Risk factors for malnutrition among school-aged children: a cross-sectional study in rural Madagascar

Abstract

Background For over 20 years, Madagascar has been challenged by continued high prevalence of stunting, underweight and wasting among children under 5 years of age. Yet, nutritional status of post-under-five age group has never been assessed in the country, despite its importance in relation not only to physical health but also to cognitive capacity and educational achievements of children. This study aims to estimate prevalence of malnutrition among schoolchildren aged 5–14 years in Madagascar. It further attempts to identify the possible risk factors for their malnutrition. This is the first study that estimates prevalence of malnutrition among school-aged children in Madagascar. Methods A cross-sectional household survey was conducted in Antananarivo-Avaradrano district, Analamanga region, Madagascar. The study targeted 393 first and second graders 5–14 years of age enrolled at 10 primary schools, where school-feeding was implemented. Data were collected from anthropometric measurements, their subsequent household structured interviews and observations. Bivariate (Chi-square test or Mann-Whitney’s U test) and multivariable (logistic regression) analyses were performed, to identify the possible risk factors associated with malnutrition. Results The overall prevalence rates of stunting, underweight and thinness were 34.9%, 36.9% and 11.2%, respectively. Nineteen children (4.8%) suffered from all the three forms of undernutrition. Older schoolchildren had a significantly greater likelihood of being stunted, underweight and thin. The greater number of members a household had, the higher likelihood of being stunted and thin its schoolchild had. Children having lower Household Dietary Diversity Score were more likely to be underweight. Yet, ‘ Had lunch at school yesterday ’ was associated neither with being stunted nor with being underweight and thin. This implies room for improvement of the current school feeding program. Conclusions Prevalence rates of stunting and underweight among 393 children examined were as high as the national averages among children under 5 years of age. Adequate food availability and dietary diversity over a sufficient period (incl. 5–14 years of age) are necessary for increasing likelihood of catch-up in height-for-age and weight-for-age, which are expectable during adolescence. To supplement inadequate household dietary diversity practices, school-feeding program may need to use more animal-protein ingredients. Electronic supplementary material The online version of this article (10.1186/s12889-019-7013-9) contains supplementary material, which is available to authorized users.

Prevalence and correlates of objectively measured weight status among urban and rural Mozambican primary schoolchildren: A cross-sectional study

“…Future studies among populations in similar settings may need to consider measuring the potential influences of such variables. Previous studies have found socioeconomic status [61,62] and older participant's age [62,63] to be correlates of thinness among children of this age group. Because thinness, which measures the nutritional status of children above five years of age and adolescents, is generally not an indicator prioritized globally [62], it is rarely monitored nor reported, hence the few available comparable data.…”

Nutritional status of school children living in Northern part of Sri Lanka

“…Very few studies have addressed nutritional issues of school-going children to assess the magnitude of the problem. [3] In several countries the coexistence of the paradoxical situation of adult obesity with childhood malnutrition has been noted. Number of studies has shown that many households, particularly in middle-income countries, contain both underweight and obese individuals, which is described as the 'dual burden' of malnutrition [4].…”

“…The prevalence of obesity has increased rapidly in almost all countries, and these country-speci c trends are now coalescing to create a true pandemic. This pandemic is penetrating the poorest nations in the world mainly among the urban middle-aged adults and younger age groups [3]. Childhood obesity is also increasing in Sri Lanka with 14-15% prevalence of overweight and obesity among 8-12-year-old school children within the Colombo Municipal area and the world bank report in 2016 estimates that 2% of the under ve-year-old children to be affected [7,8].…”

Nutritional status of school children living in Northern part of Sri Lanka

“…A literature search was done in Pubmed using the keywords and most have addressed under nutrition in children under-5-year of age. Very few studies have addressed nutritional issues of school-going children to assess the magnitude of the problem [3]. In several countries the coexistence of the paradoxical situation of adult obesity with childhood malnutrition has been noted.…”

“…The prevalence of obesity has increased rapidly in almost all countries, and these countryspeci c trends are now coalescing to create a true pandemic. This pandemic is penetrating the poorest nations in the world mainly among the urban middle-aged adults and younger age groups [3]. Childhood obesity is also increasing in Sri Lanka with 14-15% prevalence of overweight and obesity among 8-12year-old school children within the Colombo Municipal area and the world bank report in 2016 estimates that 2% of the under ve-year-old children to be affected [7,8].…”