Sex differences in the effect of birth order and parents' educational status on stunting: a study on Bengalee preschool children from eastern India.

One of the greatest problems facing developing countries, including rural India, is undernutrition in terms of stunting among under 5-year-old children. However, there exists scanty information on the prevalence of stunting among preschool children in India and in particular in West Bengal. This study investigated prevalence of stunting and identified the predictor(s) of stunting among 1-5-year-old Bengalee rural preschool children of Integrated Child Development Services (ICDS) centres. This cross-sectional study was undertaken at different ICDS centres of Chapra Block, Nadia District, West Bengal, India. A total of 673 preschool children (323 boys and 350 girls), aged 1-5 years were selected from 30 randomly selected ICDS centres to study the impact of parents' educational status and child birth order on stunting. The overall (age and sex combined) rate of stunting was 39.2%. Child birth order (BO) (chi(2)=14.10, df=1, p<0.001), father educational status (FES) (chi(2)=21.11, p<0.001) and mother educational status (MES) (chi(2)=14.34, df=1, p>0.001) were significantly associated with the prevalence of stunting among girls. Logistic regression analyses revealed that both FES (Wald=19.97, p<0.001) as well as MES (Wald=13.95, p<0.001) were strong predictors of stunting among girls. Similarly BO (Wald=13.71, p<0.001) was a strong predictor of stunting among girls. Girls with >or=3rd BO had significantly higher risk (OR=2.49, CI=1.54-4.03) of stunting than those with <or=2nd BO. Moreover, girls with FES lower than secondary level had significantly (OR=3.30, CI=1.96-5.58) higher rate of stunting than those with FES>or=secondary level. Similarly, girls with MES<secondary level had significantly (OR=2.50, CI=1.54-4.03) higher rate of stunting than those with FES>or=secondary level. In conclusion our study revealed that BO as well as parents' educational status were strong predictors of stunting among girls but not boys. Sex discrimination could be a likely cause for this sex difference in the impact of BO and parents' educational status.