الفهرس 
EPIDEMIOLOGY AND RISK FACTORS OF STUNTING IN CHILDREN UNDER FIVE YEARS OLDOnly 14 pages are availabe for public view
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Abstract
G
rowth monitoring is an essential element of child health care. Children’s healthy growth and development, and detection of variations from typical growth can be confirmed by proper growth monitoring. Stunting is one of the children health indicators. It is a largely irreversible outcome of inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life. Globally affecting approximately 162 million children under the age of 5 years. In Egypt around one in five children under age five is stunted.
The aim of this work was to evaluate detection and referral processes of cases of stunting among a sample of children aged less than 5 years attending two maternal and child Health Care Centers in Cairo and to identify risk factors for growth abnormalities mainly stunting, wasting and underweight among the studied sample.
The study tools were includes I: a structures Interview Questionnaire was designed and applied on (300) mothers child pairs, II: An interview questionnaire to assess knowledge and skills of HCW in detection of stunted, III: an observational checklist: for whole growth monitoring care process.
Study results revealed that observations of growth monitoring process were undertaken for 300 children, they were 153 boys(51%) and 147 girls (49%). Growth indices findings (stunted= height for age Z-score < -2 were 27 (9.3%), underweight =weight for age Z-score < -2 were 5 (1.7%), wasting=weight for height Z-score < -2 were 5 (1.7%).
Observational checklist results for growth monitoring process for the detection process, in both centers revealed that four items were not done, which are (recording gender and MUAC, tracing visits and having target list). Three and two of 14 items were poorly done, seven and eight items were satisfactorily done in the studied centers respectively and 4 items were well done. Summarized items for evaluation of measuring height where Out of 11 checklist items five items were poorly done, one was satisfactorily and 4 were well done, for evaluation process of measuring weight, out of eight items only one item was poorly done in one centre and one was satisfactorily done in both centres (4,5 items) respectively were well done and 2 were not done, for evaluation process of plotting measurements on growth charts, plotting is well done, however neither recording findings in child`s card nor in the health centre’s register were done for evaluation the interpretation of the growth pattern process where none of the 5 items is done.
Interview questionnaire with six healthcare workers (HCW) in the two maternal and child healthcare centres (Four in 1st, and two in 2nd),all of them were females, their mean age was 40 and ± SD 9.52. Three of them are nurses and three are nurse aid. All of them reported receiving training for anthropometric measures and plotting results on growth charts. However on assessing their knowledge about percentiles on growth chart, only 1 of 6 gave the right answer (17%).
Regarding to the important risk factors associated with growth abnormalities, the likelihood of being stunted and underweight in the present study was lower for girls than for boys.
Analysis showed that the proportion of growth abnormalities in children whose mothers and fathers had a higher level of education were lower than that of children with illiterate parents.
Regarding to breast feeding, the majority of children (61.7%) were breastfed or weaned from breast feeding. The percentage of children with growth abnormalities was higher (14.2%) in those who are receiving an artificial or mixed feeding type compared to those breastfed or weaned.
Regarding to mother’s working status, (11.9%) of children of those mothers not worked were with growth abnormalities, on other hand, only (8.3%) of children of worked mothers had growth abnormalities.
Regarding to health service utilization, (5.0%) of mothers who visited antenatal care units less than four times during pregnancy had children with growth abnormalities compared to (11.8%) of children with mothers who visited antenatal care units four times or more.
Recommendations include early intervention strategies must be taken to prevent growth abnormality and health education toward better child nutrition attitude.