Why under five children are stunted in Pakistan? A multilevel analysis of Punjab Multiple indicator Cluster Survey (MICS-2014)

Abstract

Background: Pakistan is facing a serious problem of child under-nutrition as about 38% of children in Pakistan are stunted. Punjab, the largest province by population and contributes high gross domestic product (GDP) share in economy has reported 27% moderately and 10% severely stunted children of less than 5 years. Thus, this study aims at examining the determinants of stunting (moderate and severe) at different level of hierarchy empirically in Punjab province of Pakistan. Methodology: Data for this study is coming from Punjab Multiple Indicators Cluster Survey (MICS-2014), used twostage, stratified cluster sampling approach. Sub-national level data covering urban and rural areas were used for this study consists of 25,067 children less than 5 year's ages, from nine administrative divisions and 36 districts of Punjab province of Pakistan. Descriptive statistics and multilevel hierarchical models were estimated. Multilevel data analyses have an advantage because it provides robust standard error estimates and helps in finding variation in the data at various levels. Results: Punjab has a stunting prevalence of about 27% moderately and 10% severely stunted children of less than 5 years. The results depict that increasing the age of the child, increasing birth order, illiterate mothers and fathers, lack of sanitation facilities and being poor are associated significantly with the likelihood of moderate and severe stunting. Surprisingly, there is a gender bias in stunting in Punjab, Pakistan and being a girl child is more likely associated with moderate and severe stunting, which shows the patriarchal nature of the society and a substantial prevalence of gender bias in household resource allocations. Conclusion: This outcome of our analysis points towards targeting not only households (focus on girls) but also their families and communities.

Relationship between Environment, Smoking Behavior, Education, Poverty, and Prevalence of Stunted Toddler in Indonesia: An Ecological Analysis

“…The information from this analysis is in line with previous research in South Africa and Pakistan (Mahmood et al, 2020;Mkhize and Sibanda, 2020). Lack of sanitation facilities is also informed as a determinant of the stunted toddler (Mahmood et al, 2020).…”

“…The information from this analysis is in line with previous research in South Africa and Pakistan (Mahmood et al, 2020;Mkhize and Sibanda, 2020). Lack of sanitation facilities is also informed as a determinant of the stunted toddler (Mahmood et al, 2020). Not only applies to toddlers, but improper sanitation is also reported to be one of the factors affecting the nutritional status of adolescent girls in Eastern India (Chattopadhyay et al, 2019).…”

Impact of children born with low birth weight on stunting and wasting in Sindh province of Pakistan: a propensity score matching approach

“…Data from demographic and health survey and Multi-indicator Cluster Surveys datasets from 84 countries findings are consistent with our analysis and shows the prevalence for being wasted, stunted, and concurrently wasted and stunted among children less than five years 4 . Similar survey findings revealed that child age, birth order, education of parents, poor sanitation facilities and poverty are associated significantly with the likelihood of moderate and severe stunting in one of the province of Pakistan 6 , 33 . Study supported our findings that the families with choice of male babies could results malnourished and underweight babies in their families 34 .…”

“…Furthermore, it has been reported about 6 million children were stunted and wasted 4 . LBW is highly prevalent in particularly south Asian countries like, India, Pakistan and Bangladesh 2 , 5 , 6 .…”

Relationship between Environment, Smoking Behavior, Education, Poverty, and Prevalence of Stunted Toddler in Indonesia: An Ecological Analysis

“…The information from this analysis is in line with previous research in South Africa and Pakistan (Mahmood et al, 2020; Mkhize and Sibanda, 2020). Lack of sanitation facilities is also informed as a determinant of the stunted toddler (Mahmood et al, 2020). Not only applies to toddlers, but improper sanitation is also reported to be one of the factors affecting the nutritional status of adolescent girls in Eastern India (Chattopadhyay et al, 2019).…”