title: Determinants of child stunting in the Royal Kingdom of Bhutan: an in-depth analysis of nationally representative data.
abstract: Stunting is associated with poor survival and development in children. Our analysis identifies the factors most significantly associated with child stunting in Bhutan using a nationally representative sample of 2085 children 0-23 months old. We find that 27.5% of children were stunted and almost half (42.6%) of the stunted children were severely stunted. Children's mean height-for-age z-score deteriorated significantly with age (from -0.23 in infants 0-5 months old to -1.60 in children 18-23 months old) and levels of severe stunting were significantly higher among boys. Multivariate regression analysis indicates that children from the Eastern/Western regions had a 64% higher odds of being stunted than children from the Central region (OR 1.64; 95% CI 1.29-2.07); similarly, children from the two lower wealth quintiles had 37% higher odds of being stunted than children from the two upper wealth quintiles (OR 1.37; 95% CI 1.00-1.87). Children whose mothers received three or fewer antenatal care visits during the last pregnancy had a 31% higher odds of being stunted (OR 1.31; 95% CI 1.01-1.69) while children whose mothers did not receive antenatal care from a doctor, nurse or midwife had a 51% higher odds of being stunted (OR 1.51; 95% CI 1.18-1.92). Recommended complementary feeding practices tended to be associated with lower odds of stunting, particularly in the first year of life. Specifically, children who were not fed complementary foods at 6-8 months had about threefold higher odds of being severely stunted than children who were fed complementary foods (OR 2.73; 95% CI 1.06-7.02).
authors.affiliation: United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal.
authors.forename: Victor M
authors.initials: VM
authors.lastname: Aguayo
authors.affiliation: United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal.
authors.forename: Nina
authors.initials: N
authors.lastname: Badgaiyan
authors.affiliation: United Nations Children's Fund (UNICEF), Regional Office for South Asia, Kathmandu, Nepal.
authors.forename: Kajali
authors.initials: K
authors.lastname: Paintal
mesh_terms: D000367:Age Factors; D001631:Bhutan / Q000453:epidemiology; D005260:Female; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D008297:Male; D009035:Mothers; D016017:Odds Ratio; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D012737:Sex Factors; D012959:Socioeconomic Factors
keywords: Bhutan; children; feeding; growth; height; stunting