Prevalence and Factors Associated with Stunting among Public Primary School Pupils in Kasulu District, Western Tanzania

Background: Underfeeding of a child in the first 2 years of life results in irreversible growth damage. Globally, stunting has declined from 39.7% in 1990 to 26.7% in 2010 while in Africa has remained at 40% since 1990. However, stunting is little known in primary pupils.This study estimated the prevalence of stunting and contributing factors among public primary school pupils in Kasulu District.Method: Cross-sectional study was conducted among public primary pupils. Systematic random sampling was used to select study participants and then stratified to 5-7 and 8-12 years. Socio-economic factors, dietary practices, water, sanitation, and hygiene behaviours; school performance/attendance data were collected using a pretested questionnaire. Measurements were standardised to the World Health Organization HAZ-Scores for both girls and boys. Descriptive statistics, bivariate, and multivariable logistic regression were used to generate results.Results: A total of 400 pupils (100%RR) were recruited into the study, mean age of 7.51 (STD= 1.54) years and a half (50.3%) were boys. The prevalence of stunting was 127 (31.8%) (95% CI: 27.2%–36.6%), with no sex difference (63 (31.7%) – girls vs. 64 (31.8%) – boys; p = 0.969). Household wealth influenced stunting; lowest quintile (AOR= 28; 95% CI: 3.64 – 214.6; p<0.001) 2nd quintile (AOR = 17; 95%CI: 2.20 – 138.5; p<0.01), the 3rd quintile (AOR = 8.0; 95%CI: 0.99 – 64.67; p = 0.051) and 4th quintile (AOR = 4.2; 95%CI: 0.49 – 36.75; p = 0.191) when compared to 5th (highest) wealthquintile. Food insecurity (AOR = 10.6; 95%CI: 4.60 – 24.60; p< 0.001), less protein in meal were the risk for stunting (AOR = 14.6; 95%CI: 4.07 – 52.42; p<0.001).Inappropriate hand wash after toilets both at school, (AOR=3.5; 95%CI:1.62–7.58; p=0.001), and home (AOR = 13.0; 95%CI: 2.73 – 61.76; p = 0.001) were the risk for stunting. Stunted pupils had irregular school attendance (AOR = 9.4;95%CI: 4.42 – 19.93; p<0.001) and poor performance (AOR = 23.6; 95%CI: 10.24 –54.19; p<0.001). Food insecurity influenced poor performance (AOR = 3.9; 95%CI:1.67–8.92; p<0.01) and irregular school attendance (AOR=5.4, p=0.000).Conclusion: Stunting among public primary school pupils is very high despite the prevention effort. Low wealth, food insecurity, poor hand hygiene, and lack of protein in a meal significantly influence stunting. Also, it affects the pupils’ academic performance and attendance, availability of food in both quantity and quality, community nutritio