Understanding the Complexities of Child Undernutrition: A Multilevel Analysis

Abstract

Within the context of Pakistan, the conditions of stunting, wasting, and underweight present health hazards, which encompass susceptibility to infectious diseases such as respiratory infections, diarrheal diseases, and other illnesses, thereby increasing the burden on healthcare systems. This study investigates child malnutrition factors within socio-demographic, environmental, maternal, and nutritional contexts across Pakistan's four administrative provinces: Punjab, Balochistan, Khyber Pakhtunkhwa (KP), and Sindh. It employs a multilevel mixed-effect regression analysis with data sourced from the Pakistan Multiple Indicator Cluster Survey (MICS). Maternal factors, specifically maternal education, and the place of delivery, emerge as pivotal determinants significantly influencing nutritional outcomes. Among nutrient factors, the adherence to minimum dietary diversity stands out as particularly impactful. In the realm of environmental factors, the utilization of unclean cook stoves surfaces as a noteworthy contributor to nutritional challenges. Furthermore, within the socioeconomic domain, the wealth index quintile proves to be a substantial influencer, exhibiting pronounced impacts on stunting, wasting, and underweight conditions. This study scrutinizes the intricate factors influencing child undernutrition across diverse provinces in Pakistan, In Balochistan, higher odds of undernutrition, particularly underweight, are prominent, potentially attributed to socio-economic challenges and limited access to healthcare infrastructure. Punjab and Sindh exhibit elevated odds of stunting and underweight, potentially linked to socio-economic factors and variations in healthcare access. In KP, being underweight and wasting demonstrate significant odds, possibly influenced by socio-economic and environmental factors. These Regional disparities, notably prominent in Balochistan, underscore the diverse contextual challenges, necessitating targeted interventions tailored to the specific needs and socio-economic contexts of each province. ICC results show that in this study, household-level factors within districts have a more substantial impact on undernutrition among children compared to district-level factors.