Abstract
BackgroundSevere 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.MethodsA 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.ResultsAt 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)].ConclusionThe 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.
Highlights
Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad
SAM can be a direct cause of child death, or it can act as an indirect cause by dramatically increasing the case fatality rate in children suffering from common childhood illnesses such as diarrhoea, pneumonia or measles
These results are in line with the findings from another study conducted in south-eastern Chad [20] which showed that recent episodes of diarrhoea, fever and pneumonia were strongly associated with SAM
Summary
Severe acute malnutrition (SAM) is one of the leading causes of morbidity and mortality in Chad. The aim of this study was to investigate individual and householdlevel risk factors for SAM among under-five children in Mao health district. Severe acute malnutrition (SAM) is the most extreme form of acute undernutrition, resulting from acute food shortages, a recent bout of illness, inappropriate child care or feeding practices, or a combination of these factors. SAM can be a direct cause of child death, or it can act as an indirect cause by dramatically increasing the case fatality rate in children suffering from common childhood illnesses such as diarrhoea, pneumonia or measles. Children experiencing SAM can face long-term consequences for their future health, learning and economic performance [4]. Southern Asia and Sub-Saharan Africa bear the greatest share of SAM children; around 75% of all severely malnourished children live in lower-middle income countries [5], including Chad, where the prevalence of SAM is persistently high
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