Abstract
Childhood malnutrition remains endemic in South Asia, although the burden varies by country. We examined the anthropometric status and risk factors for malnutrition among children aged 0–59 months through the 2015 National Nutrition Survey in Bhutan. We assessed in 1,506 children nutritional status (by z‐scores of height‐for‐age [HAZ], weight‐for‐height [WHZ], and weight‐for‐age [WAZ]), estimating prevalence, adjusted for survey design, of stunting, wasting, underweight, and overweight (<−2 for HAZ, WHZ, and WAZ and >2 for WHZ). Children were also assessed for pedal oedema. We conducted multivariable linear/logistic regression analysis to identify child, maternal, and household risk factors for childhood undernutrition and overweight, excluding children with oedema (1.7%). Mean (SE) HAZ, WHZ, and WAZ were −0.82 (0.13), 0.10 (0.04), and −0.42 (0.05), respectively. Prevalence of stunting, wasting, underweight, and overweight were 21.2%, 2.6%, 7.4%, and 2.6%, respectively. In multivariable regressions, risk of stunting significantly increased by age: 5.3% at <6 months (reference), 16.8% at 6–23 months (OR = 3.06, 95% CI [0.63, 14.8]), and 25.0% at 24–59 months (OR = 5.07, [1.16, 22.2]). Risk of stunting also decreased in a dose–response manner with improved maternal education. None of the examined variables were significantly associated with wasting or overweight. Despite a WHZ distribution comparable with the World Health Organization reference (with ~2.6% vs. an expected 2.5% of children beyond 2 z in each tail), stunting persists in one fifth of preschool Bhutanese children, suggesting that other nutrient deficits or nonnutritional factors may be constraining linear growth for a substantial proportion of children.
Highlights
Approval for the Nutrition Survey (NNS) 2015 methodology and sampling strategy was obtained from the National Statistical Bureau of Bhutan, and ethical clearance for the study was sought from the Research Ethical Board of Health, Ministry of Health
Findings from the 2015 NNS provide a comprehensive overview of the nutritional status of Bhutanese preschool children by geographic area, urban–rural residence and other common risk factors
A prevalence of 21% is similar in magnitude to rates in middle‐income Asian countries, including Vietnam (23%; General Statistics Office of Vietnam, 2011) and Tajikistan (27%; UNICEF, 2016), while remaining moderate for South Asia, following Sri Lanka (15%) and Maldives (17%) but lower than an overall prevalence of stunting of ~37% among young children in neighbouring Bangladesh, India and Nepal (UNICEF, 2016)
Summary
The current prevalence of stunting among preschool children in Bhutan (21.2%) is lower than in neighbouring South Asian countries (Nutrition Program, Department of Public Health, Ministry of Health, 2016): Bangladesh (36%; Bangladesh National Institute of Population Research and Training, Mitra and Associates, & ICF International, 2016), India (39%; UNICEF, 2016), or Nepal (37%; Nepal Central Bureau of Statistics, 2015). Only a few national survey reports and studies using nationally representative data are available to provide information on maternal and child nutrition in Bhutan (Aguayo, Badgaiyan, & Paintal, 2015; Zangmo, de Onis, & Dorji, 2012) Against this backdrop, our study provided in‐depth information on the nutritional status of Bhutanese children using data from the National Nutrition Survey (NNS) 2015 (Nutrition Program, Department of Public Health, Ministry of Health, 2016). We describe time trends of nutritional status across prior surveys from 1986 to 2015
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