A multilevel analysis of factors associated with stunting among children under five years in Lesotho: a study of the lesotho multiple cluster indicator survey 2018.

Background: The United Nations Children's Fund (UNICEF) states that inadequate nutrition during the first 1,000 days of a child's life can contribute to stunted growth. Lesotho is currently experiencing a high prevalence of malnutrition across all age groups. Therefore, this study aims to investigate the prevalence and multilevel factors associated with stunting among children under five in Lesotho.

Methods: The study used the Lesotho Multiple Cluster Indicator Survey of 2018. The data was analysed using STATA version 14 software, and a multilevel logistic regression model was fitted. The Wald adjusted odds ratio (WAOR) with a P-value < 0.05 was also taken to indicate statistical significance.

Results: The prevalence of stunting was 33.6% [95% CI 31.6 33.6] amongst the children under five years old in Lesotho. At an individual level, the odds of stunting are lower for the children that did not receive the minimum acceptable diet (MAD) (WAOR = 0.52; CI: 0.3, 0.9), the children born with greater than 3.8 kg birth weight (WAOR = 0.51; CI: 0.4, 0.6), and those that did not have respiratory infections (WAOR = 0.61; CI: 0.4, 1.0) compared to their counterparts. At the household level, the likelihood of stunting was the lowest for education beyond secondary (WAOR = 0.26; CI: 0.2, 0.4), the fifth household wealth (WAOR = 0.34; CI: 02, 03), the safe sources of drinking water (WAOR = 0.72; CI: 06, 09) and inadequate toilet facilities (WAOR = 0.62; CI: 0.5, 0.7) compared to their counterparts. Higher odds were observed amongst the children from rural areas (WAOR = 1.95; CI: 1.3, 2.1), and mothers not residing within the household (WAOR = 1.30; CI: 1.1, 1.6) compared to their counterparts. At the community level, decreased odds were associated with the children from the communities with high community maternal education (WAOR = 0.69; CI: 0.6, 0.8) and the community male education (WAOR = 0.56; CI: 0.5, 0.7), as well as those in the communities with low safety of drinking water sources (WAOR = 0.73; CI: 0.3, 0.5), adequate toilet facilities (WAOR = 0.66; CI: 0.5, 0.8) and high maternal media exposure (WAOR = 0.37; CI: 0.3, 0.5) compared counterparts. The children from communities with high community poverty were two times (WAOR = 2.04; CI: 1.7, 2.5) more likely to be stunted.

Conclusion: The findings suggest targeting community food availability and knowledge acquisition. Expanding information availability through mass media would improve the nutritional status of children in Lesotho.