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Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan

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  • Kim, Rockli
  • Mejía-Guevara, Iván
  • Corsi, Daniel J.
  • Aguayo, Víctor M.
  • Subramanian, S.V.

Abstract

Optimal growth and development in early childhood is determined by a complex interplay of child, maternal, household, environmental, and socioeconomic factors that influence nutritional intake, but interventions to reduce child undernutrition sometimes target specific risk factors in isolation. In this analysis, we assess the relative importance of 13 correlates of child stunting selected based on a collective review of existing multi-factorial frameworks: complementary feeding, breastfeeding, feeding frequency, dietary diversity, maternal height, body mass index (BMI), education, age at marriage, child vaccination, access to improved drinking source and sanitation facilities, household indoor air quality, and household wealth. The analytic sample consisted of nationally representative cross-sectional surveys from the most recent Demographic and Health Surveys for Bangladesh (2014), India (2005), Nepal (2011), and Pakistan (2013), and from the National Nutrition Survey for Afghanistan (2013). In the mutually adjusted logistic regression model for 3,159 infants aged 6–8 months, short maternal stature (OR: 2.93; 95% CI: 1.93–4.46) and lack of complementary foods (OR: 1.47; 95% CI: 1.12–1.93) were associated with significantly higher risk of stunting. For 18,586 children aged 6–23 months, the strongest correlates of child stunting were: maternal height (OR: 3.37, 95% CI: 2.82–4.03), household wealth (OR: 2.25, 95% CI: 1.72–2.94), maternal BMI (OR: 1.59, 95% CI: 1.27–2.00), minimum dietary diversity (OR: 1.48, 95% CI: 1.27–1.72), maternal education (OR: 1.36, 95% CI: 1.18–1.56), and age at marriage (OR: 1.17, 95% CI: 1.05–1.30). Full vaccination and minimum dietary frequency were also found to be important for severe stunting for children of this age group. Some differences were found in the relative ordering and statistical significance of the correlates in country-specific analyses. Our findings indicate that comprehensive strategies incorporating a broader progress on socioeconomic conditions as well as investments in nutrition specific programs are needed to improve child undernutrition in South Asia.

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  • Kim, Rockli & Mejía-Guevara, Iván & Corsi, Daniel J. & Aguayo, Víctor M. & Subramanian, S.V., 2017. "Relative importance of 13 correlates of child stunting in South Asia: Insights from nationally representative data from Afghanistan, Bangladesh, India, Nepal, and Pakistan," Social Science & Medicine, Elsevier, vol. 187(C), pages 144-154.
    • Handle: RePEc:eee:socmed:v:187:y:2017:i:c:p:144-154
    DOI: 10.1016/j.socscimed.2017.06.017
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    References listed on IDEAS

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    1. Li, Zhihui & Kim, Rockli & Subramanian, S.V., 2021. "Economic-related inequalities in child health interventions: An analysis of 65 low- and middle-income countries," Social Science & Medicine, Elsevier, vol. 277(C).
    2. Sunil Rajpal & Rockli Kim & William Joe & S.V. Subramanian, 2020. "Stunting among Preschool Children in India: Temporal Analysis of Age-Specific Wealth Inequalities," IJERPH, MDPI, vol. 17(13), pages 1-16, June.
    3. Balietti, Anca & Datta, Souvik & Veljanoska, Stefanija, 2022. "Air pollution and child development in India," Journal of Environmental Economics and Management, Elsevier, vol. 113(C).
    4. Sudha Narayanan & Udayan Rathore & Mohit Sharma, 2019. "Women's nutritional empowerment and their well-being Identifying key drivers in India and Bangladesh," Indira Gandhi Institute of Development Research, Mumbai Working Papers 2019-004, Indira Gandhi Institute of Development Research, Mumbai, India.
    5. Kim, Rockli & Rajpal, Sunil & Joe, William & Corsi, Daniel J. & Sankar, Rajan & Kumar, Alok & Subramanian, S.V., 2019. "Assessing associational strength of 23 correlates of child anthropometric failure: An econometric analysis of the 2015-2016 National Family Health Survey, India," Social Science & Medicine, Elsevier, vol. 238(C), pages 1-1.
    6. Abdurazzakova, Dilnovoz & Kosec, Katrina & Parpiev, Ziyodullo, 2024. "Women’s involvement in intra-household decision-making and infant and young child feeding practices in Central Asia," World Development, Elsevier, vol. 178(C).
    7. Kajori Banerjee & Laxmi Kant Dwivedi, 2020. "Disparity in childhood stunting in India: Relative importance of community-level nutrition and sanitary practices," PLOS ONE, Public Library of Science, vol. 15(9), pages 1-21, September.
    8. Nidhi Wali & Kingsley E. Agho & Andre M. N. Renzaho, 2021. "Wasting and Associated Factors among Children under 5 Years in Five South Asian Countries (2014–2018): Analysis of Demographic Health Surveys," IJERPH, MDPI, vol. 18(9), pages 1-17, April.
    9. Shiva S. Halli & Rajeshwari A. Biradar & Jang Bahadur Prasad, 2022. "Low Birth Weight, the Differentiating Risk Factor for Stunting among Preschool Children in India," IJERPH, MDPI, vol. 19(7), pages 1-12, March.
    10. Zelalem G. Terfa & Sayem Ahmed & Jahangir Khan & Louis W. Niessen & on behalf of the IMPALA Consortium, 2022. "Household Microenvironment and Under-Fives Health Outcomes in Uganda: Focusing on Multidimensional Energy Poverty and Women Empowerment Indices," IJERPH, MDPI, vol. 19(11), pages 1-17, May.
    11. Purushotham, Anjali & Mittal, Nitya & Ashwini, B.C. & Umesh, K.B. & von Cramon-Taubadel, Stephan & Vollmer, Sebastian, 2022. "A quantile regression analysis of dietary diversity and anthropometric outcomes among children and women in the rural–urban interface of Bangalore, India," Food Policy, Elsevier, vol. 107(C).
    12. Suman Chakrabarti & Samuel P. Scott & Harold Alderman & Purnima Menon & Daniel O. Gilligan, 2021. "Intergenerational nutrition benefits of India’s national school feeding program," Nature Communications, Nature, vol. 12(1), pages 1-10, December.

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