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Published on: February 2, 2017
A structural equation modeling approach to examine determinants of nutritional status in Palestinian children 6-59
Ghada Issa1, Radwan Qasrawi1,2, Suliman Thwib1
1Department of Computer Sciences, Al Quds University, Jerusalem, Palestine.
Insights
Child growth in Palestine is significantly impacted by macronutrient intake, socioeconomic status, and neonatal health. Interventions should address dietary quality and broader social factors for better nutritional outcomes.
Area of Science:
- Public Health
- Nutrition Science
- Developmental Pediatrics
Background:
- Child undernutrition is a major public health issue in Palestine.
- Socioeconomic and dietary factors significantly influence child growth.
- This study investigates determinants of child growth in the West Bank.
Purpose of the Study:
- To explore direct and indirect determinants of child growth using Structural Equation Modeling (SEM).
- To analyze pathways influencing nutritional status in children aged 6-59 months.
Main Methods:
- Cross-sectional survey of 300 children from 1,400 households in the West Bank (2022).
- Assessed child growth via anthropometric indicators (HAZ, WAZ, MUAC) and dietary adequacy (MNIR).
- Utilized SEM to examine interrelationships between socioeconomic status, food insecurity, dietary intake, feeding practices, neonatal health, and food availability.
Main Results:
- Macronutrient intake, socioeconomic status, and neonatal health had the strongest direct effects on child growth.
- Infant feeding practices and micronutrient intake showed positive indirect effects.
- Food availability mediated the link between access issues and poor dietary diversity/feeding behavior.
Conclusions:
- Child nutrition in Palestine is influenced by interconnected factors: dietary intake, caregiver practices, food access, and early-life health.
- Interventions must target nutritional quality and the socio-environmental context for improved growth.
- SEM provides a robust framework for understanding these complex pathways and informing policy.
Background:
Undernutrition remains a persistent public health concern among young children in Palestine, shaped by a range of socioeconomic and dietary factors. This study applies a Structural Equation Modeling (SEM) approach to explore both direct and indirect determinants of child growth among children aged 6-59 months in the West Bank.
Methods:
Data were drawn from a 2022 cross-sectional survey involving 300 children selected from 1,400 households. Child growth was assessed using anthropometric indicators (HAZ, WAZ, MUAC) and dietary adequacy via the Mean Nutrient Inadequacy Ratio (MNIR). Latent constructs were developed for socioeconomic status, food insecurity, dietary intake (macro- and micronutrients), feeding practices, neonatal health, and food availability. SEM was used to examine interrelationships and the pathways influencing child nutritional status.
Results:
Descriptive analysis showed substantial variation in undernutrition and nutrient intake across regions, family size, and parental education. SEM results showed that macronutrient intake had the strongest direct effect on child growth, followed by socioeconomic status and neonatal health. Infant feeding practices and micronutrient intake also contributed positively, though their effects were primarily indirect. Food availability acted as a significant mediator, linking structural access issues to poor dietary diversity and feeding behavior. The model demonstrated good fit across multiple indices.
Conclusion:
Child nutrition in Palestine is shaped by interrelated determinants of dietary intake, caregiver practices, food access, and early-life health conditions. Effective interventions must target both nutritional quality and the broader social and environmental context to improve growth outcomes. SEM offers a powerful framework to understand these pathways and guide evidence-based policy design.
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