Risk factors associated with stunting among infants and young children aged 6 - 23 months in Dedza District of central Malawi

Abstract

The prevalence of stunting is high in Malawi, affecting about one third (31.2%) of children aged 6-23 months. Persistent inappropriate feeding practices are some of the major causes of stunting in young children. This study was conducted to determine risk factors associated with stunting among infants and young children aged 6-23 months in Dedza district in Central Malawi. A cross-sectional study was conducted in 12 villages in Mayani Extension Planning Area (EPA), targeting households with children aged 6-23 months. A structured questionnaire was used to collect data from the primary caregivers on household socioeconomic characteristics, household food availability, dietary diversity, responsive feeding practices among mothers and caregivers, age of introduction of complementary foods, frequency of feeding, types of foods and dietary diversity of children. Anthropometric data (weight and recumbent length) for children were measured using standard procedures. The Multivariate Logistic Regression Analysis was performed to study the independent associations of various determinants on prevalence of stunting with prevalence of stunting as a dependent variable. A total of 303 households were sampled randomly; mothers and caregivers were interviewed and 306 children were assessed for nutritional status. Introduction of complementary food varied among mothers, 9.3% introduced earlier than 6 months, 71.1% at 6 months and 10.2% later than 6 months. Dietary diversity was low but increased significantly with age categories of children, 2.9% for children 6-8 months, 15.5% for 9-11 months and 24.6% for 12-23 months (p<0.01). Minimum meal frequency was significantly (p<0.001) higher in children 6-8 months (58.7%) than in children 12-23 months (1.9%). Overall, out of the 306 children 47.1% [95% CI (41.6-53.1)] were stunted. Stunting was significantly different between male [54.5%; 95% CI (47.0-63.5)] and female (39.5%; 95% CI (31.4-47.6)] children. Age of child when complementary feeding was started [AOR: 0.138; 95% CI (0.22-0.88)], number of young children in the household [AOR: 2.548; 95% CI (1.304-4.981)] and teenage mothers [AOR: 1.265; 95% CI (0.379-1.724)] were significant independent predictors of stunting. It can be concluded that prevalence of stunting is high among infants and young children in Dedza district. Training mothers and caregivers on recommended age of introducing complementary food to a child, composition of such food, dangers of teenage pregnancies and importance of child spacing should form part of nutrition education.

Keywords: Nutritional status, dietary diversity, complementary feeding, meal frequency, responsive feeding