Determinants of childhood stunting in the Democratic Republic of Congo: further analysis of Demographic and Health Survey 2013–14

Abstract

BackgroundPrevalence of child stunting in the Democratic Republic of Congo (DRC) is among the highest in the world. There is a need to systematically investigate how stunting operates at different levels of determination and identify major factors contributing to the development of stunting. The aim of this study was to look for key determinants of stunting in the DRC.MethodsThis study used data from the DRC Demographic Health Survey 2013–14 which included anthropometric measurement for 9030 under 5 year children. Height-for-Age Z score was calculated and classified according to the WHO guideline. The association between stunting and bio-demographic characteristics was assessed using logistic regression.ResultsPrevalence of stunting was much higher in boys than girls. There was a significant rural urban gap in the prevalence of stunting with rural areas having a larger proportion of children living with stunting than urban.Male children, older than 6 months, preceding birth interval less than 24 months, being from lower wealth quintiles had the highest odds of stunting. Several provinces had in particular high odds of stunting. Early initiation of breastfeeding, mother’s age more than 20 years at the time of delivery had lower odds of stunting. The taller the mother the less likely the child was to be stunted. Similarly, mother’s BMI, access to safe water, access to hygienic toilet, mother’s education were found negatively correlated with child stunting in the bivariate logistic regression, but they lost statistical significance in multivariate analysis together with numbers of children in the family and place of residence.ConclusionsChild stunting is widespread in the DRC and increasing prevalence is worrisome. This study has identified modifiable factors determining high prevalence of stunting in the DRC. Policy implementation should in particular target provinces with high prevalence of stunting and address modifiable determinants such as reducing socioeconomic disparity. Nutrition promotion intervention, including early initiation of breastfeeding should be an immediate priority.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-017-4621-0) contains supplementary material, which is available to authorized users.

Inequality of childhood undernutrition in Bangladesh: A decomposition approach

“…This indicates that over the years, decline in the prevalence of malnutrition has been more pronounced among the richest economic groups rather than the poor. Children from the poorest households were more exposed to undernutrition, and the odds of undernutrition declined consistently as the wealth index increased . Such a scenario is very common in the South Asian regions .…”

“…Apart from the improved health care system in urban areas, better housing arrangements, improved water and sanitation facility, and transportation facilities are more prevalent in urban areas. These factors are linked with higher health care utilization and better health outcomes . Furthermore, higher socioeconomic status ensures better living conditions, which may contribute to better child care and improved feeding practices, which lead to a decline in the prevalence of different forms of malnutrition…”

“…These factors are linked with higher health care utilization and better health outcomes. [40][41][42][43] Furthermore, higher socioeconomic status ensures better living conditions, which may contribute to better child care and improved feeding practices, which lead to a decline in the prevalence of different forms of malnutrition. 8 According to the concentration curve and index analyses, improvements in nutritional indicators (stunting, wasting, and underweight) were found to be more concentrated among the rich communities.…”

“…Children from the poorest households were more exposed to undernutrition, and the odds of undernutrition declined consistently as the wealth index increased. [40][41][42][43] Such a scenario is very common in the South Asian regions. 13 Our findings are supported by previous studies that have shown the reduction of malnutrition was not guaranteed to improve equity in Bangladesh.…”

Determinants of under-nutrition among children under five years of age in Ethiopia

“…The selection of explanatory variables are theoretically driven that draw support from prior research with regard to factors affecting children's nutritional status. Previous studies are referenced in creating categories for naturally continuous and discrete variables [22][23][24][25][26] ( Table 2).…”