Abstract
ObjectivesWith a fourth of all under-five children affected, stunting remains one of the biggest health challenges worldwide. Even though the main underlying factors are known, the exact pathways to stunting varying in affected regions, and interventions thus need to be tailored to the local contexts. This study aimed assessing and comparing factors associated with stunting in two understudied sub-Saharan urban contexts with some of the highest stunting prevalence globally: Bangui, Central African Republic (~ 36%) and Antananarivo, Madagascar (42%).MethodsWe performed a case–control study on 175 + 194 stunted and 237 + 230 non-stunted control children aged 2–5 years and matched for age, gender and district of residency. Factors associated with stunting were identified using a standardized, paper questionnaire delivered by trained interviewers. Statistical analysis was done using logistic regression modelling.ResultsIn both sites, formal maternal education lowered the risk of being stunted and restricted access to soap, suffering of anaemia and low birth weight were associated with higher risk of stunting. Short maternal stature, household head different from parents, diarrhoea and coughing were associated with an increased risk and continuing breastfeeding was associated with a lower risk of stunting in Antananarivo. Previous severe undernutrition and dermatitis/ fungal skin infections were associated with higher and changes in diet during pregnancy with lower risk of stunting in Bangui.ConclusionsOur results suggest maternal education, antenatal care, iron supplementation and simple WASH interventions such as using soap and infection control as general and breastfeeding (Antananarivo) or better nutrition (Bangui) as area-specified interventions.
Highlights
Stunted child growth reflects underlying chronic undernutrition and is of major global public health concern
Most children lived with their mothers (Bangui: 93.0%, Antananarivo: 97.0%, P = 0.01) and with their fathers (Bangui: 75.0%; Antananarivo: 82.0%, P = 0.02)
10.6% of Antananarivo children and 22.5% of Bangui children lived in a household in which someone other than the father or mother was the primary earner (P < 0.001)
Summary
Stunted child growth reflects underlying chronic undernutrition and is of major global public health concern. The Central African Republic (CAR) and Madagascar, where this study was conducted, are two of the world’s most affected countries, with 42% of Malagasy and 40% of CAR children experiencing stunted growth. This syndrome is associated with several aetiologies, notably a poor, unbalanced diet, insufficient vitamin/micronutrient intake, repeated infections and changes to the gastrointestinal system, especially chronic inflammation and changes to the microbiota (Prendergast & Humphrey, 2014; Vonaesch et al, 2018a). It is important to know which factors are present in which context in order to tailor interventions to the local need
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