TY - JOUR
T1 - Population-modifiable risk factors associated with childhood stunting in sub-Saharan Africa
AU - Ahmed, Kedir Y
AU - Dadi, Abel F
AU - Ogbo, Felix Akpojene
AU - Page, Andrew
AU - Agho, Kingsley E
AU - Akalu, Temesgen Yihunie
AU - Baraki, Adhanom Gebreegziabher
AU - Tesema, Getayeneh Antehunegn
AU - Teshale, Achamyeleh Birhanu
AU - Alamneh, Tesfa Sewunet
AU - Tessema, Zemenu Tadesse
AU - Kabthymer, Robel Hussen
AU - Tamirat, Koku Sisay
AU - Ross, Allen G
N1 - Publisher Copyright:
© 2023 American Medical Association. All rights reserved.
PY - 2023/10/18
Y1 - 2023/10/18
N2 - IMPORTANCE: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals.OBJECTIVE: To evaluate key modifiable risk factors associated with childhood stunting in SSA.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries.EXPOSURES: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel.MAIN OUTCOMES AND MEASURES: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors.RESULTS: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA.CONCLUSIONS AND RELEVANCE: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.
AB - IMPORTANCE: Identifying modifiable risk factors associated with childhood stunting in sub-Saharan Africa (SSA) is imperative for the development of evidence-based interventions and to achieve the Sustainable Development Goals.OBJECTIVE: To evaluate key modifiable risk factors associated with childhood stunting in SSA.DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study examined the most recent (2014-2021) Demographic and Health Surveys data for children younger than 5 years from 25 SSA countries.EXPOSURES: Modifiable risk factors included history of diarrhea within 2 weeks, consumption of dairy products, maternal body mass index, maternal educational level, antenatal care visits, place of birth, wealth index, type of toilet, and type of cooking fuel.MAIN OUTCOMES AND MEASURES: Stunting and severe stunting, measured using the height-for-age z score, were the main outcomes. Children who scored below -2.0 SDs or -3.0 SDs were classified as having stunted or severely stunted growth, respectively. Relative risks and 95% CIs were computed using generalized linear latent and mixed models and log-binomial link functions. Population-attributable fractions (PAFs) were calculated using adjusted relative risks and prevalence estimates for key modifiable risk factors.RESULTS: This study included 145 900 children from 25 SSA countries. The mean (SD) age of the children was 29.4 (17.3) months, and 50.6% were male. The highest PAFs of severe childhood stunting were observed for mothers lacking a formal education (PAF, 21.9%; 95% CI, 19.0%-24.8%), children lacking consumption of dairy products (PAF, 20.8%; 95% CI, 16.8%-24.9%), unclean cooking fuel (PAF, 9.5%; 95% CI, 2.6%-16.3%), home birth (PAF, 8.3%; 95% CI, 6.3%-10.0%), and low-income household (PAF, 5.8%; 95% CI, 3.4%-8.0%). These 5 modifiable risk factors were associated with 51.6% (95% CI, 40.5%-60.9%) of the severe childhood stunting in SSA.CONCLUSIONS AND RELEVANCE: This cross-sectional study identified 5 modifiable risk factors that were associated with 51.6% of severe childhood stunting in SSA. These factors should be a priority for policy makers when considering future child health interventions to address chronic malnutrition in SSA.
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U2 - 10.1001/jamanetworkopen.2023.38321
DO - 10.1001/jamanetworkopen.2023.38321
M3 - Article
C2 - 37851439
SN - 2574-3805
VL - 6
JO - JAMA Network Open
JF - JAMA Network Open
IS - 10
M1 - e2338321
ER -
