Understanding the determinants of postnatal care uptake for babies: A mixed effects multilevel modelling of 2016–18 Papua New Guinea Demographic and Health Survey

Abstract Background Papua New Guinea (PNG) recorded 22 neonatal deaths out of every 1,000 livebirths in 2019. Some of these deaths are related to complications that arise shortly after childbirth; hence, postnatal care (PNC) utilisation could serve as a surviving strategy for neonates as recommended by the World Health Organisation. National level study on determinants of PNC uptake in PNG is limited. Utilising the Bronfenbrenner’s Ecological Model of Human Development, the study aimed at assessing determinants of PNC utilisation for babies by their mothers aged 15–49 in PNG. Methods The study used data from the women’s file of the 2016–18 PNG Demographic and Health Survey (2016–18 PNGDHS) and a sample of 4,908 women aged 15–49 who had complete information on the variables of interest to the study. Nineteen (19) explanatory variables were selected for the study whereas PNC for babies within first two months after being discharged after birth was the main outcome variable. At 95% confidence interval (95% CI), six multilevel logistic models were built. The Akaike Information Criterion (AIC) was used to assess models’ fit. All analyses were carried out using STATA version 14.0. Results Generally, 31% of the women utilised PNC for their babies. Women with primary education [aOR = 1.42, CI = 1.13–1.78], those belonging to the middle wealth quintile [aOR = 1.42, CI = 1.08–1.87], working class [aOR = 1.28, CI = 1.10–1.49], women who had the four or more ANC visits [aOR = 1.23, CI = 1.05–1.43], those with twins [aOR = 1.83, CI = 1.01–3.29], women who belonged to community of medium literate class [aOR = 1.75, CI = 1.34–2.27] and those of moderate socioeconomic status [aOR = 1.60, CI = 1.16–2.21] had higher odds of seeking PNC for their babies. The odds to seek PNC services for babies reduced among the cohabiting women [aOR = 0.79, CI = 0.64–0.96], those at parity four or more [aOR = 0.77, CI = 0.63–0.93], women who gave birth to small babies [aOR = 0.80, CI = 0.67–0.98] and residents in the Highlands region [aOR = 0.47, CI = 0.36–0.62]. Conclusions Maternal education, wealth quintile, occupation, partner’s education, ANC visits, marital status, parity, child size at birth, twin status, community literacy and socioeconomic status as well as region of residence were associated with PNC uptake for babies in PNG. Variation in PNC uptake for babies existed from one community/cluster to the other. There is the need to strengthen public health education to increase awareness about the benefits of seeking PNC services for babies among women in PNG. Such programs should consider maternal and community/cluster characteristics in their design.

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Individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea: insights from a nationwide demographic and health survey

International Health ◽

10.1093/inthealth/ihaa097 ◽

2020 ◽

Author(s):

Abdul-Aziz Seidu ◽

Ebenezer Agbaglo ◽

Louis Kobina Dadzie ◽

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

...

Keyword(s):

Papua New Guinea ◽

Health Survey ◽

Rural Areas ◽

Contextual Factors ◽

Statistical Significance ◽

New Guinea ◽

Wealth Quintile ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Factors Associated

Abstract Background This study sought to assess the individual and contextual factors associated with barriers to accessing healthcare among women in Papua New Guinea. Methods The study was conducted among 14 653 women aged 15–49 y using data from the 2016–2018 Papua New Guinea Demographic and Health Survey. The outcome variable was barriers to accessing healthcare. Descriptive and multilevel logistic regression analyses were conducted. Statistical significance was declared at P < 0.05. Results Women aged 15–19 y were more likely to experience at least one barrier compared with those aged 40–49 y (adjusted OR [AOR]=1.48; 95% CI 1.18 to 1.86). Women with secondary/higher education (AOR=0.68; 95% CI 0.57 to 0.81), women in the richest wealth quintile (AOR=0.36; 95% CI 0.28 to 0.46) and those in the least disadvantaged socioeconomic status (AOR=0.46; 95% CI 0.33 to 0.64) had lower odds of having challenges with at least one barrier to healthcare. However, living in rural areas increased the odds of facing at least one barrier to healthcare (AOR=1.87; 95% CI 1.27 to 2.77). Conclusions This study has demonstrated that both individual and contextual factors are associated with barriers to healthcare accessibility among women in Papua New Guinea. To enhance the achievement of the Sustainable Development Goals 3.1, 3.7 and 3.8, it is critical to deem these factors necessary and reinforce prevailing policies to tackle barriers to accessing healthcare among women in Papua New Guinea.

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Factors influencing early postnatal care utilisation among women: Evidence from the 2014 Ghana Demographic and Health Survey

PLoS ONE ◽

10.1371/journal.pone.0249480 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0249480

Author(s):

Francis Appiah ◽

Tarif Salihu ◽

Justice Ofosu Darko Fenteng ◽

Andrews Ohene Darteh ◽

Esther Twewa Djan ◽

...

Keyword(s):

Health Survey ◽

Postnatal Care ◽

National Level ◽

Scale Up ◽

Health Department ◽

World Health Organisation ◽

Demographic And Health Survey ◽

World Health ◽

Outcome Variable ◽

Factors Influencing

Introduction Early postnatal care (EPNC) utilisation is crucial for averting maternal deaths as recommended by the World Health Organisation. About 30% of women do not obtain EPNC in Ghana and no national level study have investigated the determinants of EPNC. Therefore, this study aimed at assessing factors associated with EPNC uptake among women aged 15–49 in Ghana. Materials and methods The study utilised data from the women’s file of the 2014 Ghana Demographic and Health Survey (GDHS) and sampled 1,678 women aged 15–49 who had complete data on EPNC. Descriptive computation of EPNC was done. Since EPNC (which is the main outcome variable for the study) was dichotomous, the binary logistic regression was used to determine factors influencing utilisation of EPNC at 95% two-tailed confidence interval. The results were presented as adjusted odds ratio (AOR). Stata version 14.0 was used for all the analyses. Results Descriptively, the results indicated that 31% of women aged 15–49 sought EPNC. At the inferential level, women aged 40–44 were more likely to seek EPNC compared to those aged 15–19 [AOR = 3.66, CI = 1.25–10.67]. Islam women had higher odds of EPNC as compared with Christians [AOR = 1.70, CI = 1.23–2.35]. Comparatively, women of Mande ethnic group had higher propensity to seek EPNC than the Akan [AOR = 3.22, CI = 1.20–8.69]. Residents of the Greater Accra region were over 11 times probable to utilise EPNC compared with the residents of Western region. Conclusion The key determinants of EPNC were age, religion, ethnicity, marital status and region. Therefore, the Health Promotion and Education Unit and Reproductive and Child Health Department of the Ghana Health Service need to scale up EPNC sensitisation programmes and should target women aged 15–19, Christians and other category of women with less likelihood of EPNC in order to offset the disparities.

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Postnatal care utilisation among women in rural Ghana: analysis of 2014 Ghana demographic and health survey

BMC Pregnancy and Childbirth ◽

10.1186/s12884-020-03497-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Francis Appiah ◽

Tarif Salihu ◽

Justice Ofosu Darko Fenteng ◽

Andrews Ohene Darteh ◽

Patience Kannor ◽

...

Keyword(s):

Health Survey ◽

Rural Women ◽

Postnatal Care ◽

Demographic And Health Survey ◽

World Health ◽

Care Utilization ◽

Rural Residents ◽

Maternal Deaths ◽

Rural Ghana ◽

Care Utilisation

Abstract Background Maternal mortality is high in Ghana, averaging 310 maternal deaths per 100,000 live births in 2017. This is partly due to inadequate postnatal care especially among rural communities. Ghana can avert the high maternal deaths if women meet the World Health Organisation’s recommended early postnatal care check-up. Despite the association between geographical location and postnatal care utilisation, no study has been done on determinants of postnatal care among rural residents in Ghana. Therefore, this study determined the prevalence and correlates of postnatal care utilization among women in rural Ghana. Methods The study utilised women’s file of the 2014 Ghana Demographic and Health Survey (GDHS). Following descriptive computation of the prevalence, binary logistic regression was fitted to assess correlates of postnatal care at 95% confidence interval. The results were presented in adjusted odds ratio (AOR). Any AOR less than 1 was interpreted as reduced likelihood of PNC attendance whilst AOR above 1 depicted otherwise. All analyses were done using Stata version 14.0. Results The study revealed that 74% of the rural women had postnatal care. At the inferential level, women residing in Savanna zone had higher odds of postnatal care compared to those in the Coastal zone [AOR = 1.80, CI = 1.023–3.159], just as among the Guan women as compared to the Akan [AOR = 7.15, CI = 1.602–31.935]. Women who were working were more probable to utilise postnatal care compared to those not working [AOR = 1.45, CI = 1.015–2.060]. Those who considered distance as unproblematic were more likely to utilise postnatal care compared to those who considered distance as problematic [AOR = 1.63, CI = 1.239–2.145]. Conclusions The study showed that ethnicity, ecological zone, occupation and distance to health facility predict postnatal care utilisation among rural residents of Ghana. The study points to the need for government to increase maternal healthcare facilities in rural settings in order to reduce the distance covered by women in seeking postnatal care.

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Regional disparities in postnatal care among mothers aged 15-49 years old: An analysis of the Indonesian Demographic and Health Survey 2017

F1000Research ◽

10.12688/f1000research.50938.2 ◽

2021 ◽

Vol 10 ◽

pp. 153

Author(s):

Mochammad Nur Cahyono ◽

Ferry Efendi ◽

Harmayetty Harmayetty ◽

Qorinah Estiningtyas Sakilah Adnani ◽

Hsiao Ying Hung

Keyword(s):

Maternal Mortality ◽

Health Survey ◽

Postnatal Care ◽

Secondary Data ◽

Wealth Quintile ◽

Regional Disparities ◽

Demographic And Health Survey ◽

Service Utilisation ◽

Health Coverage ◽

Live Births

Background: In Indonesia, maternal mortality remains high, significantly 61.59% occur in the postnatal period. Postnatal care (PNC) provision is a critical intervention between six hours and 42 days after childbirth and is the primary strategy to reduce maternal mortality rates. However, underutilisation of PNC in Indonesia still remains high, and limited studies have shown the regional disparities of PNC in Indonesia. Methods: This study aims to explore the gaps between regions in PNC service for mothers who have had live births during the last five years in Indonesia. This study was a secondary data analysis study using the Indonesian Demographic and Health Survey (IDHS) in 2017. A total of 13,901 mothers aged 15-49 years having had live births within five years were included. Chi-squared test and binary logistic regression were performed to determine regional disparities in PNC. Results: Results indicated that the prevalence of PNC service utilisation among mothers aged 15-49 years was 70.94%. However, regional gaps in the utilisation of PNC service were indicated. Mothers in the Central of Indonesia have used PNC services 2.54 times compared to mothers in the Eastern of Indonesia (OR = 2.54; 95% CI = 1.77-3.65, p<0.001). Apart from the region, other variables have a positive relationship with PNC service, including wealth quintile, accessibility health facilities, age of children, childbirth order, mother's education, maternal occupation, spouse's age, and spouse's education. Conclusion: The results suggest the need for national policy focuses on service equality, accessible, and reliable implementation to improve postnatal care utilisation among mothers to achieve the maximum results for the Indonesian Universal Health Coverage plan.

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Regional prevalence and socioeconomic inequalities in infant care practices: evidence from 2018 Nigeria Demographic and Health Survey

10.21203/rs.3.rs-44307/v2 ◽

2021 ◽

Author(s):

Michael Ekholuenetale ◽

Amit Arora ◽

Amadou Barrow

Keyword(s):

Socioeconomic Status ◽

Educational Attainment ◽

Health Survey ◽

Low Socioeconomic Status ◽

Wealth Quintile ◽

Household Wealth ◽

Socioeconomic Inequalities ◽

Demographic And Health Survey ◽

Skin Contact ◽

Breastfeeding Practices

Abstract Background: The effects of breastfeeding practices on children’s health are undoubtedly of great interest worldwide. However, there is inequalities in the coverage of exclusive breastfeeding (EBF), early initiation of breastfeeding (EIBF) and mother and newborn skin-to-skin contact (SSC) in many resource-constrained settings. The aim of this study was to explore regional prevalence and examine the socioeconomic inequalities in EBF, EIBF and SSC in Nigeria.Methods: Data on 2,936 infants under six months old were extracted from the 2018 Nigeria Demographic and Health Survey (NDHS) to determine EBF. In addition, data from 21,569 children were analyzed for EIBF and SSC. Concentration index (CI) and concentration curve were used to measure socioeconomic inequalities in EBF, EIBF and SSC.Results: The prevalence of EBF, EIBF and SSC were 31.8%, 44.2% and 12.1% respectively. Furthermore, Ogun State had the highest prevalence of EBF (71.4%); while Bayelsa State had the highest prevalence of SSC (67.8%) and EIBF (96.2%) respectively. Urban dwellers had higher prevalence of EBF, SSC and EIBF across household wealth quintile and by levels of mothers’ education in contrast to their rural counterparts. We quantiﬁed the degree of wealth-related and mothers education inequalities in EBF, SSC and EIBF. There were pro-rich EBF (CI = 0.118; p< 0.001), EIBF (CI = 0.103; p=0.002) and SSC (CI = 0.152; p< 0.001) respectively. Also, EBF (CI = 0.157; p< 0.001), EIBF (CI = 0.091; p< 0.001) and SSC (CI = 0.156; p< 0.001) were significantly more concentrated among mothers with higher educational attainment. The test for differences between urban versus rural was significant in EBF, SSC and EIBF by mothers educational attainment. But this was only significant in EIBF by household wealth respectively.Conclusion: Socioeconomic status determined breastfeeding practices and SSC in Nigeria. Breastfeeding practices interventions should target all mothers, especially those of low socioeconomic status and to ensure improvements in baby friendly initiatives.

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Correlate of Post-natal care utilization in rural Ethiopia: An evidence from Secondary data analysis of Ethiopian Demographic Health survey 2016.

10.21203/rs.2.16954/v1 ◽

2019 ◽

Author(s):

REKIKU Fikre Abebe ◽

Berhan Tsegaye Negash ◽

Zelalem Tenaw bogale ◽

wegene Jemebere Beru ◽

Getnet Kassahun Molla

Keyword(s):

Health Survey ◽

Rural Women ◽

Postnatal Care ◽

Wealth Quintile ◽

Outcome Variable ◽

Care Utilization ◽

Demographic Health Survey ◽

Place Of Delivery ◽

The Past ◽

The Government

Abstract Abstract Background: Postnatalcareutilizationis the most neglected care in Ethiopian,despite a large proportion of maternal and neonatal deaths occurs during postnatal period. Evidence suggested that utilization of postnatal care averts major complications of the fetus and mother.But,proportion of rular women utilization of postnatal care is low in Ethiopia. Information about prevalence and factors which determine utilization of postnatal care utlization in rular women in Ethiopia is mandatory for policy making, and program design to enhance its utilization. Objective: Theobjective of this study was to determine the prevalence of utilization of postnatal care and to identify its determinant factorsamong rural women who gave birth in the past five yearsbefore Ethiopian demographic health survey, in 2016. Method: This study utilized data from Ethiopian demographic health survey2016 for analysis. It is a national two stage, cross sectional study. It analyzed data for rural women who gave birth at least one time in the past five year before data survey time. Logistic regression was applied to identify explanatory variables associated with outcome variable. Adjusted odds ratio with 95% confidence interval was computed and P-value< 0.05 was considered as statistically significant. Result:The prevalenceof postnatal care utilizationamong rural women was 11.4%.Place of delivery[AOR=4.3, 95%CI, 1.4-5.2], ANCvisit [AOR=2.1, 95%CI, 1.1-3.9] and Women in the richest wealth quintile [AOR=2.97, 95%CI, 1.9-4.5] were factors associated with postnatal care service utilization among rural women in Ethiopia in 2016. Conclusion and recommendation: This study showed that prevalence of postnatal care utlization was low. Being in richest wealth quintile, history of ANC vist and place of delivery were positive predictors of postnatal care utlization among rural women. Regardless of proven strategies utilized to maximize utilization of postnatal care utlization by the government of Ethiopia, this study showed that prevalence is low in rural areas. Therefore, community awareness creation, increasing institutional coverage by expanding maternity waiting area and besides, the government should design and implement income increasing package among rural women.

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Geostatistical analysis and mapping: Social and environmental determinants of under-five child mortality, evidence from the 2014 Ghana Demographic and Health Survey.

10.21203/rs.2.13778/v1 ◽

2019 ◽

Author(s):

Justice Moses K. Aheto ◽

Robert Yankson ◽

Michael Give Chipeta

Keyword(s):

Health Survey ◽

Maternal Education ◽

Demographic And Health Survey ◽

Sub Saharan Africa ◽

Multiple Births ◽

Outcome Variable ◽

Under Five ◽

Spatial Risk ◽

Increased Risk ◽

Generalised Linear Mixed Model

Abstract Background Under-five mortality (U5M) rates are among the health indicators of utmost importance globally. It is the goal 3 target 2.1 of the Sustainable Development Goals that is expected to be reduced to at least 25 per 1000 livebirths by 2030. Despite a considerable reduction in U5M was observed globally, several countries especially those in sub-Saharan Africa (SSA) like Ghana are struggling to meet this target. Evidence-based targeting and utilization of the available limited public health resources are critical for effective design of intervention strategies that will enhance under-five child survival. We aimed to estimate and map U5M risk, with the ultimate goal of identifying communities at high risk where interventions can be targeted.Methods The 2014 Ghana Demographic and Health Survey data was used in this study. Geostatistical analyses were conducted on 5,801 children residing in 423 geographical clusters. The outcome variable is child survival status (alive or dead). We employed a geostatistical generalised linear mixed model to investigate both measured and unmeasured child specific and spatial risk factors for child survival. We then visualise child mortality by mapping the predictive probability of survival.Results Of the total sampled under 5 children, 280 (4.83%) experienced the outcome of interest. Children born as multiple births were at increased risk of mortality with AOR (9.28, 95% CI: 6.35 – 13.58) compared to singletons. Maternal education AOR (0.80, 95% CI: 0.68 – 0.93) and number of children under 5 within each household AOR (0.34, 95% CI: 0.28 – 0.41) were shown to have a protective effect. The predicted U5M risk in 2014 was at 8.3%. High altitude areas were highly associated with high U5M.Conclusion The analysis found that multiple births and high elevation are highly associated with U5M in Ghana. The high-resolution maps show areas and communities where interventions for U5M can be prioritised to have health impact.

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Individual and contextual factors associated with disposal of children’s stools in Papua New Guinea: evidence from the 2016–2018 demographic and health survey

BMC Public Health ◽

10.1186/s12889-020-09852-6 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Abdul-Aziz Seidu ◽

Ebenezer Agbaglo ◽

Bright Opoku Ahinkorah ◽

Louis Kobina Dadzie ◽

Ishmael Bukari ◽

...

Keyword(s):

Papua New Guinea ◽

Health Survey ◽

Contextual Factors ◽

Statistical Significance ◽

New Guinea ◽

Demographic And Health Survey ◽

Global Public Health ◽

Logistic Regression Models ◽

Factors Associated ◽

The Individual

Abstract Background Proper sanitation has been one of the topmost priorities on the global public health agenda. In the past few decades, sanitation programs targeting households have often paid little attention to the disposal of children’s stools. We assessed the individual and contextual factors associated with disposal of children’s faeces in Papua New Guinea. Methods The data used for this study forms part of the 2016–2018 Papua New Guinea Demographic and Health Survey (PDHS). For this study, we focused on women with children less than five years (n = 2095). Both descriptive and inferential analyses were carried out. Descriptive statistics were used to summarize the data, using frequency counts and percentages. The inferential analysis used multilevel logistic regression models to investigate the individual and contextual factors associated with disposal of children’s stools. These models were presented as adjusted odds ratio (AORs), together with their corresponding 95% confidence intervals. Statistical significance was set at p < 0.05. Results More than half (56%) of the women had disposed of their children’s stools unsafely. With the individual level factors, the results showed that women with children < 12 months [AOR =1.71; CI = 1.28–2.29] and women aged 20–24 [AOR =2.58; CI = 1.24–5.37], 35–39 [AOR =2.34; CI = 1.09–5.04], and 40 years and above [AOR =2.51; CI = 1.09–5.79] were more likely to practice unsafe disposal of children’s stool. The odds of unsafe disposal of faeces was also higher among women who visited the health facility for child diarrhea [AOR =1.69; CI = 1.25–2.28]. With the contextual factors, the odds of unsafe disposal of children’s stool was higher among women who lived in the Southern region [AOR =4.82; CI = 2.08–11.18], those who lived in male-headed households [AOR =1.79; CI = 1.19–2.70], and those who had unimproved toilet facilities [AOR =1.96; CI = 1.39–2.76]. On the contrary, women with unimproved source of drinking water were less likely to dispose of their children’s stool unsafely [AOR =0.54; CI = 0.35–0.83]. Conclusion Both individual and contextual factors predict unsafe disposal of children’s faeces in Papua New Guinea. It is recommended that sanitation programs should focus on behavioral change and not only on the extension of water and improved toilet facilities. Such programs should also focus on both individual and contextual factors of women.

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Determinants of Under-Five Mortality in Ghana: Evidence from the Ghana Demographic and Health Survey

International Journal of Translational Medical Research and Public Health ◽

10.21106/ijtmrph.161 ◽

2020 ◽

Vol 4 (2) ◽

pp. 112-122

Author(s):

Albert Apotele Nyaaba ◽

Augustine Tanle ◽

Louis Kobina Kobina ◽

Matthew Ayamga

Keyword(s):

Health Survey ◽

Maternal Education ◽

Population Based ◽

Cross Sectional Study ◽

Demographic And Health Survey ◽

Outcome Variable ◽

Wealth Status ◽

Cross Sectional ◽

Under Five ◽

Creative Commons

Background and Objectives: This study aims to investigate the strength of the association between socio-economic, maternal and environmental determinants and under-five mortality in Ghana. Methods: We utilized data from the 2014 Ghana Demographic and Health Survey, a population-based cross-sectional study, which included 4151 children born alive to women aged 15-49 years. The primary outcome variable was under-five mortality. Descriptive statistics and multivariate logistic regression were applied to assess the relationship and relative association of the independent variables with the outcome variable. Results: Children of women with secondary education and above and women within the middle wealth status were 0.593 and 0.886 less likely to experience under five deaths compared to women with no education and women of low wealth status (OR=0.593; 95% CI 1.690 to 2.063; p< 0.01) (OR =0.886; 95% CI 1.48 to 1.63; p<0.01). Women who had their first birth at age 20-29 years were 0.764 less likely to experience under-five deaths compared to those aged 15-19 years (OR= 0.764; 95% CI 0.994 to 1.191; p<0.01). Children born in households with pit toilets were more likely (OR= 1.51; 95% CI 1.20 to 2.30; p<0.01) to die before age five compared to children born in households with flushed toilet. Women who used bore hole /well water were more likely (OR= 1.686; 95% CI 2.94 to 3.01; p< 0.05) to experience under-five deaths compared to women who used piped water. Conclusion and Implications for Translation: This study identified the determinants that significantly predicted under-five deaths and the magnitude of the influence on under-five deaths in Ghana. It accentuates the need for increased maternal education, delayed child bearing, provision of improved drinking water and toilet facilities to reduce under-five deaths in Ghana. Key words: • Socio-economic • Maternal health • Child health • Environmental factors • Under-five mortality • Ghana • Demographic and Health Survey • DHS Copyright © 2020 Nyaaba, et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY 4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in this journal, is properly cited.

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Determinants of stunting among children < 5 years of age: Evidence from 2018-2019 Zambia Demographic and Health Survey

10.1101/2021.05.19.21257389 ◽

2021 ◽

Author(s):

Bright Nkhoma ◽

Wingston Felix Ng'ambi ◽

Peter J. Chipimo ◽

Mowa Zambwe

Keyword(s):

Drinking Water ◽

Health Survey ◽

Birth Interval ◽

Maternal Education ◽

Public Health Problem ◽

Wealth Index ◽

Demographic And Health Survey ◽

World Health ◽

Wealth Status ◽

Child Birth

ABSTRACT: OBJECTIVE: The study aimed at identifying socioeconomic and environmental factors that were associated with stunting among children aged 0 to 59 months in Zambia. BACKGROUND: Hitherto, stunting continues to be a Public Health problem worldwide. A child is stunted if his or her height is less than negative two standard deviations below the World Health Organization (WHO) standard. The study aimed to explore determinants of stunting in Zambia among children (< 5 years of age) using the Zambia Demographic and Health Survey (ZDHS) 2018 to 2019 database. METHODS: A total of 7, 045 Zambian children with complete anthropometric measurements and aged 0 to 59 months were included in the study. Nutritional status was evaluated using anthropometric; height for age, as a proxy measure of stunting. Univariate and multivariate binary logistic regression were used to examine the association between stunting and selected environmental, maternal sociodemographic and child level variables. RESULTS: A total of 2, 479 children under the age of five found to be stunted representing a prevalence of 34.9%. Stunting was higher among male children as compared to female children (38.5% vs 31.3% respectively). Additional analysis revealed that children from households whose source of drinking water was improved (34%) were less likely to be stunted compared to children from households whose source of drinking water was non-improved (40%). Stunting was statistically significantly associated with sex and age of a child; birth size; breastfeeding; residence; maternal education; wealth index; twin births and the birth interval among siblings. Children born to mothers whose previous birth interval is less than 24 months (aOR= 1.34 95%CI: 1.13-1.58; p<0.001), children from lower index households (aOR= 1.65 95%CI: 1.32-2.08; p<0.001), twin births (aOR=2.65 95%CI: 1.61-4.36; p<0.001), children whose mothers had primary education (aOR=1.16 95%CI 1.00-1.35; p=0.046), children coming from households whose source of drinking water was non-improved (aOR= 1.30 95%CI: 1.09-1.5: p=0.003), child not breastfed (aOR= 1.20 95%CI: 1.04-1.38; p=0.015) were more likely to be stunted. CONCLUSION: The study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; birth weight; maternal education; wealth status; source of drinking water; twin births, breastfeeding, residence and the birth interval among siblings. Therefore, to reduce the burden of stunting interventions that can address these factors are required such as community based education and targeted nutritional interventions. Keywords: Children, Stunting, Zambia Demographic and Health Survey

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