Abstract
Background The nutritional status is the best indicator of the well-being of the child. Inadequate feeding practices are the main factors that affect physical growth and mental development. The aim of this study was to develop a predictive score of severe acute malnutrition (SAM) in children under 5 years of age. Methods It was a case-control study. The case group (n = 263) consisted of children aged 6 to 59 months admitted to hospital for SAM that was defined by a z-score weight/height < −3 SD or presence of edema of malnutrition. We performed a univariate and multivariate analysis. Discrimination score was assessed using the ROC curve and the calibration of the score by Hosmer–Lemeshow test. Results Low birth weight, history of recurrent or chronic diarrhea, daily meal's number less than 3, age of breastfeeding's cessation less than 6 months, age of introduction of complementary diets less than 6 months, maternal age below 25 years, parity less than 5, family history of malnutrition, and number of children under 5 over 2 were predictive factors of SAM. Presence of these nine criteria affects a certain number of points; a score <6 points defines children at low risk of SAM, a score between 6 and 8 points defines a moderate risk of SAM, and a score >8 points presents a high risk of SAM. The area under ROC curve of this score was 0.9685, its sensitivity was 93.5%, and its specificity was 93.1%. Conclusion We propose a simple and efficient prediction model for the risk of occurrence of SAM in children under 5 years of age in developing countries. This predictive model of SAM would be a useful and simple clinical tool to identify people at risk, limit high rates of malnutrition, and reduce disease and child mortality registered in developing countries.
Highlights
Nutritional status is the best indicator of child well-being and indirectly the well-being of the community
In 2011, it was estimated that about 45% of deaths in children would be attributed to malnutrition [4, 5]. e Democratic Republic of Congo (DRC) is part of 5 countries in the world (India, Nigeria, Pakistan, and China) with a high mortality rate among children under 5 [6], and malnutrition is one of Journal of Nutrition and Metabolism the leading causes of death in these countries, associated with other diseases such as diarrhea, pneumonia, and malaria, which are more frequent in children under 5 [5]
Undressed or minimally dressed children were weighed using a SECA digital weighing machine and recumbent height was measured by using a height board. e management of severe acute malnutrition (SAM) follows the steps of the World Health Organization (WHO) guidelines [19] adopted by the National Nutrition Program in DRC. e control group was composed of children of the same age who were seen in the same hospital for routine consultation or preschool consultation and who did not have severe diseases
Summary
Nutritional status is the best indicator of child well-being and indirectly the well-being of the community. Poor nutritional status in early childhood affects health in adulthood [2]. E WHO estimated that severe acute malnutrition (SAM) affects about 20 million children under 5 years of age [3]. Known to be a major public health problem in low-income countries, malnutrition contributes significantly to mortality among children under 5 years of age. Infant malnutrition is influenced by multidimensional factors. High household incomes cannot guarantee a satisfactory nutritional outcome for children if households lack hygienic care, food quality, and access to health care [14,15,16]
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