Factors associated with stunting among children aged below 60 months from rural Malawi: a matched case-control study

Abstract

Stunting currently affects 37% (1.1 million) of Malawian children and causing unfavorable impact for both children and their households. Identifying risk factors to stunting would go a long way in developing appropriate interventions. The objective of this study was to identify the risk factors of stunting among children aged below 60 months from Balaka, Dedza and Mzimba districts in Malawi. A matched cross-sectional case-control study was conducted among 913 (446 controls; 467 cases) children aged below 60 months from three regions of Malawi. Household demographic, anthropometric measurements, dietary intake, food security, and morbidity information were collected. Case-Control Stepwise multiple logistic regression models are used to determine risk factors of stunting. The following were identified as risk factors for stunting including; age of child (AOR= 6.3; 95% CI: 2.9, 8.9), polygamy (AOR= 8.9; 95%, CI: 3.3, 13.03), maternal education (AOR= 9.9; 95%, CI: 2.8, 20.1), access to markets (AOR= 1.3; 95%, CI: 0.2, 2.4), childhood infections (AOR= 2.11; 95%, CI: 1.4, 4.2) and presence of oedema (AOR= 2.5; 95%, CI: 1.3, 4.1). Also, lack of food any month (AOR= 1.31; 95%, CI: 1.01, 4.9), purchasing food on credit (AOR= 1.48; 95%, CI: 1.4, 1.7), begging for food (AOR= 1.55; 95%, CI: 1.2, 2.1), mothers or caregivers consuming less than 5 food groups (MDD-W) (AOR = 4.83; 95% CI: 1.9, 16.4), exclusive breastfeeding (AOR= 5.45; 95%, CI: 4.33, 7.61) children weaned on plain water (AOR= 1.6; 95%, CI: 1.6, 2.41), powdered milk (AOR= 0.63; 95%, CI: 0.4, 1.32), juices (AOR= 0.44; 95%, CI: 0.12, 0.96) and children fed on sugary food (AOR= 0.66; 95%, CI: 0.4, 0.99) were significantly related to stunting. Stunting is associated with increasing age of children, boys, polygamous households, lack of education by mothers or caregivers, inaccessible markets, childhood infections and presence of oedema, food insecurity, breastfeeding and complementary feeding among children and dietary diversity of mothers or caregivers. These results suggest that interventions against childhood stunting should be designed according to the factors that significantly affect stunting. Key words: child growth, Malawi, stunting and complementary feeding, Regression, Food Security and Health