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Abstract

Stunting remains a major public health concern in Malawi, with a national prevalence of 35.5% among children under five. However, evidence on the independent and combined effects of household economic status and birth order on stunting among Malawian children aged 24-35 months remains limited. This study aimed to examine the independent and combined association of household economic status and birth order with stunting among children aged 24-35 months in Malawi. A secondary data analysis of a cross-sectional 2019-20 Malawi Multiple Indicator Cluster Survey (MICS) was conducted, and the final sample comprised 2,764 children aged 24-35 months with complete data. Stunting was defined as a height-for-age Z-score below -2 SD. Weighted descriptive and bivariate analyses were performed, and potential confounding was assessed using stratified analyses and the change-in-estimate method (≥10% change in prevalence ratio). Multivariable models were specified a priori and included wealth index, birth order, child’s sex, and maternal education level. The weighted prevalence of stunting was 44.2% (95% CI: 41.3-47.1%). Household economic status, birth order, and their four-level combined variable were not independently associated with stunting after adjustment (p≥0.05). However, boys had a significantly higher prevalence ratio of stunting compared with girls (cPR= 1.23; 95% CI: 1.11-1.37; p<0.001) in both crude and adjusted models. The prevalence of stunting remains high among Malawian children aged 24-35 months, and the higher prevalence ratio among boys highlights the need for strengthened growth monitoring, caregiver nutrition education, and equitable early-life nutrition interventions within Malawian primary healthcare services with particular attention to boys.

Keywords: Stunting, Birth Order, Household Economic Status, Children Aged 24-35 Months, Cross-sectional Study, Malawi

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Bahasa Abstract

Stunting masih menjadi masalah kesehatan masyarakat utama di Malawi, dengan prevalensi nasional sebesar 35.5% pada anak di bawah lima tahun. Namun, bukti mengenai pengaruh independent dan gabungan status ekonomi rumah tangga serta urutan kelahiran terhadap stunting pada anak usia 24-35 bulan di Malawi masih terbatas. Stunting didefinisikan sebagai height-for-age Z-score di bawah −2 SD. Penelitian ini bertujuan untuk mengkaji asosiasi independen dan gabungan antara status ekonomi rumah tangga dan urutan kelahiran dengan stunting pada anak usia 24–35 bulan di Malawi. Sumber data menggunakan data sekunder dari cross-sectional Malawi Multiple Indicator Cluster Survey (MICS) 2019–20, dengan sampel sebanyak 2.764 anak usia 24–35 bulan. Analisis data mengunakan analisis deskriptif dan bivariat dengan pembobotan, dan penialaian potensial confounding menggunakan analisis stratifikasi dan metode change-in-estimate (≥10% perubahan pada prevalence ratio). Model multivariat ditetapkan secara a priori dan mencakup indeks kekayaan, urutan kelahiran, jenis kelamin anak, serta tingkat Pendidikan ibu. Prevalensi stunting berbobot adalah 44,2% (95% CI: 41,3–47,1%). Status ekonomi rumah tangga, urutan kelahiran, dan variabel gabungan empat tingkat tidak berhubungan secara independen dengan stunting setelah di-adjust (p≥0,05). Namun, anak laki-laki meiliki rasio prevalensi stunting yang secara signifikan lebih tinggi dibandingkan anak perempuan (cPR= 1.23; 95% CI: 1.11-1.37; p<0.001) baik pada model crude maupun adjusted. Prevalensi stunting masih tinggi pada anak usia 24–35 bulan di Malawi, dan rasio prevalensi yang lebih tinggi pada anak laki-laki menunjukkan perlunya penguatan pemantauan pertumbuhan, edukasi gizi bagi pengasuh, serta intervensi gizi pada awal kehidupan yang berkeadilan dalam layanan kesehatan primer di Malawi, dengan perhatian khusus pada anak laki-laki.

Kata Kunci: Stunting, Urutan Kelahiran, Status Ekonomi Rumah Tangga, Anak Usia 24-35 Bulan, Studi Cross-sectional, Malawi

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