Determinants of stunting, underweight and wasting among children < 5 years of age: evidence from 2012-2013 Pakistan demographic and health survey.

backgroundChildhood malnutrition is a critical public health concern in Pakistan. We aimed to explore factors associated with malnutrition in Pakistani children (< 5 years of age) using the Pakistan Demographic and Health Survey (PDHS) 2012-2013.

methodsSample of 3071 Pakistani children aged 0-59 months from the PDHS 2012-2013, with complete anthropometric measurements were included in the study. Nutritional status was evaluated using anthropometric indices; height-for-age, weight-for-height and weight-for-age, as proxy measures of three forms of under-five malnutrition including stunting, wasting and underweight respectively. Uni- and multivariate binary logistic regressions were used to examine the association between selected maternal-socio-demographic and child level variables (such as child sex, age, size at birth, antenatal clinic visits, recent diarrheal incidence and breastfeeding status) and three proxy measures of child nutritional status.

resultsAbout 44.4% of under-five children were stunted, 29.4% were underweight and 10.7% were wasted. Children whose mothers lived in rural areas (aOR = 0.67, 95%CI 0.48-0.92), were aged ≥18 years at marriage (aOR = 0.76, 95%CI 0.59-0.99) and had visited antenatal clinic more than 3 times during pregnancy (aOR = 0.61, 95%CI 0.38-0.98) were less likely to be stunted. Mother's low educational level (aOR = 2.55, 95%CI 1.26-5.17), short stature (aOR = 2.31, 95%CI 1.34-3.98), child's small size at birth (aOR = 1.67, 95%CI 1.14-2.45) and mother's BMI were significantly associated with child's underweight status. Children whose mothers had no education were more likely to be wasted (aOR = 3.61, 95%CI 1.33-9.82).

conclusionThe study suggests that most of the analysed factors that accounted for malnutrition in Pakistani children (such as mother's age at marriage, educational level and mothers' nutritional status) are preventable. Therefore, to reduce the burden of malnutrition interventions that can address these factors are required such as community based education and targeted nutritional interventions.