Abstract
Background
Child undernutrition remains a critical issue worldwide, with Pakistan particularly struggling in South Asia. While recent studies have identified some risk factors, their relative importance is unclear. This study examines the extent of child undernutrition and the relative importance of risk factors in Punjab, Pakistan's largest province.
Methods
The study presents a trend analysis to examine undernutrition patterns in Punjab’s high-risk districts between 2004 and 2018 using data from five rounds of the Multiple Indicator Cluster Survey (MICS). Additionally, it uses binary logit regressions to assess the relative significance of 25 risk factors associated with stunting, underweight, and wasting among 38,495 preschool-age children from MICS 2018. The paper ranks a set of significant environmentally modifiable risk factors based on their strongest effect sizes. The sample of children aged 0 to 59 months was also divided into two subsets: children aged 0 to 5 months and those aged 6 to 35 months.
Results
The study observed significant reductions in stunting, underweight, and wasting, particularly in Central-North Punjab, though stunting rates have risen in 13 of 36 districts, and South Punjab experiences persistent regional disparities in underweight rates. Five key predictors identified for stunting and underweight include household poverty, maternal education, short birth intervals, underage childbirth, and low birth weight; and for wasting low birth weight, maternal education, incomplete vaccination, and recent fever. Lack of dietary diversity for children aged 6–35 months and non-exclusive breastfeeding and non-assisted deliveries for those aged 0–5 months are major challenges. A sensitivity analysis revealed consistent effect sizes, while an analysis of children with severe undernutrition revealed stable major correlates and some differences in their relative rankings.
Conclusions
The study suggests that the intervention strategies implemented in Punjab post-2007 have been partially effective in reducing childhood undernutrition, providing valuable insights. The analysis of risk factors highlights the need for a comprehensive, multifaceted approach that combines socioeconomic strategies with nutritional investment programs to effectively address undernutrition in the province. These policy implications are crucial for shaping future interventions aimed at reducing childhood undernutrition.