NDLI: Are boys more vulnerable to stunting? Examining risk factors, differential sensitivity, and measurement issues in Zambian infants and young children

Content Provider	Springer Nature : BioMed Central
Author	Thompson, Amanda L. Onyango, Mathews Sakala, Patricia Manda, John Berhane, Edna Selvaggio, Mary Pat Aongola, Agnes Martin, Stephanie L.
Abstract	Background Stunting remains a considerable public health problem globally, and sex differences in prevalence have been documented. While many risk factors for stunting have been identified, few studies examine how these factors may contribute to sex differences. We test whether: (1) boys and girls are differentially exposed to stunting risk factors, (2) boys and girls respond differently to similar exposures, and (3) these associations are sensitive to the growth measures used. Methods Data comes from 7486 Zambian infants, aged 0–23 months, participating in the SUN (Scaling Up Nutrition) 2.0 Program baseline survey. Surveys and dietary recalls were collected from primary caregivers, and anthropometry was collected for caregivers and children. Stunting was defined as height-for-age z-score (HAZ) <-2. Descriptive statistics and adjusted multilevel logistic regression models controlling for age and province were used to identify sex differences in exposures and risk factors for stunting, respectively. Interaction terms between exposure and infant sex were added to test for sex differences in response. Sensitivity testing with alternate measures of infant size, including height-for-age difference (HAD), was conducted. Results Boys were more likely to be stunted than girls (34.5% vs. 25.7%, respectively). Numerous maternal, care giving, diet, and household characteristics were associated with the risk of stunting, but few sex differences were seen in exposure to these factors. Only one risk factor—maternal marital status—showed evidence of moderation by sex at the p < 0.05 level, while a limited number of risk factors did so at the p < 0.10 level. At all ages, boys were longer than girls, and there were no sex-specific differences in the patterns of HAZ or HAD with age. Results were robust to alternate specifications. Conclusions Our results show that Zambian boys have lower mean HAZ scores than girls and a greater prevalence of stunting throughout the first two years We do not find strong evidence that infant feeding practices, environmental exposures, or care giving differ consistently between boys and girls or that boys and girls respond differently to these exposures. Our results instead indicate that further investigation of prenatal factors and/or measurement issues is needed.
Related Links	https://bmcpublichealth.biomedcentral.com/counter/pdf/10.1186/s12889-024-20826-w.pdf
Ending Page	15
Page Count	15
Starting Page	1
File Format	HTM / HTML
ISSN	14712458
DOI	10.1186/s12889-024-20826-w
Journal	BMC Public Health
Issue Number	1
Volume Number	24
Language	English
Publisher	BioMed Central
Publisher Date	2024-11-29
Access Restriction	Open
Subject Keyword	Public Health Medicine Epidemiology Biostatistics Vaccine Environmental Health Stunting Sex difference Infant and young child feeding Growth standards Zambia Medicine/Public Health
Content Type	Text
Resource Type	Article
Subject	Public Health, Environmental and Occupational Health
Journal Impact Factor	3.5/2023
5-Year Journal Impact Factor	3.9/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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