Utilizing A Multi-Stage Transition Model For Analysing Child Stunting In Two Urban Slum Settlements Of Nairobi: A Longitudinal Analysis, 2011-2014
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Date
2024
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PLOS ONE
Abstract
Introduction
Stunting is common among children in many low- and middle-income countries, particularly
in rural and urban slum settings. Few studies have described child stunting transitions and
the associated factors in urban slum settlements. We describe transitions between stunting and
states and associated factors among children living in Nairobi slum settlements.
Methods
This study used data collected between 2010 and 2014 from the Nairobi Urban and Demographic Surveillance System (NUHDSS) and a vaccination study conducted within the surveillance system. A subset of 692 children aged 0 to 3 years, with complete anthropometric
data, and household socio-demographic data was used for the analysis. Height-for-age Z-scores (HAZ) was used to define stunting: normal (HAZ ⿽ 1), marginally stunted (-2 ⿽ HAZ).
< -1), moderately stunted (-3; HAZ < -2), and severely stunted (HAZ < -3). Transitions from
one stunting level to another and in the reverse direction were computed. The associations
between explanatory factors and the transitions between four child stunting states were
modeled using a continuous-time multi-state model.
Results
We observed that 48%, 39%, 41%, and 52% of children remained in the normal, marginally
stunted, moderately stunted, and severely stunted states, respectively. About 29% transitioned from normal to marginally stunted state, 15% to a moderately stunted state, and
8% to the severely stunted state. Also, 8%, 12%, and 29% back transitioned from severely
stunted, moderately stunted, and marginally stunted states to the normal state,respectively. The shared common factors associated with all transitions to a more severe
state include: male gender, ethnicity (only for mild and severe transition states), child’s age,
and household food insecurity. In Korogocho, children whose parents were married and
those whose mothers had attained primary or post-primary education were associated with
a transition from a mild state into a moderately stunted state. Children who were breastfed
exclusively were less likely to transition from moderate to severe stunting state.
Conclusion
These findings reveal a high burden of stunting and transitions in urban slums. Context-specific interventions targeting the groups of children identified by the socio-demographic factors are needed. Improving food security and exclusive breastfeeding could potentially
reduce stunting in the slums.
Description
Research Article
Keywords
Nairobi, multi-stage transition model, child stunting