title: Individual, household, and community level risk factors of stunting in children younger than 5 years: Findings from a national surveillance system in Nepal.
abstract: Despite substantial reductions in recent years in Nepal, stunting prevalence in children younger than 5 years remains high and represents a leading public health concern. To identify factors contributing to the stunting burden, we report multilevel risk factors associated with stunting in 4,853 children aged 6-59 months in a nationally and agroecologically representative random sample from the first year of the Policy and Science for Health, Agriculture, and Nutrition Community Studies, a community-based observational, mixed-panel study. Mixed effects logistic regressions controlling for multilevel clustering in the study design were used to examine the association of individual-, household-, and community-level factors associated with stunting. Stunting prevalence was 38% in our sample. After adjustment for potential confounding variables, maternal factors, including maternal height and education, were generally the strongest individual-level risk factors for stunting, adjusted odds ratio (AOR) = 2.52, 95% CI [1.96, 3.25], short (<145 cm) versus not short mothers; AOR = 2.09, 95% CI [1.48, 2.96], uneducated mothers versus secondary school graduates. Among the household- and community-level factors, household expenditure and community infrastructure (presence of paved roads, markets, or hospitals) were strongly, inversely associated with increased stunting risk, AOR = 1.68, 95% CI [1.27, 2.24], lowest versus highest household expenditure quintile; AOR = 2.38, 95% CI [1.36, 4.14], less developed (lacking paved roads, markets, or hospitals) versus more developed communities. Although most factors associated with stunting are not rapidly modifiable, areas for future research and possible interventions emerged.
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Dorsey
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Swetha
authors.initials: S
authors.lastname: Manohar
authors.affiliation: PoSHAN Study Team, Johns Hopkins University, Kathmandu, Nepal.
authors.forename: Sumanta
authors.initials: S
authors.lastname: Neupane
authors.affiliation: PoSHAN Study Team, Johns Hopkins University, Kathmandu, Nepal.
authors.forename: Binod
authors.initials: B
authors.lastname: Shrestha
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.|Helen Keller International, New York, New York, USA.
authors.forename: Rolf D W
authors.initials: RDW
authors.lastname: Klemm
authors.affiliation: Center for Human Nutrition, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA.
authors.forename: Keith P
authors.initials: KP
authors.lastname: West
mesh_terms: D001827:Body Height; D002675:Child, Preschool; D018672:Community Health Planning; D015930:Diet Records; D004522:Educational Status; D005191:Family Characteristics; D005260:Female; D005523:Food Supply; D006130:Growth Disorders / Q000453:epidemiology*; D006306:Health Surveys; D006801:Humans; D007182:Income; D007223:Infant; D008297:Male; D009035:Mothers; D009390:Nepal / Q000453:epidemiology; D016017:Odds Ratio; D011203:Poverty; D012307:Risk Factors; D012424:Rural Population; D012959:Socioeconomic Factors
keywords: Nepal; children; multilevel; risk factors; stunting; younger than 5 years