Spatial distribution of stunting and wasting in 6-59 months children in Nepal: analysis using a Bayesian
Richa Vatsa1, Umesh Ghimire2, Suman Sapkota3
1Central University of South Bihar, SH-7, Gaya Panchanpur Road, Karhara, Post. Fatehpur, Gaya, Bihar 824236, India.
Insights
Childhood stunting and wasting are major public health issues in Nepal. This study reveals significant geographic variations and household factors linked to these malnutrition forms, emphasizing targeted interventions.
Area of Science:
- Pediatrics
- Public Health
- Spatial Epidemiology
Background:
- Childhood stunting (chronic malnutrition) and wasting (acute malnutrition) represent a significant global health challenge.
- Combined malnutrition burdens disproportionately affect children under five, necessitating comprehensive epidemiological assessments.
- Understanding the interplay and spatial distribution of stunting and wasting is crucial for effective public health strategies.
Purpose of the Study:
- To estimate the joint prevalence of stunting and wasting in Nepalese children aged 6-59 months.
- To identify child-related and household factors associated with the co-occurrence of stunting and wasting.
- To analyze the spatial patterns and geographic variations of stunting and wasting across Nepal.
Main Methods:
- Utilized data from the 2016 Nepal Demographic and Health Survey.
- Employed a Bayesian distributional bivariate probit geoadditive model to analyze linear associations and spatial effects.
- Investigated factors including birth weight, maternal health, household wealth, sanitation, food security, and birth order.
Main Results:
- Low birth weight, recent fever, and higher birth order were linked to increased stunting risk.
- Wealthier households, improved sanitation, and maternal overweight status were associated with reduced stunting.
- Children in severely food-insecure households faced a higher risk of combined stunting and wasting, while poorer households showed a lower risk.
- Spatial analysis indicated higher stunting burdens in Lumbini and Karnali, and higher wasting prevalence in Madhesh and Province 1.
Conclusions:
- Immediate nutritional interventions are critical for low-income and food-insecure households to mitigate stunting and wasting.
- Sub-regional tailored nutrition interventions are essential to address the disproportionate geographic variations in childhood malnutrition.
- Reducing the burden of childhood malnutrition in Nepal requires integrated strategies focusing on both individual and geographic determinants.
Abstract:
The combined burden of stunting and wasting in children under five years is a serious public health concern. The present study aimed to estimate the joint burden of stunting and wasting among children aged 6-59 months and explore its spatial variation across Nepal. The 2016 Nepal Demographic and Health Survey data was used to study acute and chronic childhood malnutrition. A Bayesian distributional bivariate probit geoadditive model was designed to study the linear association and geographical variation of stunting and wasting among 6-59 months, children. Child-related factors such as low birth weight, fever in the last 2 weeks preceding the survey and fourth or greater birth order were associated with a higher likelihood of stunting. The likelihood of a child being stunted was significantly less in the wealthiest households, having improved toilet facilities, and if mothers were overweight. Children from severely food insecure households were significantly more likely, and children from poorer households were significantly less likely to suffer both acute and chronic malnutrition simultaneously. Results from spatial effect showed that children from Lumbini and Karnali had a higher burden of stunting, and the likelihood that achild would have been wasted was significantly higher in Madhesh and Province 1. Immediate nutritional efforts are vital in low-income and severely food insecure households to lessen the risk of stunting and wasting in under children. Disproportionate geographic variations in stunting and wasting warrant sub-regional-specific nutrition intervention to achieve nutrition targets and reduce the burden of childhood malnutrition across the country.
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