Objective:
The study’s objective was to investigate multiple underlying social, economic, and agricultural determinants of stunting among under-five children in three distinct ecological areas in rural Myanmar.
Design:
Repeated cross-sectional surveys in three states of Myanmar.
Setting:
Rural households in Chin (mountainous), Magway (plains) and Ayeyarwady (delta).
Participants:
From two purposively selected adjacent townships in each state, we randomly selected 20 villages and, in each village, 30 households with under-five children. Households in the first survey in 2016 were revisited in late 2017 to capture seasonal variations.
Results:
Stunting increased from 40.4 % to 42.0 %, with the highest stunting prevalence in Chin state (62.4%). Univariate Poisson regression showed factors contributing to child stunting varied across the regions. Adjusted Poisson regression models showed that child’s age and short maternal stature (aRR=1.14 for Chin, aRR=1.89 for Magway and aRR=1.86 for Ayeyarwady) were consistently associated with child stunting across three areas. For Chin, village-level indicators such as crop consumption (aRR=1.18), crop diversity (aRR=0.82) and land ownership (aRR=0.89) were significantly associated with stunting. In Magway, the number of household members (aRR=1.92), wealth status (aRR=0.46), food security status (aRR=1.14), land ownership (aRR=0.85), and in Ayeyarwady, women’s decision-making (aRR=0.67) and indicators related to hygiene (aRR=1.13) and sanitation (aRR=1.45) were associated with stunting.
Conclusions:
Area-specific factors were associated with stunting. Maternal short stature and child age were consistent determinants of stunting. A multi-sectoral local approach, including improvements in transport, is needed to address the intergenerational malnutrition problem.