Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey
Abstract Background: Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study.Methods: We used the Nepal Demographic and Health Survey 2016 data, which is a nationally representative cross-sectional household survey. We used two common anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor of interest. Binary logistic regression with sampling weights was used to estimate adjusted odds ratios (OR) and 95% confidence intervals to examine the association between the PoB and childhood undernutrition.Results: The overall prevalence of stunting was 35.8%, and underweight was 27.1% in under-five children in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order >3 and <2 years of interval between birth and subsequent birth (IBBSB). The association between the birth order of children and the prevalence of undernutrition had strong statistical significance (p<0.001). Mother’s age at marriage (p=0.001), underweight mother (p<0.001), mother’s education (p<0.001), father’s education (p<0.001), wealth quintile (p<0.001), no exposure to mass media (p<0.001), children’s age (p<0.001), and place of residence(p=0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12-24 months of interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting as compared to those children with birth order one and <12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9). Conclusion: The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12-24 months after marriage was found to be associated with reduced odds of childhood stunting. To mitigate childhood undernutrition, Nepal's government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.