Predictors of Stunting in Early Infancy Among Bolivian Children

Background: Stunting in infancy results in long-term adverse effects such as impaired cognitive function, increased risk of chronic disease and decreased economic potential. In Bolivia, the prevalence of infant malnutrition is high; an estimated 9.5% of infants (0-6 months) suffer from severe or moderate stunting. The purpose of this study was to identify predictors of moderate-to-severe stunting (defined as z-score<-2 according to World Health Organization criteria) among Bolivian children in early infancy, 0-4 months of age.

Methods: 185 mother-infant pairs were recruited in El Alto, Bolivia using convenience sampling at outpatient well-child visits from June to October 2011.  Researchers collected anthropometric data from mothers (height, weight) and infants (length, weight, head circumference) at two visits (4 to 6 weeks apart) as well as baseline socio-demographic, clinical and perinatal characteristics from the mother.

Results: The prevalence of infant stunting was 15.7%. The frequency of stunting was higher among infants of low birth weight, those born pre-term (<37 weeks of gestation) or small-for-gestational age (<10^th percentile), and those delivered within 24 months of an older sibling (inter-birth spacing). Multivariable logistic regression showed that breastfeeding (OR:0.29 95%CI[0.1-0.81]), preterm birth (OR: 10.25 95% CI[3.26-32.23]), small-for-gestational age (OR:6.67 95% CI[2.21-20.18]) and inter-birth spacing of less than 24 months (OR:7.21 95% CI[2.08-24.94]) were significantly associated with stunting among Bolivian infants (<4 months).  

Conclusions: These results emphasize the need for targeted interventions to foster optimal in-utero growth and prevent small-for-gestational age and preterm births, which would lead to lower rates of stunting in Bolivia.