Influence of household remittance on childhood stunting in Nepal

Introduction: Migration is a livelihood strategy for many poor households in Nepal where about 56% of the households receive remittances, money sent by migrants. The country also has high rates of undernutrition; 41% of children under five years of age are reported to be stunted. Although remittance payments are known to increase household income potentially contributing to improvements in the health and nutrition of children, no study has examined this within the context of Nepal. Understanding these associations may provide evidence to advocate for expansion of cash transfer programs to improve the nutritional status of children in Nepal. Method: To investigate associations between the odds of stunting among children in households receiving remittances compared to those who did not, we utilized cross-sectional data of 2,498 children under 5 years of age from the Nepal Living Standard Survey 2010/11. Outcomes included low height for age (HAZ), wasting or low weight for height (WHZ), and underweight or low weight for age (WAZ). Multiple logistic regression was used to evaluate the odds of child stunting by remittances received by the families in the 12 months preceding the survey categorized into four groups: (1) not receiving remittance, (2) received less than or equal to Nrs. 15,000, (3) received Nrs. 15,001 to 60,000 and (4) received more than Nrs. 60,000. Guided by a conceptual framework, models were adjusted for variables representing child, maternal, household level characteristics and household cluster. Results: Our investigation showed that the odds of a child being stunted decreased with increased levels remittances received by households 67% (adjusted OR: 0.33, 95% CI: 0.16, 0.67) lower for households receiving more than Nrs.60,000 remittance per year. However there was no significant association between remittance and underweight and wasting. Similarly there was no difference in the risk of stunting by gender of the head of the household and income categories. Conclusion: The study finding that increased household income could potentially reduce the burden of chronic undernutrition in poor families in Nepal paves a path for the expansion of the cash transfer programs. Further research is indicated to understand the threshold of remittance or cash transfer needed to have best impact on nutritional outcomes.