Determinants Associated With Stunting Among Children Under Two Years Old In Asia: A Scoping Review

Main Article Content

Marhazlina Mohamad
Nurul Fatini Mohd Salihim
Mohd Razif Shahril

Abstract

About 18.9 million stunted children were reported in 2022 in Asia. Although there was a reduction in prevalence, the numbers were still high. This review aimed to identify the determinants associated with stunting among children under two years old in Asia. A systematic search of English-language articles published between 2013 and 2023 was conducted using PubMed and Scopus. Only 32 articles were deemed eligible. The included studies indicated several main predictors of child stunting: 1) community and societal factors, 2) household and family factors, 3) inadequate complementary feeding, 4) breastfeeding, and 5) infection. A diverse range of contributing factors is, to varying degrees, associated with stunting, demonstrating the importance of considering how those predictors interact with nutrition. Integrated health promotion, prevention, and interventions by healthcare providers and communities are needed to address this issue.

Downloads

Download data is not yet available.

Article Details

How to Cite
Mohamad, M., Mohd Salihim, N. F., & Shahril, M. R. (2025). Determinants Associated With Stunting Among Children Under Two Years Old In Asia: A Scoping Review. Malaysian Journal of Medicine and Health Sciences, 21(4), 322–336. https://doi.org/10.47836/mjmhs.21.4.39
Section
Review Article

References

World Health Organization: WHO. Stunting in a nutshell. 2015. Available from: https://www.who.int/news/item/19-11-2015-stunting-in-a-nutshell

Joint child malnutrition estimates (JME). Available from: https://www.who.int/teams/nutrition-and-food-safety/monitoring-nutritional-status-and-food-safety-and-events/joint-child-malnutrition-estimates

Institute for Public Health (IPH). Technical Report National Health and Morbidity Survey (NHMS) 2022: Maternal and Child Health, Malaysia. 2024. Available from: https://iku.gov.my/images/nhms-2022/TRNHMSmch2022.pdf

World Health Organization: WHO. Malnutrition. 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/malnutrition

Kok, D. Stunting in Malaysia: Cost, Causes & Courses for Action. Jeffrey Cheah Institute on Southeast Asia. 2019. Available from: https://sunwayuniversity.edu.my/sites/default/files/publications/2023-11/jci-jsc-wp-2019-01-stunting-in-malaysia.pdf

Water, Sanitation and Hygiene (WASH). UNICEF. 2022. Available from: https://www.unicef.org/rosa/water-sanitation-and-hygiene-wash

Aguayo VM, Nair R, Badgaiyan N, Krishna V. Determinants of stunting and poor linear growth in children under 2 years of age in India: an in-depth analysis of Maharashtra’s comprehensive nutrition survey. Maternal and Child Nutrition. 2016 May 1;12(S1):121–40. Available from: https://doi.org/10.1111/mcn.12259

Alam MA, Mahfuz M, Islam MM, Mondal D, Ahmed AMS, Haque R, et al. Contextual factors for stunting among children of age 6 to 24 months in an under-privileged community of Dhaka, Bangladesh. Indian Pediatrics/Indian Pediatrics. 2017 Mar 29;54(5):373–6. Available from: https://doi.org/10.1007/s13312-017-1109-z

Aguayo VM, Badgaiyan N, Paintal K. Determinants of child stunting in the Royal Kingdom of Bhutan: an in-depth analysis of nationally representative data. Maternal and Child Nutrition. 2014 Dec 23;11(3):333–45. Available from: https://doi.org/10.1111/mcn.12168

Beal T, Le DT, Trinh TH, Burra DD, Huynh T, Duong TT, et al. Child stunting is associated with child, maternal, and environmental factors in Vietnam. Maternal and Child Nutrition. 2019 May 2;15(4). Available from: https://doi.org/10.1111/mcn.12826

Campbell RK, Aguayo VM, Kang Y, Dzed L, Joshi V, Waid J, et al. Infant and young child feeding practices and nutritional status in Bhutan. Maternal and Child Nutrition . 2017 Dec 21;14(3). Available from: https://doi.org/10.1111/mcn.12580

Chandrasekhar S, Aguayo VM, Krishna V, Nair R. Household food insecurity and children’s dietary diversity and nutrition in India. Evidence from the comprehensive nutrition survey in Maharashtra. Maternal and Child Nutrition. 2017 Oct 1;13(S2). Available from: https://doi.org/10.1111/mcn.12447

Childhood stunting in relation to the pre- and postnatal environment during the first 2 years of life: The MAL-ED longitudinal birth cohort study. PLoS Medicine. 2017 Oct 25;14(10):e1002408. Available from: https://doi.org/10.1371/journal.pmed.1002408

Choudhury N, Raihan MJ, Sultana S, Mahmud Z, Farzana FD, Haque MA, et al. Determinants of age-specific undernutrition in children aged less than 2 years—the Bangladesh context. Maternal and Child Nutrition . 2016 Oct 12;13(3). Available from: https://doi.org/10.1111/mcn.12362

Das S, Alam MA, Mahfuz M, Arifeen SE, Ahmed T. Relative contributions of the correlates of stunting in explaining the mean length-for-age z-score difference between 24-month-old stunted and non-stunted children living in a slum of Dhaka, Bangladesh: results from a decomposition analysis. BMJ Open . 2019 Jul 1;9(7):e025439. Available from: https://doi.org/10.1136/bmjopen-2018-025439

Dearden KA, Schott W, Crookston BT, Humphries DL, Penny ME, Behrman JR. Children with access to improved sanitation but not improved water are at lower risk of stunting compared to children without access: a cohort study in Ethiopia, India, Peru, and Vietnam. BMC Public Health. 2017 Jan 23;17(1). Available from: https://doi.org/10.1186/s12889-017-4033-1

Hasan M, Islam MM, Mubarak E, Haque MdA, Choudhury N, Ahmed T. Mother’s dietary diversity and association with stunting among children <2 years old in a low socio-economic environment: A case–control study in an urban care setting in Dhaka, Bangladesh. Maternal and Child Nutrition. 2018 Sep 14;15(2). Available from: https://doi.org/10.1111/mcn.12665

Hashmi AH, Nyein PB, Pilaseng K, Paw MK, Darakamon MC, Min AM, et al. Feeding practices and risk factors for chronic infant undernutrition among refugees and migrants along the Thailand-Myanmar border: a mixed-methods study. BMC Public Health . 2019 Nov 28;19(1). Available from: https://doi.org/10.1186/s12889-019-7825-7

Hossain M, Nahar B, Haque MdA, Mondal D, Mahfuz M, Naila NN, et al. Serum Adipokines, Growth Factors, and Cytokines Are Independently Associated with Stunting in Bangladeshi Children. Nutrients. 2019 Aug 7;11(8):1827. Available from: https://doi.org/10.3390/nu11081827

Johri M, Subramanian S, Koné GK, Dudeja S, Chandra D, Minoyan N, et al. Maternal Health Literacy Is Associated with Early Childhood Nutritional Status in India. the Journal of Nutrition/the Journal of Nutrition . 2016 Jul 1;146(7):1402–10. Available from: https://doi.org/10.3945/jn.115.226290

Korpe PS, Haque R, Gilchrist C, Valencia C, Niu F, Lu M, et al. Natural History of Cryptosporidiosis in a Longitudinal Study of Slum-Dwelling Bangladeshi Children: Association with Severe Malnutrition. PLoS Neglected Tropical Diseases . 2016 May 4;10(5):e0004564. Available from: https://doi.org/10.1371/journal.pntd.0004564

Laksono AD, Wulandari RD, Amaliah N, Wisnuwardani RW. Stunting among children under two years in Indonesia: Does maternal education matter? PloS One . 2022 Jul 25;17(7):e0271509. Available from: https://doi.org/10.1371/journal.pone.0271509

Liu J, Sun J, Huang J, Huo J. Prevalence of Malnutrition and Associated Factors of Stunting among 6–23-Month-Old Infants in Central Rural China in 2019. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health . 2021 Aug 2;18(15):8165. Available from: https://doi.org/10.3390/ijerph18158165

Menon P, Bamezai A, Subandoro A, Ayoya MA, Aguayo VM. Age-appropriate infant and young child feeding practices are associated with child nutrition in India: insights from nationally representative data. Maternal and Child Nutrition . 2013 Apr 5;11(1):73–87. Available from: https://doi.org/10.1111/mcn.12036

Milton A, Attia J, Alauddin M, McEvoy M, McElduff P, Hussain S, et al. Assessment of Nutritional Status of Infants Living in Arsenic-Contaminated Areas in Bangladesh and Its Association with Arsenic Exposure. International Journal of Environmental Research and Public Health/International Journal of Environmental Research and Public Health . 2018 Jan 2;15(1):57. Available from: https://doi.org/10.3390/ijerph15010057

Mya KS, Kyaw AT, Tun T. Feeding practices and nutritional status of children age 6-23 months in Myanmar: A secondary analysis of the 2015-16 Demographic and Health Survey. PloS One . 2019 Jan 2;14(1):e0209044. Available from: https://doi.org/10.1371/journal.pone.0209044

Rah JH, Cronin AA, Badgaiyan B, Aguayo VM, Coates S, Ahmed S. Household sanitation and personal hygiene practices are associated with child stunting in rural India: a cross-sectional analysis of surveys. BMJ Open . 2015 Feb 12;5(2):e005180. Available from: https://doi.org/10.1136/bmjopen-2014-005180

Nisar Y, Dibley M, Aguayo V. Iron-Folic Acid Supplementation During Pregnancy Reduces the Risk of Stunting in Children Less Than 2 Years of Age: A Retrospective Cohort Study from Nepal. Nutrients . 2016 Jan 27;8(2):67. Available from: https://doi.org/10.3390/nu8020067

Raihan MJ, Briskin E, Mahfuz M, Islam MM, Mondal D, Hossain MI, et al. Examining the relationship between blood lead level and stunting, wasting and underweight- A cross-sectional study of children under 2 years-of-age in a Bangladeshi slum. PloS One . 2018 May 24;13(5):e0197856. Available from: https://doi.org/10.1371/journal.pone.0197856

Sari K, Sartika RAD. The effect of the physical factors of parents and children on stunting at birth among newborns in Indonesia. Journal of Preventive Medicine and Public Health . 2021 Sep 30;54(5):309–16. Available from: https://doi.org/10.3961/jpmph.21.120

Sinha B, Taneja S, Chowdhury R, Mazumder S, Rongsen-Chandola T, Upadhyay RP, et al. Low-birthweight infants born to short-stature mothers are at additional risk of stunting and poor growth velocity: Evidence from secondary data analyses. Maternal and Child Nutrition . 2017 Aug 25;14(1). Available from: https://doi.org/10.1111/mcn.12504

Sanin KI, Islam MM, Mahfuz M, Ahmed AMS, Mondal D, Haque R, et al. Micronutrient adequacy is poor, but not associated with stunting between 12-24 months of age: A cohort study findings from a slum area of Bangladesh. PloS One . 2018 Mar 29;13(3):e0195072. Available from: https://doi.org/10.1371/journal.pone.0195072

Tariq J, Sajjad A, Zakar R, Zakar MZ, Fischer F. Factors Associated with Undernutrition in Children under the Age of Two Years: Secondary Data Analysis Based on the Pakistan Demographic and Health Survey 2012–2013. Nutrients . 2018 May 26;10(6):676. Available from: https://doi.org/10.3390/nu10060676

Titaley CR, Ariawan I, Hapsari D, Muasyaroh A, Dibley MJ. Determinants of the stunting of children under two years old in Indonesia: a multilevel analysis of the 2013 Indonesia Basic Health Survey. Nutrients. 2019 May 18;11(5):1106. Available from: https://doi.org/10.3390/nu11051106

Upadhyay AK, Srivastava S. Effect of pregnancy intention, postnatal depressive symptoms and social support on early childhood stunting: findings from India. BMC Pregnancy and Childbirth. 2016 May 16;16(1). Available from: https://doi.org/10.1186/s12884-016-0909-9

Young MF, Nguyen PH, Casanova IG, Addo OY, Tran LM, Nguyen S, et al. Role of maternal preconception nutrition on offspring growth and risk of stunting across the first 1000 days in Vietnam: A prospective cohort study. PloS One . 2018 Aug 30;13(8):e0203201. Available from: https://doi.org/10.1371/journal.pone.0203201

Masroor N, Rahman JA, TinMyo H, Khattak MAK, Aye A. Factors affecting nutritional status of children below 24 months in Pekan district, Pahang, Malaysia. Malaysian Journal of Nutrition [Internet]. 2014 Jan 1;20(2):197–207. Available from: https://nutriweb.org.my/mjn/publication/20-2/e.pdf

Islam MM, Sanin KI, Mahfuz M, Ahmed AMS, Mondal D, Haque R, et al. Risk factors of stunting among children living in an urban slum of Bangladesh: findings of a prospective cohort study. BMC Public Health . 2018 Jan 30;18(1). Available from: https://doi.org/10.1186/s12889-018-5101-x

Yuliastini S, Sudiarti T, Sartika RAD. Factors Related to Stunting among Children Age 6-59 Months in Babakan Madang Sub-District, West Java, Indonesia. Current Research in Nutrition and Food Science Journal . 2020 May 4;454–61. Available from: https://doi.org/10.12944/crnfsj.8.2.10

Haq W, Abbas F. A Multilevel Analysis of Factors Associated With Stunting in Children Less Than 2 years Using Multiple Indicator Cluster Survey (MICS) 2017–18 of Punjab, Pakistan. SAGE Open . 2022 Apr 1;12(2):215824402210961. Available from: https://doi.org/10.1177/21582440221096127

Thompson AL. Greater male vulnerability to stunting? Evaluating sex differences in growth, pathways and biocultural mechanisms. Annals of Human Biology . 2021 Aug 18;48(6):466–73. Available from: https://doi.org/10.1080/03014460.2021.1998622

CHILD FOOD POVERTY Nutrition deprivation in early childhood . UNICEF. 2024. Available from: https://www.unicef.org/media/157906/file/ENGLISH-child-food-poverty-2024-brief.pdf

Rahma IM, Mutalazimah M. Correlation between Family Income and Stunting among Toddlers in Indonesia: A Critical Review. Advances in Health Sciences Research/Advances in Health Sciences Research . 2022 Jan 1; Available from: https://doi.org/10.2991/ahsr.k.220403.011

Gatica-Domínguez G, Mesenburg MA, Barros AJD, Victora CG. Ethnic inequalities in child stunting and feeding practices: results from surveys in thirteen countries from Latin America. International Journal for Equity in Health . 2020 Apr 9;19(1). Available from: https://doi.org/10.1186/s12939-020-01165-9

Huong LT, Nga VTT. Nutritional Practices among Ethnic Minorities and Child Malnutrition in Mountainous Areas of Central Vietnam. Food and Nutrition Sciences. 2013 Jan 1;04(01):82–9. Available from: https://doi.org/10.4236/fns.2013.41012

Haron MZ, Jalil RA, Hamid NAA, Omar MA, Abdullah NH. Stunting and Its Associated Factors among Children Below 5 Years Old on the East Coast of Peninsular Malaysia: Evidence from the National Health and Morbidity Survey. Malaysian Journal of Medical Sciences. 2023 Oct 30;30(5):155–68. Available from: https://doi.org/10.21315/mjms2023.30.5.13

Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, Morris SS, et al. Multi-country analysis of the effects of diarrhoea on childhood stunting. International Journal of Epidemiology. 2008 Jun 20;37(4):816–30. Available from: https://doi.org/10.1093/ije/dyn099

World Health Organization: WHO. Diarrhoeal disease . 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease

Din MAC, Teng NIMF, Manaf ZA. Maternal depression and child feeding practices: Determinants to malnutrition among young children in Malaysian rural area. Women’s Health. 2023 Jan 1;19:174550572211478. Available from: https://doi.org/10.1177/17455057221147800

Mehta K, Mukherjee SG, Bhattacharjee I, Fate K, Kachwaha S, Kant A, et al. Systems strengthening approach during antenatal care improves maternal nutrition and reduces childhood stunting in West Bengal, India. medRxiv (Cold Spring Harbor Laboratory). 2022 Oct 17; Available from: https://doi.org/10.1101/2022.10.14.22281107

Aboagye RG, Ahinkorah BO, Seidu AA, Frimpong JB, Archer AG, Adu C, et al. Birth weight and nutritional status of children under five in sub-Saharan Africa. PloS One. 2022 Jun 9;17(6):e0269279. Available from: https://doi.org/10.1371/journal.pone.0269279

Kirk CM, Uwamungu JC, Wilson K, Hedt-Gauthier BL, Tapela N, Niyigena P, et al. Health, nutrition, and development of children born preterm and low birth weight in rural Rwanda: a cross-sectional study. BMC Pediatrics . 2017 Nov 15;17(1). Available from: https://doi.org/10.1186/s12887-017-0946-1

Fall CHD, Sachdev HS, Osmond C, Restrepo-Mendez MC, Victora C, Martorell R, et al. Association between maternal age at childbirth and child and adult outcomes in the offspring: a prospective study in five low-income and middle-income countries (COHORTS collaboration). the Lancet Global Health/the Lancet Global Health . 2015 Jul 1;3(7):e366–77. Available from: https://doi.org/10.1016/S2214-109X(15)00038-8

Myrskylä M, Fenelon A. Maternal age and offspring Adult health: Evidence from the Health and Retirement Study. Demography . 2012 Aug 28;49(4):1231–57. Available from: https://doi.org/10.1007/s13524-012-0132-x

Astuti FD, Azka A, Rokhmayanti R. Maternal age correlation of stunting in children: Systematics review. Journal of Maternal and Child Health . 2022 Jul 16;7(4):479–448. Available from: https://doi.org/10.26911/thejmch.2022.07.04.11

Nguyen PH, Scott S, Headey D, Singh N, Tran LM, Menon P, et al. The double burden of malnutrition in India: Trends and inequalities (2006–2016). PloS One . 2021 Feb 25;16(2):e0247856. Available from: https://doi.org/10.1371/journal.pone.0247856

Ntambara J, Zhang W, Qiu A, Cheng Z, Chu M. Optimum birth interval (36–48 months) may reduce the risk of undernutrition in children: A meta-analysis. Frontiers in Nutrition . 2023 Jan 13;9. Available from: https://doi.org/10.3389/fnut.2022.939747

Tang J, Zhu X, Chen Y, Huang D, Tiemeier H, Chen R, et al. Association of maternal pre-pregnancy low or increased body mass index with adverse pregnancy outcomes. Scientific Reports . 2021 Feb 15;11(1). Available from: https://doi.org/10.1038/s41598-021-82064-z

Saleh A, Syahrul S, Hadju V, Andriani I, Restika I. Role of Maternal in Preventing Stunting: a Systematic Review. Gaceta Sanitaria . 2021 Jan 1;35:S576–82. Available from: https://doi.org/10.1016/j.gaceta.2021.10.087

Kadakia R, Josefson J. The relationship of Insulin-Like growth factor 2 to fetal growth and adiposity. Hormone Research in Paediatrics [Internet]. 2016 Jan 1;85(2):75–82. Available from: https://doi.org/10.1159/000443500

Pem D. Factors affecting early childhood growth and development: Golden 1000 days. Advanced Practices in Nursing [Internet]. 2016 Jan 1;01(01). Available from: https://doi.org/10.4172/2573-0347.1000101

Wahyuni SD, Murti B, Adriani RB. Meta analysis: Effects of household size, maternal education, and family income on stunting. Journal of Epidemiology and Public Health. 2023 Jul 16;8(3):323–34. Available from: https://doi.org/10.26911/jepublichealth.2023.08.03.04

Reis M. Food insecurity and the relationship between household income and children’s health and nutrition in Brazil. Health Economics . 2011 Feb 23;21(4):405–27. Available from: https://doi.org/10.1002/hec.1722

Maitra C. “A review of studies examining the link between food insecurity and malnutrition” Technical Paper, 2018.Available from http://www.fao.org/3/CA1447EN/ca1447en.pdf

Patriota ÉSO, Abrantes LCS, Figueiredo ACMG, Pizato N, Buccini G, Gonçalves VSS. Association between household food insecurity and stunting in children aged 0-59 months: Systematic review and meta-analysis of cohort studies. Maternal and Child Nutrition . 2024 Jan 9;20(2). Available from: https://doi.org/10.1111/mcn.13609

Tello B, Rivadeneira MF, Moncayo AL, Buitrón J, Astudillo F, Estrella A, et al. Breastfeeding, feeding practices and stunting in indigenous Ecuadorians under 2 years of age. International Breastfeeding Journal - Electronic Edition - . 2022 Mar 5;17(1). Available from: https://doi.org/10.1186/s13006-022-00461-0

Ahmad D, Afzal M, Imtiaz A. Effect of socioeconomic factors on malnutrition among children in Pakistan. Future Business Journal . 2020 Aug 30;6(1). Available from: https://doi.org/10.1186/s43093-020-00032-x

Infant and young child feeding . World Health Organization. 2023. Available from: https://www.who.int/news-room/fact-sheets/detail/infant-and-young-child-feeding

Khamis AG, Mwanri AW, Ntwenya JE, Kreppel K. The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatrics . 2019 Dec 1;19(1). Available from: https://doi.org/10.1186/s12887-019-1897-5

Hadi H, Fatimatasari F, Irwanti W, Kusuma C, Alfiana RD, Asshiddiqi MIN, et al. Exclusive Breastfeeding Protects Young Children from Stunting in a Low-Income Population: A Study from Eastern Indonesia. Nutrients. 2021 Nov 26;13(12):4264. Available from: https://doi.org/10.3390/nu13124264

Sari YO, Aminuddin A, Hamid F, Prihantono P, Bahar B, Hadju V. Malnutrition in children associated with low growth hormone (Gh) Levels. Gaceta Sanitaria. 2021 Jan 1;35:S327–9. Available from: https://doi.org/10.1016/j.gaceta.2021.10.046

Morales F, La Paz SMD, Leon MJ, Rivero-Pino F. Effects of malnutrition on the immune system and infection and the Role of Nutritional Strategies regarding Improvements in Children’s Health Status: a literature review. Nutrients. 2023 Dec 19;16(1):1. Available from: https://doi.org/10.3390/nu16010001

Wasihun AG, Dejene TA, Teferi M, Marugán J, Negash L, Yemane D, et al. Risk factors for diarrhoea and malnutrition among children under the age of 5 years in the Tigray Region of Northern Ethiopia. PloS One. 2018 Nov 26;13(11):e0207743. Available from: https://doi.org/10.1371/journal.pone.0207743

Lazarus M, Kashyap AK, Borkar R, Ajmariya M. Study of thyroid profile in malnourished children (6 months - 5 years) admitted in the nutritional rehabilitation centre and paediatric ward NSCB Medical College Jabalpur, India. International Journal of Contemporary Pediatrics [Internet]. 2018 Apr 20;5(3):1072. Available from: https://doi.org/10.18203/2349-3291.ijcp20181545

Wardani S, Sulistyono D. Thyroid Disorders as a factor related for stunting: A literature review. Advances in Social Science, Education and Humanities Research/Advances in Social Science, Education and Humanities Research [Internet]. 2023 Oct 10;1469–74. Available from: https://doi.org/10.2991/978-2-38476-118-0_166