Childhood stunting and wasting in Myanmar: Key drivers and implications for policies and programmes

Abstract

Child undernutrition is a public health and development problem in Myanmar that is jeopardizing children's physical and cognitive development and the country's social and economic progress. We identified key drivers of child stunting (low height‐for‐age) and wasting (low weight‐for‐height) in a nationally representative sample ( n = 3,981) of children 0–59 months of age. The national prevalence of child stunting and wasting was 28% and 7%, respectively. Boys were more likely to be stunted or wasted than girls. Older children 24–35 months were at the highest risk of stunting compared with children under 6 months (risk ratios [RR] 10.34; 95% CI [6.42, 16.65]) whereas the youngest, under 6 months, were at the highest risk of wasting compared with children 36–59 months (RR 2.04; 95% CI [1.16, 3.57]). Maternal height <145 cm (RR 5.10; 95% CI [3.15, 8.23]), perceived small child size at birth (RR 2.08; 95% CI [1.62, 2.69]), and not benefiting from institutional delivery (RR 1.52; 95% CI [1.24, 1.87]) were associated with an increased risk of child stunting, as were maternal occupation, unimproved household drinking water, living in delta, coastal or upland areas, and poorer household wealth index quintile. Increased risk of child wasting was associated with maternal underweight (RR 1.64; 95% CI [1.11, 2.42]) and open defecation (RR 1.91; 95% CI [1.25, 2.92]) as well as maternal occupation and residence in a coastal area. Our findings indicate that the key drivers of child undernutrition in Myanmar are multifaceted and start in utero. Investing in scaling‐up multisectoral approaches that include nutrition‐specific and nutrition‐sensitive interventions with a focus on improving maternal nutrition is essential for reducing child undernutrition and contributing to further gains in the country's human and economic development.

Triple trouble: Understanding the burden of child undernutrition, micronutrient deficiencies, and overweight in East Asia and the Pacific

“…Although body mass index is not commonly measured throughout pregnancy in the region, in Myanmar, prevalence of maternal underweight after pregnancy was associated with 1.6 times higher risk of child wasting compared with mothers with normal nutrition status (Blankenship, Cashin, et al, 2020). Blankenship, Cashin, et al (2020) found that the mother's perceived size of the child as smaller than normal at birth was associated with 2.1 times higher risk of stunting compared with children perceived by the mother to be of normal size. The necessity of multisectoral actions to address poor nutrition practices is explored by Li, Nguyen, Wang, Mathisen, and Fang (2020) in an examination of the individual, family, community, and health facility factors associated with inadequate breastfeeding practices in China.…”

“…Poverty is likely to be significantly exacerbated by the COVID-19 pandemic particularly among vulnerable households. In this issue, nationally representative data was examined in Myanmar (Blankenship, Cashin, et al, 2020), the Marshall Islands , and Thailand (Okubo, Janmohamed, Topothai, & Blankenship, 2020)…”

“…Despite having the highest prevalence of adult overweight in the world, little is known about MCDB in the Pacific Island countries. In this issue, Blankenship, Cashin, Nguyen, and Ip (2020) found that in the Marshall Islands, a staggering 25% of households with a child under 5 years of age included a stunted child and an overweight or obese mother.…”

“…Poverty is likely to be significantly exacerbated by the COVID‐19 pandemic particularly among vulnerable households. In this issue, nationally representative data was examined in Myanmar (Blankenship, Cashin, et al, 2020), the Marshall Islands (Blankenship, et al, 2020), and Thailand (Okubo, Janmohamed, Topothai, & Blankenship, 2020) to identify the key drivers of child malnutrition. Despite varying degrees of economic status and progression along the nutrition transition, in all three countries, the poorest households had the highest risk of child stunting, with the poorest households also having highest risk of wasting in Thailand.…”

“…In this issue, research from Cambodia, the Marshall Islands, and Myanmar confirm global evidence that maternal short stature is a leading determinant of child stunting. Increased risk of child stunting with maternal height under 160 cm was found in both Myanmar(Blankenship, Cashin, et al, 2020) and the Marshall Islands (Blankenship et al, 2020), whereas Karpati, de Neubourg, Laillou, and Poirot (2020) confirmed a strong association between maternal height (<145 cm) and child stunting in Cambodia. Shorter maternal height was also the leading predictor of MCDB in the Marshall Islands.…”