This study is reflective of a predominantly rural population in southwestern Uganda. The study provides important insights about stunting and factors associated with stunting among children aged 6–59 months in Kabale district. Prevalence of stunting in the study population varied according to the different age groups and decreased with an increase in age, overall prevalence was 41.1%. This prevalence was almost the same as for the entire regional average of 41.7% reported in the 2011 UDHS, high compared to findings from previous studies in Uganda [13,14,15] and low compared to other countries in Sub-Saharan Africa and South Asia of which these include; Malawi, Ethiopia, DR Congo, Tanzania, Nigeria, India, Pakistan, Bangladesh and Nepal [7, 16,17,18,19]. Stunting has been linked with long-term consequences such as low education attainment, increased risk of non-communicable diseases, reduced work productivity and other socio-economic disadvantages . The 2013 lancet series highlight that under-nutrition is estimated to reduce a nation’s economic advance by at least eight percent through direct productivity losses, losses via poor cognition and losses via reduced schooling [20, 21].
The factors that were significantly associated with stunting included; child’s age, major source of food for the household and disposal of child stool. Findings revealed that the prevalence of stunting was slightly higher among male children (42.2%) although this was not statistically significant. It has been noted that in Sub-Saharan Africa, male children are more likely to become stunted than females of which this may be attributed to vulnerabilities in health inequalities .
Findings also revealed that children in the age categories of 36–47 and 24–35 months were more likely to be affected by stunting compared to children in other age groups. This is consistent with a study that was carried out in Southern Ethiopia where children more likely to be stunted included those between 24–35 months . In another study carried out in Acholi sub-region, the prevalence of stunting among children aged 6–59 months peaked at 30–41 months . However, in other studies, children more likely to be stunted were in the age categories of 11–23 and 12–23 [24, 25]. It should be noted that low height-for-age in children aged 24–35 months reflects a continuing process of failing to grow (stunting) whereas for older children above 36 months, low height-for-age reflects a state of having failed to grow (being stunted).
Major source of food for the household was used as a proxy for household food security. Children in households that bought their food from the market were more likely to be stunted compared to those in households that grew their own food. This indicates that households which bought food from the village markets and or nearby shops as their major source of food did not have enough food to feed their children on. A study done in Malaysia showed that children in food-insecure households were three times more likely to be stunted than children in food-secure households . Another study carried out in Colombia showed that the risk for child stunting increased in a dose–response way as food insecurity became more severe . This finding was expected because the study was done before the harvest season.
Children whose stool was put/ rinsed in a latrine and those whose stool was thrown in garbage were more likely to be affected by stunting compared to those that used a latrine. It has been noted that access to improved sanitation and proper disposal of child’s stool have conflicting associations with stunting, especially among the older group of children. On one hand, children from households with improved sanitation are less likely to be stunted. On the other hand, children from households where their stool is properly contained and or rinsed in a latrine are more likely to be stunted even after controlling for other variables, including sanitation . This finding implies that mothers’ hygiene practices (like not washing their hands after disposing off child stool) have an effect on child health ultimately leading to stunting.
This study had a number of limitations. We did not consider seasonal variations and their effect on a range of factors affecting stunting among children in different households, though the study was conducted during a rainy season before harvest time. There might have been potential recall bias among respondents answering questions relating to events that happened in the past, especially to do with infant and young child feeding (IYCF) practices. However, questions to do with IYCF were asked based on a 24 h recall so as to minimize the effect of recall bias. Information on some potential factors or confounding variables such as parasitic infestation which is wide spread among children was not assessed reason being that this required a longer period of time and a lot of resources. This being a cross-sectional study, causality could not be established for any of the associated variables.