Risk factors of stunting among children living in an urban slum of Bangladesh

Findings of a prospective cohort study

M. Munirul Islam, Kazi Istiaque Sanin, Mustafa Mahfuz, A. M.Shamsir Ahmed, Dinesh Mondal, Rashidul Haque, Tahmeed Ahmed

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    Abstract

    Background: Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented.

    Methods: Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age.

    Result: Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population.

    Conclusion: As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

    Original languageEnglish
    Article number197
    Pages (from-to)1-13
    Number of pages13
    JournalBMC Public Health
    Volume18
    Issue number1
    DOIs
    Publication statusPublished - 30 Jan 2018

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    Growth Disorders
    Poverty Areas
    Bangladesh
    Cohort Studies
    Prospective Studies
    Parturition
    Malnutrition
    Energy Intake
    Breast Feeding
    Population
    Fats
    Regression Analysis
    Carbohydrates
    Morbidity
    Pregnancy

    Cite this

    Islam, M. M., Sanin, K. I., Mahfuz, M., Ahmed, A. M. S., Mondal, D., Haque, R., & Ahmed, T. (2018). Risk factors of stunting among children living in an urban slum of Bangladesh: Findings of a prospective cohort study. BMC Public Health, 18(1), 1-13. [197]. https://doi.org/10.1186/s12889-018-5101-x
    Islam, M. Munirul ; Sanin, Kazi Istiaque ; Mahfuz, Mustafa ; Ahmed, A. M.Shamsir ; Mondal, Dinesh ; Haque, Rashidul ; Ahmed, Tahmeed. / Risk factors of stunting among children living in an urban slum of Bangladesh : Findings of a prospective cohort study. In: BMC Public Health. 2018 ; Vol. 18, No. 1. pp. 1-13.
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    title = "Risk factors of stunting among children living in an urban slum of Bangladesh: Findings of a prospective cohort study",
    abstract = "Background: Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. Methods: Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. Result: Approximately, 18{\%} of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48{\%} at 24 months of age. Exclusive breastfeeding prevalence was only 9.4{\%} following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95{\%} CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95{\%} CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95{\%} CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95{\%} CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95{\%} CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. Conclusion: As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.",
    keywords = "Bangladesh, Dietary diversity score, Generalized estimating equation, Length at birth, Prospective cohort study, Stunting, Urban slum",
    author = "Islam, {M. Munirul} and Sanin, {Kazi Istiaque} and Mustafa Mahfuz and Ahmed, {A. M.Shamsir} and Dinesh Mondal and Rashidul Haque and Tahmeed Ahmed",
    year = "2018",
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    Islam, MM, Sanin, KI, Mahfuz, M, Ahmed, AMS, Mondal, D, Haque, R & Ahmed, T 2018, 'Risk factors of stunting among children living in an urban slum of Bangladesh: Findings of a prospective cohort study', BMC Public Health, vol. 18, no. 1, 197, pp. 1-13. https://doi.org/10.1186/s12889-018-5101-x

    Risk factors of stunting among children living in an urban slum of Bangladesh : Findings of a prospective cohort study. / Islam, M. Munirul; Sanin, Kazi Istiaque; Mahfuz, Mustafa; Ahmed, A. M.Shamsir; Mondal, Dinesh; Haque, Rashidul; Ahmed, Tahmeed.

    In: BMC Public Health, Vol. 18, No. 1, 197, 30.01.2018, p. 1-13.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Risk factors of stunting among children living in an urban slum of Bangladesh

    T2 - Findings of a prospective cohort study

    AU - Islam, M. Munirul

    AU - Sanin, Kazi Istiaque

    AU - Mahfuz, Mustafa

    AU - Ahmed, A. M.Shamsir

    AU - Mondal, Dinesh

    AU - Haque, Rashidul

    AU - Ahmed, Tahmeed

    PY - 2018/1/30

    Y1 - 2018/1/30

    N2 - Background: Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. Methods: Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. Result: Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. Conclusion: As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

    AB - Background: Bangladesh is one of the 20 countries with highest burden of stunting globally. A large portion (around 2.2 million) of the population dwells in the slum areas under severe vulnerable conditions. Children residing in the slums are disproportionately affected with higher burden of undernutrition particularly stunting. In this paper, findings of a prospective cohort study which is part of a larger multi-country study are presented. Methods: Two hundred and sixty five children were enrolled and followed since their birth till 24 months of age. Anthropometric measurements, dietary intake and morbidity information were collected monthly. Data from 9 to 12, 15-18 and 21-24 months were collated to analyze and report findings for 12, 18 and 24 months of age. Generalized estimating equation models were constructed to determine risk factors of stunting between 12 and 24 months of age. Result: Approximately, 18% of children were already stunted (LAZ < -2SD) at birth and the proportion increased to 48% at 24 months of age. Exclusive breastfeeding prevalence was only 9.4% following the WHO definition at 6 months. Dietary energy intake as well as intakes of carbohydrate, fat and protein were suboptimal for majority of the children. However, in regression analysis, LAZ at birth (AOR = 0.40, 95% CI: 0.26, 0.61), household with poor asset index (AOR = 2.81, 95% CI: 1.43, 5.52; ref.: average asset index), being male children (AOR = 1.75, 95% CI: 1.04, 2.95; ref.: female) and age (AOR = 2.34, 95% CI: 1.56, 3.52 at 24 months, AOR = 2.13, 95% CI: 1.55, 2.92 at 18 months; ref.: 12 months of age) were the significant predictors of stunting among this population. Conclusion: As the mechanism of stunting begins even before a child is born, strategies must be focused on life course approach and preventive measurement should be initiated during pregnancy. Alongside, government and policymakers have to develop sustainable strategies to improve various social and environmental factors those are closely interrelated with chronic undernutrition particularly concentrating on urban slum areas.

    KW - Bangladesh

    KW - Dietary diversity score

    KW - Generalized estimating equation

    KW - Length at birth

    KW - Prospective cohort study

    KW - Stunting

    KW - Urban slum

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    SN - 1471-2458

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