Table 1 presents the descriptive characteristics of the study population. The frequency distribution table shows the highest percentage of order 2-3 children (45.7%), with 35.1% of them having more than 24 months of the interval between birth and subsequent birth (IBBSB). 64.1% of the mothers were married at the age of 15 to 19 years, with a mean age at marriage of 17.7 years. Approximately two-thirds of the mothers (65.4%) had normal basal metabolic index (BMI), and more than half of the mothers (54.2%) of the children were not anemic. Most mothers who participated in the study were illiterate (34.6%), while 45.3% of the mothers had at least secondary education. Almost half of the mothers (46.2%) lived on agriculture. The share of the male children was slightly higher (52.2%) than female children (47.8%) in the survey. The percentage of children for each age, from one to five years, was nearly around one fifth.
The representation of the study population by area of residence was quite similar (urban-52.6% and rural- 47.4%). Newar and Janajatis represented the largest percentage (31.1%) of the study participants, while Muslims/others had the least representation (7.5%) in the present study. The distribution of the study population was nearly uniform, around 21% for all categories of wealth quintile except the richest category, which was as low as 13.2%. Most children represented Province 2 (27.4%), while Province 6 had the least percentage of children who participated in the study. 41% of the household were food secured, while only 10.5% were facing severe food insecurity.
Table 1 about here
Rate of stunting and underweight and planning of birth
The present study found a substantial percentage of children with undernutrition (stunting-35.8% and underweight-27.1%) (Table 2). We observed a relatively higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order >3 and <2 years of IBBSB, followed by birth order 2-3 children and <2 years of IBBSB (stunting-41.5% and underweight-32.3%). The association between the birth order of children and the prevalence of undernutrition was highly significant (p<0.001).
Mothers who were in the age group 35-49 at the time of the survey had the highest prevalence of child stunting (42.6%) and showed a significant association (p<0.001). Children born to the mothers in the age category of 30-34 years had the highest prevalence of underweight (30.4%) but did not show significant association (p>0.05). Mother’s age at marriage less than 15 years (stunted-42.4% and underweight-33.4%), underweight women (stunted-44.5% and underweight-42.7%), mother’s illiteracy (stunting-45.8% and underweight-36.8%), father’s illiteracy (stunting-46.3% and underweight-38.1%), poorest wealth quintile (stunted-49.1% and underweight-33.0%), no exposure to mass media (stunted-50.5% and underweight-39.7%), children’s age group 24-35 months (stunted 44.8% and underweight-31.1%), rural residence (stunted-40.2% and underweight-31.0%) were the significant predictors of childhood undernutrition (p<0.05) (Table 2).
Table 2 about here
Factors associated with stunting
Multiple logistic regression showed that children with birth order 1 and 12-24 months of IBMFB had 0.6 times significantly lower odds of being stunted as compared to children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4-0.9, p<0.05) (Table 3). None of the other birth order and birth interval showed a significant association with stunting (Table 3). The current age of the mother in the age group 20-24 years also had significantly lower odds of having stunted children as compared to the current age of the mothers in the age group < 15 years (OR 0.6, 95% CI 0.4-0.9, p<0.05). Obese mothers had decreased odds of child stunting as compared to mothers with normal BMI. The relationship was statistically significant (OR 0.6, 95% CI 0.4-0.9, p<0.05). However, the relationship between underweight mothers and child stunting was not significant. Mothers with paid jobs had significantly higher odds of stunted children as compared to the mothers who were not working (OR 1.7, 95% CI 1.2-2.4, p<0.01). All categories of wealth quintile (poorer, middle, richer, and richest) had significantly lower odds of child stunting as compared to those who were in the poorest quintile. The corresponding ORs were 0.7 (95%CI 0.5-0.9, p<0.05), 0.6 (95% CI 0.4-0.8, p<0.01), 0.5 (95% CI 0.3-0.8, p<0.01), and 0.3 (95% CI 0.2-0.6, p<0.001) respectively. Exposure to mass media also had significantly decreased odds of stunting as compared to those who did not have exposure at all. The odds ratio was 0.6 for those who were exposed less than once a week (95%CI 0.5-0.9, p<0.01). For those who were exposed at least once a week, the odds ratio was again 0.6 (95% CI 0.5-0.8, p<0.001). We observed highly significant greater odds of stunting in all age categories of the children as compared to the 0-11 months age category. The ORs were 3.2 (95% CI 2.2-4.6, p<0.001), 4.8 (95%CI 3.3-7.1, p<0.001), 3.7 (95% CI 2.4-5.6, p<0.001), and 3.8 (95% CI 2.5-5.8, p<0.001) for age category 12-23 months, 24-35 months, 36-47 months, and 48-59 months respectively. At the administrative level, Province 6 had greater odds of stunting as compared to Province 1 (OR 1.8, 95% CI 1.1-2.7, p<0.01).
Table 3 about here
Factors associated with underweight
Table 4 presents the results of the logistic regression analysis for the odds of underweight in under-five children. Any category of planning of birth did not show a statistically significant relationship with underweight as compared to first-order birth and less than 12 months of IBMFB. Underweight mothers were 1.7 times more likely to have underweight children as compared to mothers with normal BMI (OR 1.7, 95% CI 1.3-2.2, p<0.001). In contrast, obese mothers had significantly lower odds of underweight children as compared to mothers with normal BMI (OR 0.4, 95% CI 0.3-0.7, p<0.001). Poorer, richer, and richest category of wealth quintile showed significantly lower odds of underweight children as compared to those in the poorest quintile. The corresponding ORs were 0.6 (95% CI 0.4-0.9, p<0.05), 0.5 (95% CI 0.3-0.8, p<0.01), and 0.4 (0.2-0.8, p<0.01) respectively. We also observed significantly higher odds of underweight children in the age group 12-23 months (OR 1.6, 95% CI 1.2-2.2, p<0.01), 24-35 months (OR 1.9, 95% CI 1.3-2.7, p<0.001), and 48-59 months (OR 1.9, 95% CI 1.3-2.7, p<0.01) as compared to children in 0-11 months category. At ecological division, the Terai region had 1.8 times higher odds of underweight children as compared to the mountain region. The relationship was statistically significant (OR 1.8, 95% CI 1.1-3.0, p<0.05).
Table 4 about here
Interaction of PoB with maternal nutrition and wealth quintile
We tested for the interaction effect of PoB with maternal anemia for both stunting and underweight separately (not shown in the table). We also examined the interaction between PoB and household wealth quintile. We did not observe any significant interaction.