Determinants of stunting among children < 5 years of age: Evidence from 2018-2019 Zambia Demographic and Health Survey

OBJECTIVEThe study aimed at identifying socio-economic and environmental factors that were associated with stunting among children aged 0-59 months in Zambia. BACKGOUNDHitherto, stunting continues to be a Public Health problem worldwide. A child is stunted if his or her height is less than negative two standard deviations below the World Health Organization (WHO) standard. The study aimed to explore determinants of stunting in Zambia among children (< 5 years of age) using the Zambia Demographic and Health Survey (ZDHS) 2018-2019 database. METHODSA total of 7, 045 Zambian children with complete anthropometric measurements and aged 0-59 months were included in the study. Nutritional status was evaluated using anthropometric; height-for-age, as a proxy measure of stunting. Univariate and multivariate binary logistic regression were used to examine the association between stunting and selected environmental, maternal-socio-demographic and child level variables. RESULTSA total of 2, 479 children under the age of five found to be stunted representing a prevalence of 34.9%. Stunting was higher among male children as compared to female children (38.5% vs 31.3% respectively). Additional analysis revealed that children from households whose source of drinking water was improved (34%) were less likely to be stunted compared to children from households whose source of drinking water was non-improved (40%). Stunting was statistically significant associated with sex and age of a child; birth size; breastfeeding; residence; maternal education; wealth index; twin births and the birth interval among siblings. Children born to mothers whose previous birth interval is less than 24 months (aOR= 1.34 95%CI: 1.13-1.58; p<0.001), children from lower index households (aOR= 1.65 95%CI: 1.32-2.08; p<0.001), twin births (aOR=2.65 95%CI: 1.61-4.36; p<0.001), children whose mothers had primary education (aOR=1.16 95%CI 1.00-1.35; p=0.046), children coming from households whose source of drinking water was non-improved (aOR= 1.30 95%CI: 1.09-1.5: p=0.003), child not breastfed (aOR= 1.20 95%CI: 1.04-1.38; p=0.015) were more likely to be stunted. CONCLUSIONThe study established that the major predictors of stunting among children under 5 years old in Zambia were sex and age of the child; birth weight; maternal education; wealth status; source of drinking water; twin births, breastfeeding, residence and the birth interval among siblings. Therefore, to reduce the burden of stunting interventions that can address these factors are required such as community based education and targeted nutritional interventions. ARTICLE SUMMARYO_ST_ABSStrengths and limitations of the studyC_ST_ABSO_LIThe study utilised the ZDHS data as a proxy to establish the national burden of stunting in Zambia during 2018/2019, hence contributing to the body of knowledge. C_LIO_LIMany variables perataining to food intakes were not covered in ZDHS of 2018/2019 hence exluded from the study. Food intakes are very critical in measuring stunting levels. C_LI