Factors associated with stunting among children according to the level of food insecurity in the household: a cross-sectional study in a rural community of Southeastern Kenya.
BACKGROUND
Chronic malnutrition or stunting among children under 5 years old is affected by several household environmental factors, such as food insecurity, disease burden, and poverty. However, not all children experience stunting even in food insecure conditions. To seek a solution at the local level for preventing stunting, a cross-sectional study was conducted in southeastern Kenya, an area with a high level of food insecurity.


METHODS
The study was based on a cohort organized to monitor the anthropometric status of children. A structured questionnaire collected information on the following: demographic characteristics, household food security based on the Household Food Insecurity Access Scale (HFIAS), household socioeconomic status (SES), and child health status. The associations between stunting and potential predictors were examined by bivariate and multivariate stepwise logistic regression analyses. Furthermore, analyses stratified by level of food security were conducted to specify factors associated with child stunting in different food insecure groups.


RESULTS
Among 404 children, the prevalence of stunting was 23.3%. The percentage of households with severe food insecurity was 62.5%. In multivariative analysis, there was no statistically significant association with child stunting. However, further analyses conducted separately according to level of food security showed the following significant associations: in the severely food insecure households, feeding tea/porridge with milk (adjusted Odds Ratio [aOR]: 3.22; 95% Confidence Interval [95% CI]: 1.43-7.25); age 2 to 3 years compared with 0 to 5 months old (aOR: 4.04; 95% CI: 1.01-16.14); in households without severe food insecurity, animal rearing (aOR: 3.24; 95% CI: 1.04-10.07); SES with lowest status as reference (aOR range: from 0.13 to 0.22). The number of siblings younger than school age was not significantly associated, but was marginally associated in the latter household group (aOR: 2.81; 95% CI: 0.92-8.58).


CONCLUSIONS
Our results suggest that measures against childhood stunting should be optimized according to food security level observed in each community.
Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan. chisa.shinsugi@gmail.com.|Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. chisa.shinsugi@gmail.com.
Chisa
C
Shinsugi
Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan. masaki@nagasaki-u.ac.jp.|Liaison Center for International Education, Nagasaki University, Nagasaki, Japan. masaki@nagasaki-u.ac.jp.
Masaki
M
Matsumura
Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan. mhmdkarama@yahoo.com.|Centre for Public Health Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya. mhmdkarama@yahoo.com.
Mohamed
M
Karama
Department of Eco-epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. jtanaka@nagasaki-u.ac.jp.|Department of Nursing, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan. jtanaka@nagasaki-u.ac.jp.
Junichi
J
Tanaka
Nagasaki University Institute of Tropical Medicine (NUITM) - Kenya Medical Research Institute (KEMRI) Project, Nairobi, Kenya. jtasa06@gmail.com.
Mwatasa
M
Changoma
Graduate School of International Health Development, Nagasaki University, Nagasaki, Japan. skaneko@nagasaki-u.ac.jp.|Department of Eco-epidemiology, Institute of Tropical Medicine, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan. skaneko@nagasaki-u.ac.jp.
Satoshi
S
Kaneko
D000886:Anthropometry; D002648:Child; D015362:Child Nutrition Disorders / Q000453:epidemiology*; D002669:Child Welfare / Q000706:statistics & numerical data; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D005523:Food Supply / Q000706:statistics & numerical data*; D006130:Growth Disorders / Q000453:epidemiology*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D009752:Nutritional Status; D011203:Poverty; D015995:Prevalence; D012424:Rural Population / Q000706:statistics & numerical data*