Factors Associated with Stunting among Children Aged 0 to 59 Months in Harare City, Zimbabwe


  • Julita Maradzika Department of Community Medicine, College of Sciences, Health University of Zimbabwe
  • Israel P. Makwara Harare City Health Department of Health Promotion
  • S. Chipunza Harare City Health Department of Health Promotion




Stunting, mother-child pair, risk factors, social determinants of health.


Background: Child malnutrition is a major public health problem in Zimbabwe and it has been one of the leading causes of morbidity and mortality in children under five years of age in the City of Harare.

Methods: An analytic cross sectional survey was conducted on 342 mothers – child pairs of children aged 0 – 59 months in Harare’s suburbs between July and August 2014.The aim of the study was to identify factors associated with the high levels of stunting among children age 0 – 59 months. Bivariate and multivariate analyses were used to establish the risk factors for U5 years stunting.

Findings: A total of 29.2% of the children were stunted with (19.3% being moderately stunted and 9.9% severely stunted). More females (32.9%) were stunted compared to (25.9%) males. The main contributing factors for stunting among the children 0 - 59 months were found to be lack of mother’s education adjusted pOR=0.49 (95%CI: 1.04-3.27); being unemployed pOR=1.22 (95%CI: 1.08-2.03); residing in high density suburbs pOR=2.14 (95%CI: 1.61-7.55); child ever being hospitalized pOR=1.04 (95%CI: 1.01-2.14); breastfed after > 1 hour after birth pOR=1.11 (95%CI: 1.09-1.80); complementary feeds < 6 months pOR=1.30 (95%CI: 1.17-2.21); low birth weight pOR=1.46 (95%CI: 1.29-3.51) and having a poor dietary diversity pOR=1.07 (95%CI: 1.01-1.84).

Conclusions: Lack of mother’s education is the principal risk factor for stunting among the under five children in Harare exacerbated by unemployment of either the father or mother or relative, area of residence, feeding practices, birth weight, illness and infections and household dietary diversity.

Stunting is on the increase in Harare. The findings also revealed a high level of in-equalities in social determinants of health since stunting is related to socio-economic factors.

Recommendations: Any nutrition intervention has to use strategies that will comprehensively address the social determinants of health and improve the standard of living of households in the high density areas so as to have a ripple effect on the nutritional status of U5s.


[1] Grantham-McGregor S, Cheung YB, Cueto S, et al. Developmental potential in the first 5 years for children in developing countries. Lancet 2007; 369: 60-70.
[2] World Health Organization (WHO). Multicenter Growth Reference Study Group Assessment of differences in linear growth among populations in the WHO multicenter Growth reference Study. Acta Paediatric Suppl 2006; 450: 56-65.
[3] United Nations Children’s Fund. The state of the World’s Children. UNICEF, New York 2010. [Online] Available at: http://www.unicef.org/sowccp. Accessed on 14th November 2014.
[4] UNICEF-WHO-The World Bank Joint Child Malnutrition Levels & Trends in Child Malnutrition Estimates United Nations Children’s Fund, World Health Organization, and the World Bank. UNICEFWHO- World Bank (UNICEF, New York; WHO, Geneva; the World Bank, Washington, DC; 2012). WHO Library Cataloguing-in-Publication Data.
[5] Food and Nutrition Council. Zimbabwe national nutrition survey, Jan – Feb 2010 Preliminary findings. MOHCW and FAO.
[6] Zimbabwe National Statistics Agency (ZIMSTAT) and ICF International. 2012. Zimbabwe Demographic and Health Survey 2010-11. Calverton, Maryland: ZIMSTAT and ICF International.
[7] Central Statistical Office (CSO) [Zimbabwe] and Macro International, Inc. 2007. Zimbabwe Demographic and Health Survey 2005-2006 Calverton, Maryland: CSO and Macro International, Inc.
[8] Central Statistical Office [Zimbabwe] and Macro International Inc. 1995. Zimbabwe Demographic and Health Survey, 1994. Calverton, Maryland: Central Statistical office.
[9] Zimbabwe National Nutrition Survey 2010http://www.unicef. org/zimbabwe/media_12637.html/ accessed 30th November 2010.
[10] Harare City Council Nutrition Annual Report 2007-2010 Health City Health Department Zimbabwe.
[11] Mandefro A, Mekitie W, Mohammed T, et al. Prevalence of undernutrition and associated factors among children aged between six to fifty nine months in Blue Hora district, South Ethiopia. BMC Public Health 2015; 15: 41.
[12] Kandala NB, Tamaki P, Madang J, Emina BO, Kikhela PD. Malnutrition among children under the age of five in the Democratic Republic of Congo (DRC): does geographic location matter? BMC Public Health 2011; 11: 261 http://www.biomedcentral.com/1471-2458/11/261 accessed 28th September 2014
[13] Teshome B, Wambui KM, Zewditu G, Girum T. Magnitude and determinants of stunting in children under- five years of age in food surplus region of Ethiopia: The case of West Gojam Zone. Ethiopian J Health Dev 2009; 23: 98-106.
[14] Zere E, McIntyre D. Inequities in under-five child malnutrition in South Africa. Int J Equity Health 2003; 2: 7.
[15] El Taguri A, Betilmal I, Mahmud SM, et al. Risk factors for stunting in Libya. Public Health Nutr 2009; 12: 1141-9.
[16] Christiansen L, Alderman H. Child Malnutrition in Ethiopia: Can Maternal Knowledge Augment The Role of Income? 2001 The World Bank. Available from:http://www.worldbank. org.za. Accessed may 2014.
[17] Ricci JA, Becker S. Risk factors for wasting and stunting among children in Metro Cebu, Philippines. 2012. Am J Clin Nutr 1996; 63: 966-75.
[18] Rayhan I, Hayut Khan MS. Factors causing malnutrition among under five children in Bangladesh. J Nutr 2006; 5: 558-62.
[19] Akorede QJ, Abiola OM. Assessment of nutritional status of under five Children in Akure south local government, Ondo State, Nigeria March 2013 IJRRAS 14-4 www.arpapress.com/Volumes/Vol14Issue3/IJRRAS_14_3_24.pdf accessed 25th November 2015.
[20] Senbajo IO, Oshikoya KA, Odusanya O, Njokanma OF. Prevalence of and risk factors for stunting among school children and adolescents in Abeokuta, Southwest Nigeria. J Health Popul Nutr 2011; 29: 364-70.
[21] Orach CG, Kolsteren P. Outpatient care for severely malnourished children. Lancet 2002; 360: 1800-1.
[22] Ayaya SO, Esamai FO, Rotich J, Olwambula AR. Socio-economic factors predisposing under five-year-old children to severe protein energy malnutrition at the Moi Teaching and Referral Hospital, Eldoret, Kenya. Eastern African Med J 2004; 81: 415-21.
[23] Caulfield LE, De Onis M, Blössner M, Black RE. Undernutrition as an underlying cause of child deaths associated with diarrhea, pneumonia, malaria and measles. Am J Clin Nutr 2004; 80: 193-8.
[24] Guerrand RL, De Boer MD, Moore SR, Scharf RJ, Lima AAM. Nature Reviews Gastroenterology and Hepatology 2013; 10: 220-229. doi:10.1038/nrgastro.2012.239 www.nature.com › Journal home › Archive › Review accessed July 2014.
[25] GOZ Government of Zimbabwe “ZIMASSET 2013 Zimbabwe Agenda for Sustainable Socio-Economic Transformation” Towards an Empowered Society and a Growing Economy OCTOBER 2013- DECEMBER 2018 Government printers.






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