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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

      research-article
      1 , 2 , , 3 , 3
      BMC Public Health
      BioMed Central
      Malnutrition, Stunting, Wasting, Underweight, Children

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          Abstract

          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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          Most cited references59

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          Maternal and child undernutrition and overweight in low-income and middle-income countries

          The Lancet, 382(9890), 427-451
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            Global, regional, and national causes of child mortality in 2000-13, with projections to inform post-2015 priorities: an updated systematic analysis.

            Trend data for causes of child death are crucial to inform priorities for improving child survival by and beyond 2015. We report child mortality by cause estimates in 2000-13, and cause-specific mortality scenarios to 2030 and 2035. We estimated the distributions of causes of child mortality separately for neonates and children aged 1-59 months. To generate cause-specific mortality fractions, we included new vital registration and verbal autopsy data. We used vital registration data in countries with adequate registration systems. We applied vital registration-based multicause models for countries with low under-5 mortality but inadequate vital registration, and updated verbal autopsy-based multicause models for high mortality countries. We used updated numbers of child deaths to derive numbers of deaths by causes. We applied two scenarios to derive cause-specific mortality in 2030 and 2035. Of the 6·3 million children who died before age 5 years in 2013, 51·8% (3·257 million) died of infectious causes and 44% (2·761 million) died in the neonatal period. The three leading causes are preterm birth complications (0·965 million [15·4%, uncertainty range (UR) 9·8-24·5]; UR 0·615-1·537 million), pneumonia (0·935 million [14·9%, 13·0-16·8]; 0·817-1·057 million), and intrapartum-related complications (0·662 million [10·5%, 6·7-16·8]; 0·421-1·054 million). Reductions in pneumonia, diarrhoea, and measles collectively were responsible for half of the 3·6 million fewer deaths recorded in 2013 versus 2000. Causes with the slowest progress were congenital, preterm, neonatal sepsis, injury, and other causes. If present trends continue, 4·4 million children younger than 5 years will still die in 2030. Furthermore, sub-Saharan Africa will have 33% of the births and 60% of the deaths in 2030, compared with 25% and 50% in 2013, respectively. Our projection results provide concrete examples of how the distribution of child causes of deaths could look in 15-20 years to inform priority setting in the post-2015 era. More evidence is needed about shifts in timing, causes, and places of under-5 deaths to inform child survival agendas by and beyond 2015, to end preventable child deaths in a generation, and to count and account for every newborn and every child. Bill & Melinda Gates Foundation. Copyright © 2015 Elsevier Ltd. All rights reserved.
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              The World Health Organization Global Database on Child Growth and Malnutrition: methodology and applications.

              For decades nutritional surveys have been conducted using various definitions, indicators and reference populations to classify child malnutrition. The World Health Organization (WHO) Global Database on Child Growth and Malnutrition was initiated in 1986 with the objective to collect, standardize, and disseminate child anthropometric data using a standard format. The database includes population-based surveys that fulfil a set of criteria. Data are checked for validity and consistency and raw data sets are analysed following a standard procedure to obtain comparable results. Prevalences of wasting, stunting, under- and overweight in preschool children are presented using z-scores based on the National Center for Health Statistics (NCHS)/WHO international reference population. New surveys are included on a continuous basis and updates are published bimonthly on the database's web site. To date, the database contains child anthropometric information derived from 846 surveys. With 412 national surveys from 138 countries and 434 sub-national surveys from 155 countries, the database covers 99% and 64% of the under 5 year olds in developing and developed countries, respectively. This wealth of information enables international comparison of nutritional data, helps identifying populations in need, evaluating nutritional and other public health interventions, monitoring trends in child growth, and raising political awareness of nutritional problems. The 15 years experience of the database can be regarded as a success story of international collaboration in standardizing child growth data. We recommend this model for monitoring other nutritional health conditions that as yet lack comparable data.
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                Author and article information

                Contributors
                sadaf.khan@duhs.edu.pk
                sidra.zaheer@duhs.edu.pk
                nilofer.fatimi@duhs.edu.pk
                Journal
                BMC Public Health
                BMC Public Health
                BMC Public Health
                BioMed Central (London )
                1471-2458
                1 April 2019
                1 April 2019
                2019
                : 19
                : 358
                Affiliations
                [1 ]ISNI 0000 0000 9363 9292, GRID grid.412080.f, Department of Biochemistry, , Dow International Medical College, Dow University of Health Sciences, ; Karachi, Pakistan
                [2 ]ISNI 0000 0000 9363 9292, GRID grid.412080.f, Dow Research Institute of Biotechnology and Biomedical Sciences, , Dow University of Health Sciences, ; Karachi, Pakistan
                [3 ]ISNI 0000 0000 9363 9292, GRID grid.412080.f, School of Public Health, , Dow University of Health Sciences, ; Karachi, Pakistan
                Article
                6688
                10.1186/s12889-019-6688-2
                6444880
                30935382
                d90b27ce-dd28-48c2-838f-fe7a5f574920
                © The Author(s). 2019

                Open AccessThis 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
                : 22 October 2018
                : 20 March 2019
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health
                malnutrition,stunting,wasting,underweight,children
                Public health
                malnutrition, stunting, wasting, underweight, children

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