Date of Award

12-2021

Degree Type

Thesis

Degree Name

MS in Epidemiology & Biostatistics

First Advisor

Dr. Narjis Rizvi

Second Advisor

Syed Iqbal Azam

Third Advisor

Dr. Sajid Soofi

Department

Community Health Sciences

Abstract

Introduction: On a global scale, 149.2 million children under the age of 5 years have malnutrition issues that has led to childhood stunting (height-for-age z-score < 2). It is pertinent to note that the level of stunting in Pakistan has reached an alarming rate of 38% (moderately stunted) and 17% children (severely stunted) as reported by the PDHS 2017-18 survey. A stunted child faces the risks of morbidity and mortality by non[1]communicable diseases and cognitive impairments such as linguistic and motor capabilities in adulthood. Among the many maternal factors of stunting, maternal empowerment and maternal education may impact potential stunting of a child. Previously, there have been no studies reflecting the association between women’s empowerment and childhood stunting conducted in Pakistan. Hence, this study on the PDHS 2017-18 survey aims to furnish information on that front.
Methods: Secondary data analysis was done on the Pakistan Demographic Health Survey 2017-18. Our study had a sample size of 1,930 with a mother (15-49 years) and her child (0-59 months) where the mother was also a part of the domestic violence module and a child had anthropometric measurements. The outcome variable was stunting status with three categories: normal, moderately stunted, severely stunted. The main predictor variables were maternal education, women’s empowerment, household’s sociodemographic factors and child’s dietary variables. Since women’s empowermentis a composite variable with many aspects, so a women’s empowerment scale was made. The scale has a total of selected 16 binary questions and has been given a score 0-16. There were three sections of the women’s empowerment scale, domestic violence, financial independence and women’s decision-making in the household and fertility matters. Statistical methods such as descriptive and ordinal logistic regression were applied, and a final model was obtained.
Results: The factors maternal education, wealth index and breastfeeding status are positively associated with preventing stunting, while women’s empowerment had a protective effect against stunting with breastfeeding status. Children of mothers with any formal schooling and 2.87 (OR 2.87,1.66-4.96 :95%CI) times more likely to have not stunted children than mothers who belong to the lowest wealth quintile and have no formal education. Odds of moderate to severe stunting are 2.44 times higher (OR 2.44 ,1.38-4.31: 95%CI)) in children with household lying in the lowest wealth quintile. 49.4% of women are currently breastfeeding their children. A child who is currently being breastfed had 56% chance of being not stunted compared to the child who was never breastfed. Women empowerment is not significant OR 0.98(0.93-1.04: 95%CI).
Conclusion: The study discovered a significant association between maternal education childhood stunting, while there is an interaction between women’s empowerment and breastfeeding status. The effect of maternal education on childhood stunting was strongest when comparing literate to illiterate mothers. Hence, there is a dire need to address the issue of education and programs to increase awareness to mothers on how to improve their child’s nutrition and consequent health outcomes. These are poignant issues for Pakistan and a better understanding of the issues linking maternal education and empowerment with childhood stunting can help authorities to form effective policies.

First Page

1

Last Page

117

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