Hostname: page-component-546b4f848f-hhr79 Total loading time: 0 Render date: 2023-06-02T22:24:13.743Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false

Sociocultural and economic determinants of stunting and thinness among adolescent boys and girls in Nepal

Published online by Cambridge University Press:  08 July 2020

Charlotte J. W. van Tuijl
Department of Social Sciences, Health and Society, Wageningen University & Research, The Netherlands
Dónya S. Madjdian*
Department of Social Sciences, Health and Society, Wageningen University & Research, The Netherlands
Hilde Bras
Department of History, University of Groningen, The Netherlands
Binaya Chalise
Graduate School for International Development and Cooperation, Hiroshima University, Japan
*Corresponding author. Email:


Despite the increasing interest in the determinants of adolescent undernutrition in low- and middle-income countries, a comprehensive multi-level overview at the country level is missing. Using the nationally representative 2014 Nepal Adolescent Nutrition Survey, this study aimed to provide a comprehensive overview of the sociocultural and economic determinants of stunting and thinness of adolescent boys and girls in Nepal. Multivariate logistic regression models were used to estimate the associations between multiple individual, household and community determinants and stunting and thinness among 3773 adolescents aged 10–19 years (1888 boys and 1885 girls). The prevalence rates of stunting and thinness indicated suboptimal nutritional status and an inadequate growth environment in Nepali adolescents. The results highlighted an association of paternal occupation and education, household income, number of earning household members, geographical place of residence, caste/ethnicity and nutritional knowledge with stunting, with higher odds for males and older adolescents. Paternal occupation, education, household income, geographical region, caste/ethnicity and nutrition knowledge were associated with thinness, with higher odds for males and younger adolescents. The findings underscore the importance of involving adolescents, their parents and their communities in interventions. Such interventions should not only be aimed at improving adolescent nutrition but also at optimizing adolescents’ growth environment for better health and development. Future research should focus on context-specific causal pathways and mechanisms through which sociocultural and economic determinants influence nutritional outcomes within broader societal, cultural and political settings. A longitudinal approach, including a range of dietary and nutrition indicators would allow understanding how and when the relative importance of these factors change during adolescence.

Research Article
© The Author(s), 2020. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Adhikari, R (2010) Food Utilization Practices, Beliefs and Taboos in Nepal: An Overview. USAID, Washington, DC.Google Scholar
Akhter, N, Saville, N, Shrestha, B, Manandhar, DS, Osrin, D, Costello, A and Seal, A (2018) Change in cost and affordability of a typical and nutritionally adequate diet among socio-economic groups in rural Nepal after the 2008 food price crisis. Food Security 10(3), 615629.CrossRefGoogle ScholarPubMed
Akseer, N, Al-Gashm, S, Mehta, S, Mokdad, A and Bhutta, ZA (2017) Global and regional trends in the nutritional status of young people: a critical and neglected age group. Annals of the New York Academy of Sciences 1393(1), 320.CrossRefGoogle ScholarPubMed
Alam, N, Roy, SK, Ahmed, T and Ahmed, AMS (2010) Nutritional status, dietary intake, and relevant knowledge of adolescent girls in rural Bangladesh. Journal of Health, Population, and Nutrition 28(1), 8694.CrossRefGoogle ScholarPubMed
Amare, B, Ali, J, Moges, B, Yismaw, G, Belyhun, Y, Gebretsadik, S et al. (2013) Nutritional status, intestinal parasite infection and allergy among school children in Northwest Ethiopia. BMC Pediatrics 13(1), 7.CrossRefGoogle ScholarPubMed
Angdembe, MR, Dulal, BP, Bhattarai, K and Karn, S (2019) Trends and predictors of inequality in childhood stunting in Nepal from 1996 to 2016. International Journal for Equity in Health 18(1), 42.CrossRefGoogle ScholarPubMed
Antman, FM (2011) The intergenerational effects of paternal migration on schooling and work: what can we learn from children’s time allocations? Journal of Development Economics 96(2), 200208.CrossRefGoogle ScholarPubMed
Aryal, K, Neupane, S, Mehata, S, Vaidya, A, Singh, S, Paulin, F et al. (2014) Non-Communicable Diseases Risk Factors: STEPS Survey Nepal 2013. Nepal Health Research Council, Kathmandu.Google Scholar
Aryal, KK, Mehta, RK, Chalise, B, Mehata, S, Dhimal, M, Jha, BK and Karki, KB (2016) Adolescent Nutrition Survey in Nepal 2014. Nepal Health Research Council, Kathmandu, Nepal.Google Scholar
Aslam, M and Kingdon, GG (2012) Parental education and child health – understanding the pathways of impact in Pakistan. World Development 40(10), 20142032.CrossRefGoogle Scholar
Astatkie, A (2020) Dynamics of stunting from childhood to youthhood in Ethiopia: evidence from the Young Lives panel data. PLoS One 15(2), e0229011.CrossRefGoogle Scholar
Bashir, MK and Schilizzi, S (2013) Determinants of rural household food security: a comparative analysis of African and Asian studies. Journal of the Science of Food and Agriculture 93(6), 12511258.CrossRefGoogle ScholarPubMed
Benedict, RK, Schmale, A and Namaste, S (2018) Adolescent Nutrition 2000–2017: DHS Data on Adolescents Age 15–19. ICF, Rockville, MD.Google Scholar
Bennett, L, Dahal, D and Govindasamy, P (2008) Caste, Ethnic and Regional Identity in Nepal: Further Analysis of the 2006 Nepal Demographic and Health Survey. Macro International Inc., Calverton, MD.Google Scholar
Best, C, Neufingerl, N, Van Geel, L, van den Briel, T and Osendarp, S (2010) The nutritional status of school-aged children: why should we care? Food and Nutrition Bulletin 31(3), 400417.CrossRefGoogle ScholarPubMed
Black, RE, Victora, CG, Walker, SP, Bhutta, ZA, Christian, P, de Onis, M et al. (2013) Maternal and child undernutrition and overweight in low-income and middle-income countries. The Lancet 382(9890), 427451.CrossRefGoogle ScholarPubMed
Chalise, B, Aryal, KK, Mehta, RK, Dhimal, M, Sapkota, F, Mehata, S et al. (2018) Prevalence and correlates of anemia among adolescents in Nepal: findings from a nationally representative cross-sectional survey. PLoS One 13(12), e0208878.CrossRefGoogle ScholarPubMed
Chau, MM, Burgermaster, M and Mamykina, L (2018) The use of social media in nutrition interventions for adolescents and young adults – a systematic review. International Journal of Medical Informatics 120, 7791.CrossRefGoogle Scholar
Dahlgren, G and Whitehead, M (1991) Policies and Strategies to Promote Social Equity in Health. Institute for Future Studies, Stockholm.Google Scholar
Dancer, D and Rammohan, A (2009) Maternal autonomy and child nutrition: evidence from rural Nepal. Indian Growth and Development Review 2(1), 1838.CrossRefGoogle Scholar
Dercon, S and Singh, A (2013) From nutrition to aspirations and self-efficacy: gender bias over time among children in four countries. World Development 45, 3150.CrossRefGoogle Scholar
Dewey, KG and Begum, K (2011) Long-term consequences of stunting in early life. Maternal & Child Nutrition 7(s3), 518.CrossRefGoogle ScholarPubMed
Gausman, J, Kim, R and Subramanian, SV (2019) Stunting trajectories from post-infancy to adolescence in Ethiopia, India, Peru, and Vietnam. Maternal & Child Nutrition 15(4), e12835.CrossRefGoogle ScholarPubMed
Ghimire, U, Manandhar, J, Gautam, A, Tuladhar, S, Prasai, Y and Gebreselassie, T (2019) Inequalities in Health Outcomes and Access to Services by Caste/Ethnicity, Province, and Wealth Quintile in Nepal. DHS Further Analysis Reports No. 117. ICF, Rockville, MD, USA.Google Scholar
Hadley, C, Lindstrom, D, Tessema, F and Belachew, T (2008) Gender bias in the food insecurity experience of Ethiopian adolescents. Social Science & Medicine 66(2), 427438.CrossRefGoogle ScholarPubMed
Harris-Fry, H, Shrestha, N, Costello, A and Saville, NM (2017) Determinants of intra-household food allocation between adults in South Asia – a systematic review. International Journal for Equity in Health 16(1), 107.CrossRefGoogle ScholarPubMed
Hasan, MT, Soares Magalhaes, RJ, Williams, GM and Mamun, AA (2016) The role of maternal education in the 15-year trajectory of malnutrition in children under 5 years of age in Bangladesh. Maternal & Child Nutrition 12(4), 929939.CrossRefGoogle ScholarPubMed
Karimi, SM (2018) Pre-birth exposure to Ramadan, height, and the length of gestation. Economic Research Forum Working Papers. The Economic Research Forum (ERF), Dokki, Giza, Egypt. URL: Google Scholar
Krishnamurthy, P, Hobbs, C, Matthiasen, A, Hollema, S, Choularton, R, Pahari, K and Kawabata, M (2013) Climate risk and food security in Nepal – analysis of climate impacts on food security and livelihoods. CCAFS Working Paper No. 48. CGIAR Research Program on Climate Change, Agriculture and Food Security (CCAFS), Copenhagen, Denmark. URL: Google Scholar
Kunto, YS and Bras, H (2018) Women’s empowerment and gender inequality in adolescent nutritional status: evidence from the Indonesian family life survey. Journal of Biosocial Science 50(5), 640665.CrossRefGoogle ScholarPubMed
Kunto, YS and Mandemakers, JJ (2019) The effects of prenatal exposure to Ramadan on stature during childhood and adolescence: evidence from the Indonesian Family Life Survey. Economics & Human Biology 33, 2939.CrossRefGoogle ScholarPubMed
Lassi, ZS, Moin, A, Das, JK, Salam, RA and Bhutta, ZA (2017) Systematic review on evidence-based adolescent nutrition interventions. Annals of the New York Academy of Sciences 1393(1), 3450.CrossRefGoogle ScholarPubMed
Leroy, JL and Frongillo, EA (2019) Perspective: what does stunting really mean? A critical review of the evidence. Advances in Nutrition 10(2), 196204.CrossRefGoogle Scholar
McKenzie, D and Rapoport, H (2011) Can migration reduce educational attainment? Evidence from Mexico. Journal of Population Economics 24(4), 13311358.CrossRefGoogle Scholar
Madjdian, DS, Azupogo, F, Osendarp, SJ, Bras, H and Brouwer, ID (2018) Socio-cultural and economic determinants and consequences of adolescent undernutrition and micronutrient deficiencies in LLMICs: a systematic narrative review. Annals of the New York Academy of Sciences 1416(1), 117139.CrossRefGoogle Scholar
Madjdian, DS and Bras, HAJ (2016) Family, gender, and women’s nutritional status: a comparison between two Himalayan communities in Nepal. Economic History of Developing Regions 31(1), 198223.CrossRefGoogle Scholar
MoH, New ERA and ICF (2017) Nepal Demographic and Health Survey 2016. Ministry of Health Nepal, New ERA and ICF, Kathmandu, Nepal.Google Scholar
MoHP, New ERA, UNICEF, EU, USAID and CDC (2018) Nepal National Micronutrient Status Survey, 2016. Ministry of Health and Population, Nepal, Kathmandu, Nepal.Google Scholar
Moffitt, RA and Ribar, DC (2018) Child age and gender differences in food security in a low-income US inner-city population. European Economic Review 109, 2341.CrossRefGoogle Scholar
Morrison, J, Dulal, S, Harris-Fry, H, Basnet, M, Sharma, N, Shrestha, B et al. (2018) Formative qualitative research to develop community-based interventions addressing low birth weight in the plains of Nepal. Public Health Nutrition 21(2), 377384.CrossRefGoogle ScholarPubMed
Nepali, S, Simkhada, P and Davies, I (2019) Trends and inequalities in stunting in Nepal: a secondary data analysis of four Nepal demographic health surveys from 2001 to 2016. BMC Nutrition 5(1), 19.CrossRefGoogle ScholarPubMed
NPCS (2012) National Population and Housing Census 2011 (National Report). National Planning Commission Secretariat, Government of Nepal, Kathmandu, Nepal.Google Scholar
Onis, Md, Blossner, M and WHO (1997) Who Global Database on Child Growth and Malnutrition. World Health Organization, Geneva.Google Scholar
Onis, Md, Onyango, AW, Borghi, E, Siyam, A, Nishida, C and Siekmann, J (2007) Development of a WHO growth reference for school-aged children and adolescents. Bulletin of the World Health Organization 85, 660667.CrossRefGoogle ScholarPubMed
Pandey, J, Dhakal, M, Karki, S, Poudel, P and Pradhan, M (2013) Maternal and Child Health in Nepal: The Effects of Caste, Ethnicity, and Regional Identity. Further Analysis of the 2011 Nepal Demographic and Health Survey. Nepal Ministry of Health and Population, New ERA, and ICF International, Calverton, MD.Google Scholar
Poh, B, Zawiah, H, Ismail, M and Henry, C (1996) Changes in body weight, dietary intake and activity pattern of adolescents during Ramadan. Malaysian Journal of Nutrition 2(1), 110.Google ScholarPubMed
Rahman, MM, Saima, U and Goni, MA (2015) Impact of maternal household decision-making autonomy on child nutritional status in Bangladesh. Asia Pacific Journal of Public Health 27(5), 509520.CrossRefGoogle ScholarPubMed
Ratha, D, Mohapatra, S and Scheja, E (2011) Impact of Migration on Economic and Social Development: A Review of Evidence and Emerging Issues. The World Bank.CrossRefGoogle Scholar
Reed, BA, Habicht, J-P and Niameogo, C (1996) The effects of maternal education on child nutritional status depend on socio-environmental conditions. International Journal of Epidemiology 25(3), 585592.CrossRefGoogle ScholarPubMed
Resnick, MD, Catalano, RF, Sawyer, SM, Viner, R and Patton, GC (2012) Seizing the opportunities of adolescent health. The Lancet 379(9826), 15641567.CrossRefGoogle ScholarPubMed
Salam, RA, Hooda, M, Das, JK, Arshad, A, Lassi, ZS, Middleton, P and Bhutta, ZA (2016) Interventions to improve adolescent nutrition: a systematic review and meta-analysis. Journal of Adolescent Health 59(4), S29S39.CrossRefGoogle ScholarPubMed
Sawyer, SM, Afifi, RA, Bearinger, LH, Blakemore, S-J, Dick, B, Ezeh, AC and Patton, GC (2012) Adolescence: a foundation for future health. The Lancet 379(9826), 16301640.CrossRefGoogle ScholarPubMed
Sawyer, SM, Azzopardi, PS, Wickremarathne, D and Patton, GC (2018) The age of adolescence. The Lancet Child & Adolescent Health 2(3), 223228.CrossRefGoogle ScholarPubMed
Sellen, D (1998) Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. WHO Technical Report Series No. 854. WHO, Geneva.CrossRefGoogle Scholar
Siddiqui, MZ and Donato, R (2017) Undernutrition among adults in India: the significance of individual-level and contextual factors impacting on the likelihood of underweight across sub-populations. Public Health Nutrition 20(1), 130141.CrossRefGoogle ScholarPubMed
Singh, SK, Garg, G, Davey, S, Raghav, SK, Muzammil, K, Singh, JV (2014) Impact of educational status of parents on nutritional status of adolescent girls - a cross sectional study. National Journal of Community Medicine 5(3), 266269.Google Scholar
Sreeramareddy, CT, Ramakrishnareddy, N and Subramaniam, M (2015) Association between household food access insecurity and nutritional status indicators among children aged <5 years in Nepal: results from a national, cross-sectional household survey. Public Health Nutrition 18(16), 29062914.CrossRefGoogle ScholarPubMed
Subedi, YP, Marais, D and Newlands, D (2017) Where is Nepal in the nutrition transition? Asia Pacific Journal of Clinical Nutrition 26(2), 358367.Google ScholarPubMed
Svefors, P, Pervin, J, Islam Khan, A, Rahman, A, Ekström, EC, El Arifeen, S et al. (2020) Stunting, recovery from stunting and puberty development in the MINIMat cohort, Bangladesh. Acta Paediatrica 109(1), 122133.CrossRefGoogle ScholarPubMed
The Lancet (2015) Adolescent health: boys matter too. The Lancet 386(10010), 2227.CrossRefGoogle Scholar
Tumilowicz, A, Beal, T, Neufeld, LM and Frongillo, EA (2019) Challenges in use of adolescent anthropometry for understanding the burden of malnutrition. Advances in Nutrition 10, 563575.CrossRefGoogle ScholarPubMed
Victora, CG, Wagstaff, A, Schellenberg, JA, Gwatkin, D, Claeson, M and Habicht, J-P (2003) Applying an equity lens to child health and mortality: more of the same is not enough. The Lancet 362(9379), 233241.CrossRefGoogle ScholarPubMed
Vollmer, S, Bommer, C, Krishna, A, Harttgen, K and Subramanian, SV (2017a) The association of parental education with childhood undernutrition in low- and middle-income countries: comparing the role of paternal and maternal education. International Journal of Epidemiology 46(1), 312323.Google ScholarPubMed
Vollmer, S, Harttgen, K, Kupka, R and Subramanian, SV (2017b) Levels and trends of childhood undernutrition by wealth and education according to a Composite Index of Anthropometric Failure: evidence from 146 Demographic and Health Surveys from 39 countries. BMJ Global Health 2(2), e000206.CrossRefGoogle ScholarPubMed
WHO (2014) Health for the World’s Adolescents: A Second Chance in the Second Decade. World Health Organization, Geneva.Google Scholar
WHO (2018) Guideline: Implementing Effective Actions for Improving Adolescent Nutrition. World Health Organization, Geneva.Google Scholar
Yamanaka, M and Ashworth, A (2002) Differential workloads of boys and girls in rural Nepal and their association with growth. American Journal of Human Biology 14(3), 356363.CrossRefGoogle ScholarPubMed
Yeung, W-JJ, Sonalde, Desai and Jones, GW (2018) Families in Southeast and South Asia. Annual Review of Sociology 44(1), 469495.CrossRefGoogle Scholar