Abstract
We aimed to describe the co‐occurrence of known risk factors for undernutrition and the prevalence of modifiable risks in wasted, stunted and healthy children. Quota sampling was used to recruit healthy [weight for age Z scores (WAZ) > −2 SD] and undernourished [weight for length (WLZ) or WAZ scores ≤ −2 SD] children aged 6–24 months from seven clinics in low‐income areas of Nairobi. Structured interviews were used to identify exposure to socioeconomic, water and hygiene, infant feeding, dietary and behavioural risks (low interest in food, high food refusal and force feeding). We recruited 92 wasted WLZ ≤ −2 SD, 133 stunted (length for age Z scores LAZ ≤ −2 SD) and 172 healthy (LAZ and WLZ > 2SD) children. Nearly all children were exposed to hygiene risks (90%) and low dietary diversity (95%) regardless of nutritional status. Stunted children were more likely to be exposed to socio‐economic risks (54% healthy, 64% wasted and 72% stunted; P = 0.001). Compared with healthy children, wasted and stunted children were more likely to be exposed to infant feeding (25% healthy, 40% wasted and 41% stunted; P = 0.02) and behaviour risks (24% healthy, 49% wasted, and 44% stunted; P = 0.004). Overall, wasted and stunted children were twice as likely to be exposed to more than three risks (23% healthy, 48% wasted, and 50% stunted; P = <0.001). They were also more likely to be exposed to more than three modifiable risks (dietary, handwashing and behaviour risks). Wasting and stunting are associated with exposure to multiple risk factors, many of which are potentially modifiable using targeted advice.
Highlights
Risk factor studies commonly focus on rural populations in lowand middle-income countries (LMICs); yet in urban settings, a high proportion resides in slum settlements, where undernutrition rates are high
Undernourished children were exposed to a variable number and combination of risk factors, which suggests that an individualized problem-solving treatment approach is required
This study aimed to identify the co-occurrence and the number of modifiable risk factors for undernutrition, in order to better plan
Summary
Score 0 if child has low avoidance, high interest in food and low force feeding. Undernourished children are classified as either wasted or stunted based on their anthropometric measurements and tend to be managed differently, yet both conditions may be present in the same child and may coexist within communities (Kimani-Murage et al, 2015; Myatt et al, 2018; Olofin et al, 2013). A child presenting with dietary risk factors, which can potentially be modified using behaviour change interventions administered in health facilities by health care workers, is likely to be exposed to other social and childcare risks (Chisti et al, 2007). In Nairobi, close to 60% of the population resides in slums, and close to 50% of children in these slums are stunted (Concern Worldwide, 2017; Kimani-Murage et al, 2015)
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