Predictive Model of Stunting in Children 6-59 Months of Age in Kirundo Health District, Burundi
DOI:
https://doi.org/10.6000/1929-4247.2025.14.04.1Keywords:
Stunting, predictive model, Kirundo health district, children 6 to 59 monthsAbstract
An analytical cross-sectional study was conducted among a randomly selected sample of 374 households with at least one child aged 6 to 59 months in the Kirundo health district, Burundi. Sociodemographic, socioeconomic, socio-sanitary factors, food insecurity, behavioral, and environmental data were collected using a structured questionnaire. Children's weight was measured using a standard procedure (SECA scale), their height using a standard UNICEF height rod, and their age was obtained from the birth certificate. Anthropometric data were analyzed using Emergency Nutrition Assessment (ENA for Smart) software.
Modeling was performed using logistic regression to eliminate confounding factors, and all independent variables with a significance level less than or equal to 20% in the bivariate analysis were included to explore factors associated with stunting in children aged 6 to 59 months.
In this study, the prevalence of stunting is estimated at 61.5%. According to multivariate logistic regression, sex (AOR = 2.83; 95% CI:1.40-5.75), age (AOR= 10.40; 95% CI: 1.21-88.30), food insecurity (AOR = 10.47;95% CI: 3.58-30.61), latrine type (AOR = 6.83; 95% CI: 3.12-14.94), diarrhea (AOR = 2.56; 95% CI: 1.19-5.48), water source (AOR = 3.17; 95% CI: 1.54-6.52), media exposure (AOR = 0.24, 95% CI: 0.11-0.51), nutritional knowledge (AOR = 0.11; 95% CI: 0.05-0.25), birth spacing (AOR = 0.39, 95% CI: 0.16-0.93), complete vaccination (AOR = 0.06; 95% CI: 0.02-0.21), father's occupation (AOR = 0.25; 95% CI: 0.09-0.72), and mother's education (AOR = 0.21; 95% CI: 0.07-0.64) were significantly associated with stunting.
The predictive model showed an area under the curve (AUC) of 0.95, indicating excellent discrimination ability.
The high prevalence of stunting in this study highlights the importance of urgent action to end this problem.
References
Black RE, Victora CG, Walker SP, Bhutta ZA, Christian P, de Onis M, et al. Maternal and child undernutrition and overweight in low-income and middle-income countries. Lancet 2013; 382(9890): 427-51. DOI: https://doi.org/10.1016/S0140-6736(13)60937-X
WHO. WHO child growth standards: head circumference-for-age, arm circumference-for-age, triceps skinfold-for-age and subscapular skinfold-for-age: methods and development. Geneva: World Health Organization 2007.
UNICEF, WHO, World Bank Group. Levels and trends in child malnutrition: UNICEF/WHO/World Bank Group joint child malnutrition estimates: key findings of the 2021 edition. Geneva: World Health Organization 2021.
Menalu MM, Bayleyegn AD, Tizazu MA, Amare NS. Assessment of prevalence and factors associated with malnutrition among under-five children in Debre Berhan Town, Ethiopia. Int J Gen Med 2021; 14: 1683-97. DOI: https://doi.org/10.2147/IJGM.S307026
de Onis M, Branca F. Childhood stunting: a global perspective. Matern Child Nutr 2016; 12 Suppl 1: 12-26. DOI: https://doi.org/10.1111/mcn.12231
WHO. WHO Global Nutrition Target: Stunting Policy Brief. Geneva: World Health Organization 2010.
Das JK, Salam RA, Saeed M, Kazmi FA, Bhutta ZA. Effectiveness of interventions to manage acute malnutrition in children under 5 years of age in low- and middle-income countries: A systematic review. Campbell Syst Rev 2020; 16(2): e1082. DOI: https://doi.org/10.1002/cl2.1082
Nshimyiryo A, Hedt-Gauthier B, Mutaganzwa C, Kirk CM, Beck K, Ndayisaba A, et al. Risk factors for stunting among children under five years: a cross-sectional population-based study in Rwanda using the 2015 Demographic and Health Survey. BMC Public Health 2019; 19(1): 175. DOI: https://doi.org/10.1186/s12889-019-6504-z
Trihono T, Atmarita A, Tjandrarini D, Irawati A, Utami N, Tejayanti T, et al. Stunting in Indonesia: Problems and Solutions. Jakarta: Ministry of Health Indonesia 2015.
UNICEF, WHO, World Bank Group. Levels and trends in child malnutrition: Key findings of the 2020 edition of the joint child malnutrition estimates. Geneva: UNICEF, WHO, World Bank Group 2020.
Takele BA, Gezie LD, Alamneh TS. Pooled prevalence of stunting and associated factors among children aged 6-59 months in Sub-Saharan African countries: A Bayesian multilevel approach. PLoS One 2022; 17(10): e0275889. DOI: https://doi.org/10.1371/journal.pone.0275889
WHO. Nutrition Landscape Information System (NLIS) country profile indicators: interpretation guide. Geneva: World Health Organization 2010; pp. 24-31.
Akombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, wasting and underweight in Sub-Saharan Africa: A systematic review. Int J Environ Res Public Health 2017; 14(8): 863.
UNICEF. UNICEF's approach to scaling up nutrition for mothers and their children. Discussion paper. Programme Division. New York: UNICEF 2015.
Patriota ÉSO, Abrantes LCS, Figueiredo ACMG, Pizato N, Buccini G, Gonçalves VSS. Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies. Matern Child Nutr 2024; 20(2): e13609. DOI: https://doi.org/10.1111/mcn.13609
République du Burundi, Ministère des Finances du Budget et de la Coopération au Développement Économique, Ministère de la Santé et de la Lutte Contre le Sida, Ministère de l’Environnement de l’Agriculture et de l’Élevage. Enquête Nationale sur la Situation Nutritionnelle et la Sécurité Alimentaire au Burundi. ENSNMB (SMART). Bujumbura: Gouvernement du Burundi 2019.
ISTEEBU, MSPLS, ICF. Troisième Enquête Démographique et de Santé. Bujumbura: ISTEEBU, MSPLS, ICF 2016-2017.
ISTEEBU, MSPLS, ICF. Troisième Enquête Démographique et de Santé. Bujumbura: ISTEEBU, MSPLS, ICF 2010.
République du Burundi, Ministère des Finances du Budget et de la Coopération au Développement Économique, Ministère de la Santé et de la Lutte Contre le Sida, Ministère de l’Environnement de l’Agriculture et de l’Élevage. Enquête Nationale sur la Situation Nutritionnelle et de Mortalité au Burundi. ENSNMB (SMART). Bujumbura: Gouvernement du Burundi 2020.
République du Burundi, Ministère des Finances du Budget et de la Coopération au Développement Économique, Ministère de la Santé et de la Lutte Contre le Sida, Ministère de l’Environnement de l’Agriculture et de l’Élevage. Enquête Nationale sur la Situation Nutritionnelle et de Mortalité au Burundi. ENSNMB (SMART). Bujumbura: Gouvernement du Burundi 2022.
OpenEpi. OpenEpi - Toolkit Shell for Developing New Applications [Internet] 2013 [cited 2025 Jun]. Available from: https: //www.openepi.com/SampleSize/SSPropor
Raosoft Inc. Raosoft Sample Size Calculator [Internet]. Seattle: Raosoft Inc.; 2004 [cited 2025 Jun]. Available from: http: //www.raosoft.com/samplesize.html
Mucchielli R. Les méthodes d’échantillonnage dans les sciences humaines. Paris: ESF Éditeur 1979.
Urbaniak GC, Plous S. Research Randomizer (Version 4.0) [Internet] 2015 [cited 2025 Jun]. Available from: https: //www.randomizer.org/
UNICEF. Recommendations for data collection, analysis and reporting on anthropometric indicators in children under 5 years old. New York: UNICEF 2019.
Sawadogo PM, Sia D, Nguemeleu ET, Kobiane JF, Onadja Y, Robins S. Factors associated with childhood chronic malnutrition in West and Central Africa: a scoping review. Pan Afr Med J 2022; 43: 45. DOI: https://doi.org/10.11604/pamj.2022.43.45.32820
Kassie GW, Workie DL. Determinants of under-nutrition among children under five years of age in Ethiopia. BMC Public Health 2020; 20(1): 1-11. DOI: https://doi.org/10.1186/s12889-020-08539-2
Gassara G, Chen J. Household food insecurity, dietary diversity, and stunting in Sub-Saharan Africa: A systematic review. Nutrients 2021; 13(12): 4401. DOI: https://doi.org/10.3390/nu13124401
Bogale B, Gutema BT, Chisha Y. Prevalence of stunting and its associated factors among children of 6-59 months in Arba Minch Health and Demographic Surveillance Site (HDSS), Southern Ethiopia: A community-based cross-sectional study. J Environ Public Health 2020; 2020: 9520973. DOI: https://doi.org/10.1155/2020/9520973
Musimwa MA. Malnutrition chez l’enfant de moins de 5 ans à Lubumbashi et ses environs: Approche épidémio-clinique et biochimique dans un milieu minier [dissertation]. Lubumbashi: Université de Lubumbashi 2017.
Nakar Djindil S. Insécurité alimentaire et stress politique au Guéra, Tchad 1965-2006: Étude de l’impact à long terme des violences sur la production agricole, l’organisation sociale et l’accès aux services de santé 2021; pp. 172-204.
Mongbo V, Ade GNJ, Sossa-Jerome C, Makoutodé P, Saïzonou J, Aguemon B, et al. Facteurs associés à la malnutrition chez les enfants de moins de cinq ans de Za-Kpota, Bénin, 2018. Rev Mar Santé Publique 2022; 9(14).
Boah M, Azupogo F, Amporfro DA, Abada LA. The epidemiology of undernutrition and its determinants in children under five years in Ghana. PLoS One 2019; 14(7): e0219665. DOI: https://doi.org/10.1371/journal.pone.0219665
Miah R, Apanga P, Abdul-Haq Z. Risk factors for undernutrition in children under five years old: Evidence from the 2011 Ghana Multiple Indicator Cluster Survey. J AIDS Clin Res 2016; 7. DOI: https://doi.org/10.4172/2155-6113.1000585
Danso F, Appiah MA. Prevalence and associated factors influencing stunting and wasting among children aged 1 to 5 years in Nkwanta South Municipality, Ghana. Nutrition 2023; 110: 111996. DOI: https://doi.org/10.1016/j.nut.2023.111996
Amare ZY, Ahmed ME, Mehari AB. Determinants of nutritional status among children under age 5 in Ethiopia: further analysis of the 2016 Ethiopia Demographic and Health Survey. Glob Health 2019; 15(1): 62. DOI: https://doi.org/10.1186/s12992-019-0505-7
Poda GG, Hsu CY, Chao JCJ. Factors associated with malnutrition among children <5 years old in Burkina Faso: evidence from the Demographic and Health Surveys IV 2010. Int J Qual Health Care 2017; 29(7): 901-8. DOI: https://doi.org/10.1093/intqhc/mzx129
Richard SA, Black RE, Gilman RH, Guerrant RL, Kang G, Lanata CF, et al. Wasting is associated with stunting in early childhood. J Nutr 2012; 142(7): 1291-6. DOI: https://doi.org/10.3945/jn.111.154922
Organisation mondiale de la santé (OMS). Carnet de croissance — fille. La croissance de votre enfant de la naissance à l’âge de 5 ans. Genève: OMS 2008; p. 46.
Nsubuga EJ, Kato IA, Lee S, Ssenyondo M, Isunju JB. Predictors of stunting and underweight among children aged 6 to 59 months in Bussi Islands, Wakiso District, Uganda: A cross-sectional study. Nutr Metab Insights 2022; 15: 11786388221125107. DOI: https://doi.org/10.1177/11786388221125107
Shinsugi C, Matsumura M, Karama M, Tanaka J, Changoma M, Kaneko S. Factors associated with stunting among children according to the level of food insecurity in the household: a cross-sectional study in a rural community of Southeastern Kenya. BMC Public Health 2015; 15(1): 441. DOI: https://doi.org/10.1186/s12889-015-1802-6
Seretew WS, Tesema GA, Yirsaw BG, Argaw GS. Prevalence of stunting and associated factors among children under five in sub-Saharan Africa: multilevel ordinal logistic regression analysis modeling. PLoS One 2024; 19(6): e0299310. DOI: https://doi.org/10.1371/journal.pone.0299310
Fenske N, Burns J, Hothorn T, Rehfuess EA. Understanding child stunting in India: a comprehensive analysis of socio-economic, nutritional and environmental determinants using additive quantile regression. PLoS One 2013; 8(11): e78692. DOI: https://doi.org/10.1371/journal.pone.0078692
Kombi BJ, Agho KE, Hall JJ, Wali N, Renzaho AMN, Merom D. Stunting, wasting and underweight in Sub-Saharan Africa: a systematic review. Int J Environ Res Public Health 2017; 14(8): 863. DOI: https://doi.org/10.3390/ijerph14080863
Khan S, Zaheer S, Safdar NF. Determinants of stunting, underweight, and wasting among children <5 years of age: evidence from the 2012-2013 Pakistan demographic and health survey. BMC Public Health 2019; 19(1): 358. DOI: https://doi.org/10.1186/s12889-019-6688-2
Thurstans S, Opondo C, Seal A, Wells J, Khara T, Dolan C, et al. Boys are more likely to be undernourished than girls: a systematic review and meta-analysis of sex differences in undernutrition. BMJ Glob Health 2020; 5(12): e004030. DOI: https://doi.org/10.1136/bmjgh-2020-004030
Batool M, Saleem J, Zakar R, Butt MS, Iqbal S, Haider S, et al. Relationship of stunting with water, sanitation, and hygiene (WASH) practices among children under the age of five: a cross-sectional study in Southern Punjab, Pakistan. BMC Public Health 2023; 23(1): 2153. DOI: https://doi.org/10.1186/s12889-023-17135-z
Fenn B, Bulti AT, Nduna T, Duffield A, Watson F. An evaluation of an operations research project to reduce childhood stunting in a food-insecure area in Ethiopia. Public Health Nutr 2012; 15(9): 1746-54. DOI: https://doi.org/10.1017/S1368980012001115
Ali D, Saha KK, Nguyen PH, Diressie MT, Ruel MT, Menon P, et al. Household food insecurity is associated with higher child undernutrition in Bangladesh, Ethiopia, and Vietnam, but the effect is not mediated by child dietary diversity. J Nutr 2013; 143(12): 2015-21. DOI: https://doi.org/10.3945/jn.113.175182
Ali Naser I, Jalil R, Wan Muda WM, Wan Nik WS, Mohd Shariff Z, Abdullah MR. Association between household food insecurity and nutritional outcomes among children in Northeastern of Peninsular Malaysia. Nutr Res Pract 2014; 8(3): 304-11. DOI: https://doi.org/10.4162/nrp.2014.8.3.304
Agho KE, Mukabutera C, Mukazi M, Ntambara M, Mbugua I, Dowling M, et al. Moderate and severe household food insecurity predicts stunting and severe stunting among Rwanda children aged 6-59 months residing in Gicumbi district. Matern Child Nutr 2019; 15(3): e12767. DOI: https://doi.org/10.1111/mcn.12767
Wakpo A. Insécurité alimentaire des ménages: lien avec l’état nutritionnel anthropométrique des enfants de 6 à 59 mois, de leurs mères et le double fardeau nutritionnel, à Kpozoun, commune de Za-kpota au Bénin [thesis]. Cotonou (Bénin): Université Abomey - Calavi 2014.
World Food Programme. Food Consumption Score - Data Analysis - WFP VAM Resource Centre. Rome: WFP 2019.
Chirande L, Charwe D, Mbwana H, et al. Determinants of stunting and severe stunting among under-fives in Tanzania: evidence from the 2015 cross-sectional household survey. BMC Pediatr 2015; 15: 165. DOI: https://doi.org/10.1186/s12887-015-0482-9
Hasan MM, Asif CAA, Barua A, Banerjee A, Kalam MA, Kader A, et al. Association of access to water, sanitation and handwashing facilities with undernutrition of children below 5 years of age in Bangladesh: evidence from two population-based, nationally representative surveys. BMJ Open 2023; 13(6): e065330. DOI: https://doi.org/10.1136/bmjopen-2022-065330
Kim R, Subramanian SV, Orav EJ, Fawzi WW. The role of water and sanitation, diarrheal infection, and breastfeeding on child stunting: insights from a historical analysis of the Cebu longitudinal health and nutrition survey, 1984-1986. J Glob Health Sci 2019; 1: e1. DOI: https://doi.org/10.35500/jghs.2019.1.e1
Hall A, Hewitt G, Tuffrey V, de Silva N. A review and meta-analysis of the impact of intestinal worms on child growth and nutrition. Matern Child Nutr 2008; 4(Suppl 1): 118-236. DOI: https://doi.org/10.1111/j.1740-8709.2007.00127.x
Owoaje E, Onifade O, Desmennu A. Family and socioeconomic risk factors for undernutrition among children aged 6 to 23 months in Ibadan, Nigeria. Pan Afr Med J 2014; 17: 161.
https://doi.org/doi: 10.11604/pamj.2014.17.161.2389 DOI: https://doi.org/10.11604/pamj.2014.17.161.2389
Ansuya N, Nayak BS, Unnikrishnan B, George A, N SY, Mundkur SC, et al. Risk factors for malnutrition among preschool children in rural Karnataka: a case-control study. BMC Public Health 2018; 18(1): 283. DOI: https://doi.org/10.1186/s12889-018-5124-3
Gizaw Z, Demissie NG, Gebrehiwot M, Bitew BD, Nigusie A. Oral hygiene practices and associated factors among rural communities in northwest Ethiopia. BMC Oral Health 2024; 24(1): 315. DOI: https://doi.org/10.1186/s12903-024-04049-4
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