Risk factors of stunting during the complementary feeding period 6-23 months in the Philippines

Abstract

Introduction: Stunting persists as a public health problem in the Philippines, affecting 30% of under-five children. This study aimed to identify the drivers of stunting in young Filipino children aged 6-23 months. Methods: Data were extracted from the cross-sectional Updating Survey conducted in 2015 by the Food and Nutrition Research Institute of the Department of Science and Technology (FNRI-DOST). Potential predictors of stunting, which were categorised into childrelated characteristics, feeding practices, maternal socio-demographic status and health practices, and household economic and food security status, were examined using descriptive and regression analyses. Results: Of the 2,275 children aged 6-23 months, 18.7% were stunted and 8.3% were severely stunted. The risk of stunting increased significantly among older children aged 12-23 months (relative risk ratio, RRR 3.04), males within 6-23 months of age (RRR 1.99), and low-birth-weight infants (RRR 2.19). Children born from teenage mothers (RRR 1.90), mothers with short stature (RRR 2.33), and mothers with low education (RRR 1.59) posed higher risks of becoming stunted relative to their counterparts. Mothers with >4 children (RRR 2.44), coming from the poorest households (RRR 4.27), having untimely introduction of complementary foods (RRR 4.44), and not meeting the minimum meal frequency (RRR 2.30) increased the risks of severe stunting. Conclusion: The study illustrated the multi-factorial nature of stunting among Filipino children aged 6-23 months old. Therefore, a multi-sectoral approach is needed to address the underlying factors of stunting among young Filipino children to help achieve the country’s nutrition targets by 2025.

Adherence to age-appropriate feeding practices among Filipino children under two: An analysis of the 2018- 2019 Expanded National Nutrition Survey

“…The findings of a metaanalysis conducted in Bangladesh (Islam et al, 2020) reported that initiation of complementary feeding at or after seven months of age increased the risk of stunting by 1.23 times. This is also consistent with findings in the Philippines where untimely introduction of complementary foods (either too early or too late) increased the child's odds of being stunted by almost twice and of being severely stunted by more than four times (Guirindola, et al, 2021).…”

Stunting predictors among children aged 0-24 months in Southeast Asia: a scoping review

“…Based on the reported measures of effect, age of child (at 12-23 months or annually) ( 27 , 33 ) , maternal education (≤9 years or only primary or secondary) ( 16 , 34 ) , low birth weight ( 27 ) , and short maternal stature (<151 cm) ( 27 , 34 ) are the predictors with the largest relative ratio, which increases the risk of stunting in Southeast Asian countries by up to two times. Then, regarding the odds of stunting in children aged 0-24 months, the odds increase up to five times in children who are male (at six months; aOR 9.20, at 12 months; aOR 5.66) ( 37 ) , have low birth weight (<2500 gr) ( 37 ) , are born prematurely (aOR 5.10) ( 17 ) , have short parental height (mother <145 cm and father <161.9 cm; aOR 5.93) ( 14 ) , have unemployed mothers (aOR 8.40) ( 15 ) or whose mother work as farmer/breeder (aOR 11.74) ( 15 ) .…”

“…Gender, age, and birth weight of the child are predictors with the most supporting studies. However, specifically the age and gender of the child, due to their nature, this predictor which has also been shown to increase the risk of stunting up to three times (RR 3.04) and 99% (RR 1.99) respectively ( 27 ) , cannot be modified directly.…”

“…Even though there will be a decrease in the odds as the child gets older, in the sixth month of life, the odds of stunting are still 6.62 times ( 37 ) . Guirindola et al also explained that, based on the risk ratio, children with low birth weight were proven to have an increased risk of stunting by 2.19 times ( 27 ) . As with SGA, which also doubles the odds of stunting ( 29 ) , we think that the magnitude of all the odds and the risk of stunting is caused by the high vulnerability of children to contracting diseases and infections, as well as the immaturity of several children’s organs to be able to digest food properly.…”

“…These contextual predictors include wealth and socioeconomic status and sanitation and water supply. Even though it was explained that wealth and socioeconomic status increased the risk of stunting by 69% ( 27 ) , another study also showed that this predictor also had an indirect effect on the incidence of stunting by 28% ( 32 ) . Regarding the indirect effect, dietary diversity and breastfeeding are the two other predictors that have been shown to significantly mediate the effect ( 32 ) .…”