Disparities in the prevalence of child undernutrition in Malawi – a crosssectional perspective

Abstract

Background. Child undernutrition is a significant public health problem in Malawi.Objective. To determine the localisation of underweight, stunting and wasting in three main agricultural development divisions (ADDs) in Malawi.Design. Descriptive population-based cross-sectional study.Setting. Rural subsistence farming communities in Mzuzu, Lilongwe and Blantyre ADDs.Subjects. Children aged 6 - 59.9 months.Outcome measures. Anthropometric measurements were taken to determine the mean weight-for-age z-scores (WAZ), height-for-age z-scores (HAZ) and weight-for-height z-scores (WHZ). The prevalences of underweight, stunting and wasting were also determined.Results. The mean WAZ of children from Mzuzu ADD was significantly higher than that of children from Lilongwe ADD (-1.04 v. -1.43, p = 0.001) and Blantyre ADD (-1.04 v. -1.32, p = 0.03). Similarly, children from Mzuzu ADD had significantly higher WHZ than their counterparts from Lilongwe (0.22 v. -0.04, p = 0.021) and Blantyre ADDs (0.22 v. -0.09, p = 0.003). There were no significant between-group differences in mean HAZ ( F = 2.73, p = 0.07). The prevalence of underweight was significantly lower in Mzuzu ADD (16.9%) than Blantyre (25.3%) and Lilongwe (31.3%) ADDs ( 2 = 11.95, p = 0.003). Likewise, stunting was significantly lower in Mzuzu ADD (46.6%) than Blantyre (53.8%) and Lilongwe (61.3%) ADDs ( 2 = 8.71, p = 0.013). There were no differences in the prevalence of either stunting or underweight between Lilongwe and Blantyre ADDs.Conclusion. The differences in prevalence of malnutrition among preschool children in the three agro-ecological zones may result from differences in ecological, demographic, social, economic and other pressures that these populations are exposed to. As Malawi decentralises most of its public services, there is a need for nutrition and health managers in specific areas to formulate uniquely localised programmes to deal effectively with the gravity and presumed diverse causes of nutrition problems. Some blanket national interventions are less likely to help in addressing local problems.