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 Table of Contents  
ORIGINAL ARTICLE
Year : 2017  |  Volume : 30  |  Issue : 4  |  Page : 1089-1092

Prevalence of stunted growth in children less than 5-year old in Qualyoubia governorate


1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Pediatric, Faculty of Medicine, Menoufia University, Menoufia, Egypt
3 Department of Family Medicine, Kafr Shouker Family Health Units, Kfer Shoukrer, Egypt

Date of Submission16-Mar-2017
Date of Acceptance29-May-2017
Date of Web Publication04-Apr-2018

Correspondence Address:
Hend N Abdel El Halim
El Monshat El Soghra, Kafr Shouker, El Qualyoubia 32917
Egypt
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mmj.mmj_158_17

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  Abstract 


Objectives
The objective of this study was to study the prevalence of stunted growth in children under 5 years of age (in primary healthcare) in a rural area, in Qualyoubia governorate.
Background
Stunting remains an important problem in Egypt, where ∼ one-third of children under 5 years of age are affected.
Patients and methods
This is a cross-sectional study that was conducted on 1255 cases. All studied children were subjected to history taking, complete physical examination [height (cm), length (cm), weight (kg)], and laboratory investigations (measurement of hemoglobin level). Then, the stunting group was compared with the control group regarding their different characteristics according to national Egyptian growth chart.
Results
The prevalence of stunted growth in children under 5 years of age was 13.32%; stunted growth was significantly associated with age of children (stunting was more in children aged <24 months) (P = 0.005), socioeconomic level (P = 0.004), family history of short stature (P < 0.05), family size more than five (P = 0.004), and low hemoglobin level (P < 0.001).
Conclusion
The prevalence of stunted growth in children under 5 years of age attending primary healthcare in a rural area in Qualyoubia governorate was 13.32%.

Keywords: children below 5 years, prevalence, risk factors, rural area, stunting growth


How to cite this article:
Farahat TM, Ragab S, Salama AA, Abdel El Halim HN. Prevalence of stunted growth in children less than 5-year old in Qualyoubia governorate. Menoufia Med J 2017;30:1089-92

How to cite this URL:
Farahat TM, Ragab S, Salama AA, Abdel El Halim HN. Prevalence of stunted growth in children less than 5-year old in Qualyoubia governorate. Menoufia Med J [serial online] 2017 [cited 2018 Jul 21];30:1089-92. Available from: http://www.mmj.eg.net/text.asp?2017/30/4/1089/229202




  Introduction Top


Stunting remains a very important problem in Egypt, as one-third of children under 5 years of age are affected[1]. According to the United Nations Children's Fund (UNICEF), the largest number of stunted children in the Middle East was in Egypt, as ∼2.7 million children are suffering from growth failure[2].

By definition, growth impairment is considered a relatively early sign of poor health in children, depending on its setting and the age of the child. Failure to thrive is a term often used in the first years of life and is either defined as poor weight for age, poor weight for length, or poor length for age[3]. Delayed growth occurs all over the world, and there are no different prevalences in different countries, indicating that the pathological causes of primary or secondary growth failure are, except for growth failure caused by malnutrition, highly dependent on socioeconomic condition. Although there are similarities of the clinical presentation of growth failure in different parts of the world, there are many variations in the national guidelines for the diagnostic approach to short stature[4].

It is common to consider stunting as determined by three main factors:

  1. The child's birth weight
  2. His or her food intake[5]
  3. Whether the child has suffered from diseases such as diarrhea or respiratory infections and has been treated adequately for these[6].


Another type of condition effect is the child's age[7], sex, nutritional status of her or his mother – indicated, for example, by her height and BMI[8] – and socioeconomic level. Another type of condition effect is that a child's chance of getting an infectious disease, or a particular severe version of the disease, may be particularly high when there are many children and also a more crowded environment. Such effects have been suggested[9], especially for measles and some respiratory infections, although there are also examples of beneficial effects, possibly because of immune mechanisms, or long-term corticosteroid treatment; also, the number of pregnancies and births, and the intervals between them, may have had consequences for the mother's health[10].


  Patients and Methods Top


The study was conducted during the period from the beginning of July 2015 to the end of June 2016 in family health units in randomly selected rural areas (El Menshya El Kopra village, El Menshya El Soghera village and El Safen village) of Kafr Shoker district, Qualyoubia governorate. The study was conducted in family health units in the selected villages. The study was approved by the Research Ethics Committee Menoufia University, and written informed consent was signed by one of the parents. Children under 5 years old who attended to family health units in selected rural areas in regular visits were the target population for this study. Randomization was done through selection of every third child at the beginning of the working day (2 days in each unit). The study sample size was calculated using the lowest and height prevalence of stunting in the previous studies. Epi Info programmer (Atlanta, Georgia, USA) with 95% confidence interval was used to calculate the sample size (it was 300 children, which increased to 304) according to the recorded number of children under 5 years old in the selected three villages. Therefore, the calculated sample size of stunted growth was 304 out of 2281 participants, who were screened for stunting. Normal patients were considered as the control group.

Exclusion criteria were refusal to participate in the study, and a parent with short stature (one of them or both below 150 cm). These data were identified by reviewing the family health records and children with congenital anomalies.

Each child of the study group was subjected to history taking, including personal data such as age, sex, and socioeconomic standard. According to El-Gillany et al.[11] which was assessed through their education, occupation, income, number of individuals per room, type of housing, material possessions, and so on.

Past and present history of the child were recorded, such as history of diseases since birth, including gastroenteritis, otitis media, asthma, anemia, cardiac diseases, tonsillitis, delayed growth, teething, history of operation, hospitalization, and its causes.

Complete nutrition assessment was performed (assessed according to the nutritional needs of the children by 24-h recall).

Complete physical examination was performed as follows: height (cm) was measured barefoot, with the child above 2 years standing straight; length (cm) was measured while the child was lying down if the child was less than 2 years old; and weight (kg) was recorded using portable weighting scale with the child barefoot standing straight with heels together while wearing light clothes. The children were classified according to Egyptian National Growth Chart 2002 centiles regarding their height and weight as follows.

A child with height below the fifth centile was considered stunted, a child with height from above or equal to the fifth centile to below 85th centile was considered normal, and no children were found with height equal or above the 85th centile.

Laboratory investigation included estimation of hemoglobin by Sahali's method (according to HiMedia Laboratories Pvt India Est., Mumbai, India).

The hemoglobin level of the child was considered normal if it was above 11 mg/dl, and the child was considered anemic if the value was less than 11 mg/dl.

Statistical analysis

Data were collected by thorough history taking, basic physical examination, laboratory investigations, and outcome measures all were coded. Coded data were entered on the computer using a database developed for data entry on Microsoft Office Excel program for Windows, 2007. Data entry took place on a daily basis at the end of each working day. Data were then transferred to the statistical package for the social science (SPSS, v 20, SPSS Inc., Chicago, Illinois, USA), for quantitative data analysis. Simple frequencies were used for data checking. Quantitative data of normally distributed variables were expressed as mean and SD.

Qualitative data were expressed as number and percentage and analyzed by χ2-test with determination of the least significant difference between two groups. Level of significance was set at P value less than 0.05.


  Results Top


[Table 1] shows distribution of the studied group according to Egyptian National Growth Chart. The prevalence of children with normal height was 86.68% of the studied group, and prevalence of children with stunted growth was 13.32%.
Table 1: Prevalence of stunted growth among the total examined children according to Egyptian national growth charts

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Child characteristics

This study included 1427 children (735 boys and 692 girls). The characteristics of the children are shown in [Table 2]. The mean age of the studied participants was 22.66 ± 13.56 months. The percentage of girls in the studied group was 48.5%, the percentage of boys in the studied group was 51.5%, 60.5% of the fathers had secondary school education, 41.1% of the fathers were skilled workers/farmers, 79.5% of the mothers were housewives, and 56.7% were from middle socioeconomic status.
Table 2: Child demographic and family history characteristics as risk factors of stunted growth among the studied group

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Demographic and family history characteristics of the child as risk factors of stunted growth, among the studied group, are shown in [Table 2].

There was a statistically significant difference between the two studied groups as regards age (P = 0.005), as age less than 24 months represented a majority of the stunting group (69.1%), age of 24–48 months represented only 27%, and age greater than 48–60 months represented 3.9%.

There was a statistically significant difference between the two studied groups as regards mothers' education (P< 0.001), as mothers' basic education represented 11.5% of the stunting group.

There was a statistically significant difference between the two studied groups as regards fathers' occupation (P = 0.005), with fathers who were skilled workers representing 45.4% of the stunting group.

There was a statistically significant difference between the two studied groups as regards socioeconomic level (P = 0.004); 22.8% of the stunting group and 19.1% of those in the control group were of low socioeconomic status.


  Discussion Top


The present study showed that the prevalence of stunted growth was 13.32% of the study sample and prevalence of children with normal height was 86.68 [Table 1].

This prevalence was slightly lower when compared with the national surveys included in the WHO[12]. The prevalence of childhood stunting was 26.7% in 2010, whereas in Africa the prevalence of childhood stunting was about 40% in 2010.

Another study by El-Zanaty and Way[1], reported that stunting remains a very important problem in Egypt, as one-third of children less than 5 years old suffer from stunted growth.

Another study by the UNICEF reported that Egypt had the largest number of stunted children in the Middle East, as ∼2.7 million children are experiencing stunted growth[2].

A study by Eming Young[13] reported that the prevalence rate of stunting in children less than 5 years old between 1997 and 2011 decreased from 59% in 1997 to 40% in 2011.

The current study revealed that the prevalence of stunting among boys and girls under 5 years of age was 47.4 and 52.6%, respectively. This result was in agreement with those of Islam and Biswas[14], who reported that prevalence rates of chronic stunting among boys and girls less than 5 years old was 43.5 and 56.5%, respectively.

This study revealed that stunted growth was significantly higher among children less than 24 months [Table 2]. This result was in agreement with that of Katona-Apte and Mokdad[15], who reported that stunted growth is confined to those aged 2 years. The process of stunting is essentially beginning all over by children less 2 years of age.

In this study, stunting was higher among children of middle socioeconomic status (48.3%) compared with those of low socioeconomic status [Table 2]; this is in agreement with the study by Larrea and Kawachi[6], who reported that the association between child stunting and socioeconomic status in the Northeast region of Brazil decreased from 34% in 1986 to 6% in 2006 with improved a socioeconomic level of their family.

Another study by Rivera et al.[16] reported that ∼53% of children under 5 years of age from the middle socioeconomic level were stunted compared with only 34% of those in the highest socioeconomic level.


  Conclusion Top


The prevalence of stunting growth was 13.32%. Stunting growth increases with positive family history of stunted growth, presence of anemia, poor nutrition, low weight of children, and history of repeated infection of children such as chest infection, urinary tract infection, and gastroenteritis.

The presence of stunted growth alerts the primary healthcare physician to refer children to detect the underlying cause and for proper management.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
El-Zanaty F, Way A. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health and Population, National Population Council, El-Zanaty and Associates, and ORC Macro; 2009:pp. s12–13.  Back to cited text no. 1
    
2.
United Nation Children's Fund (UNICEF). Child rights report, 2003. Available from: http://www.unicef.org.uk//. [Last accessed on 2013 Mar 05].  Back to cited text no. 2
    
3.
Wright CM. Identification and management of failure to thrive: a community perspective. Arch Dis Child 2000; 82:5–9.  Back to cited text no. 3
    
4.
Grote FK, Oostdijk W, De Muinck Keizer- Schrama SM, Dekker FW, Verkerk PH, Wit JM. Growth monitoring and diagnostic work-up of short stature: an international inventorization. J Pediatr Endocrinol Metab 2005; 18:1031–1038.  Back to cited text no. 4
    
5.
Semba RD, de Pee S, Sun K, Sari M, Akhter N, Bloem MW. Effect of parental formal education on risk of child stunting in Indonesia and Bangladesh: a cross-sectional study. Lancet 2008; 371:322–328.  Back to cited text no. 5
    
6.
Larrea C, Kawachi I. Does income inequality affect child malnutrition? The case of Ecuador. Soc Sci Med 2005; 60:165–178.  Back to cited text no. 6
    
7.
Giroux S. An evaluation of infant growth: the use and interpretation of anthropometry in infants. WHO working group on infant growth. Bull World Health Organ 2008; 73:165–174.  Back to cited text no. 7
    
8.
Rahman A, Chowdhury S. Determinants of chronic malnutrition among preschool children in Bangladesh. J Biosoc Sci 2007; 39:171–173.  Back to cited text no. 8
    
9.
Rutstein SO, Johnson K. The DHS wealth index. DHS Comparative Reports 2004. Calverton, Maryland, USA: ORC Macro; 2004. Available from: http://www.who.int/child_adolescent_health/topics/prevention_care/adolescent/en/index.html. [Last accessed on 2010 Mar 10].  Back to cited text no. 9
    
10.
Zhu BP. Effects of inter pregnancy interval on birth outcomes. Findings from three recent US studies. Int J Gynecol Obstet 2005; 89:25–33.  Back to cited text no. 10
    
11.
El-Gillany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18:962–968.  Back to cited text no. 11
    
12.
World Health Organization. Department of Nutrition for Health and Development (2010) WHO Global Database on Child Growth and Malnutrition. Available from: http://www.who.int/nutgrowthdb/en/a). [Last accessed on 2012 Feb 20].  Back to cited text no. 12
    
13.
Eming Young M. From early child development to human development. Washington, DC. Processed: World Bank; 2002.  Back to cited text no. 13
    
14.
Islam A, Biswas T. Health system bottlenecks in achieving maternal and child health-related Millennium Development Goals: major findings from district level in Bangladesh. J US–Chin Med Sci 2014; 11:147–158.  Back to cited text no. 14
    
15.
Katona-Apte J, Mokdad A. Malnutriton of children in the Democratic Peoples Republic of North Korea. J Nutr 1998; 128:1315–1319.  Back to cited text no. 15
    
16.
Rivera JR, Gonzlez-Coss T, Flores M, Hern[INSIDE:1]ndez M, Lezana MA, Seplveda-Amor J. Stunting and emaciation in children under 5 in distinct regions and strata in Mexico. Salud Publica Mex 2009; 37:95–107.  Back to cited text no. 16
    



 
 
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