The Indian Journal of Pediatrics

, Volume 81, Issue 8, pp 762–765 | Cite as

Risk Factors for Severe Acute Malnutrition in Children below 5 y of Age in India: A Case-Control Study

  • Kirtisudha Mishra
  • Praveen Kumar
  • Srikanta Basu
  • Kiran Rai
  • Satinder Aneja
Original Article

Abstract

Objective

To determine the possible risk factors for severe acute malnutrition (SAM) in children below 5 y admitted in a hospital in north India.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Severe acute malnutrition Risk factors Children India 

Notes

Conflict of Interest

None.

Role of Funding Source

None.

References

  1. 1.
    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.
  2. 2.
    International Institute for Population Sciences. National Family Health Survey 3, 2005–2006. Mumbai: IIPS; 2006.Google Scholar
  3. 3.
    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.Google Scholar
  4. 4.
    Amsalu S, Tigabu Z. Risk factors for severe acute malnutrition in children under the age of five: A case-control study. Ethiop J Health Dev. 2008;22:21–5.Google Scholar
  5. 5.
    Engebretsen IM, Tylleskär T, Wamani H, Karamagi C, Tumwine JK. Determinants of infant growth in Eastern Uganda: A community-based cross-sectional study. BMC Publ Health. 2008;8:418.CrossRefGoogle Scholar
  6. 6.
    Ghosh S, Shah D. Nutritional problems in urban slum children. Indian Pediatr. 2004;41:682–96.PubMedGoogle Scholar
  7. 7.
    Wamani H, Tylleskär T, Åstrøm AN, Tumwine JK, Peterson S. 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. 2004;3:9.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Kikafunda JK, Walker AF, Collett D, Tumwine JK. Risk factors for early childhood malnutrition in Uganda. Pediatrics. 1998;102:E45.PubMedCrossRefGoogle Scholar
  9. 9.
    Rayhan MI, Khan MSH. Factors causing malnutrition among under five children in Bangladesh. Pak J Nutr. 2006;5:558–62.CrossRefGoogle Scholar
  10. 10.
    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/.
  11. 11.
    Huq MN, Tasnim T. Maternal education and child healthcare in Bangladesh. Matern Child Health J. 2008;12:43–51.PubMedCrossRefGoogle Scholar
  12. 12.
    Abuya BA, Onsomu EO, Kimani JK, Moore D. Influence of maternal education on child immunization and stunting in Kenya. Matern Child Health J. 2011;15:1389–99.PubMedCrossRefGoogle Scholar
  13. 13.
    Haidar J, Abate G, Kogi-Makau W, Sorensen P. Risk factors for child under-nutrition with a human rights edge in rural villages of North Wollo, Ethiopia. East Afr Med J. 2005;82:625–30.PubMedGoogle Scholar
  14. 14.
    Rikimaru T, Yartey JE, Taniguchi K, Kennedy DO, Nkrumah FK. Risk factors for the prevalence of malnutrition among urban children in Ghana. J Nutr Sci Vitaminol (Tokyo). 1998;44:391–407.CrossRefGoogle Scholar
  15. 15.
    Coulter JB, Omer MI, Suliman GI, Moody JB, Macfarlane SB, Hendrickse RG. Protein-energy malnutrition in northern Sudan: Prevalence, socioeconomic factors and family background. Ann Trop Paediatr. 1988;8:96–102.PubMedGoogle Scholar
  16. 16.
    Jeyaseelan L, Lakshman M. Risk factors for malnutrition in south Indian children. J Biosoc Sci. 1997;29:93–100.PubMedCrossRefGoogle Scholar
  17. 17.
    Elizabeth KE. Changing profile of undernutrition and edematous severe acute malnutrition (ESAM). Indian Pediatr. 2012;49:843.PubMedCrossRefGoogle Scholar
  18. 18.
    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.
  19. 19.
    Rao S, Kanade AN. Prolonged breast feeding and malnutrition among rural Indian children below 3 years of age. Eur J Clin Nutr. 1992;46:187–95.PubMedGoogle Scholar
  20. 20.
    Basit A, Nair S, Chakraborthy K, Darshan B, Kamath A. 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. 2012;5:163–7.PubMedCentralPubMedCrossRefGoogle Scholar
  21. 21.
    Ng’andu NH, Watts TE. Child growth and duration of breast feeding in urban Zambia. J Epidemiol Community Health. 1990;44:281–5.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Dubowitz T, Levinson D, Peterman JN, Verma G, Jacob S, Schultink W. Intensifying efforts to reduce child malnutrition in India: An evaluation of the Dular program in Jharkhand, India. Food Nutr Bull. 2007;28:266–73.PubMedGoogle Scholar
  23. 23.
    David CB, David PH. Bottle-feeding and malnutrition in a developing country: The ‘bottle-starved’ baby. J Trop Pediatr. 1984;30:159–64.PubMedCrossRefGoogle Scholar
  24. 24.
    Wang X, Wang Y, Kang C. Feeding practices in 105 counties of rural China. Child Care Health Dev. 2005;31:417–23.PubMedCrossRefGoogle Scholar
  25. 25.
    Bloss E, Wainaina F, Bailey RC. Prevalence and predictors of underweight, stunting, and wasting among children aged 5 and under in western Kenya. J Trop Pediatr. 2004;50:260–70.PubMedCrossRefGoogle Scholar
  26. 26.
    Sajilata G, Singhal RS, Kulkarni PR. Weaning foods: A review of the Indian experience. Food Nutr Bull. 2002;23:208–26.PubMedGoogle Scholar
  27. 27.
    Igbedioh SO, Edache A, Kaka HJ. Infant weaning practices of some Idoma women in Makurdi, Nigeria. Nutr Health. 1995;10:239–53.PubMedCrossRefGoogle Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  • Kirtisudha Mishra
    • 1
  • Praveen Kumar
    • 1
  • Srikanta Basu
    • 1
  • Kiran Rai
    • 2
  • Satinder Aneja
    • 1
  1. 1.Department of PediatricsKalawati Saran Children’s Hospital, Lady Hardinge Medical CollegeNew DelhiIndia
  2. 2.Department of DieticsKalawati Saran Children’s Hospital, Lady Hardinge Medical CollegeNew DelhiIndia

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