Child's Gender and Household Food Insecurity are Associated with Stunting among Young Pakistani Children Residing in Urban Squatter Settlements

BACKGROUND: The nutritional status of children is a good indicator of the overall well-being of a society and reflects food security as well as existing health-care and environmental conditions. In Pakistan, it is estimated that nearly 40% to 50% of children under the age of five are stunted. Due to greater economic opportunities available to the urban population as compared to the rural, it was believed that economic resources existed in poor urban Pakistani households but that the households lacked the skills and knowledge to translate their resources into good care and feeding practices. OBJECTIVE: This study aimed 1) to assess the prevalent care and feeding practices among children aged 6 to 18 months residing in the squatter settlements of Karachi and 2) to identify care and feeding practices, as well as any other underlying factors, associated with stunting. METHODS: A cross-sectional survey was conducted in eight settlements between October and December 2000. A total of 433 mothers of eligible children were interviewed with the use of structured questionnaires. Final analysis using multiple logistic regression was conducted on 399 mother-child pairs. RESULTS: Female children were nearly three times more likely to be stunted than male children. Households that were food insecure with hunger were also three times more likely than other households to have a stunted child. Lack of maternal formal schooling (adjusted prevalence odds ratio, 2.9; 95% confidence interval, 1.4 to 3.8) and large household size (adjusted prevalence odds ratio, 1.7; 95% confidence interval, 1.0 to 3.8) were also associated with stunting. Even though certain care and feeding practices were significant at the univariate level, they were not significant in the final multivariate analysis and so were excluded from the final model. CONCLUSIONS: In households where food insecurity exists, knowledge of care practices may not be sufficient, and interventions such as food subsidies must precede or accompany educational efforts. Further follow-up is required to explore the effect of gender differences on child care.