Background
Methods
Design and study sites
Study population, inclusion and exclusion criteria
Sample size and sampling
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n = the minimum number of households to be interviewed (95% CI)
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r2 = 2006 MICS value for the indicator
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r = expected rate for the indicator for 2011
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f = design effect for the indicator in MICS 2006
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t = non response rate for households in MICS 2006
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h = average household size in 2006 MICS
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p = proportion of children aged 12–23 months among the total population.
Variables
Distal factors | Intermediate factors |
Child’s characteristics | • Sources of drinking water • Marital status • Maternal age at child birth • Type of birth • Size of child at birth • Birth order • Area of residence • Geographic zones • Three northern and non-northern regions • Child taken to a health facility during illness • Child ever received any vaccinations • Anemia status |
• Sex of household head • Religion of household head • Ethnicity of household head • Maternal education • Wealth index quintile • Mosquito net utilization | |
Proximal factor | |
• Breastfeeding status • Child with diarrhea • Child with cough • Child given Vitamin A dose within last 6 months | |
Other Factors –NHIS status | |
• Age and Sex of child |
Measurement of nutritional status
Statistical analysis
Results
Characteristics | Overall n (%) | Male n (%) | Female n (%) |
---|---|---|---|
Stunting | |||
Mildly stunted | 2287 (31.1) | 1144 (15.6) | 1143 (15.6) |
Moderately stunted | 1355 (18.5) | 740 (10.1) | 615 (8.4) |
Severely stunted | 667 (9.1) | 380 (5.2) | 287 (3.9) |
Stunting (below −2 SD) | 2022 (27.5) | 1120 (15.3) | 902 (12.3) |
Total | 7342 | ||
Underweight | |||
Mildly underweight | 2348 (31.8) | 1197 (16.2) | 1151 (15.6) |
Moderately underweight | 973 (13.2) | 528 (7.1) | 445 (6.0) |
Severely underweight | 306 (4.1) | 186 (2.5) | 120 (1.6) |
Underweight (below -2SD) | 1279 (17.3) | 714 (9.7) | 565 (7.6) |
Total | 7395 | ||
Wasting | |||
Mildly wasted | 1547 (21.0) | 787 (10.7) | 760 (10.3) |
Moderately wasted | 448 (6.1) | 270 (3.7) | 178 (2.4) |
Severely wasted | 118 (1.6) | 75 (1.0) | 43 (0.6) |
High weight for height | 144 (2.0) | 86 (1.2) | 58 (0.8) |
Wasting (below -2SD) | 566 (7.7) | 345 (4.7) | 221 (3.0) |
Total | 7381 | ||
Body Mass Index | |||
Overweight/obese (> +2SD) | 178 (2.4) | 103 (1.4) | 75 (1.0) |
Overweight | 130 (1.8) | 80 (1.1) | 50 (0.7) |
Obese | 48 (0.7) | 23 (0.3) | 25 (0.3) |
Total | 7328 | ||
Concurrency | 88 (1.2) | 51 (0.7) | 37 (0.5) |
Total | 7293 | ||
Anemia status | |||
Normal | 1535 (34.0) | 710 (15.7) | 825 (18.3) |
Mild anemic | 1036 (22.9) | 526 (11.6) | 510 (11.3) |
Moderate anemic | 1756 (38.9) | 888 (19.7) | 868 (19.2) |
Severe anemic | 190 (4.2) | 127 (2.8) | 63 (1.4) |
Total | 4517 |
Variables | Level | Frequency (%) | Crude PR (95% CI) | Adjusted PR (95% CI) |
---|---|---|---|---|
Child’s age in months | 0–11 | 1512 (20.03) | Ref | Ref |
12–23 | 1451 (19.22) | 0.990 (0.982–0.999)* | 0.990 (0.982–0.999)* | |
24–35 | 1518 (20.11) | 0.994 (0.986–1.002) | 0.994 (0.986–1.002) | |
36–47 | 1599 (21.18) | 0.997 (0.989–1.004) | 0.997 (0.989–1.004) | |
48–59 | 1470 (19.47) | 0.960 (0.993–1.007) | 1.000 (0.993–1.007) | |
Sex of child | Male | 3859 (51.11) | Ref | Ref |
Female | 3691 (48.89) | 0.754 (0.495–1.149) | 1.003 (0.998–1.009) | |
Distal Factors | ||||
Sex of household head | Male | 5012 (67.84) | Ref | Ref |
Female | 2376 (32.16) | 1.000 (0.996–1.006) | 1.000 (0.995–1.006) | |
Religion of household head | Christian | 3623 (47.99) | Ref | Ref |
Muslim | 2376 (31.47) | 1.084 (0.661–1.770) | 0.997 (0.990–1.004) | |
Traditional/ Spiritualist | 1070 (14.17) | 1.147 (0.613–2.145) | 0.997 (0.989–1.006) | |
Other religion/ No Religion | 481 (6.37) | 2.024 (1.016–4.034)* | 0.987 (0.974–1.002) | |
Ethnicity of household head | Akan | 1889 (25.02) | Ref | Ref |
Ga/Dangme | 281 (3.72) | 1.004 (0.990–1.018) | 1.002 (0.988–1.012) | |
Ewe | 587 (7.77) | 1.006 (0.991–1.016) | 1.008 (0.998–1.017) | |
Northern tribes | 4572 (60.56) | 1.004 (0.997–1.010) | 1.008 (1.000–1.016)* | |
Non-Ghanaian/ others | 221 (2.93) | 0.995 (0.976–1.015) | 0.997 (0.975–1.020) | |
Maternal education | None | 4081 (54.05) | Ref | Ref |
Primary | 1363 (18.05) | 1.356 (0.812–2.264) | 0.996 (0.990–1.004) | |
Middle/JSS | 1565 (20.73) | 0.956 (0.550–1.663) | 1.001 (0.993–1.010) | |
Secondary + | 541 (7.17) | 0.663 (0.240–1.834) | 1.007 (0.995–1.019) | |
Wealth index quintile | Poorest | 3528 (46.73) | Ref | Ref |
Second | 1499 (19.85) | 0.853 (0.493–1.491) | 1.005 (0.998–1.012) | |
Middle | 1045 (13.84) | 0.945 (0.513–1.743) | 1.004 (0.995–1.012) | |
Fourth | 836 (11.07) | 0.364 (0.131–1.008) | 1.010 (1.003–1.017)* | |
Richest | 642 98.50) | 0.970 (0.460–2.044) | 1.000 (0.984–1.014) | |
Mosquito net utilization | ||||
Mother and child slept under mosquito net last night | Yes | 3268 (43.28) | Ref | Ref |
No | 4282 (56.72) | 0.801 (0.528–1.213) | 1.003 (0.942–1.068) |
Variables | Level | Frequency (%) | Crude PR (95% CI) | Adjusted PR (95% CI) |
---|---|---|---|---|
Intermediate factors | ||||
Sources of drinking water | Pipe water | 2538 (34.35) | Ref | Ref |
Tube Well, Borehole, Tanker | 2308 (31.24) | 1.002 (0.996–1.008) | 0.994 (0.986–1.002) | |
River, Spring and other water bodies | 946 (12.80) | 0.996 (0.987–1.005) | 1.001 (0.997–1.005) | |
Bottled Water, Sachet Water | 1596 (21.60) | 1.003 (0.997–1.010) | 0.995 (0.986–1.003) | |
Marital status | Currently married | 4654 (63.51) | Ref | Ref |
Formerly married | 587 (8.01) | 1.003 (0.994–1.011) | 0.989 (0.957–1.022) | |
Never married | 2087 (28.48) | 0.996 (0.990–0.998)* | 0.992 (0.981–0.997)* | |
Maternal age at child birth | Less than 20 | 1400 (18.54) | Ref | Ref |
20–34 | 5226 (69.22) | 1.002 (0.995–1.009) | 1.001 (0.994–1.005) | |
35–49 | 924 (12.24) | 1.002 (0.993–1.012) | 1.001 (0.998–1.012) | |
Type of birth | Twin | 296 (3.92) | Ref | Ref |
Single | 7254 (96.68) | 1.000 (0.992–1.026) | 1.009 (0.984–1.034) | |
Size of child at birth | Large | 825 (43.13) | Ref | Ref |
Average | 870 (45.48) | 1.004 (0.998–1.010) | 1.004 (0.997–1.010) | |
Small | 218 (11.40) | 1.001 (0.991–1.012) | 1.001 (0.990–1.012) | |
Birth order | 1 | 2127 (28.17) | Ref | Ref |
2–3 | 2973 (39.83) | 1.000 (0.993–1.006) | 0.997 (0.991–1.002) | |
4–6 | 1919 (25.42) | 1.002 (0.996–1.010) | 0.995 (0.987–1.003) | |
7 + | 531 (7.03) | 1.001 (0.991–1.012) | 1.000 (0.996–1.014) | |
Area of residence | Urban | 2117 (28.04) | Ref | Ref |
Rural | 5433 (71.96) | 1.329 (0.810–2.183) | 1.001 (0.997–1.034) | |
Geographic zones | Coastal/southern Zone | 1806 (23.92) | Ref | Ref |
Middle zone | 1624 (21.51) | 0.872 (0.480–1.581) | 1.011 (1.000–1.014)* | |
Northern zone | 4120 (54.57) | 0.817 (0.500–1.336) | 1.012 (0.998–1.026) | |
Three northern and non-northern regions | All but three northern regions | 2551 (33.79) | Ref | Ref |
Three northern regions | 4999 (66.21) | 0.848 (0.552 – 1.302) | 0.996 (0.986 – 1.001) |
Variables | Level | Frequency (%) | Crude PR (95% CI) | Adjusted PR (95% CI) |
---|---|---|---|---|
Proximal factors | ||||
Breastfeeding status | ||||
Child ever been breastfed | Yes | 7484 (99.17) | 0.231 (0.075–0.710) | 1.028 (0.956–1.105) |
No | 63 (0.83) | Ref | Ref | |
Child health status | ||||
Child with diarrhoea | Yes | 1126 (14.92) | 1.069 (0.606–1.886) | 1.027 (0.986–1.069) |
No | 6422 (85.08) | Ref | Ref | |
Child with cough | Yes | 1672 (22.15) | 0.717 (0.412–1.246) | 1.048 (0.993–1.106) |
No | 5876 (77.85) | Ref | Ref | |
Child given Vitamin A dose within last 6 months | Yes | 2269 (30.65) | 0.925 (0.591–1.447) | |
No | 5134 (69.35) | Ref | Ref | |
Child taken to a health facility during illness | Yes | 893 (78.06) | 1.669 (0.202–13.809) | 1.001 (0.928–1.092) |
No | 251 (21.94) | Ref | Ref | |
Child ever received any vaccinations | Yes | 1211 (90.31) | 0.517 (0.153–1.749) | 0.961 (0.912–1.012) |
No | 130 (9.69) | Ref | Ref | |
Anaemia status | Normal | 1535 (33.98) | Ref | Ref |
Anaemia | 2882 (66.02) | 0.920 (0.518–1.632) | 1.025 (0.931–1.128) |
Nutritional status of children
Predictors of overweight with concurrent stunting (focus on age, sex and the distal factors)
Model 1 | Model 2 | Model 3 | Model 4 | ||||||
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Variables | Level | Adjusted PR (95% CI) | p - value | Adjusted PR (95% CI) |
p-value | Adjusted PR (95% CI) |
p-value | Adjusted PR (95% CI) |
p-value |
Child’s age in months | 0–11 | Ref | 0.495 | Ref | 0.461 | Ref | 0.474 | Ref | 0.155 |
12–23 | 0.990 (0.982–0.999) | 0.991 (0.982–1.000) | 0.991 (0.982–0.999) | 0.993 (0.975–1.011) | |||||
24–35 | 0.994 (0.986–1.002) | 0.994 (0.967–1.002) | 0.994 (0.986–1.002) | 0.994 (0.948–1.000) | |||||
36–47 | 0.997 (0.989–1.004) | 0.997 (0.990–1.004) | 0.997 (0.989–1.004) | 1.000 (0.987–1.013) | |||||
48–59 | 1.000 (0.993–1.007) | 1.000 (0.993–1.007) | 1.000 (0.993–1.007) | 1.001 (0.985–1.018) | |||||
Sex of child | Male | 0.186 | 0.186 | 0.188 | 0.951 | ||||
Female | 1.003 (0.998–1.009) | 1.004 (0.999–1.009) | 1.004 (0.999–1.009) | 1.003 (0.987–1.020) | |||||
Religion of household head | Christian | Ref | 0.147 | Ref | 0.129 | Ref | 0.991 | ||
Muslim | 0.997 (0.990–1.004) | 0.997 (0.989–1.004) | 1.017 (0.989–1.045) | ||||||
Traditional/ Spiritualist | 0.998 (0.990–1.007) | 0.998 (0.989–1.007) | 0.981 (0.933–1.032) | ||||||
Other religion/ No Religion | 0.989 (0.975–1.003) | 0.989 (0.975–1.003) | 1.020 (1.002–1.038) | ||||||
Ethnicity of household head | Akan | Ref | 0.073 | Ref | 0.350 | Ref | 0.947 | ||
Ga/Dangme | 1.003 (0.989–1.018) | 1.004 (0.989–1.019) | 1.013 (0.996–1.030) | ||||||
Ewe | 1.009 (0.999–1.018) | 1.009 (0.998–1.020) | 1.023 (1.000–1.046) | ||||||
Northern tribes | 1.008 (1.000–1.016) | 1.006 (0.996–1.017) | 1.001 (0.970–1.032) | ||||||
Non-Ghanaian/ others | 0.999 (0.977–1.021) | 0.998 (0.977–1.020) | 0.976 (0.911–1.046) | ||||||
Maternal education | None | Ref | 0.969 | Ref | 0.944 | 0.430 | |||
Primary | 0.995 (0.988–1.003) | 0.996 (0.988–1.003) | 0.986 (0.963–1.011) | ||||||
Middle/JSS | 1.000 (0.992–1.009) | 1.000 (0.992–1.009) | 1.016 (0.992–1.039) | ||||||
Secondary + | 1.003 (0.990–1.016) | 1.003 (0.990–1.016) | 1.022 (0.982–1.063) | 0.335 | |||||
Wealth index quintile | Poorest | Ref | 0.205 | Ref | 0.335 | Ref | |||
Second | 1.004 (0.997–1.012) | 1.005 (0.997–1.012) | 0.991 (0.967–1.015) | ||||||
Middle | 1.004 (0.995–1.012) | 1.004 (0.993–1.015) | 0.991 (0.969–1.012) | ||||||
Fourth | 1.011 (1.004–1.019) | 1.011 (1.001–1.021) | 0.997 (0.972–1.023) | ||||||
Richest | 1.001 (0.986–1.016) | 1.001 (0.984–1.019) | 0.954 (0.900–1.013) | ||||||
Maternal age at child birth | Less than 20 | Ref | 0.633 | Ref | 0.873 | ||||
20–34 | 1.001 (0.995–1.008) | 0.989 (0.969–1.001) | |||||||
35–49 | 1.002 (0.993–1.011) | 1.000 (0.981–1.019) | |||||||
Area of residence | Urban | Ref | 0.848 | Ref | 0.855 | ||||
Rural | 0.999 (0.991–1.007) | 1.003 (0.987–1.020) | |||||||
Geographic zones | Coastal/southern Zone | Ref | 0.544 | Ref | 0.707 | ||||
Middle zone | 0.999 (0.989–1.010) | 0.987 (0.967–1.008) | |||||||
Northern zone | 1.000 (0.988–1.012) | 0.989 (0.957–1.022) | |||||||
Three northern and non-northern regions | All but three northern regions | Ref | 0.885 | Ref | 0.564 | ||||
Three northern regions | 1.003 (0.990–1.016) | 1.000 (0.967–1.034) | |||||||
Breastfeeding status | |||||||||
Child ever been breastfed | Yes | 0.995 (0.984–1.006) | 0.034 | ||||||
No | Ref | ||||||||
Child health status | |||||||||
Child with diarrhoea | Yes | 1.019 (1.006–1.032) | 0.04 | ||||||
No | Ref | ||||||||
Child with cough | Yes | 1.003 (0.985–1.021) | 0.807 | ||||||
No | Ref | ||||||||
Child ever received any vaccinations | Yes | 0.997 (0.960–0.995) | 0.010 | ||||||
No | Ref | ||||||||
Malaria rapid test outcome | Positives | Ref | 0.299 | ||||||
Negative | 1.012 (0.994–1.030) |