Nutritional status and its concomitant factors among pre-school children in Malda, India: A micro-level study using a multilevel approach

Abstract

BackgroundMalnutrition was the main cause of death among children below five years in every Indian state in 2017. Despite several flagship programmes and schemes implemented by the Indian Government, the latest edition of the Global Nutrition Report 2018 addressed that India tops in the number of stunted children, that is a matter of concern. Thus, a micro-level study was designed to know the level of nutritional status and to study this by various disaggregate levels, as well as to examine the risk factors of stunting among pre-school children aged 36-59 months in Malda. MethodA primary quantitative survey was conducted using structured questionnaires following a multi-stage, stratified simple random sampling procedure. A sum of 731 samples collected. Anthropometric measures of children were collected following the WHO child growth standard. Children were classified as stunted, wasted and underweight if their HAZ, WHZ and WAZ scores, respectively were less than −2SD. Univariate descriptive statistics have been carried out to describe the sample characteristics and random intercept multilevel logistic regression model has been employed to estimate the effects of possible risk factors on childhood stunting. ResultsThe prevalence of stunting in the study area is 40 per cent among children aged 36-59 months which is very high prevalence as per the WHO’s cut-off values (≥40 per cent) for public health significance. Results of the multilevel analysis revealed that preceding birth interval, low birth weight, duration of breastfeeding, mother’s age at birth, mother’s education and occupation are the associated risk factors of stunting. Among them, low birth weight (OR 2.22, 95%CI: 1.44-3.41) and bidi worker as mothers’ occupation (OR 1.92, 95%CI: 1.18-3.12) are the most influencing factors of stunting. Further, about 14 per cent and 86 per cent variation in stunting lies at community and child/household level respectively.ConclusionSpecial attention needs to be placed for the modifiable risk factors of childhood stunting. Policy interventions should direct community health workers to encourage women as well as their male partner to increase birth interval using various family planning practices, provide extra care for low birth weight baby that can help to reduce childhood stunting.