Why under five children are stunted in Pakistan? A multilevel analysis of Punjab Multiple indicator Cluster Survey
Tahir Mahmood1,2, Faisal Abbas3, Ramesh Kumar4,5
1Department of Economics, University of Chitral, Chitral, Pakistan.
Insights
Child stunting in Pakistan is high, with 27% moderate and 10% severe cases in Punjab. Factors like poverty, illiteracy, poor sanitation, and being a girl child increase stunting risk, requiring targeted interventions.
Area of Science:
- Public Health
- Pediatrics
- Socioeconomics
Background:
- Child under-nutrition is a significant issue in Pakistan, with 38% of children stunted.
- Punjab province reports 27% moderate and 10% severe stunting in children under five.
- This study investigates the hierarchical determinants of child stunting in Punjab.
Purpose of the Study:
- To empirically examine the factors contributing to moderate and severe child stunting.
- To analyze determinants at various hierarchical levels within the Punjab province.
- To identify key risk factors for child stunting in a large population.
Main Methods:
- Utilized data from the Punjab Multiple Indicators Cluster Survey (MICS-2014).
- Employed a two-stage, stratified cluster sampling approach covering urban and rural areas.
- Applied descriptive statistics and multilevel hierarchical models to analyze data from 25,067 children.
Main Results:
- Confirmed high stunting rates in Punjab: 27% moderate and 10% severe.
- Identified significant risk factors: increasing child age, birth order, parental illiteracy, poor sanitation, and poverty.
- Revealed a gender bias, with girls being more susceptible to stunting, indicating societal inequities.
Conclusions:
- Interventions should target households, with a specific focus on girls.
- Addressing societal factors like gender bias and improving household resources are crucial.
- Community-level interventions are necessary to combat child stunting effectively.
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 two-stage, 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.
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