The importance of public health, poverty reduction programs and women’s empowerment in the reduction of child stunting in rural areas of Moramanga and Morondava, Madagascar

Abstract

BackgroundMalnutrition accounts for 45% of mortality in children under five years old, despite a global mobilization against chronic malnutrition. In Madagascar, the most recent data show that the prevalence of stunting in children under five years old is still around 47.4%. This study aimed to identify the determinants of stunting in children in rural areas of Moramanga and Morondava districts to target the main areas for intervention.MethodsA case-control study was conducted in children aged from 6 to 59.9 months, in 2014–2015. We measured the height and weight of mothers and children and collected data on child, mother and household characteristics. One stool specimen was collected from each child for intestinal parasite identification. We used a multivariate logistic regression model to identify the determinants of stunting using backwards stepwise methods.ResultsWe included 894 and 932 children in Moramanga and in Morondava respectively. Stunting was highly prevalent in both areas, being 52.8% and 40.0% for Moramanga and Morondava, respectively. Stunting was most associated with a specific age period (12mo to 35mo) in the two study sites. Infection with Trichuris trichiura (aOR: 2.4, 95% CI: 1.1–5.3) and those belonging to poorer households (aOR: 2.3, 95% CI: 1.6–3.4) were the major risk factors in Moramanga. In Morondava, children whose mother had activities outside the household (aOR: 1.7, 95% CI: 1.2–2.5) and those perceived to be small at birth (aOR: 1.6, 95% CI: 1.1–2.1) were more likely to be stunted, whereas adequate birth spacing (≥24months) appeared protective (aOR: 0.4, 95% CI: 0.3–0.7).ConclusionInterventions that could improve children’s growth in these two areas include poverty reduction, women’s empowerment, public health programmes focusing on WASH and increasing acceptability, and increased coverage and quality of child/maternal health services.

Dietary diversity of 6- to 59-month-old children in rural areas of Moramanga and Morondava districts, Madagascar

“…The children included in this study on feeding practices were those participating in a study on the determinants of chronic malnutrition [ 10 ], for which data collection took place from February to November 2014. The study was carried out in two rural areas, the Health and Demographic Surveillance Site (HDSS) of Moramanga and the Bemanonga Commune of the Morondava district.…”

Faktor Risiko Stunting pada anak di Negara Berkembang

“…Status Sosial Ekonomi Keluarga, hasil pendapatan keluarga merupakan salah satu indikator sosial ekonomi keluarga lebih baik sehingga keluarga dapat mencukupi dan memenuhi kebutuhan konsumsi gizi dalam keluarga, didukung hasil penelitian yang menyatakan bahwa pekerjaan dan pendapatan orang tua sebagai petani berisiko anak mengalami stunting 26 pendapatan keluarga yang rendah berisiko terhadap stunting 27 penelitian yang dilakukan di 3 propinsi di Indonesia yaitu Bali, Jawa Barat dan NTT faktor risiko stunting salah satunya adalah pendapatan ayah yang rendah 28 Hasil riset yang dilakukan di Kota Semarang menunjukkan bahwa tingkat social ekonomi keluarga yang rendah berisiko 11 kali mengalami stunting 29 , Hasil riset di Propinsi Maluku menunjukkan variabel pendapatan keluarga yang rendah menjadi faktor risiko stunting 30 penelitian yang dilakukan di India, Nepal, Ethiopia, dan Madagascar menyatakan bahwa faktor social ekonomi yang terkait dengan pendapatan dan kemiskinan berhubungan dengan stunting [31][32][33][34][35] ibu tidak bekerja juga berisiko 3,11 kali mengalami stunting .…”

“…Berdasarkan hasil penelitian di daerah miskin dan pedesaan bahwa penyakit infeksi menular seperti diare berisiko terhadap stunting 51 hasil penelitian di Ethiopia menunjukkan anak yang menderita diare berisiko 6,3 kali mengalami stunting 52 hasil penelitian Hywot Yisak et al bahwa anak yang mengalami diare berisiko 2,4 kali mengalami stunting 33 , penelitian Blessing et al menyatakan bahwa balita yang mengalami diare 2 minggu terakhir menjadi determinan terjadinya stunting 53 dan beberapa penelitian membuktikan bahwa penyakit infeksi menjadi faktor risiko terjadinya stunting. 24,33,52,54 Selanjutnya dapat di lihat beberapa perbedaan hasil penelitian tentang faktor risiko stunting di Indonesia dan negara berkembang lainnya di bawah ini Jika dilihat berdasarkan kerangka konsep WHO menunjukkan peninjauan yang menyeluruh terhadap artikel-artikel tentang determinan terjadinya stunting pada anak di Indonesia dan Negara berkembang lainya, dari hasil literature review yang kami lakukan diperoleh secara konsisten untuk variable tinngi badan ibu, kelahiran premature, BBLR, panjang badan lahir, pendidikan ibu yang rendah, penyakit infeksi, social ekonomi keluarga merupakan faktor risiko terjadinya stunting di Indonesia 55 , belakangan ini telah dilakukan penelitian cross sectional menunjukkan bahwa variable penyapihan ASI dini, tinggi badan ayah, konsumsi air minum yang tidak diolah, lingkungan kumuh berisiko terjadinya stunting 56 , sedangkan penelitian di Pulau Madura diperoleh bahwa pemberian makanan pendamping ASI terlalu dini berisiko mengalami stunting pada anak 57 .…”

What does women’s empowerment have to do with malnutrition in Sub-Saharan Africa? Evidence from demographic and health surveys from 30 countries

“…Estimation indicated about 165 million under 5 children are stunted while wasting accounted for 52 million [1,2]. Globally, 45% of child mortality is due to malnutrition [8,9]. In 2015, estimates put the number of child mortality due to malnutrition at 405700 [1,8].…”

“…Globally, 45% of child mortality is due to malnutrition [8,9]. In 2015, estimates put the number of child mortality due to malnutrition at 405700 [1,8]. Due to persisting malnutrition, the World Health Organisation called for worldwide action to stem down the tide of stunting among children by 40% by 2025 [8,9].…”