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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

      , 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 references 44

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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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            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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              The effects of malnutrition on child mortality in developing countries.

              Conventional methods of classifying causes of death suggest that about 70% of the deaths of children (aged 0-4 years) worldwide are due to diarrhoeal illness, acute respiratory infection, malaria, and immunizable diseases. The role of malnutrition in child mortality is not revealed by these conventional methods, despite the long-standing recognition of the synergism between malnutrition and infectious diseases. This paper describes a recently-developed epidemiological method to estimate the percentage of child deaths (aged 6-59 months) which could be attributed to the potentiating effects of malnutrition in infectious disease. The results from 53 developing countries with nationally representative data on child weight-for-age indicate that 56% of child deaths were attributable to malnutrition's potentiating effects, and 83% of these were attributable to mild-to-moderate as opposed to severe malnutrition. For individual countries, malnutrition's total potentiating effects on mortality ranged from 13% to 66%, with at least three-quarters of this arising from mild-to-moderate malnutrition in each case. These results show that malnutrition has a far more powerful impact on child mortality than is generally appreciated, and suggest that strategies involving only the screening and treatment of the severely malnourished will do little to address this impact. The methodology provided in this paper makes it possible to estimate the effects of malnutrition on child mortality in any population for which prevalence data exist.
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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
                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
                © 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.

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                Research Article
                Custom metadata
                © The Author(s) 2019

                Public health

                malnutrition, stunting, wasting, underweight, children

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