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Background: Childhood stunting is a well-known indicator to signifies the chronic malnutrition status that access the overall well-being of children. Stunting affects children’s development and when established, it typically becomes permanent. According to UNICEF framework of malnutrition, childhood stunting is interrelated with multiple factors ranging from the individual to the national level, indicating the importance of contextual effect on the childhood malnutrition. In Myanmar, chronic malnutrition is still a public health concern along with the significant burden. The aim of this study was to explore the burden of stunting among under five children in Myanmar and to assess the effect of induvial and community factors on childhood stunting.

Methods: This study used the national representative Demographic and Health Survey of Myanmar (2015-2016). The sample of 4,183 children of 0 to 59 months with complete anthropometric measurement were included in the analysis. Multi-level logistic regression models with two levels were fit to the data due to the hierarchical structure of the data, with individuals at level one nested within communities (n=439) at level two. The main outcome of the study is stunting status of under 5 children defined by height-for-age Z score less than -2 standard deviations (SD).

Results: The prevalence of stunting in Myanmar was 30% among which 22% of moderate and 8% of severe stunting. Moreover, residential and regional variations were observed, Chin state showed highest prevalence at 40%. The study observed 8% of the variation in childhood stunting was attributable to the differences across communities. Proportional change in variance (PCV) explained variation in stunting across the communities was explained by 3.4% of the variations were explained by child factors alone, 48.2 % by child, maternal and household factors and 58.6% by both individual level and community level factors included in the study. After adjusting individual and community factors, child age group 25-36 months (OR=8.9; 95% CI=6.63 -11.95), female sex (OR=0.78; 95% CI=0.67 -0.90), small size at birth (OR=2.59; 95% CI=2.00 -3.35), maternal height less than 150 cm (OR=2.05; 95% CI=1.76 -2.4), poorest household wealth quintile (OR=2.14; 95% CI=1.49 -3.07) and cluster elevation of more than 1500 meter (OR=2.00; 95% CI=1.21 -3.3) showed the strongest association with childhood stunting.

Conclusion: The study provides evidence that over and above individual level factors and communities factors are important explanations for the variation of childhood stunting in Myanmar. The importance of the context where children live revealed that the nutrition policy and program implications need to focus on community attributes to attain the full potential in addressing childhood malnutrition. Moreover, the future interventions need to be focus in reducing social inequalities and addressing regional differences to ensure equal opportunities and accessibility by different social groups across the country.