Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case–control study

Pravana, Nilesh Kumar; Piryani, Suneel; Chaurasiya, Surendra Prasad; Kawan, Rasmila; Thapa, Ram Krishna; Shrestha, Sumina

doi:10.1136/bmjopen-2017-017084

Cited by 112 publications

(155 citation statements)

References 24 publications

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“…The possible explanation for this would be the exclusive breastfeeding rather than early breastfeeding provides protective nutrition to the children for an extended period of time. This nding is in agreement with ndings from Nepal and India [45,46,48].…”

Section: Discussionsupporting

confidence: 93%

“…Exclusive breastfeeding practice in this study was signi cantly associated with SAM. This nding was comparable with the studies from Nepal and Pakistan [11,45,46]. The nding highlights the importance of exclusive breastfeeding from which children receive nutrition that have several bene ts including reduction in gastrointestinal infection [47].…”

Section: Discussionsupporting

confidence: 87%

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Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Ghimire¹,

Aryal²,

Gupta³

et al. 2020

Preprint

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Background: Despite consistent efforts to enhance child nutrition, poor nutritional status of children continues to be a major public health problem in Nepal. This study identified the predictors of severe acute malnutrition (SAM) among children aged 6-59 months in the two districts of Nepal. Methods: We used data from a cross-sectional study conducted among 6 to 59 months children admitted to the Outpatient Therapeutic Care Centres (OTCC). The nutritional status of children was assessed using mid-upper arm circumference (MUAC) measurement. To determine which variables predict the occurrence of SAM, adjusted odds ratio was computed using multivariate logistic regression and p-value <0.05 was considered as significant. Results: Out of 398 children, 5.8 percent were severely malnourished and the higher percentage of female children were malnourished. Multivariate analysis showed that severe acute malnutrition was significantly associated with family size (five or more members) (Adjusted Odds Ratio [AOR]: 3.96; 95% Confidence Interval [CI]: 1.23 - 12.71). Children from severely food insecure households (AOR: 4.04; 95% CI: 1.88-10.53) were four times more likely to be severely malnourished. Higher odds of SAM were found among younger age-group (AOR: 12.10; 95% CI: 2.06 - 71.09) children (0 - 12 vs. 24 - 59 months). . Conclusions: The findings of this study indicated that household size, household food access, and the child’s age were the major predictors of severe acute malnutrition. Engaging poor families in kitchen gardening to ensure household food access and nutritious diet to the children, along with health education and promotion to the mothers of young children are therefore recommended to reduce child undernutrition.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 87%

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Ghimire¹,

Aryal²,

Gupta³

et al. 2020

Preprint

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“…Several studies from Bangladesh, Pakistan and our country observed a correlation between low parental education and increased risk of wasting in children. [10][11][12][13][14][15] Islam and others in their study concluded that poverty is a very important risk factor for wasting as are unsafe drinking water sources and lack of latrines. Similar observations were made by Meshramand others.…”

Section: Number Of Patients %mentioning

confidence: 99%

“…Baily W observed that the infants of adolescent mothers were admitted to hospitals with malnutrition at an earlier age than infants of older mothers. 19,15 Sanitation facility in present study was assessed through the presence of toilet facility, source of drinking water and availability of proper drainage facility. Toilet facility was present in 40% of the family whereas 60% of the family defecated in open.…”

Section: Number Of Patients %mentioning

confidence: 99%

A study of clinical profile and outcome of SAM children admitted in nutritional rehabilitation centre, Patna Medical College and Hospital, Patna, Bihar, India

Tiwari

Jaiswal

Saurabh

et al. 2018

Int J Contemp Pediatr

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Background: Severe Acute malnutrition (SAM) with severe wasting remains a major killer of children. In Bihar 48% of children are stunted, 21 % are wasted and 7% are severely wasted. Even during the first six months of life, 31% are wasted. Under nutrition generally decreases with the increasing mother’s schooling, better nutritional status of the mother. Stunting and under nutrition are higher in rural areas than in urban areas.Methods: It is a hospital based observational study done between June 2017 to December 2017. A total of 55 SAM patients with medical complications in the age group of 6 months to 60 months admitted in Nutritional Rehabilitation center (NRC), Department of Pediatrics, Patna Medical College, Patna were included in the study. Socio-Economic profile, effectiveness of NRC in treating SAM children, and effect of timely initiation of complementary feed on nutritional status of children were assessed.Results: A total of 55 children were admitted in the NRC of PMCH, Patna during the period of June 2017 to Dec 2017. 56.4% were males and 43.6% were females. 36% o were in the age group of 12months to 24months. 78% belonged to below poverty line. Major medical complications were anemia (53%), LRTI (33%) and acute gastroenteritis (29%). Immunisation was complete in only 45%. In only 53% babies Complimentary feeding was initiated after 6 months of age. 67% of the mothers of SAM children were illiterate. 95% children were discharged after gaining proper weight. Defaulter rate was 4% and death rate was 2%. 78% of the admitted children showed good weight gain i.e.>10 gm/kg/day, whereas in 15% children weight gain was in the range of 5-10 gm/kg/day.Conclusions: Many factors such as literacy, income, age of marriage and sanitation facility indirectly or directly influence the nutritional status of children. NRCs provide life-saving care for children with SAM as demonstrated by the high recovery rate (95%).

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“…Previous studies conducted in the region have found that poor socioeconomic status, lower level of parental education, younger age of mother at birth, short birth interval, and initiation of complimentary feeding are important determinants of undernutrition among under-five children. 25–27 We also observed significant nutrition disparity by household socioeconomic status. In populous countries like Bangladesh, India, and Pakistan, almost half of the children in poorest households were underweight.…”

Section: Discussionmentioning

confidence: 69%

Double burden of malnutrition in children aged 24-59 months by socioeconomic status in five South Asian countries: evidence from Demographic and Health Surveys

Hossain

Shawon

Al-Abid

et al. 2019

Preprint

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BackgroundDeveloping countries are now facing double burden of undernutrition and overnutrition among children and adults. We aimed to explore the double burden of malnutrition among children aged 24-59 months by household’s socioeconomic status in South Asian context.MethodsChildren with valid information on height and weight from the latest Demographic and Health Survey from Bangladesh, India, Pakistan, Maldives, and Nepal were included in this study. Underweight and overweight were defined according to definitions of World Health Organisation and International Obesity Task Force, respectively. We used multiple logistic regressions to estimate the association of socioeconomic status with childhood underweight and overweight.ResultsSouth Asian countries had significant burden of underweight, ranging from 19% in Maldives to 38% in India. Bangladesh, India, and Nepal had prevalence of overweight between 2% and 4%, whereas Pakistan and Maldives had prevalence of 7% and 9%, respectively. Households with higher wealth index and education were consistently associated with lower odds of underweight children. When compared to poorest households, richest households had higher odds of being overweight in Bangladesh (OR 1.96, 95% CI 1.27-3.02) and India (OR 1.53, 95% CI 1.41-1.66) while lower odds of being overweight in Pakistan (OR 0.22, 95% CI 0.14-0.34). Households with higher education were more likely to have overweight children in Bangladesh and India.ConclusionsChildhood underweight is associated with lower socioeconomic conditions while there is a substantial burden of childhood overweight in higher socioeconomic groups. These disparities by socioeconomic conditions should be considered while developing national nutrition programs and strategies.KEY MESSAGESIn South Asia, there is a substantial burden of undernutrition among under-five children while a differential burden of overnutrition is also seen.Household wealth and educational attainment were inversely associated with childhood underweight.Children in households with higher levels of wealth and educational attainment were more likely to be overweight in Bangladesh and India, while evidence supporting such association was not clear for other South Asian countries.The urban-rural difference in the burden of childhood underweight and overweight can be explained by the distributions of households’ socioeconomic status.

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Determinants of severe acute malnutrition among children under 5 years of age in Nepal: a community-based case–control study

Cited by 112 publications

References 24 publications

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

Severe acute malnutrition and its associated factors among children under-five years: a facility-based cross-sectional study

A study of clinical profile and outcome of SAM children admitted in nutritional rehabilitation centre, Patna Medical College and Hospital, Patna, Bihar, India

Double burden of malnutrition in children aged 24-59 months by socioeconomic status in five South Asian countries: evidence from Demographic and Health Surveys

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