Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad: a matched case-control study

Abstract

BackgroundSevere acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The reasons behind persistently high prevalence of SAM in the Kanem region are still poorly understood, leaving national and international partners without clearly identified drivers to address. Current knowledge of SAM determinants in this context is largely based on very limited data. The aim of this study was thus to investigate individual and household-level risk factors for SAM among under-five children in Mao health district.MethodsA matched case-control study was conducted on 411 (137 cases and 274 controls) children aged 6–59 months with their caretakers from mid-February to August 2017. Data were collected by using a structured interviewer administered questionnaire, anthropometric measurements and through direct observations of household environment. Controls were matched to their cases on place of residence and on age (± 3 months). Data were double-entered, processed and analysed using Epi Info 7.2.0.1. Conditional logistic regression was used to analyse the association of independent variables with SAM. For multivariable analysis, two models were constructed to investigate risk factors for SAM, at individual and household level. A stepwise backwards elimination approach with a significance level of p = 0.05 was used to build the final models.ResultsAt the individual level, SAM was significantly associated with diarrhoea [AOR (95% CI) = 10.7 (4.2–27.3)], fever [AOR (95% CI) = 8.4 (3.1–22.8)], vomiting [AOR (95% CI) = 7.6 (3.0–19.7)], being stunted [AOR (95% CI) = 5.3 (1.7–16.3)], and type of complementary meal [AOR (95% CI) = 4.4 (1.0–19.6)]. At the household level, SAM was significantly associated with undernourished caretaker [AOR (95% CI) = 2.6 (1.2–5.5)], caretaker’s hand washing habits [AOR (95% CI) = 1.9 (1.2–3.1)], absence of toilet [AOR (95% CI) = 1.9 (1.1–3.6)], caretaker’s marriage status [AOR (95% CI) = 7.7 (2.0–30.1)], and low household food diversity [AOR (95% CI) = 1.8 (1.0–3.1)].ConclusionThe present study identified the need to address both treatment and prevention of infections in children through an integrated approach. Well-organized efforts to improve child feeding practices, household hygiene and sanitation conditions, women’s nutritional status, along with increasing household food diversity are likely to lead to improved nutritional status of children in this setting.

Predictors of relapse of acute malnutrition following exit from community-based management program in Amhara region, Northwest Ethiopia: An unmatched case-control study

“…The finding was in agreement with studies conducted in India [25], Nigeria [53] and Ethiopia [36]. Food insecurity can be linked to inadequate intake of diversified foods and studies have reported consumption of low dietary diversity food as being associated with acute malnutrition [54,55]. Other studies pointed to the role of low socioeconomic status or monthly income in food insecurity [56][57][58][59] which directly or indirectly reduces the HH purchasing power, and thus, reduces access to food.…”

Peer Review #1 of "Rural children remain more at risk of acute malnutrition following exit from community based management of acute malnutrition program in South Gondar Zone, Amhara Region, Ethiopia: a comparative cross-sectional study (v0.1)"

“…Unsurprisingly, the odds of acute malnutrition among children in food insecure HHs were higher than in food secure HHs. The finding was in agreement with studies conducted in India (62), Nigeria (63), and Ethiopia (56) Acute malnutrition in food insecure HHs can also be linked to inadequate intake of diversified foods as studies have reported that consumption of low dietary diversity food (≤ 3 food groups) as being associated with acute malnutrition (64)(65)(66). Other studies also pointed to the role of low socioeconomic status or monthly income in food insecurity (49,66) which directly or indirectly reduces the HH purchasing power, and thus, reduces access to food.…”

“…Odds of acute malnutrition were higher among children whose mothers had practiced hand washing only after one or two of the key points compared to those who washed hands more frequently. The World Health Organization (WHO) recommends washing hands at four key time points : before eating, before preparing food, after defecation, and after disposal of child feces (67)., Our finding are similar to other studies where caregivers who washed hands regularly were less likely to have acutely malnourished children (46,52,65). Hand washing reduces the risk of contamination by excreta and thereby transmission of pathogens (68).One of the strength of this study is that this is the first cross-sectional study employing a comparative (control) group Manuscript to be reviewed…”

Hunger in Vulnerable Families in Southeastern Europe: Associations With Mental Health and Violence

“…Poor nutrition has detrimental effects on children's health, as well as on their physical, mental and social development (2)(3)(4). Consequences of undernutrition can include weakened immunity, susceptibility to long-term developmental delays or deficits, and increased risk of death, as well as prolonged negative effects on learning and economic performance (5)(6)(7). Undernutrition can result from illness, food shortage, inappropriate childcare or feeding practices, or a combination of these factors (5).…”

“…Consequences of undernutrition can include weakened immunity, susceptibility to long-term developmental delays or deficits, and increased risk of death, as well as prolonged negative effects on learning and economic performance (5)(6)(7). Undernutrition can result from illness, food shortage, inappropriate childcare or feeding practices, or a combination of these factors (5). Different causes of hunger may therefore be associated with different risk profiles.…”