Factors associated with wasting among children under five years old in South Asia: Implications for action

PLoS One. 2018 Jul 3;13(7):e0198749. doi: 10.1371/journal.pone.0198749. eCollection 2018.

Abstract

South Asia continues to carry the greatest share and number of wasted children worldwide. Understanding the determinants of wasting is important as policymakers renew efforts to tackle this persistent public health and development problem. Using data from national surveys in Bangladesh, India, the Maldives, Nepal, Pakistan and Afghanistan, this analysis explores factors associated with wasting among children aged 0 to 59 months (n = 252,797). We conducted multivariate mixed logistic regression and backwards stepwise methods to identify parsimonious models for each country separately (all p values <0.05). Younger children (0 to 5 months), and those whose mothers had a low body mass index (<18.5 kg/m2) had greater odds of being wasted in all countries. Later birth order, being male, maternal illiteracy, short maternal stature, lack of improved water source, and household poverty were also associated with wasting in various countries, but not systematically in all. Seasonality was also not consistently associated with wasting in the final models. These findings suggest that pre-conception (adolescence), pregnancy and early postpartum, represent windows of opportunity for tackling child wasting, not only stunting. Our analysis suggests that the underlying determinants of wasting and stunting in South Asia are similar, but not universal across geographies. Cost-effective interventions to prevent both stunting and wasting, and to treat severe wasting, need to be scaled up urgently. Separating these two manifestations of child undernutrition in conceptual and programmatic terms may unnecessarily impair progress to reach the Sustainable Development Goals targets aimed at addressing both child stunting and wasting.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Asia, Southeastern / epidemiology
  • Body Height
  • Body Mass Index
  • Cachexia / physiopathology
  • Child Nutrition Disorders / diagnosis*
  • Child Nutrition Disorders / epidemiology
  • Child Nutrition Disorders / physiopathology
  • Child Nutrition Disorders / prevention & control
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Growth Disorders / diagnosis*
  • Growth Disorders / epidemiology
  • Growth Disorders / physiopathology
  • Growth Disorders / prevention & control
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Pregnancy
  • Risk Factors
  • Sex Factors
  • Socioeconomic Factors
  • Wasting Syndrome / diagnosis*
  • Wasting Syndrome / epidemiology
  • Wasting Syndrome / physiopathology
  • Wasting Syndrome / prevention & control

Grants and funding

This work was supported by the Regional Office for South Asia of the United Nations Children’s Fund (UNICEF) (contract number 43169667 to PW) and Victor Aguayo, Associate Director, Chief Nutrition in the Programme Division of UNICEF was a key collaborator in the design and content of this study.