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Nutritional status and stunting among pre‐school children in Bhutan: Findings of the 2015 National Nutrition Survey

The high prevalence of stunting along with the region's large population make South Asia home to about 40% of the world's stunted children. The prevalence, severity, and distribution of undernutrition or risk factors for stunting are relatively little known in Bhutan. A second Bhutan National Nutrition Survey (BNNS) was conducted in 2015 among children aged 0–59 months (n=1,506) and their households. Adjusting for survey design, we estimated nutritional status by Z‐scores of height‐for‐age (HAZ), weight‐for‐height (WHZ) and weight‐for‐age (WAZ) and prevalences of stunting, wasting, underweight, and overweight (WHZ>2) carried out linear and logistic regression analyses to identify child, caregiver and household characteristics associated linear growth and relative odds ratios (OR) of stunting. Mean (SE) HAZ, WHZ and WAZ was −0.81 (0.13), 0.10 (0.04) and −0.41 (0.05), and the prevalence of stunting, wasting, underweight and overweight was 21.2%, 2.5%, 7.3% and 2.6%, respectively. In univariate logistic regressions, risk of stunting was higher in rural than urban areas (26.1% vs. 16.0%; OR=1.86, 95% CI: 0.87, 4.00; p=0.07), in the East than West or Central regions (29.1% vs. 17.0%, OR=1.41, 95% CI: 0.82, 2.42; p=0.11) and varied in a dose‐response manner by SES, from 33.7% in the lowest fifth to 16.6% in the highest fifth (reference group) of a wealth index (OR range from 3.75 to 8.95). These associations were not significant on multivariable adjustment (p>0.10 for all). The risk of stunting significantly increased by age: 5% at <6 mo (OR=1), 17.1% at 6–23 mo (OR=3.59; 95% CI: 0.74, 17.4; p=0.07) and 24.9% at 24–59 mo (OR=6.12; 1.40, 26.9; p=0.03) and was far lower among children of university‐educated (6.6%; OR=0.05; 95% CI: 0.00, 0.89; p=0.05) than uneducated mothers (35.4%; OR=1). Despite a lower national risk of pre‐school stunting compared to other South Asian countries, strong age‐ and household wealth‐associated gradients in risk exist. Programs to prevent stunting may achieve the greatest impact among children in lowest household wealth and educated strata within the East region.