TY - JOUR
T1 - Individual and household risk factors of severe acute malnutrition among under-five children in Mao, Chad
T2 - A matched case-control study
AU - Dodos, Jovana
AU - Altare, Chiara
AU - Bechir, Mahamat
AU - Myatt, Mark
AU - Pedro, Brigitte
AU - Bellet, Francois
AU - Lapegue, Jean
AU - Peeters, Joachim
AU - Altmann, Mathias
N1 - Funding Information:
The study was funded by UNICEF country office in Chad.
Publisher Copyright:
© 2018 The Author(s).
PY - 2018/8/1
Y1 - 2018/8/1
N2 - Background: Severe 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. Methods: A 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. Results: At 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)]. Conclusion: The 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.
AB - Background: Severe 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. Methods: A 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. Results: At 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)]. Conclusion: The 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.
KW - Childhood illnesses
KW - Household determinants
KW - Risk factors
KW - Severe acute malnutrition
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U2 - 10.1186/s13690-018-0281-5
DO - 10.1186/s13690-018-0281-5
M3 - Article
C2 - 30083315
AN - SCOPUS:85050724244
SN - 0778-7367
VL - 76
JO - Archives of Public Health
JF - Archives of Public Health
IS - 1
M1 - 35
ER -