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. 2022 Jan;18 Suppl 1(Suppl 1):e12982.
doi: 10.1111/mcn.12982. Epub 2020 Mar 5.

Elucidating the sustained decline in under-three child linear growth faltering in Nepal, 1996-2016

Giles Hanley-Cook  1 , Alemayehu Argaw  1   2 , Pradiumna Dahal  3 , Stanley Chitekwe  3 , Sanjay Rijal  3 , Ram Padarath Bichha  4 , Kedar Raj Parajuli  4 , Patrick Kolsteren  1
Affiliations

Elucidating the sustained decline in under-three child linear growth faltering in Nepal, 1996-2016

Giles Hanley-Cook et al. Matern Child Nutr. 2022 Jan.

Abstract

Childhood linear growth faltering remains a major public health concern in Nepal. Nevertheless, over the past 20 years, Nepal sustained one of the most rapid reductions in the prevalence of stunting worldwide. First, our study analysed the trends in height-for-age z-score (HAZ), stunting prevalence, and available nutrition-sensitive and nutrition-specific determinants of linear growth faltering in under-three children across Nepal's Family Health Survey 1996 and Nepal's Demographic and Health Surveys 2001, 2006, 2011, and 2016. Second, we constructed pooled multivariable linear regression models and decomposed the contributions of our time-variant determinants on the predicted changes in HAZ and stunting over the past two decades. Our findings indicate substantial improvements in HAZ (38.5%) and reductions in stunting (-42.6%) and severe stunting prevalence (-63.9%) in Nepalese children aged 0-35 months. We also report that the increment in HAZ, across the 1996-2016 period, was significantly associated (confounder-adjusted p < .05) with household asset index, maternal and paternal years of education, maternal body mass index and height, basic child vaccinations, preceding birth interval, childbirth in a medical facility, and prenatal doctor visits. Furthermore, our quantitative decomposition of HAZ identified advances in utilisation of health care and related services (31.7% of predicted change), household wealth accumulation (25%), parental education (21.7%), and maternal nutrition (8.3%) as key drivers of the long-term and sustained progress against child linear growth deficits. Our research reiterates the multifactorial nature of chronic child undernutrition and the need for coherent multisectoral nutrition-sensitive and nutrition-specific strategies at national scale to further improve linear growth in Nepal. [Correction added on 6 November 2020, after first online publication: in abstract, the citation year in the fourth sentence has been changed from '2001' to '2011'.].

Keywords: Demographic and Health Surveys; Nepal; chronic malnutrition; infant and child nutrition; linear growth; statistical decompositions; stunting.

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Conflict of interest statement

PD, SC, and SR are members of UNICEF. RPB and KRP are members of Nepal's Ministry of Health and Population. The authors alone are responsible for the views expressed in this publication and declare that they have no conflicts of interest.

Figures

Figure 1
Figure 1
Shifts in the distribution of height‐for‐age z‐score (HAZ), 1996 to 2016. Source: Kernel density estimates from Nepal's Family Health Survey 1996 and Nepal Demographic and Health Survey 2016
Figure 2
Figure 2
Shifts in height‐for‐age z‐score (HAZ), by child's age, from 1996 to 2016. Source: Local polynomial smoothing predictions with 95% CIs estimated from Nepal's Family Health Survey 1996 and Nepal Demographic and Health Survey 2016. CI, confidence interval
Figure 3
Figure 3
Non‐parametric estimates of the relationships between height‐for‐age z‐score (HAZ) and continuous variables. Source: Local polynomial smoothing predictions with 95% CI estimated from Nepal's Family Health Survey 1996 and Nepal Demographic and Health Surveys 2001, 2006, 2011, 2016. CI, confidence interval
Figure 4
Figure 4
Estimated contributions of nutrition‐sensitive and nutrition‐specific determinants to changes in child linear growth outcomes, from 1996 to 2016. Source: Author's estimates from Nepal's Family Health Survey 1996 and Nepal Demographic and Health Surveys 2001, 2006, 2011, 2016. HAZ, height‐for‐age z‐score
See this image and copyright information in PMC

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