Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India.
This case-control study was conducted in a medical college hospital in children below 5 y of age. All cases of SAM (diagnosed as per WHO definition) between 6 and 59 mo of age were compared with age-matched controls with weight for height above -2SD of WHO 2006 growth standards. Data regarding socio-demographic parameters, feeding practices and immunization were compared between the groups by univariable and multivariable logistic regression models.
A total of 76 cases and 115 controls were enrolled. Among the 14 factors compared, maternal illiteracy, daily family income less than Rs. 200, large family size, lack of exclusive breast feeding in first 6 mo, bottle feeding, administration of pre-lacteals, deprivation of colostrum and incomplete immunization were significant risk factors for SAM. Regarding complementary feeding, it was the consistency, rather than the age of initiation, frequency and variety which showed a significant influence on occurrence of SAM. Multivariate analysis revealed that the risk of SAM was independently associated with 6 factors, namely, illiteracy among mothers, incomplete immunization, practice of bottle feeding, consistency of complementary feeding, deprivation of colostrum and receipt of prelacteals at birth.
The present study identifies certain risk factors which need to be focused on during health planning and policy making related to children with SAM in India.
- United Nation’s Children’s Fund. Tracking progress on child and maternal nutrition a survival and developmental priority. [homepage on the Internet]. 2009 [cited 2011 Oct 6]. Available from: UNICEF, Web site: http://www.unicef.pt/docs/Progress_on_Child_and_Maternal_Nutrition_EN_110309.pdf.
- National Family Health Survey 3, 2005–2006. IIPS, Mumbai
- Black RE, Allen LH, Bhutta ZA, Caulfield LE, de Onis M, Ezzati M, et al.; Maternal and Child Undernutrition Study Group. Maternal and child undernutrition: Global and regional exposures and health consequences. Lancet. 2008;371:243–60.
- Amsalu, S, Tigabu, Z (2008) Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiop J Health Dev 22: pp. 21-5
- Engebretsen, IM, Tylleskär, T, Wamani, H, Karamagi, C, Tumwine, JK (2008) Determinants of infant growth in Eastern Uganda: A community-based cross-sectional study. BMC Publ Health 8: pp. 418 CrossRef
- Ghosh, S, Shah, D (2004) Nutritional problems in urban slum children. Indian Pediatr 41: pp. 682-96
- Wamani, H, Tylleskär, T, Åstrøm, AN, Tumwine, JK, Peterson, S (2004) Mothers’ education but not fathers’ education, household assets or land ownership is the best predictor of child health inequalities in rural Uganda. Int J Equity Health 3: pp. 9 CrossRef
- Kikafunda, JK, Walker, AF, Collett, D, Tumwine, JK (1998) Risk factors for early childhood malnutrition in Uganda. Pediatrics 102: pp. E45 CrossRef
- Rayhan, MI, Khan, MSH (2006) Factors causing malnutrition among under five children in Bangladesh. Pak J Nutr 5: pp. 558-62 CrossRef
- World Health Organization, United Nations Children’s Fund. WHO/WHO child growth standards and the identification of severe acute malnutrition in infants and children. [homepage on the Internet]. 2009 [cited 2013 Apr 27]. Available from: http://www.who.int/nutrition/publications/severemalnutrition/9789241598163/en/.
- Huq, MN, Tasnim, T (2008) Maternal education and child healthcare in Bangladesh. Matern Child Health J 12: pp. 43-51 CrossRef
- Abuya, BA, Onsomu, EO, Kimani, JK, Moore, D (2011) Influence of maternal education on child immunization and stunting in Kenya. Matern Child Health J 15: pp. 1389-99 CrossRef
- Haidar, J, Abate, G, Kogi-Makau, W, Sorensen, P (2005) Risk factors for child under-nutrition with a human rights edge in rural villages of North Wollo, Ethiopia. East Afr Med J 82: pp. 625-30
- Rikimaru, T, Yartey, JE, Taniguchi, K, Kennedy, DO, Nkrumah, FK (1998) Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutr Sci Vitaminol (Tokyo) 44: pp. 391-407 CrossRef
- Coulter, JB, Omer, MI, Suliman, GI, Moody, JB, Macfarlane, SB, Hendrickse, RG (1988) Protein-energy malnutrition in northern Sudan: Prevalence, socioeconomic factors and family background. Ann Trop Paediatr 8: pp. 96-102
- Jeyaseelan, L, Lakshman, M (1997) Risk factors for malnutrition in south Indian children. J Biosoc Sci 29: pp. 93-100 CrossRef
- Elizabeth, KE (2012) Changing profile of undernutrition and edematous severe acute malnutrition (ESAM). Indian Pediatr 49: pp. 843 CrossRef
- Patwari AK, Kumar S, Beard J. Undernutrition among infants less than 6 months of age: An underestimated public health problem in India. Matern Child Nutr. 2013; doi:10.1111/mcn.12030.
- Rao, S, Kanade, AN (1992) Prolonged breast feeding and malnutrition among rural Indian children below 3 years of age. Eur J Clin Nutr 46: pp. 187-95
- Basit, A, Nair, S, Chakraborthy, K, Darshan, B, Kamath, A (2012) Risk factors for under-nutrition among children aged one to five years in Udupi taluk of Karnataka, India: A case control study. Australas Med J 5: pp. 163-7 CrossRef
- Ng’andu, NH, Watts, TE (1990) Child growth and duration of breast feeding in urban Zambia. J Epidemiol Community Health 44: pp. 281-5 CrossRef
- Dubowitz, T, Levinson, D, Peterman, JN, Verma, G, Jacob, S, Schultink, W (2007) Intensifying efforts to reduce child malnutrition in India: An evaluation of the Dular program in Jharkhand, India. Food Nutr Bull 28: pp. 266-73
- David, CB, David, PH (1984) Bottle-feeding and malnutrition in a developing country: The ‘bottle-starved’ baby. J Trop Pediatr 30: pp. 159-64 CrossRef
- Wang, X, Wang, Y, Kang, C (2005) Feeding practices in 105 counties of rural China. Child Care Health Dev 31: pp. 417-23 CrossRef
- Bloss, E, Wainaina, F, Bailey, RC (2004) Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya. J Trop Pediatr 50: pp. 260-70 CrossRef
- Sajilata, G, Singhal, RS, Kulkarni, PR (2002) Weaning foods: A review of the Indian experience. Food Nutr Bull 23: pp. 208-26
- Igbedioh, SO, Edache, A, Kaka, HJ (1995) Infant weaning practices of some Idoma women in Makurdi, Nigeria. Nutr Health 10: pp. 239-53 CrossRef
- Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study
The Indian Journal of Pediatrics
Volume 81, Issue 8 , pp 762-765
- Cover Date
- Print ISSN
- Online ISSN
- Springer India
- Additional Links
- Severe acute malnutrition
- Risk factors
- Industry Sectors
- Author Affiliations
- 1. Department of Pediatrics, Kalawati Saran Children’s Hospital, Lady Hardinge Medical College, New Delhi, 110001, India
- 2. Department of Dietics, Kalawati Saran Children’s Hospital, Lady Hardinge Medical College, New Delhi, India