Meta-Analysis – Associations between Low Birth Weight, Maternal Education, Maternal Ageat Childbirth, and Exclusive BreastfeedingWith Stunting in Children under Five

Abstract

Background: In-utero and early childhood nutrition play a crucial role in child growth and development. Malnutrition before pregnancy, low weight gain during pregnancy, and maternal age at childbirth may have immediate and long-term effects on fetal health, i.e. low birth weight (LBW) and stunting. Therefore, this study intends to systematically review and meta-analyze maternal and child factors associated with stunting in children under five.

Subjects and Method: This was a systematic review and meta-analysis by collecting available publications in online databases of PubMed, Google Scholar, and Science Direct, published from 2015 to 2023. Articles were searched by the eligibility criteria using the PICO format. Population: children under five. Intervention: low birth weight, low maternal education, maternal age at childbirth <20 years old, and nonexclusive breastfeeding. Comparison: normal birth weight, high maternal education, maternal age at childbirth ≥20 years old, and exclusive breastfeeding. Outcome: stunting. Keywords for the article search were “low birth weight” OR “low mother education” OR “maternal age birth” OR “exclusive breastfeeding” OR “children under 5 years” AND “cross-sectional study”. This study selected cross-sectional, full-text articles using a PRISMA flow diagram. The pooled odds ratio (OR) was estimated using Review Manager 5.3.

Results: Meta-analysis included 18 cross-sectional studies from Indonesia, India, Nepal, Pakistan, Ethiopia, Tanzania, the Republic of Congo, Ghana, and Rwanda. The total sample size was 902,940 children. Low birth weight (OR= 2.04; 95% CI= 1.49 to 2.78; p= 0.001), low maternal education (OR= 1.90; 95% CI= 1.21 to 2.99; p= 0.005), maternal age at birth delivery <19 years old (OR= 1.16; 95% CI= 1.05 to 1.28; p= 0.003), and did nonexclusive breastfeeding (OR= 1.60; 95% CI= 1.02 to 2.53; p= 0.04) were associated with increased risk of stunting in children under five.

Conclusion: Low birth weight, low maternal education, maternal age at birth delivery <19 years old, and nonexclusive breastfeeding are associated with an increased risk of stunting in children under five.

Keywords: low birthweight, exclusive breastfeeding, stunting, children under five