Risk factors for severe acute malnutrition in children under the age of five: A case-control study

Abstract

Abstract

Introduction: Malnutrition is one of the leading causes of morbidity and mortality in children under the age of five in developing countries. Ethiopia being one of these countries malnutrition is an important public health problem, however little information is available on risk factors for severe acute malnutrition.

Objective: To identify and determine the risk factors for severe acute malnutrition in children under the age of five. Methods: Matched case-control study design was applied. The cases were 102 severely malnourished children under the age of five and the controls (n=102) were recruited concurrently from children admitted with other medical problems. The controls were age matched and of good nutritional status. The study was conducted from July 2005 to April 2006 in admitted patients to Gondar University Hospital.

Results: The mean age of the cases and controls were 24.1 (+ 14.8) and 21.5 (+16.2) months, respectively. The socioeconomic risk factors for severe acute malnutrition were maternal illiteracy (OR=3.83, 95% CI 1.93-7.67), paternal illiteracy (OR=2.04, 95% CI 1.13–3.71), monthly family income of less than 50 USD (OR =3.44, 95% CI 1.66–7.20) and large family size with the number of children greater than 3 (OR=1.96, 95% CI 1.04 –3.73). Inappropriate infant and young child feeding practices were commonly seen in children with severe acute malnutrition. The identified inappropriate feeding practices were supplementation with prelacteal feeds (OR=2.31, 95% CI 1.025.27), lack of exclusive breastfeeding in the first six months of age (OR = 3.00, 95% CI 1.58 -5.73), late initiation (at 12 months of age or beyond) of complementary diet (OR = 4.03, 95% CI 1.45 – 11.74), and bottle-feeding (OR = 3.01, 95% CI 1.24 -7.49). Similarly there was a significant difference between the parents/caregivers of the cases and the controls in their knowledge for infant and young child feeding practices. Relatively a small proportion (40.2%) of the caregivers in the cases knew that complementary diet should be started at the age of 6 months compared to 66.7% in the controls (OR=0.34, 95% CI 0.18-0.62) and prelacteal feeds were thought to be important in 28.4% of the cases compared to 8.8% of the controls (OR=4.11, 95% CI 1.73-10.01). Further analysis with logistic regression revealed that the risk for severe acute malnutrition was independently associated with lack of exclusive breastfeeding for the first six months of life (OR=3.22, 95% CI 1.31-7.91) and late initiation of complementary diet (OR=3.39, 95% CI 1.20–9.57) after the effects of other significant risk factors were controlled for.

Conclusion: The findings of this study confirm the association of severe acute malnutrition with inappropriate infant and young child feeding practices. To reduce childhood malnutrition due emphasis should be given in improving the knowledge and practice of parents on appropriate infant and young child feeding practices. [Ethiop.J.Health Dev. 2008;22 (1):21-25]