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      Factors associated with stunting among children below five years of age in Zambia: evidence from the 2014 Zambia demographic and health survey

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          Abstract

          Background

          Stunting continues to be a major public health problem globally. Stunting is a manifestation of many factors including inadequate food intake and poor health conditions. However, poor quality nutritional diets during pregnancy, infancy and early childhood lead to inadequate nutrient intake. The prevalence of stunting in Zambia has been over 40% and remains unacceptably high. There is limited information on factors associated with stunting in Zambia. Thus to better understand factors contributing to the high stunting levels, the 2013/14 Zambia Demographic and Health Survey (ZDHS) data was analysed.

          Methods

          Data was extracted using a data extraction tool and analysed using Stata version 13. Sample data of 12, 328 children aged 0–59 months was analysed. The analysis involved simple and multiple logistic regression to find associations between independent variables and stunting.

          Results

          The prevalence of stunting among under five children in Zambia is 40%. From the 4937 children who were stunted, stunting was higher among male children as compared to female children (42.4 and 37.6% respectively). Additional analysis revealed that children whose source of drinking water was improved (33.7%) were less likely to be stunted compared to children whose source of drinking water was poor (47.7%). Stunting was associated with sex and age of a child; mother’s age and education; residence; wealth and duration of breastfeeding. For instance, children whose mothers had higher education showed a 75% reduction of odds compared to children whose mothers had no education (AOR = 0.35, 95%CI: 0.22, 0.54; p < 0.05). Similarly, wealth status showed an inverse relationship. Children who came from rich households showed a 32% reduction of odds compared to children who came from poor households (AOR = 0.68, 95%CI: 0.57, 0.82; p < 0.05).

          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; mother’s age and level of education; wealth status; improved source of drinking water; duration of breastfeeding and residence. Therefore, multiple measures targeted at reducing child stunting should be taken in a bid to influence policy and conceiving of programmes.

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          Most cited references21

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          Long-term consequences of stunting in early life.

          This review summarizes the impact of stunting, highlights recent research findings, discusses policy and programme implications and identifies research priorities. There is growing evidence of the connections between slow growth in height early in life and impaired health and educational and economic performance later in life. Recent research findings, including follow-up of an intervention trial in Guatemala, indicate that stunting can have long-term effects on cognitive development, school achievement, economic productivity in adulthood and maternal reproductive outcomes. This evidence has contributed to the growing scientific consensus that tackling childhood stunting is a high priority for reducing the global burden of disease and for fostering economic development. Follow-up of randomized intervention trials is needed in other regions to add to the findings of the Guatemala trial. Further research is also needed to: understand the pathways by which prevention of stunting can have long-term effects; identify the pathways through which the non-genetic transmission of nutritional effects is mediated in future generations; and determine the impact of interventions focused on linear growth in early life on chronic disease risk in adulthood. © 2011 Blackwell Publishing Ltd.
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            Boys are more stunted than girls in Sub-Saharan Africa: a meta-analysis of 16 demographic and health surveys

            Background Many studies in sub-Saharan Africa have occasionally reported a higher prevalence of stunting in male children compared to female children. This study examined whether there are systematic sex differences in stunting rates in children under-five years of age, and how the sex differences in stunting rates vary with household socio-economic status. Methods Data from the most recent 16 demographic and health surveys (DHS) in 10 sub-Saharan countries were analysed. Two separate variables for household socio-economic status (SES) were created for each country based on asset ownership and mothers' education. Quintiles of SES were constructed using principal component analysis. Sex differentials with stunting were assessed using Student's t-test, chi square test and binary logistic regressions. Results The prevalence and the mean z-scores of stunting were consistently lower amongst females than amongst males in all studies, with differences statistically significant in 11 and 12, respectively, out of the 16 studies. The pooled estimates for mean z-scores were -1.59 for boys and -1.46 for girls with the difference statistically significant (p < 0.001). The stunting prevalence was also higher in boys (40%) than in girls (36%) in pooled data analysis; crude odds ratio 1.16 (95% CI 1.12–1.20); child age and individual survey adjusted odds ratio 1.18 (95% CI 1.14–1.22). Male children in households of the poorest 40% were more likely to be stunted compared to females in the same group, but the pattern was not consistent in all studies, and evaluation of the SES/sex interaction term in relation to stunting was not significant for the surveys. Conclusion In sub-Saharan Africa, male children under five years of age are more likely to become stunted than females, which might suggest that boys are more vulnerable to health inequalities than their female counterparts in the same age groups. In several of the surveys, sex differences in stunting were more pronounced in the lowest SES groups.
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              Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007.

              To assess trends in the prevalence and social distribution of child stunting in Brazil to evaluate the effect of income and basic service redistribution policies implemented in that country in the recent past. The prevalence of stunting (height-for-age z score below -2 using the Child Growth Standards of the World Health Organization) among children aged less than 5 years was estimated from data collected during national household surveys carried out in Brazil in 1974-75 (n = 34,409), 1989 (n = 7374), 1996 (n = 4149) and 2006-07 (n = 4414). Absolute and relative socioeconomic inequality in stunting was measured by means of the slope index and the concentration index of inequality, respectively. Over a 33-year period, we documented a steady decline in the national prevalence of stunting from 37.1% to 7.1%. Prevalence dropped from 59.0% to 11.2% in the poorest quintile and from 12.1% to 3.3% among the wealthiest quintile. The decline was particularly steep in the last 10 years of the period (1996 to 2007), when the gaps between poor and wealthy families with children under 5 were also reduced in terms of purchasing power; access to education, health care and water and sanitation services; and reproductive health indicators. In Brazil, socioeconomic development coupled with equity-oriented public policies have been accompanied by marked improvements in living conditions and a substantial decline in child undernutrition, as well as a reduction of the gap in nutritional status between children in the highest and lowest socioeconomic quintiles. Future studies will show whether these gains will be maintained under the current global economic crisis.
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                Author and article information

                Contributors
                bubilemzumara@yahoo.com
                pabwembya@gmail.com
                hikabasa@yahoo.com
                rhmgode@yahoo.com
                jbanda6053@gmail.com
                Journal
                BMC Nutr
                BMC Nutr
                BMC nutrition
                BioMed Central (London )
                2055-0928
                20 December 2018
                20 December 2018
                2018
                : 4
                : 51
                Affiliations
                [1 ]ISNI 0000 0000 8914 5257, GRID grid.12984.36, University of Zambia School of Public Health, Nationalist Road, U. T. H, P.O. Box 50110, ; Lusaka, Zambia
                [2 ]ISNI 0000 0000 8914 5257, GRID grid.12984.36, University of Zambia, School of Public Health, Nationalist Road, U .T. H, ; P.O. Box 50110, Lusaka, Zambia
                [3 ]National Food and Nutrition Commission, Plot#5112 Lumumba Road, P. O Box 32669, Lusaka, Zambia
                Author information
                http://orcid.org/0000-0001-6066-0674
                Article
                260
                10.1186/s40795-018-0260-9
                7050779
                32153912
                d325de3a-243a-43a9-9699-d13de65bc2da
                © The Author(s). 2018

                Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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.

                History
                : 15 January 2018
                : 5 December 2018
                Categories
                Research Article
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                © The Author(s) 2018

                stunting,zambia demographic and health survey,socio-demographic factors,children

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