Household Food Security and Child Stunting in a Humanitarian Setting: A Cross-Sectional Study in Nyarugusu Refugee Camp, Tanzania

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In humanitarian settings such as refugee camps, limited access to resources exacerbates the risk. This study assessed the association between household food security and stunting among children in Nyarugusu Refugee Camp. Methods A cross-sectional quantitative study was conducted from March to April 2024 among children aged 6–59 months and their mothers/caregivers. Multistage cluster sampling was used. Data were collected via the Kobo tool and analyzed using Stata 15. Descriptive statistics and multivariable regression were performed, P-value < 0.05 was considered statistically significant. Results A total of 420 children aged 6–59 months participated. The prevalence of stunting was 43%. Children from households with moderate and severe food insecurity had a higher prevalence of stunting ( aPR 4.51, 95% CI: 1.37–14.81; aPR 7.61, 95% CI: 2.23–15.99, respectively). Conversely, a lower prevalence of stunting was observed among children living with their mothers ( aPR 0.55, 95% CI: 0.33–0.94), those whose mothers or caregivers had attained secondary education ( aPR 0.35, 95% CI: 0.16–0.78) or higher education ( aPR 0.30, 95% CI: 0.10–0.90), and those whose caregivers were married or cohabiting ( aPR 0.40, 95% CI: 0.20–0.81). Conclusion Stunting was more likely among children from food-insecure households, while higher maternal education and having married or cohabiting caregivers were protective. Efforts to reduce stunting should focus on improving household food security, promoting dietary diversity, and supporting female education. Stunting Household food security children aged 6–59 months Humanitarian camps Tanzania Figures Figure 1 Introduction Stunting remains one of the most persistent public health challenges globally, particularly in low-resource and humanitarian settings [ 1 ]. Defined as low height-for-age, stunting is a manifestation of chronic undernutrition and is associated with long-term adverse outcomes in physical and cognitive development, leading to reduced productivity and impaired health in adulthood [ 2 ]. According to the World Health Organization (WHO), approximately 149 million children aged 6–59 months are affected by stunting worldwide, with the highest burden concentrated in sub-Saharan Africa, where structural poverty, food insecurity, and limited access to healthcare services remain pervasive [ 3 ]. Humanitarian contexts in East Africa are shaped by protracted conflicts, political instability, and recurrent climate-related shocks, which drive population displacement and disrupt livelihoods and food systems [ 4 ]. Countries such as Tanzania, Uganda, Kenya, and Ethiopia host large refugee populations residing in overcrowded camps characterized by limited access to essential services, including healthcare, clean water, sanitation, and adequate nutrition [ 5 ]. Refugees often depend on external aid, which may be inconsistent or insufficient, exacerbating food insecurity and increasing the risk of child malnutrition [ 6 ]. Moreover, displacement disrupts traditional coping mechanisms, caregiving practices, and income-generating activities, further compounding nutritional vulnerability among children [ 6 ]. Tanzania hosts one of the largest refugee populations in the east Africa region, predominantly from the Democratic Republic of Congo and Burundi [ 7 ]. Refugee camps in Tanzania operate within resource-constrained environments marked by fragile food systems, inadequate healthcare infrastructure, and poor sanitation, placing young children at particularly high risk of undernutrition and stunting [ 8 ]. Humanitarian agencies provide food rations to mitigate food insecurity, persistently high levels of stunting in refugee camps suggest that food assistance alone may be insufficient to address the multifactorial determinants of chronic undernutrition. These challenges extend beyond food quantity to include key dimensions of food security availability, accessibility, utilization, and stability over time [ 4 ], [ 6 ]. Household food security is a fundamental determinant of child nutritional status, influencing both dietary adequacy and diversity, as well as caregiving and feeding practices [ 6 ]. Food security is typically assessed through the dimensions of food availability, accessibility, utilization, and stability [ 9 – 10 ]. In refugee camp settings, these dimensions are frequently compromised by reliance on aid, limited livelihood opportunities, market constraints, and environmental instability. While the association between food insecurity and child stunting is well documented in general populations, evidence from humanitarian settings remains limited, and the pathways through which household food security interacts with socio-demographic factors to influence child growth remain scant [ 9 ], [ 11 ]. Therefore, this study examined the association between household food security, selected socio-demographic characteristics, and stunting among children aged 6–59 months in Nyarugusu Refugee Camp, Tanzania. Methods Study design A cross-sectional study design using a quantitative approach was conducted between March and April 2024 to assess the association between household food security, and stunting among children aged 6–59 months. Study Setting The study was conducted in Nyarugusu Refugee Camp, located in Kasulu District Council, Kigoma Region, western Tanzania. Nyarugusu is the largest refugee camp in the region and hosts refugees primarily from the Democratic Republic of Congo and Burundi. Study population The study population comprised refugee mothers or primary caregivers and their children aged 6–59 months residing in selected zones of Nyarugusu Refugee Camp, Kasulu District Council, Kigoma Region, Tanzania. Sample size determination The sample size was calculated using Cochran’s formula for estimating proportions, based on an assumed stunting prevalence of 44% [ 12 ], a 5% margin of error, and a 95% confidence level. The minimum required sample size was 378 participants. To account for a potential non-response rate of 10%, the final sample size was adjusted to 420 mothers or caregivers of children aged 6–59 months. Sampling procedure A multistage cluster sampling technique was employed. In the first stage, seven zones (50% of the total 14 zones) were selected proportionally according to the ethnic composition of the camp, using a 4:2:1 ratio for Congolese, Burundian, and mixed-ethnicity zones, respectively. In the second stage, 90 villages were randomly selected from the chosen zones, followed by random selection of clusters within each village. In the final stage, households with eligible children aged 6–59 months were identified. When more than one eligible child was present in a household, the youngest child was selected for inclusion in the study. Inclusion and exclusion criteria Eligible participants were mothers or caregivers of children born within the camp and belonging to registered refugee households. Children born preterm (before 37 completed weeks of gestation) and those with known physical or metabolic conditions affecting feeding or growth were excluded from the study. Study variables The dependent variable was child stunting, defined as height-for-age Z-score below − 2 standard deviations from the WHO Child Growth Standards median. The independent variable was household food security status, categorized as food secure, mildly food insecure, moderately food insecure, or severely food insecure based on HFIAS scores. Socio-demographic characteristics of children (age, sex, living arrangement) and caregivers (age, marital status, education level, relationship to the child). Data collection tool Data were collected using a structured, interviewer-administered questionnaire developed in English and translated into Swahili to accommodate linguistic diversity among participants. The questionnaire was digitized using Kobo Forms and administered on tablet devices. The tool consisted of three sections: (1) socio-demographic characteristics of the child and caregiver, (2) child anthropometric measurements and (3) household food security assessment. Child height was measured using a standard height/length board. Children shorter than 87 cm were measured in the recumbent position, while those measuring 87 cm or taller were measured standing, in accordance with WHO guidelines [ 13 ] Household food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), following Food and Agriculture Organization (FAO) guidelines [ 14 ] Based on standardized scoring algorithms, households were categorized as food secure, mildly food insecure, moderately food insecure, or severely food insecure. The questionnaire demonstrated good internal consistency, with a Cronbach’s alpha of 0.8514, item–rest correlations ranging from 0.365 to 0.839, and an average variance of 0.072, indicating high reliability. Data collection procedure Data collection was conducted by three trained research assistants with medical and research experience. Preference was given to trained refugee nurses residing within the camp, owing to their familiarity with the setting and prior involvement in data collection activities with humanitarian agencies. The research team underwent a three-day training covering study objectives, research protocols, ethical considerations, informed consent procedures, identification of malnutrition types (with emphasis on stunting), use of the Kobo tool, and standardized anthropometric measurement techniques. Practical demonstrations and role-play sessions were conducted to ensure accurate measurement and recording of child height. Completed questionnaires were submitted electronically to a secure Kobo server accessible only to the principal investigator to ensure data confidentiality and security. Data analysis Data were exported from Kobo to Microsoft Excel and subsequently imported into STATA version 15 for cleaning and analysis. Data cleaning included checking for missing values and assessing the distribution of variables. Descriptive statistics were used to summarize socio-demographic characteristics and the prevalence of stunting, presented as proportions. Bivariable analyses were conducted to examine associations between independent variables household food security and socio-demographic characteristics of mothers/caregivers and the dependent variable, stunting. Categorical variables were analyzed using the Chi-square or Fisher’s exact test, as appropriate. Associations were expressed as Prevalence ratios (PR) with 95% confidence intervals (CI). Variables with a P-value < 0.2 in bivariable analyses were included in multivariable logistic regression to adjust for potential confounders. The final model was built using a forward stepwise approach, sequentially adding variables to identify factors independently associated with stunting. Results Socio-demographic characteristics A total of 420 mothers or caretakers of children aged 6–59 months participated in this study. The median age of the children was 39 months, with an interquartile range (IQR) of 30–47 months. The mothers or caretakers had a median age of 33 years, with an interquartile range of 30–38 years. The majority of the children were female (58.8%), predominantly aged between 36 and 47 months (40.7%), and most (89.3%) had no reported history of chronic diseases. Among the interviewed mothers or caretakers, the majority were female (85.2%), and most were biological mothers (68.6%). Over half of the mothers or caretakers (55.0%) were aged between 25 and 34 years. Additionally, 43.8% had attained a primary level of education, and 70.0% reported being married or cohabiting at the time of the study. More than one-third of the households (34.8%) had more than four children, as summarized in Table 1 . Table 1 Socio-demographic characteristics of participants Variable Frequency (N = 420) Percentage (100%) Child age (in months) 6–11 2 0.5 12–23 33 7.9 24–35 116 27.6 36–47 171 40.7 48–59 98 23.3 Child sex Female 247 58.8 Male 173 41.2 Child-chronic disease Yes 45 10.7 No 375 89.3 Mothers/caretakers age (years) 15–24 28 6.7 25–34 231 55.0 35–44 114 27.1 ≥ 45 47 11.2 Sex Female 358 85.2 Male 62 14.8 Education level No formal education 50 11.9 Primary school 184 43.8 Secondary school 155 36.9 College/University 31 7.3 Marital status Single 71 16.9 Married/cohabit 294 70.0 Divorced/widow 55 13.1 Relationship with child Mother 288 68.6 Caretaker 132 31.4 No. of children aged 6–59 months per house ≤ 4 274 65.2 > 4 146 34.8 Prevalence of stunting The study indicates that 43% of children aged 6–59 months were classified as stunted. These children had a height-for-age Z-score of less than − 2 standard deviations (SD) from the median, according to the WHO 2006 growth standards. Figure 1 illustrates the prevalence of stunting among these children. Factor associated with stunting among children aged 6–59 months In the multivariable analysis, household food insecurity was strongly associated with stunting. Children from moderately food-insecure households had a higher prevalence of stunting compared to those from food-secure households ( aPR 4.505, P-value 0.013), and prevalence was highest among children from severely food-insecure households ( aPR 7.611, P-value 0.001), indicating a clear dose-response relationship, where increasing severity of food insecurity substantially elevates stunting risk. Maternal or caretaker marital status was associated with stunting prevalence. Children whose mothers or caretakers were married or cohabiting had a lower prevalence of stunting compared to children of single mothers or caretakers ( aPR 0.400, P-value 0.011). Similarly, children of divorced or widowed mothers or caretakers also had lower stunting prevalence ( aPR 0.214, P-value 0.048), suggesting that stable stable household structures may provide better caregiving and nutritional support, thereby reducing stunting risk. Maternal or caretaker education was inversely related to stunting prevalence. Children whose mothers or caretakers had attained secondary or tertiary education had lower prevalence of stunting compared to those whose mothers or caretakers had no formal education ( aPR 0.351, P-value 0.010 and aPR 0.298, P-value 0.032 respective), higher maternal education likely enhances child nutrition through improved knowledge of feeding practices, health-seeking behaviours, and overall caregiving. Living arrangements influenced stunting prevalence as well. Children living with their biological mothers had lower stunting prevalence compared to those living with other caretakers ( aPR 0.554, P-value 0.027), highlighting the protective role of maternal caregiving in promoting child growth. The number of children aged 6–59 months per household was not significantly associated with stunting prevalence. Households with more than four children showed slightly higher prevalence compared to those with four or fewer children ( aPR 1.391, P-value 0.208), but this difference was not statistically significant. Table 2 Factor associated with stunting among children aged 6–59 months Variable Bi-variable analysis P-Value Multivariable analysis P-Value cPR 95% CI aPR 95% CI Household food security status Food secure Ref Mildly insecure 1.122 0.317–3.972 0.858 0.862 0.218–3.405 0.832 Moderately insecure 4.836 2.154–20.47 0.001 4.505 1.370-14.807 0.013* Severely insecure 6.642 1.612–14.50 0.005 7.611 2.229–15.991 0.001* Marital status Single Ref Married/co-habiting 0.401 0.236–0.681 0.001 0.400 0.197–0.812 0.011* Divorced/ widowed 0.543 0.266–1.107 0.093 0.214 0.464–0.985 0.048* Education level No-formal education Ref Primary school 0.538 0.284–1.020 0.058 0.519 0.238–1.136 0.101 Secondary 0.318 0.165–0.616 0.001 0.351 0.158–0.778 0.010* University/ College 0.292 0.113–0.751 0.011 0.298 0.099–0.901 0.032* Relationship with child Caretaker Ref Mother 0.500 0.329–0.759 0.001 0.554 0.328–0.935 0.027* No. of children 6–59 months per household ≤ 4 children Ref ˃4 children 1.495 0.998–2.242 0.051 1.391 0.832–2.326 0.208 *Key: CI = Confidence Interval, cPR = Crude Prevalence Ratio, aPR = Adjusted Prevalence Ratio, * significant Discussion Prevalence of stunting This study revealed that 43% of children aged 6–59 months exhibited stunted growth. The prevalence observed significantly exceeds many regional and global benchmarks. For instance, the Food and Agriculture Organization of the United Nations (FAO) reports a stunting prevalence of 30% for Africa and 30.6% for Tanzania in the same age group, while the global estimate stands at 22.3% [ 15 ]. Moreover, the findings differ from the Tanzania Demographic and Health Survey (TDHS) of 2022, which reported a national stunting prevalence of 30%, with notable variations between rural (33%) and urban (21%) areas, underscoring the nuanced nature of stunting across Tanzania [ 16 ]. These disparities underscore the considerable burden of stunting in the refugee camp population and highlight the urgent need for targeted, context-specific interventions. The elevated prevalence of stunting in this study may be attributed to its focus on a vulnerable and resource-constrained subgroup refugees who often experience heightened food insecurity, limited access to healthcare, and poor living conditions. Unlike national surveys, which provide aggregated data from diverse geographical and socioeconomic settings, this study offers a concentrated view of stunting within a high-risk population, thereby uncovering unique challenges and determinants that may not be apparent in broader national datasets. Similarly, studies conducted in the Morogoro and Ruvuma regions of Tanzania reported stunting prevalence among children aged 6–59 months at 42.2% and 44%, respectively [ 17 – 18 ]. These findings highlight the widespread nature of stunting across both refugee and non-refugee populations in Tanzania, indicating that it is not an isolated phenomenon but rather a systemic public health challenge. The consistency in these findings reinforces the need for comprehensive and coordinated nutrition strategies that address the multifaceted drivers of child undernutrition. In refugee settings in particular, interventions must consider the compounded impact of displacement, food insecurity, and limited healthcare access. The findings of this study emphasize the urgent need for context-specific interventions to reduce the high prevalence of stunting among children aged 6–59 months in humanitarian settings. Addressing stunting requires a multifaceted approach that improves child health and nutrition outcomes. Such efforts are vital to achieving Sustainable Development Goal (SDG) Target 2.2, which aims to end all forms of malnutrition including stunting and wasting in children under five and to meet the nutritional needs of adolescent girls, pregnant and lactating women, and older adults [ 19 ]. Association between household food security and stunting Household Food Insecurity Access was significantly associated with stunted growth among children aged 6–59 months. Specifically, children living in households experiencing moderate or severe food insecurity were more likely to be stunted compared to those from food-secure households. This finding is consistent with evidence from systematic reviews and studies conducted in low- and middle-income countries, including Tanzania, which have shown that children in food-secure environments are at a lower risk of stunting [ 20 – 22 ]. These finding explain the critical importance of addressing household food insecurity as a core strategy for reducing childhood stunting. Interventions aimed at enhancing food access and affordability such as agricultural development programs, social protection schemes, and targeted nutrition assistance may play a vital role in improving nutritional outcomes and reducing stunting prevalence, particularly among vulnerable populations in low-resource settings. Association between socio-demographic characteristics of mothers/caretakers and stunting The marital status of mothers or caretakers was significantly associated with the stunting status of their children. Specifically, children whose mothers or caretakers were married or cohabiting were less likely to experience stunted growth compared to those whose caregivers were single or not in a partnership. This finding is consistent with evidence from cross-sectional surveys conducted in sub-Saharan African countries, which demonstrated that children born to married mothers were at a lower risk of stunting [ 23 – 24 ]. The convergence of findings across studies explains the potential influence of stable familial relationships particularly marital status on child health outcomes. Children raised in households with married or cohabiting caregivers may benefit from more supportive and nurturing environments, which can foster improved growth and development. Marital stability may also be associated with greater access to healthcare services, improved household food security, and enhanced social support systems, all of which are critical determinants of optimal child nutrition. These findings highlight the importance of promoting and supporting stable family structures as a strategy to improve child well-being and reduce the prevalence of stunting. The education level of mothers or caretakers was significantly associated with the stunting status of their children. Specifically, children whose mothers or caretakers had attained higher levels of education, such as secondary school or university/college, were less likely to experience stunted growth. This finding is consistent with studies conducted in Tanzania, which indicated that children of mothers with higher education levels achieved higher Z-scores for weight and length compared to children of mothers with lower education levels [ 25 – 27 ] Furthermore, this result aligns with a study conducted in lower-middle-income countries, which found that children of mothers and caretakers with low literacy levels were at a higher risk of stunting compared to those whose caregivers had higher literacy levels [ 28 – 29 ]. The consistency of these findings underscores the significant role of maternal education in food security outcomes, particularly in the dimensions of food access, utilization, and stability. Mothers with higher education levels typically have better access to resources, greater knowledge of nutrition and healthcare, and are more likely to engage in practices that support better food security. These factors contribute to improved access to nutritious food, better utilization of available resources, and enhanced stability in food availability, which in turn support healthier growth outcomes for their children. The implication of this finding is that investing in maternal education can be an effective strategy to enhance food security and promote child health and development. The presence of mothers in the household is a critical factor in child health and development. This study indicates that children living with their mothers are less likely to experience stunted growth compared to those living with other caretakers. This finding aligns with previous research conducted in sub-Saharan countries, where children living with caretakers had higher odds of stunting compared to those living with their mothers [ 23 ], [ 30 ]. Several factors may explain the consistency between the study’s findings and those from surveys conducted in sub-Saharan Africa. Notably, a mother’s presence in the household is often linked to better access to maternal care and nutritious food both of which are critical for a child's growth and development. Mothers generally play a central role in caregiving and ensuring the overall well-being of their children, thereby positively influencing their nutritional status and contributing to improved food security outcomes. The implications of this finding suggest that interventions aimed at reducing stunting should focus on strengthening maternal and caregiver support systems. Such interventions could include programs designed to enhance maternal education, improve access to healthcare, and provide nutritional guidance, all of which are essential for improving child health outcomes. Study Limitations This study relied on participants to recall information related to food security dimensions, specifically food availability, access, utilization, and stability. With mothers/caregivers serving as the respondents, the study was susceptible to recall bias. To mitigate this, careful selection and structuring of the questions were ensured, and respondents were given ample time to recall the relevant information. Conclusion Stunting among children aged 6–59 months was less prevalent among those living with married or cohabiting mothers/caretakers and those whose mothers/caretakers had higher education levels, underscoring the protective role of family stability and maternal education in child growth. In contrast, moderate to severe household food insecurity was strongly associated with increased stunting, highlighting the critical influence of food access on child nutrition. Recommendation Integrated and multisectoral interventions are recommended to reduce stunting among children, with a focus on improving household food security, strengthening maternal education, and supporting stable caregiving environments. Policymakers and program implementers should prioritize social protection and food assistance programs for food-insecure households, alongside income-generating initiatives to enhance household resilience. Declarations Acknowledgements Authors thank the study participants for their time and valuable contributions, which greatly enriched this research. We also acknowledge the support and collaboration of the Tanzania Ministry of Home Affairs, the Tanzania Red Cross Society (TRCS), the International Organization for Migration (IOM), and the Nyarugusu Refugee Camp administration, whose assistance was essential to the successful completion of the study. Competing interests The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article. Funding information This study was self-funded by the authors, with no external financial support received for the research. Ethical considerations Ethical approval was obtained from the Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board (Ref. No. DA.282/298/01.C/). Permission to access Nyarugusu Refugee Camp was granted by the Ministry of Home Affairs and Nyarugusu Refugee camp administration. Informed consent was obtained from all participating mothers or caretakers; participants unable to read or write provided consent via thumbprint following oral explanation. Participant confidentiality was maintained using unique identifiers, and electronic data were securely stored on the principal investigator’s Kobo account. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki. Consent to Participate declaration: Informed consent was obtained from all participants included in the study. Both written and verbal consent procedures were used, as approved by the ethics committee. Consent to Publish declaration: Not applicable Clinical trial number: Not applicable What is already know on this topic Stunting among children under five remains a major public health problem in low- and middle-income countries and is strongly associated with chronic household food insecurity, low maternal education, and unfavorable caregiving environments. Previous studies have shown that inadequate nutrition, poor socioeconomic conditions, and limited access to education and health services significantly increase the risk of impaired growth in early childhood. What this study adds This study provides context-specific evidence from a refugee setting, demonstrating that children living with married or cohabiting mothers/caretakers and those whose mothers/caretakers have higher education levels have a lower prevalence of stunting. It also highlights moderate to severe household food insecurity as a key driver of stunting, underscoring the need for integrated nutrition, food security, and maternal education interventions in humanitarian contexts. Author contributions Heri Francis Wagi: Conceptualization, Drafting, Designing, Data analysis, Interpretation, Manuscript writing. Johnson Dominic Mshangila: Data analysis, Interpretation, Manuscript writing. Anna Tengia Kessy: Conceptualization, Drafting, Designing, and Manuscript revising. 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Young maternal age is a risk factor for child undernutrition in Tamale Metropolis, Ghana. BMC Res Notes. Dec. 2018;11(1):1–5. 10.1186/S13104-018-3980-7/TABLES/3 . Afework E, Mengesha S, Wachamo D. ‘Stunting and Associated Factors among Under-Five-Age Children in West Guji Zone, Oromia, Ethiopia’, J Nutr Metab , vol. 2021, 2021. 10.1155/2021/8890725 Elverud IS, Størdal K, Chiduo M, Klingenberg C. ‘Factors Influencing Growth of Children Aged 12–24 Months in the Tanga Region, Tanzania’, J Trop Pediatr , vol. 66, no. 2, pp. 210–217, Apr. 2020, 10.1093/TROPEJ/FMZ056 Sunguya BF, Zhu S, Mpembeni R, Huang J. Trends in prevalence and determinants of stunting in Tanzania: An analysis of Tanzania demographic health surveys (1991–2016). Nutr J. Dec. 2019;18(1):1–13. 10.1186/S12937-019-0505-8/TABLES/3 . Hiliza JN, Germana L, Kasangala A, Joram F. Prevalence and Factors Associated with Stunting among Public Primary School Pupils in Kasulu District, Western Tanzania. East Afr Health Res J. Nov. 2020;4(2):172. 10.24248/EAHRJ.V4I2.641 . Amaha ND, Woldeamanuel BT. Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey. Nutr J. Dec. 2021;20(1):1–9. 10.1186/S12937-021-00677-6/TABLES/3 . Ahmed KY et al. Oct., ‘Population-Modifiable Risk Factors Associated With Childhood Stunting in Sub-Saharan Africa’, JAMA Netw Open , vol. 6, no. 10, p. e2338321, 2023, 10.1001/jamanetworkopen.2023.38321 Amaha ND, Woldeamanuel BT. Maternal factors associated with moderate and severe stunting in Ethiopian children: analysis of some environmental factors based on 2016 demographic health survey. Nutr J. Dec. 2021;20(1):1–9. 10.1186/S12937-021-00677-6/tables/3 . Additional Declarations No competing interests reported. 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04:22:21","extension":"html","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":122720,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8376089/v1/8a6a483331323a87775085ce.html"},{"id":100749561,"identity":"8504835e-c588-4b55-92a6-1a4b1a6d617f","added_by":"auto","created_at":"2026-01-21 04:22:21","extension":"jpg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":48066,"visible":true,"origin":"","legend":"\u003cp\u003ePrevalence of stunting among children aged 6-59 months.\u003c/p\u003e","description":"","filename":"1.jpg","url":"https://assets-eu.researchsquare.com/files/rs-8376089/v1/278650cb3f5cb2dfe53acc98.jpg"},{"id":100804052,"identity":"da390f37-8ad0-4564-833f-db57370a2ab6","added_by":"auto","created_at":"2026-01-21 14:35:33","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1190432,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8376089/v1/f8715573-a00e-4fed-9d4e-55db7a87a710.pdf"},{"id":100796605,"identity":"c20dcb5e-1a74-44c6-a954-2ab86a722b6d","added_by":"auto","created_at":"2026-01-21 13:44:26","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":21452,"visible":true,"origin":"","legend":"","description":"","filename":"STROBECHECKLIST.docx","url":"https://assets-eu.researchsquare.com/files/rs-8376089/v1/48d4c7a336b94f55031edecc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eHousehold Food Security and Child Stunting in a Humanitarian Setting: A Cross-Sectional Study in Nyarugusu Refugee Camp, Tanzania\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eStunting remains one of the most persistent public health challenges globally, particularly in low-resource and humanitarian settings [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Defined as low height-for-age, stunting is a manifestation of chronic undernutrition and is associated with long-term adverse outcomes in physical and cognitive development, leading to reduced productivity and impaired health in adulthood [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. According to the World Health Organization (WHO), approximately 149\u0026nbsp;million children aged 6\u0026ndash;59 months are affected by stunting worldwide, with the highest burden concentrated in sub-Saharan Africa, where structural poverty, food insecurity, and limited access to healthcare services remain pervasive [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHumanitarian contexts in East Africa are shaped by protracted conflicts, political instability, and recurrent climate-related shocks, which drive population displacement and disrupt livelihoods and food systems [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Countries such as Tanzania, Uganda, Kenya, and Ethiopia host large refugee populations residing in overcrowded camps characterized by limited access to essential services, including healthcare, clean water, sanitation, and adequate nutrition [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Refugees often depend on external aid, which may be inconsistent or insufficient, exacerbating food insecurity and increasing the risk of child malnutrition [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Moreover, displacement disrupts traditional coping mechanisms, caregiving practices, and income-generating activities, further compounding nutritional vulnerability among children [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTanzania hosts one of the largest refugee populations in the east Africa region, predominantly from the Democratic Republic of Congo and Burundi [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Refugee camps in Tanzania operate within resource-constrained environments marked by fragile food systems, inadequate healthcare infrastructure, and poor sanitation, placing young children at particularly high risk of undernutrition and stunting [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Humanitarian agencies provide food rations to mitigate food insecurity, persistently high levels of stunting in refugee camps suggest that food assistance alone may be insufficient to address the multifactorial determinants of chronic undernutrition. These challenges extend beyond food quantity to include key dimensions of food security availability, accessibility, utilization, and stability over time [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e], [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHousehold food security is a fundamental determinant of child nutritional status, influencing both dietary adequacy and diversity, as well as caregiving and feeding practices [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Food security is typically assessed through the dimensions of food availability, accessibility, utilization, and stability [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In refugee camp settings, these dimensions are frequently compromised by reliance on aid, limited livelihood opportunities, market constraints, and environmental instability. While the association between food insecurity and child stunting is well documented in general populations, evidence from humanitarian settings remains limited, and the pathways through which household food security interacts with socio-demographic factors to influence child growth remain scant [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Therefore, this study examined the association between household food security, selected socio-demographic characteristics, and stunting among children aged 6\u0026ndash;59 months in Nyarugusu Refugee Camp, Tanzania.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eA cross-sectional study design using a quantitative approach was conducted between March and April 2024 to assess the association between household food security, and stunting among children aged 6\u0026ndash;59 months.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in Nyarugusu Refugee Camp, located in Kasulu District Council, Kigoma Region, western Tanzania. Nyarugusu is the largest refugee camp in the region and hosts refugees primarily from the Democratic Republic of Congo and Burundi.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThe study population comprised refugee mothers or primary caregivers and their children aged 6\u0026ndash;59 months residing in selected zones of Nyarugusu Refugee Camp, Kasulu District Council, Kigoma Region, Tanzania.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size was calculated using Cochran\u0026rsquo;s formula for estimating proportions, based on an assumed stunting prevalence of 44% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], a 5% margin of error, and a 95% confidence level. The minimum required sample size was 378 participants. To account for a potential non-response rate of 10%, the final sample size was adjusted to 420 mothers or caregivers of children aged 6\u0026ndash;59 months.\u003c/p\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eA multistage cluster sampling technique was employed. In the first stage, seven zones (50% of the total 14 zones) were selected proportionally according to the ethnic composition of the camp, using a 4:2:1 ratio for Congolese, Burundian, and mixed-ethnicity zones, respectively. In the second stage, 90 villages were randomly selected from the chosen zones, followed by random selection of clusters within each village. In the final stage, households with eligible children aged 6\u0026ndash;59 months were identified. When more than one eligible child was present in a household, the youngest child was selected for inclusion in the study.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cp\u003eEligible participants were mothers or caregivers of children born within the camp and belonging to registered refugee households. Children born preterm (before 37 completed weeks of gestation) and those with known physical or metabolic conditions affecting feeding or growth were excluded from the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy variables\u003c/h3\u003e\n\u003cp\u003eThe dependent variable was child stunting, defined as height-for-age Z-score below \u0026minus;\u0026thinsp;2 standard deviations from the WHO Child Growth Standards median.\u003c/p\u003e \u003cp\u003eThe independent variable was household food security status, categorized as food secure, mildly food insecure, moderately food insecure, or severely food insecure based on HFIAS scores. Socio-demographic characteristics of children (age, sex, living arrangement) and caregivers (age, marital status, education level, relationship to the child).\u003c/p\u003e\n\u003ch3\u003eData collection tool\u003c/h3\u003e\n\u003cp\u003eData were collected using a structured, interviewer-administered questionnaire developed in English and translated into Swahili to accommodate linguistic diversity among participants. The questionnaire was digitized using Kobo Forms and administered on tablet devices. The tool consisted of three sections: (1) socio-demographic characteristics of the child and caregiver, (2) child anthropometric measurements and (3) household food security assessment.\u003c/p\u003e \u003cp\u003eChild height was measured using a standard height/length board. Children shorter than 87 cm were measured in the recumbent position, while those measuring 87 cm or taller were measured standing, in accordance with WHO guidelines [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eHousehold food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), following Food and Agriculture Organization (FAO) guidelines [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Based on standardized scoring algorithms, households were categorized as food secure, mildly food insecure, moderately food insecure, or severely food insecure.\u003c/p\u003e \u003cp\u003eThe questionnaire demonstrated good internal consistency, with a Cronbach\u0026rsquo;s alpha of 0.8514, item\u0026ndash;rest correlations ranging from 0.365 to 0.839, and an average variance of 0.072, indicating high reliability.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eData collection was conducted by three trained research assistants with medical and research experience. Preference was given to trained refugee nurses residing within the camp, owing to their familiarity with the setting and prior involvement in data collection activities with humanitarian agencies.\u003c/p\u003e \u003cp\u003eThe research team underwent a three-day training covering study objectives, research protocols, ethical considerations, informed consent procedures, identification of malnutrition types (with emphasis on stunting), use of the Kobo tool, and standardized anthropometric measurement techniques. Practical demonstrations and role-play sessions were conducted to ensure accurate measurement and recording of child height. Completed questionnaires were submitted electronically to a secure Kobo server accessible only to the principal investigator to ensure data confidentiality and security.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData analysis\u003c/h2\u003e \u003cp\u003eData were exported from Kobo to Microsoft Excel and subsequently imported into STATA version 15 for cleaning and analysis. Data cleaning included checking for missing values and assessing the distribution of variables.\u003c/p\u003e \u003cp\u003eDescriptive statistics were used to summarize socio-demographic characteristics and the prevalence of stunting, presented as proportions.\u003c/p\u003e \u003cp\u003eBivariable analyses were conducted to examine associations between independent variables household food security and socio-demographic characteristics of mothers/caregivers and the dependent variable, stunting. Categorical variables were analyzed using the Chi-square or Fisher\u0026rsquo;s exact test, as appropriate. Associations were expressed as Prevalence ratios (PR) with 95% confidence intervals (CI).\u003c/p\u003e \u003cp\u003eVariables with a P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.2 in bivariable analyses were included in multivariable logistic regression to adjust for potential confounders. The final model was built using a forward stepwise approach, sequentially adding variables to identify factors independently associated with stunting.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eSocio-demographic characteristics\u003c/h2\u003e \u003cp\u003eA total of 420 mothers or caretakers of children aged 6\u0026ndash;59 months participated in this study. The median age of the children was 39 months, with an interquartile range (IQR) of 30\u0026ndash;47 months. The mothers or caretakers had a median age of 33 years, with an interquartile range of 30\u0026ndash;38 years.\u003c/p\u003e \u003cp\u003eThe majority of the children were female (58.8%), predominantly aged between 36 and 47 months (40.7%), and most (89.3%) had no reported history of chronic diseases. Among the interviewed mothers or caretakers, the majority were female (85.2%), and most were biological mothers (68.6%).\u003c/p\u003e \u003cp\u003e Over half of the mothers or caretakers (55.0%) were aged between 25 and 34 years. Additionally, 43.8% had attained a primary level of education, and 70.0% reported being married or cohabiting at the time of the study. More than one-third of the households (34.8%) had more than four children, as summarized in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-demographic characteristics of participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (N\u0026thinsp;=\u0026thinsp;420)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercentage (100%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eChild age (in months)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e12\u0026ndash;23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e24\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e116\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e48\u0026ndash;59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild\u003c/b\u003e sex\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e247\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e173\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild-chronic disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e375\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e89.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMothers/caretakers age (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e231\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e35\u0026ndash;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e358\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCollege/University\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried/cohabit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e294\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e70.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/widow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e288\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e68.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCaretaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo. of children aged 6\u0026ndash;59 months per house\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e274\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e65.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of stunting\u003c/h2\u003e \u003cp\u003eThe study indicates that 43% of children aged 6\u0026ndash;59 months were classified as stunted. These children had a height-for-age Z-score of less than \u0026minus;\u0026thinsp;2 standard deviations (SD) from the median, according to the WHO 2006 growth standards. Figure\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e illustrates the prevalence of stunting among these children.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eFactor associated with stunting among children aged 6\u0026ndash;59 months\u003c/h2\u003e \u003cp\u003eIn the multivariable analysis, household food insecurity was strongly associated with stunting. Children from moderately food-insecure households had a higher prevalence of stunting compared to those from food-secure households (\u003cem\u003eaPR\u003c/em\u003e 4.505, \u003cem\u003eP-value\u003c/em\u003e 0.013), and prevalence was highest among children from severely food-insecure households (\u003cem\u003eaPR\u003c/em\u003e 7.611, \u003cem\u003eP-value\u003c/em\u003e 0.001), indicating a clear dose-response relationship, where increasing severity of food insecurity substantially elevates stunting risk.\u003c/p\u003e \u003cp\u003eMaternal or caretaker marital status was associated with stunting prevalence. Children whose mothers or caretakers were married or cohabiting had a lower prevalence of stunting compared to children of single mothers or caretakers (\u003cem\u003eaPR\u003c/em\u003e 0.400, \u003cem\u003eP-value\u003c/em\u003e 0.011). Similarly, children of divorced or widowed mothers or caretakers also had lower stunting prevalence (\u003cem\u003eaPR\u003c/em\u003e 0.214, \u003cem\u003eP-value\u003c/em\u003e 0.048), suggesting that stable stable household structures may provide better caregiving and nutritional support, thereby reducing stunting risk.\u003c/p\u003e \u003cp\u003eMaternal or caretaker education was inversely related to stunting prevalence. Children whose mothers or caretakers had attained secondary or tertiary education had lower prevalence of stunting compared to those whose mothers or caretakers had no formal education (\u003cem\u003eaPR\u003c/em\u003e 0.351, \u003cem\u003eP-value\u003c/em\u003e 0.010 and \u003cem\u003eaPR\u003c/em\u003e 0.298, \u003cem\u003eP-value\u003c/em\u003e 0.032 respective), higher maternal education likely enhances child nutrition through improved knowledge of feeding practices, health-seeking behaviours, and overall caregiving.\u003c/p\u003e \u003cp\u003eLiving arrangements influenced stunting prevalence as well. Children living with their biological mothers had lower stunting prevalence compared to those living with other caretakers (\u003cem\u003eaPR\u003c/em\u003e 0.554, \u003cem\u003eP-value\u003c/em\u003e 0.027), highlighting the protective role of maternal caregiving in promoting child growth.\u003c/p\u003e \u003cp\u003eThe number of children aged 6\u0026ndash;59 months per household was not significantly associated with stunting prevalence. Households with more than four children showed slightly higher prevalence compared to those with four or fewer children (\u003cem\u003eaPR\u003c/em\u003e 1.391, \u003cem\u003eP-value\u003c/em\u003e 0.208), but this difference was not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFactor associated with stunting among children aged 6\u0026ndash;59 months\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eBi-variable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c6\" namest=\"c5\" rowspan=\"2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c10\" namest=\"c7\"\u003e \u003cp\u003eMultivariable analysis\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c12\" namest=\"c11\" rowspan=\"2\"\u003e \u003cp\u003eP-Value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ecPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003eaPR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHousehold food security status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFood secure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMildly insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.317\u0026ndash;3.972\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.858\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.862\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.218\u0026ndash;3.405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.832\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eModerately insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e4.836\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e2.154\u0026ndash;20.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e4.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e1.370-14.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.013*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSeverely insecure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e6.642\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e1.612\u0026ndash;14.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e7.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e2.229\u0026ndash;15.991\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMarried/co-habiting\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.401\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.236\u0026ndash;0.681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.197\u0026ndash;0.812\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.011*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eDivorced/ widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.266\u0026ndash;1.107\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.464\u0026ndash;0.985\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.048*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eNo-formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003ePrimary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.538\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.284\u0026ndash;1.020\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.519\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.238\u0026ndash;1.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.101\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.165\u0026ndash;0.616\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.158\u0026ndash;0.778\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eUniversity/ College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.292\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.113\u0026ndash;0.751\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.298\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.099\u0026ndash;0.901\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.032*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship with child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c13\" namest=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eCaretaker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e0.500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.329\u0026ndash;0.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e0.554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.328\u0026ndash;0.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e\u003cb\u003e0.027*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNo. of children 6\u0026ndash;59 months per household\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;4 children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eRef\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e˃4 children\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003e1.495\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e \u003cp\u003e0.998\u0026ndash;2.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c8\" namest=\"c7\"\u003e \u003cp\u003e0.051\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c10\" namest=\"c9\"\u003e \u003cp\u003e1.391\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c12\" namest=\"c11\"\u003e \u003cp\u003e0.832\u0026ndash;2.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e0.208\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003e*Key: CI\u0026thinsp;=\u0026thinsp;Confidence Interval, cPR\u0026thinsp;=\u0026thinsp;Crude Prevalence Ratio, aPR\u0026thinsp;=\u0026thinsp;Adjusted Prevalence Ratio, \u003cb\u003e*\u003c/b\u003esignificant\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003ePrevalence of stunting\u003c/h2\u003e \u003cp\u003eThis study revealed that 43% of children aged 6\u0026ndash;59 months exhibited stunted growth. The prevalence observed significantly exceeds many regional and global benchmarks. For instance, the Food and Agriculture Organization of the United Nations (FAO) reports a stunting prevalence of 30% for Africa and 30.6% for Tanzania in the same age group, while the global estimate stands at 22.3% [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Moreover, the findings differ from the Tanzania Demographic and Health Survey (TDHS) of 2022, which reported a national stunting prevalence of 30%, with notable variations between rural (33%) and urban (21%) areas, underscoring the nuanced nature of stunting across Tanzania [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. These disparities underscore the considerable burden of stunting in the refugee camp population and highlight the urgent need for targeted, context-specific interventions.\u003c/p\u003e \u003cp\u003eThe elevated prevalence of stunting in this study may be attributed to its focus on a vulnerable and resource-constrained subgroup refugees who often experience heightened food insecurity, limited access to healthcare, and poor living conditions. Unlike national surveys, which provide aggregated data from diverse geographical and socioeconomic settings, this study offers a concentrated view of stunting within a high-risk population, thereby uncovering unique challenges and determinants that may not be apparent in broader national datasets.\u003c/p\u003e \u003cp\u003eSimilarly, studies conducted in the Morogoro and Ruvuma regions of Tanzania reported stunting prevalence among children aged 6\u0026ndash;59 months at 42.2% and 44%, respectively [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. These findings highlight the widespread nature of stunting across both refugee and non-refugee populations in Tanzania, indicating that it is not an isolated phenomenon but rather a systemic public health challenge. The consistency in these findings reinforces the need for comprehensive and coordinated nutrition strategies that address the multifaceted drivers of child undernutrition. In refugee settings in particular, interventions must consider the compounded impact of displacement, food insecurity, and limited healthcare access.\u003c/p\u003e \u003cp\u003eThe findings of this study emphasize the urgent need for context-specific interventions to reduce the high prevalence of stunting among children aged 6\u0026ndash;59 months in humanitarian settings. Addressing stunting requires a multifaceted approach that improves child health and nutrition outcomes. Such efforts are vital to achieving Sustainable Development Goal (SDG) Target 2.2, which aims to end all forms of malnutrition including stunting and wasting in children under five and to meet the nutritional needs of adolescent girls, pregnant and lactating women, and older adults [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between household food security and stunting\u003c/h2\u003e \u003cp\u003eHousehold Food Insecurity Access was significantly associated with stunted growth among children aged 6\u0026ndash;59 months. Specifically, children living in households experiencing moderate or severe food insecurity were more likely to be stunted compared to those from food-secure households. This finding is consistent with evidence from systematic reviews and studies conducted in low- and middle-income countries, including Tanzania, which have shown that children in food-secure environments are at a lower risk of stunting [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThese finding explain the critical importance of addressing household food insecurity as a core strategy for reducing childhood stunting. Interventions aimed at enhancing food access and affordability such as agricultural development programs, social protection schemes, and targeted nutrition assistance may play a vital role in improving nutritional outcomes and reducing stunting prevalence, particularly among vulnerable populations in low-resource settings.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eAssociation between socio-demographic characteristics of mothers/caretakers and stunting\u003c/h2\u003e \u003cp\u003eThe marital status of mothers or caretakers was significantly associated with the stunting status of their children. Specifically, children whose mothers or caretakers were married or cohabiting were less likely to experience stunted growth compared to those whose caregivers were single or not in a partnership. This finding is consistent with evidence from cross-sectional surveys conducted in sub-Saharan African countries, which demonstrated that children born to married mothers were at a lower risk of stunting [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe convergence of findings across studies explains the potential influence of stable familial relationships particularly marital status on child health outcomes. Children raised in households with married or cohabiting caregivers may benefit from more supportive and nurturing environments, which can foster improved growth and development. Marital stability may also be associated with greater access to healthcare services, improved household food security, and enhanced social support systems, all of which are critical determinants of optimal child nutrition. These findings highlight the importance of promoting and supporting stable family structures as a strategy to improve child well-being and reduce the prevalence of stunting.\u003c/p\u003e \u003cp\u003e The education level of mothers or caretakers was significantly associated with the stunting status of their children. Specifically, children whose mothers or caretakers had attained higher levels of education, such as secondary school or university/college, were less likely to experience stunted growth. This finding is consistent with studies conducted in Tanzania, which indicated that children of mothers with higher education levels achieved higher Z-scores for weight and length compared to children of mothers with lower education levels [\u003cspan additionalcitationids=\"CR26\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] Furthermore, this result aligns with a study conducted in lower-middle-income countries, which found that children of mothers and caretakers with low literacy levels were at a higher risk of stunting compared to those whose caregivers had higher literacy levels [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe consistency of these findings underscores the significant role of maternal education in food security outcomes, particularly in the dimensions of food access, utilization, and stability. Mothers with higher education levels typically have better access to resources, greater knowledge of nutrition and healthcare, and are more likely to engage in practices that support better food security. These factors contribute to improved access to nutritious food, better utilization of available resources, and enhanced stability in food availability, which in turn support healthier growth outcomes for their children. The implication of this finding is that investing in maternal education can be an effective strategy to enhance food security and promote child health and development.\u003c/p\u003e \u003cp\u003eThe presence of mothers in the household is a critical factor in child health and development. This study indicates that children living with their mothers are less likely to experience stunted growth compared to those living with other caretakers. This finding aligns with previous research conducted in sub-Saharan countries, where children living with caretakers had higher odds of stunting compared to those living with their mothers [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e], [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Several factors may explain the consistency between the study\u0026rsquo;s findings and those from surveys conducted in sub-Saharan Africa. Notably, a mother\u0026rsquo;s presence in the household is often linked to better access to maternal care and nutritious food both of which are critical for a child's growth and development. Mothers generally play a central role in caregiving and ensuring the overall well-being of their children, thereby positively influencing their nutritional status and contributing to improved food security outcomes.\u003c/p\u003e \u003cp\u003eThe implications of this finding suggest that interventions aimed at reducing stunting should focus on strengthening maternal and caregiver support systems. Such interventions could include programs designed to enhance maternal education, improve access to healthcare, and provide nutritional guidance, all of which are essential for improving child health outcomes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003eStudy Limitations\u003c/h2\u003e \u003cp\u003eThis study relied on participants to recall information related to food security dimensions, specifically food availability, access, utilization, and stability. With mothers/caregivers serving as the respondents, the study was susceptible to recall bias. To mitigate this, careful selection and structuring of the questions were ensured, and respondents were given ample time to recall the relevant information.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003e Stunting among children aged 6\u0026ndash;59 months was less prevalent among those living with married or cohabiting mothers/caretakers and those whose mothers/caretakers had higher education levels, underscoring the protective role of family stability and maternal education in child growth. In contrast, moderate to severe household food insecurity was strongly associated with increased stunting, highlighting the critical influence of food access on child nutrition.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eRecommendation\u003c/h2\u003e \u003cp\u003eIntegrated and multisectoral interventions are recommended to reduce stunting among children, with a focus on improving household food security, strengthening maternal education, and supporting stable caregiving environments. Policymakers and program implementers should prioritize social protection and food assistance programs for food-insecure households, alongside income-generating initiatives to enhance household resilience.\u003c/p\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAuthors thank the study participants for their time and valuable contributions, which greatly enriched this research. We also acknowledge the support and collaboration of the Tanzania Ministry of Home Affairs, the Tanzania Red Cross Society (TRCS), the International Organization for Migration (IOM), and the Nyarugusu Refugee Camp administration, whose assistance was essential to the successful completion of the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was self-funded by the authors, with no external financial support received for the research.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical considerations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was obtained from the Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board (Ref. No. DA.282/298/01.C/). Permission to access Nyarugusu Refugee Camp was granted by the Ministry of Home Affairs and Nyarugusu Refugee camp administration. Informed consent was obtained from all participating mothers or caretakers; participants unable to read or write provided consent via thumbprint following oral explanation. Participant confidentiality was maintained using unique identifiers, and electronic data were securely stored on the principal investigator’s Kobo account. The study was conducted in full compliance with the ethical principles of the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Participate declaration:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all participants included in the study. Both written and verbal consent procedures were used, as approved by the ethics committee.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish declaration:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat is already know on this topic\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStunting among children under five remains a major public health problem in low- and middle-income countries and is strongly associated with chronic household food insecurity, low maternal education, and unfavorable caregiving environments. Previous studies have shown that inadequate nutrition, poor socioeconomic conditions, and limited access to education and health services significantly increase the risk of impaired growth in early childhood.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWhat this study adds\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study provides context-specific evidence from a refugee setting, demonstrating that children living with married or cohabiting mothers/caretakers and those whose mothers/caretakers have higher education levels have a lower prevalence of stunting. It also highlights moderate to severe household food insecurity as a key driver of stunting, underscoring the need for integrated nutrition, food security, and maternal education interventions in humanitarian contexts.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHeri Francis Wagi: Conceptualization, Drafting, Designing, Data analysis, Interpretation, Manuscript writing.\u003c/p\u003e\n\u003cp\u003eJohnson Dominic Mshangila: Data analysis, Interpretation, Manuscript writing.\u003c/p\u003e\n\u003cp\u003eAnna Tengia Kessy: Conceptualization, Drafting, Designing, and Manuscript revising.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data supporting the findings of this study are available upon reasonable request and with approval from the relevant authorities. In accordance with institutional regulations governing research in the refugee camp and to protect participant confidentiality, the data are not publicly available.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003e\u0026lsquo;Child Health and Development\u0026rsquo;, Accessed. Apr. 11, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-health/children-in-humanitarian-settings\u003c/span\u003e\u003cspan address=\"https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/child-health/children-in-humanitarian-settings\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026lsquo;Malnutrition in children\u0026rsquo;. Accessed: Apr. 11, 2025. [Online]. 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Dec. 2021;20(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/S12937-021-00677-6/tables/3\u003c/span\u003e\u003cspan address=\"10.1186/S12937-021-00677-6/tables/3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Stunting, Household food security, children aged 6–59 months, Humanitarian camps, Tanzania","lastPublishedDoi":"10.21203/rs.3.rs-8376089/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8376089/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eStunting remains a major public health concern in sub-Saharan Africa, with high prevalence in Tanzania. In humanitarian settings such as refugee camps, limited access to resources exacerbates the risk. This study assessed the association between household food security and stunting among children in Nyarugusu Refugee Camp.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional quantitative study was conducted from March to April 2024 among children aged 6\u0026ndash;59 months and their mothers/caregivers. Multistage cluster sampling was used. Data were collected via the Kobo tool and analyzed using Stata 15. Descriptive statistics and multivariable regression were performed, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 420 children aged 6\u0026ndash;59 months participated. The prevalence of stunting was 43%. Children from households with moderate and severe food insecurity had a higher prevalence of stunting (\u003cem\u003eaPR\u003c/em\u003e 4.51, 95% CI: 1.37\u0026ndash;14.81; \u003cem\u003eaPR\u003c/em\u003e 7.61, 95% CI: 2.23\u0026ndash;15.99, respectively). Conversely, a lower prevalence of stunting was observed among children living with their mothers (\u003cem\u003eaPR\u003c/em\u003e 0.55, 95% CI: 0.33\u0026ndash;0.94), those whose mothers or caregivers had attained secondary education (\u003cem\u003eaPR\u003c/em\u003e 0.35, 95% CI: 0.16\u0026ndash;0.78) or higher education (\u003cem\u003eaPR\u003c/em\u003e 0.30, 95% CI: 0.10\u0026ndash;0.90), and those whose caregivers were married or cohabiting (\u003cem\u003eaPR\u003c/em\u003e 0.40, 95% CI: 0.20\u0026ndash;0.81).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e Stunting was more likely among children from food-insecure households, while higher maternal education and having married or cohabiting caregivers were protective. Efforts to reduce stunting should focus on improving household food security, promoting dietary diversity, and supporting female education.\u003c/p\u003e","manuscriptTitle":"Household Food Security and Child Stunting in a Humanitarian Setting: A Cross-Sectional Study in Nyarugusu Refugee Camp, Tanzania","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-21 04:22:16","doi":"10.21203/rs.3.rs-8376089/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-11T12:38:33+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-04T15:58:26+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T05:28:56+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-01-26T13:33:09+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"149309209311246401364510042448937434196","date":"2026-01-22T02:48:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"225553731627716040614276067929608020146","date":"2026-01-18T06:07:38+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"167021575043935172862666093109358281429","date":"2026-01-16T10:06:34+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-16T05:55:23+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-17T12:36:26+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-17T12:33:31+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2025-12-16T12:01:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"a6743524-02ea-4195-8071-462633531d41","owner":[],"postedDate":"January 21st, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T09:03:20+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-21 04:22:16","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8376089","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8376089","identity":"rs-8376089","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}