruthi Cyriac ◽

Shivani Patel

Keyword(s):

Health Surveys ◽

Labour Force ◽

Participation Rate ◽

Household Wealth ◽

Individual Characteristics ◽

Overweight And Obesity ◽

Demographic And Health Surveys ◽

Labour Force Participation Rate ◽

Per Capita ◽

The Impact

Abstract Objectives Identify contextual (state characteristics) and compositional (individual characteristics) drivers of changes in overweight in women from 1998–2016 across 26 states of India. Methods Nationally representative data on individual socio-demographics and objectively-measured anthropometry for non-pregnant and ever-married women 15–49y were obtained from the Indian National Family Health Surveys (NFHS-2, 1998–99, n = 61,979; NFHS-3, 2005–06, n = 66,694; and NFHS-4, 2015–16, n = 387,732). Individual-level data were merged with year-matched state-level nutritional and economic indicators obtained from multiple national databases. State indicators included per capita consumption of cereals, oils and sugar, per capita gross state domestic product (GDP), literacy rates, labour force participation rate, and population proportion engaged in sedentary employment. Cross-classified generalized linear mixed models (GLMM) with random effects classified each woman by state and round of survey. Models examined overweight/obesity trends as well as estimated the adjusted odds ratios and 95% Bayesian credible intervals for overweight/obesity associated with contextual and individual factors. Results From 1998 to 2016, the prevalence of overweight/obesity increased in all states of India. Higher household wealth (Quintile 5 vs 1: 4.18 [4.06–4.30]), education (post-secondary vs pre-school or less: 1.55 [1.51–1.60]), were associated with higher adjusted odds of overweight/obesity. State average sugar (g; 1.04 [1.03–1.05]) and oil (g; 1.04 [1.03–1.06]) intake, log (GDP per capita) (2.18 [2.14–2.21]) and literacy rates (1.01 [1.01–1.01]) were positively and independently associated with higher odds of overweight. The impact of state characteristics on prevalence of overweight/obesity decreased across rounds. Conclusions While the role of state economic and nutritional context as a driver of overweight has waned over time, contextual indicators remain salient correlates of an individual adult's likelihood of being overweight. Findings suggest that rising overweight in India must be understood and addressed from a socio-ecological lens that considers context alongside individual risks. Funding Sources None.

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Factors Associated with Stunting among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys

Nutrients ◽

10.3390/nu12123875 ◽

2020 ◽

Vol 12 (12) ◽

pp. 3875

Author(s):

Nidhi Wali ◽

Kingsley E. Agho ◽

Andre M.N. Renzaho

Keyword(s):

South Asia ◽

Health Surveys ◽

Age Groups ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Factors Associated ◽

Child Undernutrition ◽

The Common ◽

Nutrition Sensitive ◽

Children Under 5

South Asia continues to be the global hub for child undernutrition with 35% of children still stunted in 2017. This paper aimed to identify factors associated with stunting among children aged 0–23 months, 24–59 months, and 0–59 months in South Asia. A weighted sample of 564,518 children aged 0–59 months from the most recent Demographic and Health Surveys (2014–2018) was combined of five countries in South Asia. Multiple logistic regression analyses that adjusted for clustering and sampling weights were used to examine associated factors. The common factors associated with stunting in three age groups were mothers with no schooling ([adjusted odds ratio (AOR) for 0–23 months = 1.65; 95% CI: (1.29, 2.13)]; [AOR for 24–59 months = AOR = 1.46; 95% CI: (1.27, 1. 69)] and [AOR for 0–59 months = AOR = 1.59; 95% CI: (1.34, 1. 88)]) and maternal short stature (height < 150 cm) ([AOR for 0–23 months = 2.00; 95% CI: (1.51, 2.65)]; [AOR for 24–59 months = 3.63; 95% CI: (2.87, 4.60)] and [AOR for 0–59 months = 2.87; 95% CI: (2.37, 3.48)]). Study findings suggest the need for a balanced and integrated nutrition strategy that incorporates nutrition-specific and nutrition-sensitive interventions with an increased focus on interventions for children aged 24–59 months.

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