Multivariate logistic regression analysis on the association between anthropometric
      indicators of under-five children in Nigeria: NDHS 2018

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Abstract

Background

Child malnutrition is a huge health problem having multifaceted consequences for child survival and long-term well-being. Although, several studies investigated stunting, underweight, and wasting in low- and middle-income countries, in Nigeria, the link between them received little attention. The aim of this study is, therefore, to assess the association between anthropometric indicators of under-five children such as stunting, underweight and wasting given that of other characteristics of children and households.

Methods

The data for this study was obtained from Nigerian Demographic and health survey (NDHS) in 2018. A total of 11,314 under-five children were involved. Multivariate logistic regression model was used to determine the association between stunting, underweight and wasting given that of the estimated effect of other determinants.

Results

From 11,314 under-five children the study considered 36.2, 21.4 and 6.7% of them suffered from stunting, underweight and wasting, respectively. About half (50.7%) of the children were male, 24.1% was obtained from North West region of Nigeria, and 37.8% of them were from households having unimproved drinking water. The pairwise dependency between stunting and underweight; underweight and wasting was measured using odds ratio (OR) of 15.796, and 16.750 respectively. The estimated odds of children from richest household to become stunted, underweight, and wasted was respectively 0.392, 0.540, 0.786 times that of the estimated odds of children from poorest households.

Conclusion

The prevalence of under-five children with stunting, underweight and/or wasting in Nigeria was very high. The important determinants of stunting, underweight, and wasting for under five children were household wealth index, women body mass index, sex of the child, anemia, mothers’ age at first birth, and a diarrhea two weeks prior to the survey. Whereas, region, religion, multiple birth, women’s educational level significantly associated with both stunting and underweight. Both stunting and wasting significantly associated with underweight.

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Most cited references 18

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Wasting and stunting--similarities and differences: policy and programmatic implications.

André Briend, Tanya Khara, Carmel Dolan (2015)

Wasting and stunting are often presented as two separate forms of malnutrition requiring different interventions for prevention and/or treatment. These two forms of malnutrition, however, are closely related and often occur together in the same populations and often in the same children. Wasting and stunting are both associated with increased mortality, especially when both are present in the same child. A better understanding of the pathophysiology of these two different forms of malnutrition is needed to design efficient programs. A greatly reduced muscle mass is characteristic of severe wasting, but there is indirect evidence that it also occurs in stunting. A reduced muscle mass increases the risk of death during infections and also in many other different pathological situations. Reduced muscle mass may represent a common mechanism linking wasting and stunting with increased mortality. This suggests that to decrease malnutrition-related mortality, interventions should aim at preventing both wasting and stunting, which often share common causes. Also, this suggests that treatment interventions should focus on children who are both wasted and stunted and therefore have the greatest deficits in muscle mass, instead of focusing on one or the other form of malnutrition. Interventions should also focus on young infants and children, who have a low muscle mass in relation to body weight to start with. Using mid-upper-arm circumference (MUAC) to select children in need of treatment may represent a simple way to target young wasted and stunted children efficiently in situations where these two conditions are present. Wasting is also associated with decreased fat mass. A decreased fat mass is frequent but inconsistent in stunting. Fat secretes multiple hormones, including leptin, which may have a stimulating effect on the immune system. Depressed immunity resulting from low fat stores may also contribute to the increased mortality observed in wasting. This may represent another common mechanism linking wasting and stunting with increased mortality in situations where stunting is associated with reduced fat mass. Leptin may also have an effect on bone growth. This may explain why wasted children with low fat stores have reduced linear growth when their weight-for-height remains low. It may also explain the frequent association of stunting with previous episodes of wasting. Stunting, however, can occur in the absence of wasting and even in overweight children. Thus, food supplementation should be used with caution in populations where stunting is not associated with wasting and low fat stores.

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Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey

Sadaf Khan, Sidra Zaheer, Nilofer Safdar (2019)

Background Childhood malnutrition is a critical public health concern in Pakistan. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012–2013. Methods Sample of 3071 Pakistani children aged 0–59 months from the PDHS 2012–2013, with complete anthropometric measurements were included in the study. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. Uni- and multivariate binary logistic regressions were used to examine the association between selected maternal-socio-demographic and child level variables (such as child sex, age, size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status) and three proxy measures of child nutritional status. Results About 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Children whose mothers lived in rural areas (aOR = 0.67, 95%CI 0.48–0.92), were aged ≥18 years at marriage (aOR = 0.76, 95%CI 0.59–0.99) and had visited antenatal clinic more than 3 times during pregnancy (aOR = 0.61, 95%CI 0.38–0.98) were less likely to be stunted. Mother’s low educational level (aOR = 2.55, 95%CI 1.26–5.17), short stature (aOR = 2.31, 95%CI 1.34–3.98), child’s small size at birth (aOR = 1.67, 95%CI 1.14–2.45) and mother’s BMI were significantly associated with child’s underweight status. Children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33–9.82). Conclusion The study suggests that most of the analysed factors that accounted for malnutrition in Pakistani children (such as mother’s age at marriage, educational level and mothers’ nutritional status) are preventable. Therefore, to reduce the burden of malnutrition interventions that can address these factors are required such as community based education and targeted nutritional interventions.

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Determinants of underweight, stunting and wasting among schoolchildren

Mekides Wolde, Yifru Berhan, Alemzewed Chala (2015)

Background The cause of under-nutrition in schoolchildren is complex and varying from region to region. However, identifying the cause is the basic step for nutritional intervention programs. Methods School based cross-sectional survey was conducted among 450 schoolchildren aged 7-14 years, using multi-stage sampling techniques in Dale Woreda, southern Ethiopia. A structured questionnaire and 24-hour recall methods were administered to determine the sociodemographic and dietary intake of participants. Stool microscopic examination was done. Weight and height were measured using a standard calibrated scale. Odds ratio generated from logistic regression was used to determine the strength of variables association. Results Older age group (10-14 vs. 7-9) (AOR = 3.4; 95% CI, 1.7-6.6) and having Trichuris Trichura infection (AOR = 3.9; 95% CI, 1.4 -11.6) increased the risk of being stunted. Children whose mothers have completed primary education are less likely to be stunted than children whose mothers do not have formal education (AOR = 0.3; 95% CI, 0.2-0.8). Having large family size (AOR = 3.3; 95% CI, 1.4-7.9) and inadequate intake of carbohydrate (AOR = 3.1; 95% CI, 1.4-6.8) were independent predictors of wasting. Children whose mothers completed primary education are less likely to be underweight (AOR = 0.3; 95% CI, 0.1-0.9). Children live in food insecure households are more likely to be stunted, under-weight and wasted than children live in food secure households (AOR = 2.5; 95%, 1-5.6; AOR = 3.9; 95% CI, 1.2-12.0; AOR = 4.8; 95% CI, 1.7-13.6;). Conclusion Household food insecurity, low maternal education and infection with Trichuris trichura were some of the major factors contributing to under-nutrition in the study area.

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Author and article information

Contributors

Lijalem Melie Tesfaw:

ORCID: http://orcid.org/0000-0003-2564-0509

lijalemmelie@gmail.com

Haile Mekonnen Fenta: hailemekonnen@gmail.com

Journal

Journal ID (nlm-ta): BMC Pediatr

Journal ID (iso-abbrev): BMC Pediatr

Title: BMC Pediatrics

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2431

Publication date (Electronic): 22 April 2021

Publication date PMC-release: 22 April 2021

Publication date Collection: 2021

Volume: 21

Electronic Location Identifier: 193

Affiliations

GRID grid.442845.b, ISNI 0000 0004 0439 5951, Department of Statistics, , Bahir Dar University, ; Bahir Dar, Ethiopia

Author information

Lijalem Melie Tesfaw http://orcid.org/0000-0003-2564-0509

Article

Publisher ID: 2657

DOI: 10.1186/s12887-021-02657-5

PMC ID: 8061068

PubMed ID: 33397296

SO-VID: 54f6b19a-8221-4979-9392-ca63c5cbaa2a

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 7 March 2021

Date accepted : 8 April 2021

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ScienceOpen disciplines: Pediatrics

Keywords: anthropometric indicators,multivariate logistic regression model,nigeria,under-five children

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ScienceOpen disciplines: Pediatrics

Keywords: anthropometric indicators, multivariate logistic regression model, nigeria, under-five children

Multivariate logistic regression analysis on the association between anthropometric indicators of under-five children in Nigeria: NDHS 2018

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Conclusion

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Chinese Journal of School Health

Most cited references 18

Wasting and stunting--similarities and differences: policy and programmatic implications.

Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey

Determinants of underweight, stunting and wasting among schoolchildren

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