Care and feeding practices and their association with stunting among young children residing in Karachi's squatter settlements

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


The nutrition, growth and development of infants and young children depends not only on sufficient food, but also adequate health services and appropriate care behaviors. A household's capacity to provide care to a child is dependent on the availability of resources within the household and the wider community. These resources are not only economic but also include maternal skills and behaviors that can be learnt. The nutritional status of children is a good indicator of overall well being in a society and reflects food security as well as existing health care and environmental conditions. In Pakistan, it is estimated that nearly 40-50% of children under the age of five are stunted, or low height-for-age. Inadequate feeding and repeated illness are the immediate causes of stunting which are exacerbated as a result of household food insecurity, unhygienic environment and the consequent inability of families to adequately take care of their young. The objective of this study was to explore various child-care and feeding practices prevalent among children between the ages of six and eighteen months residing in Karachi's squatter settlements and to identify feeding and care factors associated with stunting among them. A community-based cross sectional survey was conducted in eight squatter settlements of Karachi between October and December 2000. A total of 399 mothers of eligible children were interviewed using a structured questionnaire. Anthropometric measurements were also taken of the mother and child. Stunting was classified as height/length-for-age Z-score less than -2 standard deviations and evaluated against the currently recommended international growth reference, i.e. the US National Center for Health Statistics reference population (NCHS). The final results of our study indicated that being a female child (aOR=2.8, 95% CI: 1.6, 4.7) as well as household food insecurity in the past 12 months (aOR=2.8, 95% CI: 1.6, 4.9) were strongly associated with young children being stunted. Among socio demographic and parental characteristics, no formal schooling of the mother (aOR=2.7; 95% CI: 1.3, 5.6); and peri-urban residence (aOR=2.0; 95% CI: 1.1, 3.8) were also significantly associated with a child being stunted. Stunted children also appeared to be from large households (aOR=1 .1; 95% CI: 0.9, 3.0). These results suggest that in this population, linear growth among young children influenced by household food insecurity compounded by large household size, lack maternal education as well as a gender preference in favor of the male child. It is recommended that an investment into basic services such as primary education especially of girls are essential to break the cycle of malnutrition, along with a clear set of guidelines for the community regarding cheap, easily available and appropriate home foods to feed their child. However, in poor households where food insecurity exists, knowledge on care and feeding practices may not be sufficient and other types of interventions such as food stamps must precede or accompany educational efforts if an impact on child health and nutrition is to be expected.

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