Assessment of Stunting and Its Effect on Wasting in Children Under Two in Rural Madagascar

Abstract

Background/objectives: This study aims to determine the prevalence of stunting in children under two years old and its association with the maternal profile (including anthropometric measurements), care, feeding practices, and socioeconomic level. It also attempts to assess if stunting may contribute to an underestimation of wasting by performing a preliminary speculative analysis using the expected height for age instead of the real observed height of the children.

Methods: The study employed a cross-sectional design, examining mother-child pairs in the rural municipality of Ampefy in the Itasy Region of Madagascar, between 2022 and 2023. A total of 437 mother-child (0-24 months) pairs participated in the study. A questionnaire was administered to collect data on the maternal lifestyle. Maternal medical histories were reviewed, and anthropometric parameters of both the mothers and their child were taken by specialized and trained health professionals with multiple years of experience.

Results: The prevalence of stunting in children was 57.4% (95% CI: 52.64-62.10). Stunting was associated with maternal anthropometric measurements (p < 0.001), maternal education (p = 0.004), and breastfeeding (p = 0.047), which appears to have a protective effect. The weight-for-length z-score indicated that only 12.4% of the total children were affected by wasting. In the preliminary speculative analysis using the WHO height-for-age standard, the theoretical prevalence of wasting was estimated to be 42.3%, with a considerable prevalence of severe wasting. The main limitations of this study were the possible selection bias, the limitations inherent to the taking of anthropometric measurements in small children, and therefore, the possible misclassification of the children. The use of a theoretical weight-for-length z-score to estimate a theoretical prevalence of wasting using an untested speculative analysis is also a limitation to the validity of the estimation.

Conclusions: Stunting affected over half of the children included in the study (57.4%), but the prevalence of wasting was below what was expected, at 12.4%. In the preliminary speculative analysis using the expected height for age, it was estimated that wasting could possibly affect up to 42.3% of the children. This discrepancy, while it cannot be taken as factual due to the nature of the analysis, could serve as a warning that perhaps the elevated rates of stunting may be masking wasting in some children and other forms of nutritional assessments may be needed in areas where stunting is prevalent.

Keywords: Madagascar; infant malnutrition; nutritional programs; stunting; wasting.

Figure 1

Heatmap of simultaneous WFA and stunting status.

Figure 2

Heatmap of simultaneous BAZ and stunting status.