Factors Associated with Stunted Growth in Children Under Five Years in Antananarivo, Madagascar and Bangui, Central African Republic
Pascale Vonaesch, Serge Ghislain Djorie, Kaleb Jephté Estimé Kandou, Maheninasy Rakotondrainipiana, Laura Schaeffer, Prisca Vega Andriatsalama, Ravaka Randriamparany, Bolmbaye Privat Gondje, Synthia Nazita Nigatoloum, Sonia Sandrine Vondo, Aurélie Etienne, Annick Robinson, Francis Allen Hunald, Lisette Raharimalala, Tamara Giles‐Vernick, Laura Tondeur, Frédérique Randrianirina, Alexandra Bastaraud, Jean‐Chrysostome Gody, Philippe Sansonetti, Rindra Vatosoa Randremanana, AFRIBIOTA Investigators, Laurence Barbot-Trystram, Robert Barouki, Alexandra Bastaraud, Jean‐Marc Collard, Maria Doria, Aurélie Etienne, Serge Ghislain Djorie, Tamara Giles‐Vernick, Bolmbaye Privat Godje, Jean‐Chrysostome Gody, Francis Allen Hunald, Nathalie Kapel, Jean-Pierre Lombart, Alexandre Manirakiza, Synthia Nazita Nigatoloum, Lisette Raharimalala, Maheninasy Rakotondrainipiana, Rindra Vatosoa Randremanana, Harifetra Mamy Richard Randriamizao, Frédérique Randrianirina, Annick Robinson, Pierre‐Alain Rubbo, Philippe Sansonetti, Laura Schaeffer, Ionela Gouandjika-Vassilache, Pascale Vonaesch, Sonia Sandrine Vondo, Inès Vigan-Womas
Abstract
OBJECTIVES: With a fourth of all under-five children affected, stunting remains one of the biggest health challenges worldwide. Even though the main underlying factors are known, the exact pathways to stunting varying in affected regions, and interventions thus need to be tailored to the local contexts. This study aimed assessing and comparing factors associated with stunting in two understudied sub-Saharan urban contexts with some of the highest stunting prevalence globally: Bangui, Central African Republic (~ 36%) and Antananarivo, Madagascar (42%). METHODS: We performed a case-control study on 175 + 194 stunted and 237 + 230 non-stunted control children aged 2-5 years and matched for age, gender and district of residency. Factors associated with stunting were identified using a standardized, paper questionnaire delivered by trained interviewers. Statistical analysis was done using logistic regression modelling. RESULTS: In both sites, formal maternal education lowered the risk of being stunted and restricted access to soap, suffering of anaemia and low birth weight were associated with higher risk of stunting. Short maternal stature, household head different from parents, diarrhoea and coughing were associated with an increased risk and continuing breastfeeding was associated with a lower risk of stunting in Antananarivo. Previous severe undernutrition and dermatitis/ fungal skin infections were associated with higher and changes in diet during pregnancy with lower risk of stunting in Bangui. CONCLUSIONS: Our results suggest maternal education, antenatal care, iron supplementation and simple WASH interventions such as using soap and infection control as general and breastfeeding (Antananarivo) or better nutrition (Bangui) as area-specified interventions.