Do Minimum Acceptable Diet and Family Caregiving Mediate the Associations of Maternal Education and Household Wealth with Childhood Stunting and Wasting in Sri Lanka?

Abstract Objective: To investigate the extent to which the associations of socioeconomic position (SEP) with stunting and wasting are mediated by minimum acceptable diet (MAD) and a family care indicator (FCI) in Sri Lanka. Design: Secondary data analysis of children from the 2016 Sri Lanka Demographic and Health Survey. The outcomes were stunting and wasting, the exposure was a composite measure combining maternal education and household wealth, and the mediators were binary MAD and FCI variables (adequate vs inadequate). Analyses were performed using counterfactual mediation models adjusted for age, sex and residence place. Setting: A nationally representative sample of children from Sri Lanka. Participants: Mothers/caregivers of children under 36 months (4,325). Results: Twenty percent of children were stunted and 14% were wasted. Lower SEP was associated with higher odds of stunting and wasting, and inadequate MAD and FCI. Inadequate FCI was associated with higher odds of stunting (OR=1.47, 95%CI= 1.24, 1.74) but not wasting (OR=1.14, 95%CI= 0.94, 1.38), whereas MAD was not associated with stunting or wasting. Neither MAD nor FCI significantly mediated the relationship between SEP and stunting and wasting. All mediation estimates were statistically non-significant at the 5% level. For example, the proportion mediated by FCI on the association between the lowest composite SEP and stunting was 13% (Mean Difference=0.13, 95%CI= -0.64, 0.90). Conclusion: We did not find consistent or strong evidence that the associations of SEP with childhood stunting and wasting in Sri Lanka are mediated by MAD and FCI. Research with larger samples is needed for more precise estimates.