Analyses of national and local data to determine associations in separate child and adult samples: Examining predictors of stunting among 24 to 59 month old children in Bangladesh and interrogating associations of weight history and attempts to lose/manage weight in West Texas, USA
Rana, Ziaul H
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Background: Stunting is a major public health problem in Bangladesh. The persistent prevalence of stunting in Bangladesh remains virtually unchanged, and the rate of reduction is even lower than in the past. Most notably, the prevalence of stunting is higher among 24 to 59 months of children. Stunting is an indication of the serious, irreversible physical and intellectual impairment caused by chronic malnutrition early in a child’s life, and it persists into later adulthood when not addressed during the initial years of life. Stunting relies on complex interactions of various nutritional and non-nutritional factors, and previous and ongoing policies and programs in Bangladesh were not fruitful enough to increase the pace of stunting reduction. Therefore, the purpose of this study was to critically analyze the factors of stunting among 24 to 59 months of children in Bangladesh. Methods: This study used the national nutrition survey data from the Nutrition, Health and Demographic Survey of Bangladesh (NHDSBD-2013), which is the first nationally representative child health survey ever undertaken in Bangladesh with the support of USDA. A total of 4182 children of 24 to 59 months were participated. Both nutritional and non-nutritional factors, such as socio-economic, child anthropometry, dietary intake, food security, child feeding practice, maternal nutritional knowledge and practice, domestic violence, and women empowerment are the selected independent variables of this study. To measure association, Kendall’s Tau correlation coefficient was used. Logistic regression was used to identify associations of predictors with outcome variables including stunting. Results: Stunting is the most prevalent form of undernutrition at 47%; 44% of the children were underweight and 28% were wasted. Stunted children had a lower intake in almost all the nutrients comparing non-stunted children. Among the households, 25.6% were suffering from food insecurity. Majority of the mothers had a high score for nutritional knowledge, and practices, cooking and cleanliness knowledge, but moderate score for cooking and cleanliness practices, and three-fourth mothers had a high scores for child feeding practices. Nearly 40% of the mothers reported the existence of intimate partner violence. Maternal nutritional knowledge and practice had a strong and significant correlation with their child feeding practices, and parent’s education and the household income were positively and significantly associated with these maternal knowledge and practices. The education of parents and household food security condition were the major determinants of domestic violence. For women empowerment, mother income generation, food security, and presence of domestic violence were the most important determinants. Parent’s education level, income generation by mothers, household floor type, child feeding practices, household food security condition, and maternal domestic violence situation were the major predictors of stunting. Conclusions: The prevalence of stunting is still high in Bangladesh, and children of 2 to 5 years are the most vulnerable. Household food security, maternal nutritional knowledge and practice, child feeding are practices are still in poor condition. Domestic violence and women empowerment have contributory factor on overall life standard and nutrition. Household food security, child feeding practice, parent’s education, household domestic violence are the predominant determinants of these child chronic malnutrition.